598
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TABLE 1 Summary of windows evaluated in FLASH examination. Anatomic location
Normal finding(s) Left paralumbar fossa Kidney deep to spleen; splenic head visible Abnormal finding(s)
Colon between spleen and kidney Colon displacing spleen ventrally Mural thickening of colon
Left middle third
Spleen against body wall Amorphous small intestine deep to spleen
Gastric window (ICS 12–14 at level of shoulder)
Cranioventral thorax (R & L, ICS 7 dorsal to point of elbow)
Right paralumbar fossa Stomach with gas cap deep to spleen Air- filled lung against body wall
Kidney against body wall with amorphous, motile duodenum
Right middle third (ICS 11–14 at level of shoulder)
Ventral abdomen/inguinal Gas- filled caecum against body wall Gas- filled colon Amorphous small intestine Abbreviation: FLASH, Fast Localised Abdominal Sonography for Horses.
Dilated small intestine Mural thickening of small intestine Peritoneal effusion
Stomach dilated +/− fluid filled Pleural fluid
Duodenum dilated with fluid Mural thickening of duodenum Multiple loops of dilated small intestine Dilated mesenteric vessels against body wall
Dilated small intestine Peritoneal effusion
NORMAN
chronic/intermittent colic, diarrhoea, liver or kidney dysfunction, anaemia, abdominal distention, weight loss and hypoproteinaemia. In order to obtain meaningful information to aid in the investigation of these clinical presentations, a full abdominal ultrasonographic evaluation is indicated. Each of
the solid organs must be interrogated for relative
echogenicity, architectural soundness and size. The stomach, small bowel and colon should be similarly evaluated, with multi- ple measurements made of the small intestinal wall if possible. In healthy horses, failing to discern discrete loops of small intestine is common (le Jeune & Whitcomb, 2014 ). The inguinal recesses provide an excellent window for visualising small intestine. Fluid within the loops assists with visualisation of the mucosal surface, as does the use of a higher frequency (7.5–11 MHz) transducer, when available (le Jeune & Whitcomb, 2014 ). Wall thickness of the normal small intestine is 3 mm (le Jeune & Whitcomb, 2014 ). Other notable findings include lymphadenopathy and effusions. Effusions are generally first detected at the most dependent part of the abdomen, but may be sequestered closer to the cause of the effusion. Lymph nodes are most readily imaged in the right flank area associated with the lateral caecal vasculature (Bermillet et al., 2023 ; le Jeune & Whitcomb, 2014 ). A comprehensive ab- dominal ultrasonographic evaluation is time consuming, and at least an hour is required to fully scrutinise each intercostal space and the ventral abdomen. The diagnostic utility of this technique requires the sonographer to possess a commanding knowledge of the anatomy and sufficient experience to accurately interpret any alterations of the anatomy. As such, findings on such an examina- tion may prompt consultation with, or referral of the case to, a specialist in Internal Medicine.
Although practitioners are generally more familiar with ab-
dominal ultrasonography because of its applications to diagnosing the acute abdomen, thoracic ultrasonography can also be useful. Indications for thoracic ultrasonography include fever, weight loss, tachypnoea, cough, sternal oedema, pleurodynia, and/or history of trauma with suspicion of rib fractures, haemothorax or pneumo- thorax. Pulmonary lesions are only detected sonographically if they extend to the pleural surface. Disorders that are confined to the air- ways, deep to air- filled parenchyma, such as equine asthma, are not sonographically accessible. Ultrasonographic evaluation of the thorax is most useful
in
identifying pleural effusions, pulmonary consolidation, pneumo- thorax and neoplastic processes that occur at the pleural surface. Familiarity with the anatomy of the pleural space and diaphragm is required to accurately interpret the images obtained. The healthy pleural surface can be imaged with a 7.5–15.0 MHz linear trans- ducer at a depth setting of 5 to 6 cm or a 6.0–10.0 MHz micro- convex transducer at a depth setting of 6 to 1 cm (Reef, 2012 ). In cases of pathology such as pleural effusion, or in very obese patients, a 2.5 to 5.0 MHz curvilinear transducer at a depth of 25 to 30 cm may be needed to ascertain the deeper extents of the pathology (Reef, 2012 ). The transducer face should be parallel to the ribs within the intercostal spaces to prevent cut- off at the edges of the image. The examination proceeds scanning each in- tercostal space from dorsal to ventral, allowing the completion of an entire respiratory cycle before moving to the next intercostal apace (Reef, 2012 ). Rapid point- of- care evaluative protocols have been also validated
for use in cardiac (FoCUS: Focused Cardiac Ultrasound) (Eberhardt & Schwarzwald, 2022 ) and cardiothoracic (CRASH: Cardio Respiratory
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