Ultrasound has become a widely used tool in veterinary medicine to evaluate the liver, biliary tract, spleen, kidneys, adrenal glands, GI tract, pancreas, abdominal lymph nodes, urinary tract, peritoneal space, and reproductive organs.
Abnormal fluid accumulations, masses/nodules, organomegaly, and other abnormalities are generally identified in much greater detail with ultrasound than can be appreciated with routine radiology. In addition, ultrasound-guided fine needle aspiration (FNA) allows precision sampling at a much lower risk than blind aspiration. Sedation is only rarely needed to perform abdominal ultrasound and/or ultrasound-guided FNA.
Cardiac ultrasonography is the gold standard of diagnostics in veterinary cardiology. At WTVS we are able to examine the heart to look for valvular disease (such as mitral valve endocardiosis in small dogs), dilated cardiomyopathy (generally large dogs), hypertrophic cardiomyopathy (cats), and cardiac/pericardial masses as well as other acquired cardiac conditions. Sedation is only rarely needed to perform echocardiography; in fact, it is usually preferable not to sedate patients so as not to interfere with cardiac rate, rhythm, and contractility.
NOTE: In some cases, particularly those with congenital anomalies or unusual/challenging heart disease, the patient may need to be referred to a veterinary cardiologist for more specialized evaluation.
Ultrasonography of the thorax is useful in evaluating the pleural space disorders, the mediastinum (particularly if masses or lymphadenopathy present), and, in some cases, diseased lung. As with abdominal ultrasound, ultrasound-guidance allows precision FNA, which minimizes the risk of inadvertent lung, vascular, or cardiac laceration. Sedation is not usually required for thoracic ultrasound, although if aspirates are performed, sedation is commonly used.
Ultrasonography of the neck is most commonly used to identify parathyroid gland or thyroid gland lesions, particularly when a palpable neck mass is present or Hyperparathyroidism is suspected. In addition, we can utilize ultrasound to evaluate the jugular and carotid vasculature to look for thromboembolic or mass lesions. Sedation is sometimes required to thoroughly evaluate the neck with ultrasound.
Ultrasound-guided fine needle aspiration
We can take aspirates of intra-abdominal and intra-thoracic structures for cytologic evaluation. Provided there is no bleeding tendency, the risk of hemorrhage is generally low, and the risks of inadvertent large vessel or organ laceration are minimal when ultrasound guidance is utilized. Sedation is usually utilized with thoracic FNA and occasionally utilized for abdominal FNA.
Bone marrow aspiration/biopsy
We can take bone marrow samples in cases where further assessment of bone marrow evaluation is warranted including (but not limited to) pancytopenia, bicytopenia, or severe non-regenerative anemia. The risk of hemorrhage is minimal. Generally will pursue samples at the proximal humerus but, if needed, can use the pelvic approach. Local anesthetic and heavy sedation is utilized for this procedure.
Aspirates can be taken of joints with minimal risk of hemorrhage. Heavy sedation is utilized for this procedure.
Esophagostomy tube placement
E-tubes are great for especially cats but also small to medium-sized dogs who would benefit from nutritional supplementation due to prolonged anorexia. Requires general anesthesia.
Cerebrospinal fluid (CSF) aspiration
In select cases, we can perform a CSF tap to allow further analysis (cytology and fluid analysis, infectious disease testing, etc.) of CNS diseases. This procedure carries a risk of brain herniation and is most aptly performed based on the results of a brain MRI or CT scan; however, if transport to a neurologist is not possible, in certain cases it may be warranted, provided the risks have been thoroughly discussed with the patient’s owner. Requires general anesthesia.
Upper and lower GI endoscopy
Flexible endoscopy allows visualization, biopsy collection, and/or foreign body retrieval within the pharynx/larynx, esophagus, stomach, small intestine, and colon/rectum. Depending on the patient and the procedure, the majority of cases can be discharged from the hospital the same day.
Endoscopy of the urinary bladder, urethra, vaginal cavity, and vestibule allows non-invasive visualization and, if needed, biopsy collection. This is also a highly effective method for diagnosing or ruling out ectopic ureters in females.
Diseases of the nasal cavity and, in some cases the nasopharynx, can be evaluated with rigid endoscopy. This allows visualization and diagnosis of nasal tumors, inflammatory diseases, foreign bodies, and other less common disease processes.
Balloon dilation of benign esophageal stricture
This procedure is performed using endoscopy and involves dilation of the stricture using incrementally larger balloons that are run alongside the endoscope. Some cases respond to a single procedure whereas others require multiple dilation events.