The expected frequency and amount of free peritoneal fluid estimated using the abdominal FAST-applied abdominal fluid scores in healthy adult and juvenile dogs

Assessing primary care veterinarians' use of and confidence in performing point-of-care ultrasound

BACKGROUND

Point-of-care ultrasound (POCUS) is gaining popularity in the veterinary field, but there is little information on operator confidence.

METHODS

A survey was distributed to primary care veterinarians (PCVs) via social media between May and July 2020. Details of participants' training in and use of POCUS were recorded. Participants' confidence in using thoracic and abdominal POCUS was also assessed using a five-point Likert scale.

RESULTS

Two hundred and one PCVs used POCUS, of which 32% reported using a non-standardised protocol. Fifty percent of PCVs were self-taught and 17.4% had attended a specific practical course. The median confidence score was 4 out of 5 (interquartile range [IQR] 2-5) for identifying abdominal abnormalities, irrespective of the training method. The median confidence score for thoracic abnormalities was 3 out of 5 (IQR 1-4) for those taught by a colleague or who were self-taught using journal articles or videos.

LIMITATIONS

The survey-based nature of the study relies on self-reporting and is therefore liable to recall bias.

CONCLUSIONS

PCVs' confidence in using POCUS is lacking, particularly with thoracic POCUS. Standardised practical training for PCVs, particularly in thoracic POCUS, would be beneficial. Future studies should explore how best to deliver this training.

Assessment of a standing position during abdominal point-of-care ultrasound on abdominal fluid score in dogs

OBJECTIVE

To assess the use of a standing position during abdominal point-of-care ultrasound (POCUS) examination when evaluating dogs for peritoneal effusion.

DESIGN

Randomized prospective study over 17 months.

SETTING

Single-center, university veterinary teaching hospital.

ANIMALS

Thirty dogs presenting for acute abdominal disease. Eligibility included suspicion for free peritoneal effusion and the ability to stand.

INTERVENTIONS

Dogs underwent standing abdominal POCUS, right lateral abdominal POCUS, and a full abdominal ultrasound. We originally had nothing listed. It now includes all three ultrasound evaluations that were performed for each patient.

MEASUREMENTS AND MAIN RESULTS

Patients underwent both a right lateral and standing abdominal POCUS via a previously described abdominal focused assessment with sonography for trauma (A-FASTrl and A-FASTs, respectively) technique in a randomized and sequential order followed by a full abdominal ultrasound (AUS-full). The A-FASTs examination included a right flank location in addition to the following standard views: subxiphoid, left flank, urinary bladder, and umbilicus. Five-second cine loops were obtained at each location for each examination and reviewed in the order they were obtained. Locations for both A-FAST exams were interrogated in the same order every time. The cine loops were scored for the degree of peritoneal effusion based on a previously published abdominal fluid scoring system by a board-certified radiologist, radiology resident, and radiology intern. The overall abdominal fluid score (AFS) was compared to a subjective full abdominal ultrasound score given by a board-certified radiologist. Six dogs had no peritoneal effusion, 13 had a small volume (AFS 1 or 2), and 11 had a moderate to large volume (AFS 3 or 4). Excellent agreement (intraclass correlation coefficient) was found between the A-FASTs and A-FASTrl techniques (0.95, 0.93, 0.94), good agreement between A-FASTs and AUS-full (0.80, 0.77, 0.82), and good agreement between A-FASTrl and AUS-full (0.80, 0.82, 0.84). The interobserver agreement was good (0.87) for the A-FASTs technique and excellent (0.91) for the A-FASTrl technique. Mean observer agreement score was excellent (0.94) when evaluating A-FASTrl to A-FASTs, good (0.86) when evaluating A-FASTs to AUS-full, and good (0.87) when evaluating A-FASTrl to AUS-full.

CONCLUSION

Performing a standing abdominal POCUS examination may be a valid option for identifying and quantifying peritoneal effusion in situations when a more traditional right lateral approach cannot be performed.

N-terminal brain natriuretic peptide, cardiac troponin-I, and point-of-care ultrasound in dogs with cardiac and noncardiac causes of nonhemorrhagic ascites

BACKGROUND

Nonhemorrhagic ascites (NHA) can be caused by cardiac diseases (cNHA) and noncardiac diseases (ncNHA). N-terminal brain natriuretic peptide (NT-proBNP), cardiac troponin-I (cTnI), and point-of-care ultrasound (POCUS) may differentiate between cNHA and ncNHA.

HYPOTHESIS/OBJECTIVES

We compared NT-proBNP and cTnI concentrations as well as POCUS findings in dogs presented with cNHA and ncNHA.

ANIMALS

Dogs (n = 60) were enrolled based on identification of NHA with an effusion packed cell volume < 10%.

METHODS

Blood samples were collected and POCUS was performed on all dogs. Dogs were diagnosed with cNHA (n = 28) or ncNHA (n = 32) based on echocardiography. The cNHA group was subdivided into cardiac non-pericardial disease (n = 17) and pericardial disease (n = 11).

RESULTS

The NT-proBNP concentration (median; range pmol/L) was significantly higher in the cNHA group (4510; 250-10 000) compared to the ncNHA group (739.5; 250-10 000; P = .01), with a sensitivity of 53.8% and specificity of 85.7% using a cut-off of 4092 pmol/L. The NT-proBNP concentrations were significantly higher in the cardiac non-pericardial disease group (8339; 282-10 000) compared with the pericardial disease group (692.5; 250-4928; P = .002). A significant difference in cTnI concentration (median; range ng/L) between the cNHA group (300; 23-112 612) and ncNHA group (181; 17-37 549) was not detected (P = .41). A significantly higher number of dogs had hepatic venous and caudal vena cava distension in the cNHA group compared to the ncNHA group, respectively (18/28 vs 3/29, P < .0001 and 13/27 vs 2/29, P < .001). Gall bladder wall edema was not significantly different between groups (4/28 vs 3/29, P = .74).

CONCLUSIONS AND CLINICAL IMPORTANCE

NT-proBNP concentration and POCUS help distinguish between cNHA and ncNHA.

ULTRASONOGRAPHIC EVALUATION OF COELOMIC FLUID IN HEALTHY CORN SNAKES (PANTHEROPHIS GUTTATUS)

Free coelomic fluid can be a physiologic or pathologic finding in snakes. In this study, ultrasonography was used to assess the presence, volume, and type of coelomic fluid in 18 (16 females, 2 males) clinically healthy corn snakes (Pantherophis guttatus) using a semiquantitative scoring system. Each snake was divided into five equal regions (R1-R5) by length (from rostrum to vent) and fluid volume was scored on a scale of 0 to 4. Coelomic fluid was sampled when possible and cytologic analysis was performed. The majority of snakes (16/18) were found to have some degree of free coelomic fluid. The coelomic fluid samples that were collected (n= 6) were classified as transudates, acellular or primarily lymphocytic. Fluid was most likely to be found in R3 compared with all other regions and least likely to be found in R1 compared with R2, R3, and R4. A higher score of volume was found in R3 compared with R1 and R5. This study describes the distribution and abundance of coelomic fluid in snakes, as well as a method for point of care ultrasound (POCUS) in this species.

The wedge sign: A possible lung ultrasound sign for pulmonary thromboembolism

OBJECTIVE

To describe the finding of the lung ultrasound (LUS) "wedge sign" in dogs with presumptive pulmonary thromboembolism (PTE).

CASE SERIES SUMMARY

This case series describes 2 dogs with predisposing risk factors of (1) right transvenous pacemaker terminating in its right ventricle, severe protein-losing nephropathy, and glucocorticoid therapy, and (2) caval syndrome, each having the LUS "wedge sign" in upper lung regions, a sign consistent with pulmonary infarction and peripheral PTE.

NEW OR UNIQUE INFORMATION PROVIDED

Historically, the diagnosis of canine PTE has been made through supportive findings because the gold standard test, computed tomography pulmonary angiography (CTPA), poses limitations. The use of LUS has shown promise in people for detecting PTE, with the advantages of availability, being radiation- and contrast medium-sparing, rapid (<90 s), point-of-care, real-time information. Our cases suggest a possible new first-line approach for suspecting canine PTE by using LUS and the finding of the "wedge sign" in nongravity-dependent caudodorsal and perihilar lung regions.

AFAST Target-Organ Approach and Fluid Scoring System in Dogs and Cats

Point-of-care ultrasonography as part of the physical examination is becoming considered a core skill. AFAST includes 5 acoustic windows over the abdomen and serves as a rapid screening test for free fluid (ascites, retroperitoneal, pleural and pericardial effusion) and soft tissue abnormalities (target-organ approach), and has an abdominal fluid scoring system (semiquantitating volume). Moreover, add-on skills are possible without additional views that include characterizing the caudal vena cava and hepatic veins (volume status), measuring the urinary bladder (volume estimation and urine output), screening for free air (pneumoperitoneum, pneumoretroperitoneum), and assessing gastrointestinal motility.

Global FAST for Patient Monitoring and Staging in Dogs and Cats

Please verify if FAST should be expanded at first use - "focused assessment with sonography for trauma"?: Global FAST consists of abdominal FAST, thoracic FAST, and Vet BLUE combined as a single point-of-care ultrasound examination used as an extension of the physical examination. By applying its unbiased set of 15 data imaging points, information is gained while avoiding image interpretation errors, such as satisfaction of search error and confirmation bias error, through selective POCUS imaging. Moreover, Global FAST is used for integrating information from both cavities, rapidly screening for the Hs and Ts of cardiopulmonary resuscitation, and staging localized versus disseminated disease, helpful diagnostically and prognostically for patient work-up. By seeing a problem list, patient care is improved.