UltrasonographyUltrasonography

Sakina RubabSakina Rubab99thth semester, DVM semester, DVM

UCV&ASUCV&ASIslamia University of BahawalpurIslamia University of Bahawalpur

Ultrasound PhysicsUltrasound Physics

Characterized by sound waves of Characterized by sound waves of high frequencyhigh frequency

Higher than the range of human Higher than the range of human hearing (20-20000Hz)hearing (20-20000Hz)

Diagnostic U/S = 1-20 MHzDiagnostic U/S = 1-20 MHz

Components Components

Monitor/ DisplayMonitor/ Display Transducer/ ProbeTransducer/ Probe Control panelControl panel

Ultrasound machineUltrasound machine

Transcutaneous :Concave Image

Transrectal: Linear image

Transrectal probe

Transcutaneous probe

Monitor

Control panel U/S gel

Principle Principle

ElectricityElectricity TransducerTransducer Ultrasound wavesUltrasound waves TissueTissue TransducerTransducer ImageImage

TypesTypes

Doppler Doppler

A mode: (Amplitude) One dimensionalA mode: (Amplitude) One dimensional

B mode: (Brightness) Two dimensionalB mode: (Brightness) Two dimensional Real time B mode: Real time B mode: motion can be seen motion can be seen

Ultrasound of the Female Ultrasound of the Female Reproductive System Reproductive System

Transcutaneous Ultrasonography in a pregnant doe

Ultrasonographic image of a fetus

TechniqueTechnique

7.5-10mHz transducers7.5-10mHz transducers 5 mHz in mid to late term pregnancy, 5 mHz in mid to late term pregnancy,

pyometra, ovarian tumorspyometra, ovarian tumors Dorsal recumbency is routine Dorsal recumbency is routine

Larger animals standingLarger animals standing Full bladder enhances visualization of Full bladder enhances visualization of

uterusuterus Acoustic windowAcoustic window

How is interpretation done?How is interpretation done?

Anechoic Anechoic Black Black HypoechoicHypoechoic Grey Grey HyperechoicHyperechoic White White

Types/Frequency of Types/Frequency of TransducersTransducers

TransrectalTransrectal

TranscutaneousTranscutaneous

Transrectal Transducer Transrectal Transducer

7.5 MHz------- Early pregnancy diagnosis7.5 MHz------- Early pregnancy diagnosis 5 MHz -------- Pregnancy diagnosis after 5 MHz -------- Pregnancy diagnosis after

40 40 days days 3.5 MHz--------Late pregnancy diagnosis; 3.5 MHz--------Late pregnancy diagnosis;

early pregnancy early pregnancy diagnosisdiagnosis

Transcutaneous TransducerTranscutaneous Transducer

3.5 MHz--------Late pregnancy diagnosis 3.5 MHz--------Late pregnancy diagnosis

Normal Ultrasound AnatomyNormal Ultrasound Anatomy

OvaryOvary Mix of hyper and hypo echoic signalsMix of hyper and hypo echoic signals Difference can be made between small inactive and Difference can be made between small inactive and

large active ovaries.large active ovaries. C.LC.L

Different from ovarian stromaDifferent from ovarian stroma Hypo echoic relative to the ovarian stromaHypo echoic relative to the ovarian stroma Undefined borderUndefined border Vary according to the stage of pregnancy and Vary according to the stage of pregnancy and

development development C.L of pregnancy usually have the cavity in it, appears C.L of pregnancy usually have the cavity in it, appears

anechoic anechoic

Foll iclesFoll icles Waves of follicles can be followed for their Waves of follicles can be followed for their

development and regression.development and regression. 2mm follicles are considered to be smallest one; 2mm follicles are considered to be smallest one;

anechoic structures as they growanechoic structures as they grow Shape: can be Oval, asymmetrical, round.Shape: can be Oval, asymmetrical, round.

OvulationOvulation Appearance of large follicle and then disappearanceAppearance of large follicle and then disappearance Timing of the ovulation can be determined as size Timing of the ovulation can be determined as size

increasesincreases Ovulation seen as pear shaped structure with pointingOvulation seen as pear shaped structure with pointing 4 min period for evacuation of fluid from follicle4 min period for evacuation of fluid from follicle

Ovarian Blood VesselsOvarian Blood Vessels Appear as small, medium follicles 2-5 mm in Appear as small, medium follicles 2-5 mm in

sizesize Altering the plane of scanning they move and Altering the plane of scanning they move and

their shape changes.their shape changes. They becomes elongated from oval or They becomes elongated from oval or

rounded shape rounded shape

Uterine HornUterine Horn Scan both cross and longitudinal sectionScan both cross and longitudinal section Outlined by dark ring which is a vascular coatOutlined by dark ring which is a vascular coat Changes due to physiological statesChanges due to physiological states Caruncles on the endometrial sizeCaruncles on the endometrial size

Uterine BodyUterine Body Longitudinal axis view; rotate the probe in Longitudinal axis view; rotate the probe in

clockwise and anti clock wise direction to see clockwise and anti clock wise direction to see the bifurcation the bifurcation

CervixCervix Hyper echoic imageHyper echoic image External os can be seenExternal os can be seen

VaginaVagina Hyper echoic; ovoid; fluid filledHyper echoic; ovoid; fluid filled

Urinary bladderUrinary bladder AnechoicAnechoic Confusion with pregnancyConfusion with pregnancy

Pregnancy diagnosisPregnancy diagnosis

DaysDays Structures SeenStructures Seen 17-1917-19 C.L and Little anechoic lumen in ipsilateral hornC.L and Little anechoic lumen in ipsilateral horn 22-24 22-24 Anechoic lumen increasesAnechoic lumen increases Echogenic streaksEchogenic streaks Heart beat Heart beat

DaysDays Structures SeenStructures Seen 3030 More pronounced changes presentMore pronounced changes present Membranes Membranes 3535 Uterine caruncles Uterine caruncles CRLCRL

Day 49-52 of gestationDay 49-52 of gestation Considerable skill is requiredConsiderable skill is required 7.5MHz (cross and dorsal plane)7.5MHz (cross and dorsal plane) Genital tubercle is the target structure from Genital tubercle is the target structure from

which penis and clitoris is formedwhich penis and clitoris is formed At day 42 structure begin to migrate from At day 42 structure begin to migrate from

perineum to Anusperineum to Anus In female, migration does not occur genital In female, migration does not occur genital

tubercle is located caudal to pelvic limbstubercle is located caudal to pelvic limbs

Ovarian StructuresOvarian Structures

PyometraPyometra U/S is modality of choice for U/S is modality of choice for

DxDx Enlarged uterus & uterine Enlarged uterus & uterine

hornshorns Luminal contentsLuminal contents

Homogenous, anechoicHomogenous, anechoic Echogenic, “swirling”Echogenic, “swirling”

May see varying wall thicknessMay see varying wall thickness Endometrium may contain Endometrium may contain

anechoic focianechoic foci Ddx: hydrometra, mucometraDdx: hydrometra, mucometra Monitor response to therapy Monitor response to therapy

18 day pregnancy18 day pregnancy

Organogenesis Organogenesis

Fetal Fetal StructureStructure

Days Post Days Post LH SurgeLH Surge

Fetal orientationFetal orientation 2828

Limb budsLimb buds 3535

SkeletonSkeleton 33-3933-39

Stomach, bladderStomach, bladder 35-3935-39

LungsLungs 38-4238-42

Kidneys, eyesKidneys, eyes 39-4739-47

Cardiac chambersCardiac chambers 4040

IntestinesIntestines 57-6357-63

Ultrasonography of Male Ultrasonography of Male Reproductive SystemReproductive System

ProstateProstate

NormalNormal AbnormalAbnormal

Prostate DiseasesProstate Diseases

Benign Prostatic Benign Prostatic HyperplasiaHyperplasia Older intact dogsOlder intact dogs Symmetrical Symmetrical

enlargementenlargement May be up to 4 times May be up to 4 times

normalnormal Variable echogenicity Variable echogenicity

and textureand texture

ProstatitisProstatitis Acute or chronicAcute or chronic Symmetrical or Symmetrical or

asymmetrical asymmetrical Heterogenous Heterogenous

appearanceappearance May see hypoechoic May see hypoechoic

areas (cyst or areas (cyst or abscess)abscess)

Mineralization, fibrosisMineralization, fibrosis

Prostate DiseasesProstate Diseases NeoplasiaNeoplasia

Older neutered dogsOlder neutered dogs Enlarged Enlarged Irregular shapeIrregular shape Texture variesTexture varies

Hyperechoic foci with Hyperechoic foci with acoustic shadowing = acoustic shadowing = mineralizationmineralization

May see cyst-like lesionsMay see cyst-like lesions

CystsCysts Developmental or Developmental or

congenitalcongenital Anechoic contentsAnechoic contents Thin hyperechoic wallThin hyperechoic wall Vary in size and numberVary in size and number

Prostatic CystProstatic Cyst

TestesTestes

Homogenous textureHomogenous texture Parietal and visceral tunics:Parietal and visceral tunics:

hyperechoichyperechoic Mediastinum testis:Mediastinum testis:

Echogenic linear structure on midlineEchogenic linear structure on midline Tail of the epididymisTail of the epididymis

Nearly anechoic Nearly anechoic Coarse echotextureCoarse echotexture

Testicular NeoplasiaTesticular Neoplasia

Interstitial, Sertoli cell, seminomaInterstitial, Sertoli cell, seminoma May all appear the sameMay all appear the same

Mixed appearance on U/SMixed appearance on U/S HemorrhageHemorrhage NecrosisNecrosis

Testes-cont’dTestes-cont’d

Retained testesRetained testes Small sizeSmall size Caudal to kidneys to Caudal to kidneys to

inguinal canalinguinal canal Difficult to see on U/SDifficult to see on U/S

OrchitisOrchitis Patchy, hypoechoic Patchy, hypoechoic

parenchymaparenchyma Hyperechoic if chronicHyperechoic if chronic

Epididymal Epididymal enlargementenlargement

AbscessesAbscesses Irregular shapedIrregular shaped Hypoechoic contentsHypoechoic contents

May look like May look like neoplasia!neoplasia!

AdvantagesAdvantages

Noninvasive Noninvasive PainlessPainless Widely available, easy-to-use and less Widely available, easy-to-use and less

expensive expensive Safe and does not use any ionizing radiationSafe and does not use any ionizing radiation Clear picture of soft tissues than x-ray images.Clear picture of soft tissues than x-ray images.

LimitationsLimitations

Quality depends on skills of operatorQuality depends on skills of operator Overweighed patients not clear image of Overweighed patients not clear image of

target organstarget organs Can not be used through bone or gasCan not be used through bone or gas

ReferencesReferences

www.ncbi.nlm.nih.gov/pubmed/17688602www.ncbi.nlm.nih.gov/pubmed/17688602 www.tandfonline.com/doi/pdf/10.1081/E-www.tandfonline.com/doi/pdf/10.1081/E-

EBAF-120047343EBAF-120047343 www.researchgate.net/...www.researchgate.net/...UltrasonograpUltrasonograp

hichic ......smallsmall __ruminantruminant __reproductionreproduction http://onlinelibrary.wiley.com/doi/10.1111/j.http://onlinelibrary.wiley.com/doi/10.1111/j.

1439-0531.2010.01640.x/full1439-0531.2010.01640.x/full

Thank youThank you