The Essentials of Veterinary Point of Care Ultrasound: Pleural Space and Lung

Dr. Søren Boysen obtained his DVM from the University of Saskatchewan (Canada), completed a small animal internship at the Atlantic Veterinary College (Canada), and a residency at Tufts University (United States), becoming a diplomate of the American College of Veterinary Emergency and Critical Care in 2003. He is the former Chief of Small Animal Emergency and Critical Care at the University of Montreal, and currently a full professor of veterinary emergency and critical care at the University of Calgary. Extensively published, and a recipient of numerous teaching and research excellence awards, he has become an internationally recognized speaker. Although he loves all things emergency and critical care, he is considered a pioneer of veterinary point-of-care ultrasound (VPOCUS), having published the first small animal focused assessment of sonography for trauma (FAST) exam in collaboration with colleagues from Tufts. With many great colleagues from around the world he continues to actively research and develop ultrasound training techniques, education programs, and workshops for nonspecialist practitioners. Along with point-of-care ultrasound, his research interests include hemorrhage, coagulation, and perfusion.

Kris Gommeren graduated in 2002 from Ghent University (Belgium), where he subsequently performed an internship and a residency in internal medicine, becoming a Diplomate of the European College of Veterinary Internal Medicine in 2009. After his residency he briefly worked in a private referral practice, but soon moved to the University of Liège, where he has been in charge of the Emergency and Critical Care Service since 2008. He obtained his PhD on the effects of systemic inflammation on the cardiovascular system. In 2017 he became a Diplomate of the European College of Veterinary Emergency and Critical Care. He remains actively involved in the residency programs of both internal medicine and emergency and critical care. For years Kris has been actively involved in the European Veterinary Emergency and Critical Care Society (EVECCS), of which he is past president. He is a consultant for an international veterinary company, working on the development of emergency and critical care facilities and the training of personnel. His main fields of interest are point-of-care ultrasound, the cardiovascular system, fluid therapy and the assessment of volume status.

Born and raised in Montreal, Dr. Serge Chalhoub graduated from the DVM program at the Faculty of Veterinary Medicine (FMV) of the University of Montreal in 2004. He then completed a one-year rotating small animal internship at the same institution. After working for two years as a general practitioner and emergency veterinarian at the DMV Centre in Montreal, Dr. Chalhoub pursued a residency in small animal internal medicine at the Animal Medical Center (AMC) in New York City. Once completed in 2009 he stayed on at the AMC as their first renal/hemodialysis fellow. During this time, he was also trained in interventional radiology and endoscopy. Dr. Chalhoub is currently a senior instructor at the University of Calgary’s Faculty of Veterinary Medicine (UCVM). He was the recipient of the 2013 Canadian Veterinary Medical Association’s Teacher of the Year Award, the 2015 University of Calgary Team Teacher of the Year Award, and the 2017 Carl J. Norden Distinguished Teacher Award. He is the coordinator of the UCVM-CUPS Pet Health Clinic for disadvantaged Calgarians. He has authored and coauthored numerous scientific articles and book chapters on veterinary point-of-care ultrasound, renal and urinary medicine.

1. Introduction

Evolution

Using binary questions

Summary

2. General technique

Introduction to the Calgary Pleural and Lung

Ultrasound (PLUS) approach

Indications

Contraindications and complications

Serial exams

Machine functions

Transducer manipulations

Patient positioning and preparation

The Calgary PLUS Technique

Application of the Calgary PLUS approach

3. Image interpretation: Normal findings

Bat sign

Glide sign

A lines

B lines

Curtain sign

Lung pulse

Dry lung

Z lines

4. Image interpretation: Clinical applications for the pleural space

Is there pneumothorax?

Probe orientation/selection

Where and how to look for pneumothorax

(step by step)

Key criteria to rule out pneumothorax

Key criteria to confirm pneumothorax

Pitfalls

Is there pleural effusion?

Probe orientation/selection

Where and how to look for pleural effusion (step by step)

Key criteria to rule out pleural effusion

Key criteria to confirm pleural effusion

Tricks to differentiate pleural from pericardial

effusion

Pitfalls

5. Image interpretation: Clinical applications for the lungs (visceral pleural surface)

Is there alveolar interstitial syndrome (AIS)?

Probe orientation/selection

Where and how to look for AIS (step by step)

Key criteria to rule out AIS

Key criteria to confirm AIS

Pitfalls

Is there lung consolidation?

Probe orientation/selection

Classifications of lung consolidation

Where and how to look for lung consolidation

(step by step)

Key criteria to rule out lung consolidations

Key criteria to confirm lung consolidations

Pitfalls

Is there pleural thickening and/or subpleural irregularities?

Where and how to look for pleural thickening and subpleural irregularities

Defining pleural thickening and subpleural irregularities

Significance of pleural thickening and subpleural irregularities

6. Lung and pleural space procedures

Thoracocentesis

Chest tube placement

Lung aspirate/biopsy