Vet BLUE (Lung Ultrasound) Video Clips

Video clip WB49 showing the Trick of the (FASTVet) Trade using the One-eyed Gator by placing the rib head in the center of view.  By doing so, echoes are dispersed off the highly reflective centered rib head and the Glide Sign along the Lung Line is easily observed.

Video clip WB17 showing classic Gator Sign and Dry Lung.  Note the Glide Sign and A-lines.

Video clip WB10 showing Dry Lung – Glide Sign with A-lines. The Wet Lung vs Dry Lung Concept may be used to guide diuretic therapy. Note Cardiac Preset.

Video clip WB11 showing a single ULR (the long hyper-echoic [bright white] streak that extends from the lung line to the far field oscillating in synchronization wit breathing).  In general expect ALL fields to be dry in BOTH dogs and cats of any age.  We published Vet BLUE baseline frequency of ULRs of dogs in Vet Radiol and Ultrasound in 2014 (Lisciandro, Fosgate, Fulton, et al.) and found single ULRs at one Vet BLUE site in 11% of the 98 dogs.  We found the same finding in cats (in review, Lisciandro, Fulton, Fosgate, et al.)

Video clip WB01 from a dog with severe heartworm disease and in acute respiratory distress. The ULRs indicate severe interstitial edema (presumably from eosinophilic inflammation) and an obvious wedge or V sign along the lung line is a classic wedge-shaped infarction suggesting PTE (worm [parasitic] embolism).

Video clip WB02 from same dog in WB01 diagnosed with caval syndrome. Note many ULRs and heartworms in the right ventricle.

Video clip WB03 ULRs represent interstitial-alveolar edema of various forms. In blunt trauma, these represent lung contusions until proven otherwise. Numbers correlate with degree.

Video clip WB04 showing confluent ULRs which we record at infinity using the “&” symbol when using keyboards that lack the infinity symbol. The finding represents interstitial-alveolar edema but cannot characterize the cause which may include cardiogenic lung edema, non-cariogenic lung edema, hemorrhage, pneumonia, inflammatory conditions so the clinician must think about regional distribution and clinical context.

Video clip WB05 showing a small blip along the lung line (or small comet-tail). It’s NOT a ULR. ULRs must extend from the lung line through the far field. The blip may represent a trivial lesion or thickening along the pleural surface. It’s true identity and significance is unknown.

Video clip WB06 showing obvious Shred Sign, a deviation from the lung line repenting consolidation of lung with aeration through airways still present (white reflections within the Shred Sign). The Shred Sign ventrally often represents bacterial pneumonia, aspiration pneumonia. Place lung ultrasound findings in clinical context. NOTE on Cardiac Preset so very contrasty.

Video clip WB07 showing a Shred Sign as in WB06 on the Cardiac Preset (Crd located in up right of screen). The acutely coughing and distressed dog had aspiration pneumonia.

Video clip WB08 showing PITFALLS in lung ultrasound. Upholding screen orientation is imperative by keeping the head to the left and the tail to the right consistently. When abnormalities come in from the right, the sonographer should always ask the question – could the abnormality be abdominal contents? – such as gallbladder and liver here. Note the screen orientation is incorrect and the study “sloppy” in the manner of proper orientation. Note Cardiac Preset.

Video clip WB09 showing infinity ULRs in a cat with left-sided heart failure (ULRs) and right-sided heart failure (small volume pleural effusion).  Note the 3.2 cm scale on the left of the image. Ultrasound loves fluid represented by the black stipe along the lung line. By paying attention to lung ultrasound, diagnosis is better attained and patient care is better directed. The cat’s infinity ULRs justify aggressive diuretic therapy (whereas if lungs were dry then minimize diuretics). Note Cardiac Preset.

Video clip WB10 showing Dry Lung – Glide Sign with A-lines. The Wet Lung vs Dry Lung Concept may be used to guide diuretic therapy. Note Cardiac Preset.

Video clip WB11 showing a single ULR (the long hyper-echoic [bright white] streak that extends from the lung line to the far field oscillating in synchronization wit breathing).  In general expect ALL fields to be dry in BOTH dogs and cats of any age.  We published Vet BLUE baseline frequency of ULRs of dogs in Vet Radiol and Ultrasound in 2014 (Lisciandro, Fosgate, Fulton, et al.) and found single ULRs at one Vet BLUE site in 11% of the 98 dogs.  We found the same finding in cats (in review, Lisciandro, Fulton, Fosgate, et al.)

Video clip WB12 showing 4 intercostal spaces visible at the Vet BLUE view.  Several intercostal spaces may be visible in puppies, kittens and cats.  Lung is dry – Glide Sign with A-lines.  Note Cardiac Preset.

Video clip WB13 showing a classic Nodule Sign.  On lung ultrasound, the Nodule Sign typically includes a rounded anechoic (black) circular lesion coming off the lung line that has a hyper echoic (white) far border with or without acoustic enhancement.

Video clip WB14 showing infinity ULRs at the Vet BLUE middle lung lobe region in a left-sided heart failure cat.  Care should be taken NOT to diagnose pleural (PE) and pericardial effusion (PCE) (and other pleural space disease/conditions) during Vet BLUE because of the shallow depth setting (note the centimeter scale on the right).  Through haste and failure to not increase depth and not perform TFAST, the sonographer may inadvertently diagnose a heart chamber as either PE or PCE potentially leading to the most catastrophic mistake of performing centesis on a heart chamber.

Video clip WB15 showing greater than 3 ULRs defined as more than 3 over a single intercostal space but still splitting into individual ULRs.  The Vet BLUE finding is recorded as ” >3 ” in the medical record.  Numbers of ULRs correlate to the degree of interstitial-alveloar edema found on computerized tomography (CT) in humans.  The image was taken from a dog with left-sided congestive heart failure.

Video clip WB16 showing small volume pleural effusion along with infinity ULRs at the cranial lung lobe region during Vet BLUE.  Note the heart beating to the right; and that a single image should never be considered diagnostic adhering to the sage axiom – 1 view is NO view.  Furthermore, TFAST, radiography, complete echocardiography, CT are other imaging modalities to be considered to help increase the probability of a correct diagnosis.

Video clip WB17 showing classic Gator Sign and Dry Lung.  Note the Glide Sign and A-lines.

Video clip WB18 showing infinity ULRs and dry lung interchanging during the image.  The likely explanation is that 2 separate parts or 2 separate lung lobes are moving through the Vet BLUE view.  It is important to note that Vet BLUE is a regional lung ultrasound exam that does not correlate directly with lung anatomy; however, also note that the Vet BLUE regional exam was designed to evaluate lung similarly to how we interpret lung radiography.

Video clip WB19 showing ultrasound-guided thoracocentesis. US-guided refers to performing the procedure with real-time ultrasound whereas ultrasound-directed refers to establishing the location using ultrasound then removing the probe to perform the procedure.  US-guided and US-directed procedures are explained well in our textbook, Focused Ultrasound Techniques for the Small Animal Practitioner, in Chapter 17 by Dr Soren Boysen, DVM, Dipl. ACVECC, Professor, University of Calgary.

Video clip WB20 showing a small volume pleural effusion (the black stripe along the lung line).  Note a lot of pleural fluid on ultrasound may be in fact be a small volume pleural effusion.  It is of utmost importance to look at the centimeter scale to the right of the image to accurately assess pleural effusion volume.  Note the pleural effusion fluid stripe is approximately 1-2 millimeters (mm). If the sonographer is unsure of the TFAST diagnosis of pleural effusion, then consider thoracic radiography.  The image also shows proper orientation with the head to the left and tail to the right so that it is easy to rule out intra-abdominal contents falsely creating lung pathology (because the pitfall would enter the view from the right).

Video clip WB21 showing the Trick of the Trade using the One-eyed Gator by placing the rib head in the middle of the field of view.  By doing so, the echoes are cast obliquely along the lung line making the Glide Sign more readily visible.

Video clip WB22 showing the Gator Sign Orientation for ALL Lung Ultrasound.  The Gator Sign consists of the 2 rib heads on either side of the intercostal space. The Gator Sign allows the sonographer to locate the expected Lung Lung, where lung is expected against the thoracic wall. The presence of the Glide Sign or ULRs rules out pneumothorax at the point along the thoracic wall.  When pneumothorax is not present, the following questions are asked: Is the lung Wet or Dry (ULRs or Glide Sign and A-lines)?  Is there anything off the Lung Line (Shred Sign, Tissue Sign, Nodule Sign)? And can any lung ultrasound findings be abdominal contents (pitfall of lung ultrasound, proper orientation of head to left, tail to right helps prevent the mistake)?

TFAST Pericardial Site (PCS) Views


Video clip WB33 showing the classic Right Pericardial TFAST view and the left ventricular (LV) short-axis “mushroom” view.
  Note that the right ventricle (RV) is half moon-shaped and caps the LV.  Pericardial effusion (PCE) and pleural effusion (PE) should never be diagnosed at this view (level of the heart or higher on the heart [toward its base]) because of the real possibility of mistaking the RV for either PCE or PE.  The heart should always be viewed in its entirety using the landmark of the pericardium typically the brightest white line in the far field.  Volume status and cardiac function may be judged by the filling and contractility of the LV at this view.  The reality of the Right Pericardial TFAST view is that air interference generally intermittently obscures the image when using a micro convex probe (ultrasound does not transmit through air).

Video clip WB34 showing Pericardial Effusion at the Right Pericardial TFAST view.  The FASTVet tenet is to always image toward the muscular apex of the heart away from heart chambers to support the diagnosis of pericardial effusion (PCE).  We refer to this as the Bull’s Eye Sign because as the probe is directed along the short-axis of the heart the rounded sold gray muscular apex of the heart become surrounded by PCE – described in Focused Ultrasound Techniques for the Small Animal Practitioner, Wiley 2014.

The FASTVet tenet of imaging toward the muscular apex of the heart also takes place at the FAST DH view referred to as the Racetrack Sign – described in Focused Ultrasound Techniques for the Small Animal Practitioner, Wiley 2014.

Video clip WB35 showing Pericardial Effusion at the Right Pericardial TFAST view.  Compare WB35 with WB34 and its text.  The view is “whited out” by air-filled lung at the beginning of the clip before acquiring a view of the heart in its entirety (ultrasound does not transmit through air).

Video clip WB36 showing the long-axis 4-chamber view of the heart at the Right Pericardial TFAST view.  In addition to the tenet of imaging toward the apex of the heart for the Bull’s Eye Sign (Right Pericardial TFAST view) and the Racetrack Sign (FAST DH view), the long-axis 4-chamber view is an acceptable view for supporting the diagnosis of pericardial effusion (see also WB33, 34, 35).  Never use the left ventricular short-axis view at the level of the LV and RV and higher toward the heart’s base because it is too easy for the non-radiologist, non-cardiologist sonographer to mistake heart chambers for pericardial effusion.

Video clip WB37 showing how easy it is to mistake heart chambers for free fluid (pericardial effusion or pleural effusion) by not adhering to viewing the heart in its entirety and clearly observing the pericardium in the far field.  Note the centimeter scale on the far right of the image of 4.1 cm (which is approximately 1 3/4 inches).  The view shown is the Left Pericardial TFAST view.  See also WB33-36.

Video clip WB38 showing the Right Pericardial TFAST view and how cardiac anatomy MUST be identified and the diagnosis of free fluid should never be made at this level (or higher toward the base of the heart).  It is too easy to misidentify the right ventricle (RV) for either pericardial effusion (PCE) or pleural effusion (PE).  Volume status (LV filling) and contractility are good.

Video clip WB39 showing the Right Pericardial TFAST view.  The left ventricular short-axis “mushroom” view is important for evaluating both volume status (LV filling) and contractility.  Note that volume is fair as shown here.  Compare to WB38 and WB40.

Video clip WB40 showing the Right Pericardial TFAST view and poor volume status (LV filling). Compare to WB39 and 38.  The small dog with Hemorrhagic Gastroenteritis Syndrome (note the centimeter scale on the right) was being treated for pain because blood pressure and physical exam findings fooled the veterinarian into thinking patient volume status was acceptable.  Clearly and simply by incorporating Global FAST during patient rounds better directed care as the dog needed more volume (fluid challenge/increased intravenous fluid rate).  The heart is appropriately visualized in its entirety (pericardium clearly visible in far field).

Video clip WB41 showing another example of poor volume status evident by an attenuated left ventricle on the left ventricular short-axis “mushroom” view at the right TFAST PCS view.

Video clip WB42 showing an example of good volume status and contractility evident  by an acceptably-sized left ventricle and contractility on the left ventricular short-axis “mushroom” view at the right TFAST PCS view.

Video clip WB43 showing an example of good volume status and contractility evident  by an acceptably-sized left ventricle and contractility on the left ventricular short-axis “mushroom” view at the right TFAST PCS view.  Note the right ventricle in the near field at this level of the heart because this is where mistakes are made for the RV being misinterpreted as pleural or pericardial effusion.  It is best to NEVER diagnose either effusion at any short-axis views of the heart unless the probe is directed toward the muscular apex of the heart below (ventral) this view.  We call it the Bull’s Eye Sign and its published in our textbook Focused Ultrasound Techniques for the Small Animal Practitioner, Wiley 2014.

Video clip WB44 to compare with WB43 showing how the right ventricle (RV) and its ugly papillary muscle can be mistaken for pathology and lead to the centesis of a heart chamber.  Never diagnose pleural or pericardial effusion at short-axis views of the heart unless the probe is directed toward the muscular apex where there are no heart chambers. See WB43 text and the Bull’s Eye Sign.

Video clip WB45 showing pericardial effusion (Bull’s Eye Sign) and directing the probe along the short-axis toward the apex of the heart where there are no heart chambers. We refer to this as the Bull’s Eye Sign.  See WB44, and 43.

Video clip WB46 showing Heartworms (Dirofilaria immitis) in the right ventricle (RV) of the heart in the short-axis view at the right TFAST PCS view.  Heart worms are clumped together and their bodies appear as bright white equal signs.  The ultrasound lung rockets (ULRs) off the pericardium indicate interstitial lung edema. A good trick when there is too much motion in real-time is to freeze the image and take advantage of the cine feature by then slowly rolling the cine ball and watching the image in slower motion.

Video clip WB47 the left ventricular short-axis “mushroom” view in a cat.  Note that the image is mirrored to most of the previous WB images of the heart; and the preset is cardiac (Crd in the upper right of the screen).  To better assess filling and contractility freeze the image and take advantage of the cine function to roll the cine ball slowly to better assess (slowing down the image) LV filling and contractility.

Video clip WB48 showing the left ventricular short-axis “mushroom” view in a cat.  Unlabeled.  See text in WB47.

AFAST, TFAST Diaphragmatico-Hepatic (DH) View

Video clip WB50 showing a positive DH view with classic free fluid in between liver lobes.  Logic would dictate that free fluid would be toward the table top (accumulate in a gravity-dependent manner) in right lateral recumbency; however, if you look at the liver anatomy, the liver lobes are actually located next to one another “above the gallbladder”; thus are best interrogated by fanning away from the table top.  Note also that the liver capsule is indistinguishable from hepatic parenchyma thus the liver lobes can only be appreciated when free fluid separates them.

Video clip WB51 showing the DH view with good depth into the thorax to appreciate the cardiac bump (heart beating against the diaphragm) to determine the presence or absence of pericardial effusion, and interrogating along the diaphragm for pleural effusion. The most savvy sonographer also pays attention to the deep window into lung at the DH view. Lung has many ULRS visible supporting that interstitial lung edema is present.

Video clip WB52 showing the DH view with the caudal vena cava (CVC) and its expected “bounce” of 50% (change in diameter).  Note the greater than 3 to infinity lung rockets (ULRs) along the diaphragm.  The case was a puppy that was stepped on presenting respiratory distress from severe lung contusions (ULRs indicate lung contusions in trauma until proven otherwise).  Global FAST (AFAST, TFAST and Vet BLUE) helped dictate appropriate therapy by ruling out hemoabdomen, ruptured urinary bladder, diaphragmatic hernia, hemothorax and hemopericardium.  The dogs distress was from severe lung contusions.

Video clip WB53 showing the DH view and classic rim of pericardial effusion rounding the muscular apex of the heart referred to as the Racetrack Sign in our textbook Focused Ultrasound Techniques for the Small Animal Practitioner, Wiley 2014.

Video clip WB54 showing the DH view and the absence of intra-abdominal free fluid and the absence of pericardial effusion (PCE).  Note the Cardiac Bump against the diaphragm  In clinically relevant PCE, the Race Track Sign should be clear and obvious.  See WB53.

Video clip WB55 showing the DH view in a cat with pleural effusion (PE).  Note other significant findings including ultrasound lung rockets (ULRs) which support interstitial lung edema.  Seemingly large amounts of free fluid on ultrasound are in fact smaller volumes, so always eyeball the centimeter scale on the right of the screen.  Moreover, in cases that are dubious, radiography is an often excellent ancillary test in stable cats and dogs.

Video clip WB56 showing the DH view in the same cat in WB55.  Not labelled.

Video clip WB57 showing the DH view and pericardial effusion (PCE). The Racetrack Sign describes the rounding of PCE around the muscular apex of the heart where no heart chambers exist and thus prevent mistaking heart chambers for PCE or pleural effusion (Lisciandro JVECC 2015).

Video clip WB58 showing the DH view positive for free intra-abdominal fluid.  Note the image was filmed on the cardiac preset so it is very contrasty.

Video clip WB59 showing the DH view with several important findings including PCE, likely pleural effusion (1 view is no view so additional TFAST views will prove helpful), intra-abdominal free fluid and the gallbladder (GB) halo sign.  The GB halo sign may be seen with anaphylaxis and right sided heart conditions including pericardial effusion and right-sided failure or overload.

AFAST Spleno-Renal (SR) View

Video clip WB60 showing the SR view and retroperitoneal fluid and BOTH left (LK) and right (RK) kidneys.

Video clip WB23 showing BOTH kidneys at the AFAST SR view in a cat.  Both kidneys may be seen through the AFAST SR view in both cats and small dogs.  It is not a mirror image which can only occur when a strong air-soft tissue interface is present.  Note there is free fluid in the right retroperitoneal space.  Differentiating free fluid in the peritoneal cavity vs. retroperitoneal space generally requires multiple views (completion of the AFAST exam). Note on Cardiac Preset (Crd in upper right of image) making the image very contrasty (blacks and whites without grays).

Video clip WB24 showing the AFAST SR view in a cat with BOTH kidneys visible and free fluid in the retroperitoneal space.  The patient is moving while performing the study.  Distinguishing free fluid in peritoneal cavity vs. retroperitoneal space generally requires multiple views and completion of the entire AFAST exam.  Note on Cardiac Preset (Crd in upper right of image) making the image very contrasty (blacks and whites without grays).

Video clip WB25 showing the same AFAST SR view in a cat as in WB24 but with less patient movement.  Note on Cardiac Preset (Crd in upper right of image) making the image very contrasty (blacks and whites without grays).

Video clip WB26 showing retroperitoneal fluid at the AFAST SR view in a urinary obstructed cat (note the enlarged urinary bladder to the right of the image).  It is common for cats and dogs with prolonged urinary obstruction to have weeping of urine through the kidney(s) and urinary bladder without a rupture in their urinary tract.  Abdominal fluid scores (AFS) range from 1-4 with additional free fluid in the retroperitoneal space(s).  In such cases, the effusion (typically a transudate) should rapidly resolve within 24-hours (even high-scoring AFS 3 and 4 cats and dogs) in cases that are responding to therapy (resolution of their azotemia with fluid therapy).

Video clip WB27 showing a bright (hyper echoic) renal cortex suggesting ethylene glycol and referred to as the “halo sign.”  Importantly, the renal “halo sign” is not pathognomonic for ethylene glycol; and has also been referred to as the “medullary rim sign” in some ultrasound textbooks.  Kidney values, acid-base status, ethylene glycol assays and other appropriate testing should be performed, and the patient’s clinical picture assessed, before making the diagnosis of ethylene glycol toxicosis.

Video clip WB28 showing an incidental or unexpected finding of a splenic mass at the AFAST SR view in a dog.  The FASTVet manner of performing the SR view is to interrogate the left kidney in its sagittal or longitudinal plane by fanning in both directions and then rocking the probe toward the head to pick up the tail of the spleen.  During AFAST in this dog, a splenic mass was detected, which could be life-saving for your patients (rather than missing the condition).

Video clip WB29 showing an incidental and unexpected finding at the AFAST SR view in a dog with cortical cysts.  Note the round fluid-filled (black, anechoic) structures at the cranial and caudal pole of the left kidney as it is interrogated through the sagittal or longitudinal plane. The interrogation is recommended and taught by FASTVet because of incidental and unexpected findings that otherwise would have been missed (see WB28).

Video clip WB30 showing the AFAST SR view and why we teach the mantra – spleen, left kidney and colon whites out everything through the far field.  Here the colon is in the near field.  By sliding the probe dorsally the left kidney and a possible splenic mass come into view near the clip’s end.  The clip is too short to draw conclusions but emphasizes the presence of an air-filled colon disrupting ultrasound imaging (since ultrasound does not transmit through air).

Video clip WB31 showing extended imaging of the AFAST SR view of WB30.  Note the left kidney is clearly in view initially then followed by a cavitated large soft tissue mass that likely originates from the spleen.

Video clip WB32 showing the classic AFAST SR view interrogation of the left kidney.  The left kidney should be imaged in longitudinal (or sagittal) orientation as symmetrically as possible and then fanned completely through in both directions (until it disappears in both directions).  Linear stripes are generally NOT free fluid.  The thin black stripe (< 1mm, look at cm scale on the right of the image) is in fact the wall of bowel on the far side of the kidney.

The AFAST Cysto-Colic View

Video clip WB61 showing the CC view and how probe pressure can distort the shape of the urinary bladder (UB).  The CC view is negative for free fluid.

Video clip WB62 showing a positive at the CC view in the “CC Pouch” where the urinary bladder (UB) kisses the ventral abdominal wall.  The preset is on cardiac (note Crd in upper right corner of image) making it very contrasty compared to abdominal presets.  Also, in haste interrogating AFAST views leads to mistakes.  Note how the site is interrogated until the rounded contour of the urinary bladder is clearly seen at the end of the clip.

Video clip WB63 showing a positive CC view with a small pocket of free fluid.

Video clip WB64 showing an incidental or unexpected finding in a dog that was hit-by -a-car.  During the negative AFAST exam an obvious bladder wall abnormality is seen.  The owner was told that the trauma work-up was negative; however, an abnormality was observed in the urinary bladder and the suspect lesion needed to be pursued.  The owner confronted me a few weeks later while I was in the waiting room area looking outside and she told me adamantly, “you saved my dog’s life!” The diagnosis was a transitional cell carcinoma and her dog was placed on piroxicam.  Nearly one year later, she returned with her dog for straining and was so appreciative of the time she had post-our initial meeting.  Caution should be used in trauma patients because large blood clots may appear as “masses” as do thrombi in dogs and cats with severe cystitis.


 Video clip WB65 showing incidental and unexpected finding of bladder stones (cystic calculi).  Note how they image as a highly reflective surface in the near-field that shadows through the far-field and how the urinary bladder (UB) is interrogated by fanning through longitudinally in both directions.  Caution should be exercised since the air-filled colon (or small intestine) when located between the bladder and ventral body wall may mimic bladder stones and other pathology.  Be smart and if you think there are bladder stones, schedule a complete abdominal ultrasound or take an abdominal radiograph.

Video clip WB66 showing the classic CC view aided by a full urinary bladder (UB).  Note how the urinary bladder is immediately adjacent to the ventral body wall (kissing the ventral body wall) in the CC Pouch which is where free fluid would pocket.  Also, note how the urinary bladder is interrogated by fanning through it longitudinally.

Video clip WB67 showing another classic interrogation of the CC view with the urinary bladder present.  See text in WB66.

Video clip WB68 showing the FASTVet recommended manner in which to interrogate the CC view.  The urinary bladder is imaged against (kissing) the ventral abdominal wall so that the probe is directed into the CC Pouch.  The urinary bladder is then interrogated by fanning in the longitudinal (or sagittal) orientation.  Note that the urinary bladder wall appears thickened; however, the urinary bladder wall may only be fully assessed in a moderately filled or larger urinary bladder.

The AFAST Hepato-Renal (HR) View

Video clip WB69 showing the classic negative for free fluid HR view with loops of small intestine (SI) appearing like “hamburgers” on cross-section that then stream out into linear when in longitudinal (sagittal) orientation.  The HR view is called the “Big Lie” because in general it is the most gravity-dependent view below the umbilicus in which neither target-organ is viewed.  Occasionally in cats and small dogs, the right kidney may be visualized; however, the liver is generally never visualized at the HR view unless it is enlarged.

Video clip WB70 showing another example of the classic negative for free fluid HR view. It is  not uncommon to have the spleen in the near-field.  The target-organ approach helps build ultrasound skills.  Every time the spleen is seen the FASTVet sonographer is banking in their minds what normal splenic echotexture appears like and also learns splenic anatomy (the splenic hilus, that looks like a “V” or a “whale tail”, is also in view).

Video clip WB71 showing a classic positive for free intra-abdominal fluid at the HR view.  Note the black triangulation in between loops of small intestine. The HR view is called the “Home Run View” because it completes the AFAST exam and in higher fluid scoring dogs and cats will be the site for abdominocentesis because ultrasound cannot characterize the type of free fluid (only fluid sampling and testing can).  From experience, it is uncommon for the HR view to be the only positive site during AFAST.  The most common low-scoring sites are in fact the DH and CC views.

Video clip WB72 showing a classic negative HR view.  Small intestine (SI) appearing like “hamburgers” in cross-section and spleen are typically seen during the HR view.

Video clip WB73 showing the classic AFAST 5th view negative for free fluid in which the right kidney is imaged.  It is not part of the fluid scoring system (Lisciandro et al. JVECC 2009), but may help right sided retroperitoneal free fluid (although by performing the 5th view its unknown if sensitivity is increased).  By surveying the right kidney, the probability of picking up incidental and unexpected findings is likely increased.  The AFAST does not dictate this 5th view; however, for sonographers comfortable with the 4-view AFAST the 5th view should be added.  The FASTVet order is generally doing AFAST, TFAST and Vet BLUE and then with the patient standing (gastro-intestinal tract falls away from the right kidney), the site is then imaged.  Of note, the right kidney in dogs is further cranial, oblique, and cupped within the renal fossa of the liver making it harder to image than the left kidney.

Video clip WB74 showing an HR positive view with black triangulations indicating the presence of free intra-abdominal fluid.  The patient is small and to the left of the screen the liver, spleen and gallbladder come into view.  Note the cardiac preset was used (note Crd in the upper right hand corner of the image) making the image very contrasty (blacks and whites with no grays).

Video clip WB75 showing a classic negative HR view.  Unlabeled. Note the preset is abdominal (Abd in upper right corner of image) to be compared with WB74 recorded on cardiac preset.

Video clip WB76 showing small volume effusion at the AFAST 5th view.  Compare to WB73.

Video clip WB77 showing the major pitfall of the HR view where a large necrotic mass may mimic free fluid (and the other is a fluid filled uterus).  Note the circular rim of anechoic fluid within the large mid-abdominal mass.  The sonographer needs to think about such pitfall possibilities when imaging the HR view.

This Completes the Wiley Blackwell Videos which are part of our textbook Focused Ultrasound Techniques for the Small Animal Practitioner, Wiley 2014.  

We hoped you found these videos helpful in learning AFAST, TFAST and Vet BLUE ultrasound.  Please check out our other Video Library Images.

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