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Abdominal Ultrasound

Patients are positioned in dorsal recumbency (padded trough provided) and all abdominal organs including adrenals, pancreas, abdominal lymph nodes and vasculature are routinely thoroughly evaluated. Measurements are routinely taken and are recorded in a thorough report, with a comment on every organ / structure; this is available the same day. Ectopic ureter requests must be specified as these require more prolonged fasting (see ‘patient preparation’) and extra time must be allocated for this examination.

Thoracic Ultrasound

Cases suitable for thoracic ultrasound include those with pleural effusion, mediastinal disease, thoracic masses, pulmonary interstitial or granulomatous disease, diaphragmatic hernia / PPDH, etc. Ultrasound-guided sampling of mediastinal and thoracic masses is often indicated, for example trucut biopsy of mediastinal or solid lung masses.  In addition guided FNA of diffuse pulmonary interstitial disease has a high diagnostic rate with minimal complications in cases where BAL has been unhelpful, eg diffuse pulmonary interstitial neoplasia, mycoplasma infections.

Ultrasound of the Neck

This is useful for identification of thyroid and parathyroid lesions and is particularly recommended in patients being evaluated for hypercalcaemia. Patients require a good level of sedation and will be evaluated in dorsal recumbency with the head fully extended. There will be extensive clipping of the ventral cervical region. Echolaryngography is a technique which assesses motion of the arytenoid cartilidges and has a high diagnostic success rate for laryngeal paralysis in conscious dogs, avoiding the need for sedation or anaesthesia (and consequently avoiding the diagnostic complication of medication-induced reduced laryngeal motion).

Portosystemic Shunt Evaluation

Ultrasound evaluation for abnormalities of the portal vasculature is performed in patients in which there is a high clinical index of suspicion and a compatible bile acid stimulation test (usually >100 postprandial). General ultrasound examination of the abdomen is initially performed and will usually detect other characteristics of portosystemic shunt, which are visualised due to increased circulating volume and altered hepatic metabolism. The patient is then repositioned into lateral recumbency and evaluation of the hepatic and abdominal vasculature thoroughly performed using colour and spectral Doppler, to permit detection of the anomalous vessel. A full description of vessel origin, course and insertion is provided with associated diameters sufficient for surgical intervention without the requirement for further imaging in the majority of cases. This can be a time consuming process, and adequate time should be allocated for provision of the assistant. Ultrasound evaluation of portosystemic shunts holds advantages over CT evaluations such as not requiring anaesthesia or administration of contrast agents and their associated risks, and reduced cost.

Ultrasound Guided FNA and Biopsy / Coagulation profiling

Ultrasound guided biopsy is a minimally invasive procedure with a high diagnostic rate. Fine needle aspiration is even less invasive and less costly but cytology sometimes gives inconclusive results. Sedation is usually sufficient for biopsy, depending on the tissue being sampled. Fine needle aspiration can be performed under very light sedation. Coagulation profiling on-site is available to give immediate results and permit same-day biopsy sampling in patients with questionable coagulability.  PT and APTT values are obtained assessing both the intrinsic and extrinsic coagulation pathways.  This is recommended in all patients undergoing trucut liver biopsy and in other cases as advised.  All patients undergoing biopsy should be hospitalised for the remainder of the day to monitor for haemorrhage, although this is a very rare complication (less than 0.25%).  Laboratory fees are included in the fee and a patient report will be sent with the cytology / histopathology report to aid in interpretation.



Echocardiography includes thorough B-mode examination from the right parasternal and left parasternal (cranial and caudal) windows, M-mode examination, and Doppler evaluation (colour flow and spectral pulsed-wave and continuous-wave) of inflow and outflow tracts, including subcostal aortic outflow velocity where indicated.  An integrated ECG ensures accurate timing of measurements.  The measurements obtained provide information on cardiac chamber dimensions, wall thicknesses, systolic and diastolic function, and morphology and function of cardiac valves, and allows the diagnosis of acquired and congenital cardiac diseases.  Breed associated heart testing is not available using NVi services – please go to www.bsava.org.uk/vcs/testing/menu.htm for information on veterinary cardiologists recommended for breed testing schemes.


Upper and lower gastrointestinal endoscopy are often indicated subsequent to abdominal ultrasound.  For example if the mucosal layer of the duodenum is thickened then duodenal biopsies can be collected – pyloric intubation is feasible in the vast majority of patients from 3-60kg with the NVi 9mm 1.5 metre flexible veterinary gastroscope. Additionally evaluation of the oesophagus and retrieval of gastric foreign bodies etc. can be performed. Lower GI endoscopy is often indicated in cases where the mucosal layer of the distal ileum is affected (diffuse thickening or focal / mass lesions) and intubation of the ileocolic junction permits biopsy of this region; also cases with lesions of the colon or caecum are suitable. For cases where abdominal ultrasound indicates that the submucosal or muscularis layers of the intestine are affected 9as is often the case in cats), exploratory surgery is preferred as these layers are not accessible to internal (endoscopic) biopsy.

Bronchoscopy is frequently indicated to permit retrieval of foreign bodies eg grass seeds, and also to perform guided BAL or sample focal mass lesions.  Evaluation of the trachea also allows for grading of tracheal collapse. Rhinoscopy is also useful as a mobile procedure for retrieval of foreign bodies, however for evaluation of the majority of chronic nasal conditions CT is ideally performed prior to rhinoscopy as there is a high risk of misdiagnosis by performing rhinoscopy alone (referral required).

Cystoscopy is a useful procedure for detection of ectopic ureter on the odd occasion where ultrasound evaluation cannot confirm both normal ureteral insertions, and also to obtain biopsy specimens from bladder or urethral neoplasia prior to starting chemotherapy.


Contrast-enhanced Ultrasound

Contrast-enhanced ultrasound is suitable for cases where sonographically-visible lesions are unsuitable for guided sampling or other biopsy method.  Using an intravenously administered contrast agent, determination of beign or malignant nature of lesions can be obtained with a very high sensitivity and specificity. For patients suitable for contrast-enhanced ultrasound please contact Sophie or Paul directly to book in a patient.