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Front line ultrasound imaging of the feline kidney
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Most practices nowadays will have access to an ultrasound machine, using it for selected imaging of clinical cases; in this paper Greg Lisciandro discusses how a structured approach to abdominal scanning can be part of the clinician’s first-line physical exam, and demonstrates how this can help rapid identification of renal abnormalities and related problems.
Gregory Lisciandro
DVM, Dip. ACVECC, Dip. ABVP - Hill Country Veterinary Specialists, Spicewood, Texas
Dr. Lisciandro qualified from Cornell University, completed a rotating internship in small animal medicine and surgery at The Animal Medical Center, New York City, and a residency in Emergency and Critical Care in Texas. He has spent approximately half of his career in general practice and half in emergency and critical care, and his main interest is in point-of-care ultrasound. He has published many clinical studies and is currently co-owner of a specialist small animal practice and CEO of FASTVet.com, an education-based veterinary ultrasound company.
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Key Points
- Point-of-care ultrasound is gaining more and more use in first opinion veterinary medicine, and can now be regarded as the clinician’s first-choice imaging method.
- A structured approach to abdominal scanning should minimize the risk of missing important pathologies.
- Many renal abnormalities can be detected using a standardized approach.
- Recording ultrasound findings using specific templates helps to emphasize the objectives whilst imaging, as well as chronicling patient data for future reference and comparison.
Introduction
Global FAST (an acronym for Focused Assessment with Sonography for Trauma) is a well-defined point of care ultrasound protocol that was first created as a triage and post-interventional screening test by human trauma surgeons in the 1990s, and then progressed into a non-trauma and monitoring imaging tool. The technique has now been developed for the veterinary field, and comprises abdominal FAST (AFAST), thoracic FAST (TFAST), and Vet BLUE (brief lung ultrasound examination) methods for assessing the small animal patient, although the latter two techniques will not be discussed in any detail in this paper.
The G-FAST approach includes target-organ interrogation (abdomen and thoracic organs including heart and lung) and involves 15 specific, standardized probe maneuvers (Figure 1); when performed by a competent person the entire procedure can be accomplished in around six minutes. This article focuses on findings at the AFAST Spleno-Renal (SR) and Hepato-Renal (HR) views (as described below) which allow easy detection of soft tissue renal and adjacent ureteral abnormalities, as well as free fluid within the peritoneal cavity and retroperitoneal space. The recording of findings on goal-directed templates gives value to the examinations and enables clear objectives to be achieved.
Importantly, a word of caution should be sounded. The veterinary point-of-care ultrasound (V-POCUS) movement lends itself to "satisfaction of search error" through selective imaging (picking and choosing) and will often fulfill a preconceived clinical bias, thus missing other important imaging information. This is potentially dangerous; a clinician would never selectively perform a physical examination, so without following a standardized global protocol whilst scanning, the clinician may not only miss pathology but will also fail to integrate other important G-FAST findings into the overall assessment of the patient (1) (2)(3) (4) (5) (6). The mindset for those using ultrasound is that the G-FAST approach serves as an extension of the physical exam, as it is a standardized, achievable format that can be easily utilized by the non-specialist radiologist veterinarian and should be the first-line imaging modality; in other words, it is a new quick assessment test.
AFAST can be used for general abdominal evaluation, and includes a standardized fluid scoring system for assessment of free fluid; the target-organ approach involves visualization of the kidneys and adjacent ureters and retroperitoneal space. TFAST and Vet BLUE can be combined with this, and may be used for staging renal patients and assessing their overall volume status, as well as urine production and output. [...]
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