Podcast
Questions and Answers
What does the blue color in the color Doppler image indicate regarding portal blood flow in the dog?
What does the blue color in the color Doppler image indicate regarding portal blood flow in the dog?
Why is ultrasound considered unreliable for establishing a diagnosis of liver disease?
Why is ultrasound considered unreliable for establishing a diagnosis of liver disease?
Which of the following factors might influence the hepatic arterial resistance index (RI) in dogs?
Which of the following factors might influence the hepatic arterial resistance index (RI) in dogs?
How many portal triads are recommended to ensure adequate diagnostic utility in liver biopsies?
How many portal triads are recommended to ensure adequate diagnostic utility in liver biopsies?
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What is an important consideration when conducting liver biopsies in patients?
What is an important consideration when conducting liver biopsies in patients?
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What common clinical condition may cause portal vein thrombosis in dogs?
What common clinical condition may cause portal vein thrombosis in dogs?
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What can potentially happen 24 hours after a liver biopsy in some cats?
What can potentially happen 24 hours after a liver biopsy in some cats?
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What is one of the recommended materials to use for preparing the skin before an ultrasound examination?
What is one of the recommended materials to use for preparing the skin before an ultrasound examination?
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What is the typical RI value for the hepatic artery in normal, fasted dogs as reported?
What is the typical RI value for the hepatic artery in normal, fasted dogs as reported?
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Which imaging technique provides a measurement of flow velocity in the portal vein?
Which imaging technique provides a measurement of flow velocity in the portal vein?
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Why might some clinicians advocate for culturing liver samples?
Why might some clinicians advocate for culturing liver samples?
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What is advised to improve the transmission of ultrasound waves during examination?
What is advised to improve the transmission of ultrasound waves during examination?
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What characteristic pattern does nodular hyperplasia exhibit when imaged?
What characteristic pattern does nodular hyperplasia exhibit when imaged?
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What is one risk associated with inadequate sample sizes in liver biopsies?
What is one risk associated with inadequate sample sizes in liver biopsies?
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What should be considered abnormal when detected after the first few weeks of life?
What should be considered abnormal when detected after the first few weeks of life?
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Which imaging method is NOT mentioned for confirming a patent ductus venosus?
Which imaging method is NOT mentioned for confirming a patent ductus venosus?
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What is the normal state of portal blood flow velocity (PBFV) in the main portal vein described as?
What is the normal state of portal blood flow velocity (PBFV) in the main portal vein described as?
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What is the cause of the small undulations in the Doppler spectral pattern of the portal vein's blood flow?
What is the cause of the small undulations in the Doppler spectral pattern of the portal vein's blood flow?
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What is the reported mean portal blood flow velocity (PBFV) in normal unsedated dogs?
What is the reported mean portal blood flow velocity (PBFV) in normal unsedated dogs?
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Where do the intestinal capillaries in the portal vein connect to?
Where do the intestinal capillaries in the portal vein connect to?
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What happens to portal blood flow velocity during expiration according to the provided content?
What happens to portal blood flow velocity during expiration according to the provided content?
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Which of the following statements is true regarding the portal vein's role?
Which of the following statements is true regarding the portal vein's role?
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What is a key characteristic of typical hepatic cysts?
What is a key characteristic of typical hepatic cysts?
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Which statement about nodular hyperplasia in older dogs is accurate?
Which statement about nodular hyperplasia in older dogs is accurate?
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Why might nodular hyperplasia be difficult to detect on ultrasound?
Why might nodular hyperplasia be difficult to detect on ultrasound?
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What age range is associated with the earliest findings of nodules in dogs?
What age range is associated with the earliest findings of nodules in dogs?
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What type of cysts can be formed outside the biliary tract?
What type of cysts can be formed outside the biliary tract?
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What consistent feature may present at the proximal portion of hepatic cysts?
What consistent feature may present at the proximal portion of hepatic cysts?
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How might the appearance of cysts vary according to their type?
How might the appearance of cysts vary according to their type?
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What is NOT a characteristic of nodules associated with focal nodular hyperplasia?
What is NOT a characteristic of nodules associated with focal nodular hyperplasia?
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What is the most common primary hepatic tumor in dogs?
What is the most common primary hepatic tumor in dogs?
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Which imaging technique provides a more detailed evaluation of the liver?
Which imaging technique provides a more detailed evaluation of the liver?
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How much more common are metastatic liver tumors in dogs compared to primary hepatic tumors?
How much more common are metastatic liver tumors in dogs compared to primary hepatic tumors?
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What characteristic is commonly associated with target lesions in the liver?
What characteristic is commonly associated with target lesions in the liver?
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Which of the following does NOT typically produce target lesions?
Which of the following does NOT typically produce target lesions?
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What positive predictive value is associated with finding one or more target lesions in the liver for malignancy?
What positive predictive value is associated with finding one or more target lesions in the liver for malignancy?
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Which of the following tumors is the second most common primary hepatic tumor in dogs?
Which of the following tumors is the second most common primary hepatic tumor in dogs?
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Which one of the following best characterizes primary liver tumors in cats?
Which one of the following best characterizes primary liver tumors in cats?
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Which appearance is commonly associated with hepatocellular carcinoma?
Which appearance is commonly associated with hepatocellular carcinoma?
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Which type of neoplasia shows multiple focal hypoechoic nodules?
Which type of neoplasia shows multiple focal hypoechoic nodules?
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What is a characteristic feature of histiocytic sarcoma as seen in ultrasound images?
What is a characteristic feature of histiocytic sarcoma as seen in ultrasound images?
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Which imaging finding is indicative of diffuse hepatic involvement?
Which imaging finding is indicative of diffuse hepatic involvement?
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Which of the following is a feature of cholangiocarcinoma as shown in ultrasound imaging?
Which of the following is a feature of cholangiocarcinoma as shown in ultrasound imaging?
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What finding is typically associated with benign diseases that may mimic malignancy?
What finding is typically associated with benign diseases that may mimic malignancy?
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Which description best characterizes a focal irregular hyperechoic mass?
Which description best characterizes a focal irregular hyperechoic mass?
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In ultrasound imaging, which of the following is a hallmark of hepatocellular carcinoma?
In ultrasound imaging, which of the following is a hallmark of hepatocellular carcinoma?
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Study Notes
Liver Ultrasonography
- Ultrasonography is a crucial imaging method for evaluating the liver, including the hepatic parenchyma, portal veins, hepatic veins, gallbladder, and biliary system.
- Common indications include hepatomegaly, masses, suspected liver tumors (primary or metastatic), ascites, and unexplained increases in liver enzymes.
- Other factors may necessitate liver imaging (e.g., protein-losing enteropathy, pancreatitis, hyperadrenocorticism).
- Ultrasound guidance is used for percutaneous liver sampling (aspirates/biopsies) and monitoring disease response/progression.
- Minimum sampling of two liver lobes is recommended in studies to identify disease.
- Variation in diagnoses between two lobes is possible; correlating the biopsy findings with clinical information is important.
- Cytologic and histologic diagnoses may not align with ultrasound findings. Ultrasound is not a diagnostic tool for cytology or histology.
- Sufficient portal triad samples are crucial for accurate assessment. Biopsy techniques can typically achieve this; human criteria suggest 12-15 portal triads.
- Copper stains are needed to accurately measure copper concentration in samples.
- Culture of bile is more successful than liver samples for bacteria identification.
- Laparoscopic biopsy balances adequate sample size, visualization, and minimally invasiveness.
- Hemorrhage is the major complication. Check coagulation parameters (platelets, PT, PTT) prior to biopsy.
- Precautions should be used in the presence of thrombocytopenia (<80,000/uL), especially in dogs.
Technique
- Complete abdominal examination is advisable (but only liver imaging is discussed).
- Clip hair from the 10th intercostal space over the ventral abdomen and lateral walls.
- Utilize acoustic gel for coupling with skin, or alcohol for cleaning.
- Avoid stomach gas interference.
- Dorsal or lateral recumbency positions are ideal for liver evaluation.
- Transducer selection depends on the animal's size; 5.0 to 8.0 MHz microconvex transducer is suitable for most medium/large dogs; higher frequencies for smaller animals, 3.0 MHz for larger animals.
- Systematic sequences of images are recommended, starting with the subxiphoid position and angling the beam.
- Assess the caudate lobe along the right costal arch.
- Intercostal windows (10th to 12th right/left spaces) can help visualize the liver, especially in animals with a small liver, stomach gas, or deep chest.
- Right intercostal view is commonly needed to visualize the caudal vena cava, portal vein, common bile duct and lymph nodes in the porta hepatis region. A sector transducer is preferred for better fitting.
Anatomy
- The liver is bordered cranially by the diaphragm and ventrally by the falciform fat.
- The liver is bordered by the right kidney, stomach, and spleen.
- The curvilinear echogenic line is a reflection between the diaphragm and lung, representing the diaphragm.
- Falciform fat (variable echogenicity) lies ventral to the liver.
- Lobes include, left (lateral and medial), right (lateral and medial), quadrate, and caudate lobes.
- Portal veins have bright, echogenic walls.
- Hepatic veins appear as anechoic structures.
- Hepatic veins connect into the caudal vena cava near the diaphragm.
- Portal vein distribution differs from hepatic veins.
- Hepatic arteries and bile duct branches aren't usually visible within the liver unless using Doppler ultrasonography.
- Characteristics arterial signals allow locating the hepatic artery.
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