Post on 07-May-2015
Thoracic Ultrasonographic
Examination
I- Lung and Pleura
Right side Left side
Applied Anatomy
Applied Anatomy
Lower airway Trachea
Incomplete tracheal rings
Tracheal bronchus
Left Lung – 2 lobes Divided Cranial Caudal
Right Lung – 4 lobes Divided Cranial Middle Caudal Accessory
(shaded)
Normal ultrasound of lung and pleura
Reverbration artifacts presents medially to the pleural layers due to presence of air inside the alveoli 3.5 MHz
Reverbration artifacts presents medially to the pleural layers due to presence of air inside the alveoli 5 MHz
Reverbration artifacts presents medially to the pleural layers due to presence of air inside the alveoli 6 MHz
Lung diseases diagnosed by
ultrasonography
1 -Pneumonia
Sonogram of a lung of a calf with pneumonia of the cranial lobe the normal lung tissue with reverberation artifacts on the left is distinctly delineated from the abnormal hypoechoic tissue with hyperechoic dot
Drenching pneumonia
2-Lung abscesses
Unripe lung abscesses appeared as anechoic areas surrounded by hypoechoic lines
Ripened abscesses appeared as hypoechoic areas
Old caseatyed abscesses appeared as echogenic circumscribed areas
3-Emphysema
Sonogram of pulmonary emphysema (5 MHz): the numerous echogenic bands (C) from the lung surface are comet-tail
Pleural diseases diagnosed by
ultrasonography
Pleurisy
Early stage of pleuropneumonia
Early stage of pleural effusion
Fibrinous pleuro-pneumonia
II- Heart (Echocardiography)
Applied Anatomy
• Right parasternal long axis view• Right parasternal short axis view• Left parasternal view
Techniques of echocardiograph
•4th intercostal space (ICS) midway between point of shoulder (POS) and point of elbow (POE)
•Scan plane marker dorsal and slightly cranial (1 o'clock position)
Right parasternal long axis view
B mode ultrasonography
Right parasternal long axis view
Right ventricular out flow view tract
RVOT
Left ventricular out flow view tract
LVOTFour chamber view
A- RVOT
B- LVOT
C- 4- chamber view
Right ventricular out flow view tractRVOT
Angle transducer towards the left 3rd ICS
Should image:
1. the right atrium (RA)
2. tricuspid valve (TV),
3. right ventricle (RV),
4. pulmonic valve (PV)
5. pulmonary artery (PA)
RVOT
Left ventricular out flow view tractLVOT
Angle transducer straight across the thorax towards the left 4th ICS for left ventricular outflow tract (LVOT). Should image:
1-Right atrium (RA),
2-Tricuspid valve (TV),
3-Right ventricle (RV),
4-Interventricular septum (IVS)
5-Aortic valve (AV),
6-Aortic root (AR)
7-Left ventricle
7-Left atrium (LA).
LVOT
Four chamber view
Angle transducer caudally towards the left 5th ICS. Should image:
• Right atrium (RA)
• Tricuspid valve (TV)
• Right ventricle (RV)
• Interventricular septum (IVS)
• Left ventricle (LV)
• Mitral valve (MV)
• Left atrium (LA)
4 chamber view
Right parasternal short axis view
Rotate the transuducer 90 oSo that the scan plan is cranial and slightly ventral (4 o'clock)
Right parasternal short axis view
Left ventricularview Mitral valve view Aortic valve view
A- LV. view
B- Mitral valve view
C- Aortic valve view
Left ventricular view tractLVOT
Aim slightly ventrally to include the cardiac apex and papillary muscles.Should image the
1- right ventricle (RV)
2- interventricular septum (IVS)
3- left ventricle (LV)
4- dorsal aspects of the papillary muscles
5- left ventricular free wall
(LVFW).
LV view
Mitral valve view
Aortic valve view
Aim dorsally and slightly clockwise for AV Should image1- Tricuspid valve (TV),
2- Aortic root (AR)
3- Aortic valve (AV),
4- Left atrium (LA)
5- Left atrial appendage (LAA).
Aortic view
Left parasternal long axis view
• Should be done if:-LA or LV enlargement-MR, PR or AR-Atrial Fibrillation-Pericardial effusion-When all left heart cannot be visualized adequately from right side
Left parasternal long axis view
RVOT and PA LVOT and AR Mitral Valve
A- RVOT and PA
B- LVAT and AR
C- Mitral valve
RVOT and PA
Place transducer in left 3rd ICS and aim straight across the thorax and the scan plane marker facing cranially for PV Should image:
1- Pulmonary artery (PA)
2- Pulmonic valve (PV)
3- Tricuspid valve (TV)
4- Right ventricle (RV)
5- Aortic root (AR).
MV. View
Place the transducer in the left 5th ICS and aim straight across the thorax with scan plane marker facing dorsally and slightly cranially
M mode ultrasonography
RV.length (diastole)--- 3.8 cm
RV.length (systole)--- 2.7 cm
LV length (diastole)----11.9cm
LV length (systole)---- 7.35 cm
IVS d ------------------ 3.02 cm
IVS s ------------------ 4.55 cm
Cardiovascular diseases diagnosed by
ultrasonography
1 -Congenital diseases
1-Ventricular septal defect (VSD)
2- Atrial septal defect (ASD)
3- Parent ductus arteriosis (PDA)
VSD
1 -Aquired diseases
1-Pericardial diseases (pericarditis) 2- Myocardial diseases (myocardial degeneration) 3- Endocardial diseases (endocarditits)
1-Pericardial diseases (pericarditis)
Pericarditis appeared from left parasternal view at 4th intercostal space
2 -Myocardial diseases (myocardial degeneration)
3-Endocardial diseases (endocarditis)
Tricasped endocarditis