What should the client expect when their pet has an ultrasound exam?
They should withhold food for at least 8 hours prior. And they should be advised that their pet’s ventral abdomen or/and chest will be shaved (see appointment procedures). Having the client present is not encouraged since it will likely slow the exam and distract the sonographer from completing a thorough exam. But if the client insists then please discuss this with Dr. Morris prior to the exam. Exceptions may be made to accommodate your client.
How long does the exam take to perform?
Most echocardiograms and abdominal sonograms are completed in approximately 30 to 45 minutes.
Where should the exam take place in my practice?
A room that can be darkened without interrupting your normal workflow; such as, a spare exam room, surgery room, Xray room or treatment area.
Is sedation or anesthesia needed?
Generally no. We find sedation rarely necessary. If patients are aggressive or unusually anxious then injectable sedation using, for example, Butorphanol (0.2mg/kg) and Acepromazine (0.02mg/kg) IM or IV will be enough to take the “edge” off the nervousness and relax to allow a thorough sonogram. Fractious or aggressive cats will usually need at least Midazolam (0.2mg/kg) and Buprenex (0.01mg/kg) IM. Injectable sedatives or gas anesthesia (Isofluorane) are often used for the majority of the ultrasound-guided biopsy procedures. The duration of this biopsy procedure is approximately 5 to 10 minutes.
Will my staff need to help hold?
Yes, we will need one staff member with animal restraint experience.
Who interprets the ultrasound findings?
Dr. Morris is an IVUSS certified clinical sonographer; she interprets her own exams. Should a cardiology consult be required and or desired, then referral to a cardiologist is recommended. Unusual findings may be reviewed by another experienced sonographer before a final report is completed.
How soon will I get a written report?
Dr. Morris’s ultrasound reports are emailed within 24 hours of the exam. Cardiac ultrasounds that are reviewed by a cardiologist are sent the next day.
What does an ultrasound-guided Tru-cut biopsy entail?
The pet is placed under light anesthesia/ heavy sedation for approximately 5 to 10 minutes. The biopsy is performed while the structure to be biopsied and the biopsy needle are simultaneously visualized sonographically. Activation of the color flow Doppler system allows for visualization and thus avoidance of nearby blood vessels. It is a very precise procedure and quite safe. A normal coagulation panel including a platelet count should be confirmed prior.
What does a fine needle aspirate (FNA) entail?
Often FNA is performed using a 22g x 1.5inch needle, usually without sedation. A normal platelet count should be confirmed prior.
When should I request a FNA vs. Tru-cut biopsy?
In general, FNAs are requested when you suspect a mass, cyst, abscess, free fluid or abnormally enlarged organ suggestive of infiltrative disease. A FNA is a safe and inexpensive means to collect cells to be prepared for cytological interpretation and for culture/MIC.
FNAs are often obtained from abnormal liver, spleen, lymph nodes, intestinal masses, pancreas, adrenals, prostate and unknown abdominal masses. These aspirates can provide results that help diagnose and direct treatment of the patient. Results are proportional to the quality of the sample and the degree of exfoliation from the lesion. Some lesions fail to give up their cells. Keep in mind that FNAs do not provide information regarding structure of the tissue sampled. Sedation is often not needed for FNAs. The site should be shaved and cleaned with alcohol soaked gauze wipes.
Tru-Cut biopsy is usually requested when FNAs sample was not cellular or a larger tissue sample is needed to demonstrate tissue structure in pursuing a definitive diagnosis of non-infiltrative diseases involving the liver; such as, Hepatoma vs. Heptocellular carcinoma vs. Early cirrhosis vs. Chronic hepatitis vs. Microvascular dysplasia vs. Copper storage disease. In renal disease it is less often requested in private practice to define the cause of chronic renal disease; such as, interstitial nephritis, chronic glomerulonephritis and amyloidosis.