Received: 2 January 2024 | Accepted: 11 March 2024 DOI: 10.1111/eve.13974
R E V I EW A R T I C L E
Maximising the use of point- of- care ultrasonography of the adult equine abdomen and thorax
Tracy E. Norman
Staunton Veterinary Clinic , Staunton , Virginia , USA
Correspondence: Tracy E. Norman Email:
drtracynorman@gmail.com
Summary Point- of- care ultrasonography is a powerful tool for the practitioner in determining diag- nosis and prognosis in unwell horses. Proper case selection and patient preparation are keys to successful ultrasonographic examinations of the equine thorax and abdomen. Practitioners can expand the use of their equipment to augment evaluations for multiple clinical complaints. The most common application for body cavity ultrasonography in the adult horse is acute abdominal pain.
K E YWORDS horse , abdomen , colic , sonography , thorax , ultrasonography
Diagnostic ultrasonography has become widely used in equine prac- tice for a diversity of applications due to the availability of affordable, portable equipment. Ultrasonography is superior to radiography in evaluating soft tissue structures, allows real- time assessment and does not use ionising radiation. The most common uses of ultraso- nography by equine practitioners are reproductive and musculo- skeletal evaluations, but its use in evaluating intra- abdominal and thoracic disease is growing. The value of diagnostic information yielded by sonographic
evaluation of the equine thoracic and abdominal cavities is influ- enced by the availability of suitable equipment, the proper prepa- ration of the patient and the technique and experience of the examiner. This review will outline key strategies for making the most of equine thoracic and abdominal ultrasonography with con- siderations of case selection, patient preparation, equipment and examination technique. Case selection involves understanding manifestations of dis-
ease, the experience and education of the operator, and the lim- itations of sonography as a modality. By far, the most common application of abdominal sonography in equine practice is acute abdominal pain. For these patients, ultrasonography is used in con- junction with the physical examination, nasogastric intubation and palpation per rectum to determine the best treatment plan for the patient (referral vs. on- farm treatment, surgical vs. medical manage- ment vs. euthanasia). The most appropriate approach to these pa- tients is a limited, rapid examination that efficiently and specifically addresses these concerns.
Equine Vet Educ. 2024;36:597–602.
The Fast Localised Abdominal Sonography for Horses (FLASH)
technique is a systematic examination in seven discrete windows that can be performed in a short amount of time and has been demonstrated to be easy to master for practitioners of all levels of expertise (Busoni et al., 2011 ). Evaluation of the anatomy in each of these windows gives the examiner important data about the like- lihood of a colonic displacement, distention of the stomach and/ or small intestine, intestinal wall thickness and the presence or ab- sence of peritoneal and pleural effusions, and only requires around 10 min to perform (Busoni et al., 2011 ). The examination should be performed in the same way each time to maximise efficiency and accuracy. Please see Table 1 for a summary of the windows and their associated diagnostic information. The FLASH technique was reported by Busoni et al. ( 2011 ) to be
highly sensitive (80%) and specific (96.15%) for identifying small in- testinal dilation associated with obstruction. A more recent study by Corrie et al. ( 2024 ) evaluated the outcome of horses with colic that were assessed using the FLASH technique in first- opinion practice. These authors found that the observation of dilated small intestine on the FLASH examination was strongly correlated with nonsur- vival. This growing body of evidence supports the FLASH technique as a powerful tool for practitioners to make rapid assessments for the cause of abdominal pain, thus allowing prompt intervention and improved survival (Southwood, 2023 ). As effective a tool as FLASH is at providing information about it is inappropriate to apply this technique
acute colic, however,
aaep.org/wiley-redirect
to other applications for abdominal sonography, including fever, © 2024 EVJ Ltd. | 597
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