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APPENDIX III

Abbreviations, Terminology, and Glossary

Abbreviations

IVS:

Interventricular septum

LA:

Left atrial

AFAST: Abdominal focused assessment with

LA:Ao:

Left atrial to aortic ratio

sonography for trauma

LV:

Left ventricular

AFAST 3 :

Abdominal focused assessment with

LVFW:

Left ventricular free wall

sonography for trauma, triage, and

mdll:

Middle lung lobe region

tracking (monitoring)

MUG-DPL:

Modified ultrasound-guided DPL

AFS:

Abdominal fluid score

MVD:

Mitral valve disease

ALI:

Acute lung injury

NCPE:

Non-cardiogenic pulmonary edema

A-lines:

Reverberation artifact

Nd:

Nodule(s) sign

Ao:

Aortic

PCE:

Pericardial effusion

ARDS:

Acute respiratory distress syndrome

PCS:

Pericardial site

AXR:

Abdominal radiographs

PE:

Pleural effusion

B-lines:

Same as ULRs

phll:

Perihilar lung lobe region

BLUE:

Bedside lung ultrasound exam

PP-line:

Pulmonary-pleural line

CC:

Cysto-colic

PTX:

Pneumothorax

cdll:

Caudo-dorsal lung lobe region

RV:

Right ventricular

CPE:

Cardiogenic pulmonary edema

RVFW:

Right ventricular free wall

crll:

Cranial lung lobe region

Sh:

Shred sign

CT:

Computed tomography

SQE:

Subcutaneous emphysema

CTS:

Chest tube site

SR:

Spleno-renal

DCM:

Dilated cardiomyopathy

T 3 :

Trauma, triage and tracking (monitoring)

DH:

Diaphragmatico-hepatic

TFAST:

Thoracic focused assessment with

DPL:

Diagnostic peritoneal lavage

sonography for trauma

ECG:

Electrocardiography

TFAST 3 :

Thoracic focused assessment with sonog-

FAST:

Focused assessment with sonography for trauma

raphy for trauma, triage, and tracking (monitoring)

Ff:

Free fluid sign

Ti:

Tissue sign

GI:

Gastrointestinal

TXR:

Thoracic radiographs

HCM:

Hypertrophic cardiomyopathy

ULRs:

Ultrasound lung rockets (same as

HR:

Hepato-renal

B-lines)

Focused Ultrasound Techniques for the Small Animal Practitioner, First Edition. Edited by Gregory R. Lisciandro. © 2014 John Wiley & Sons, Inc. Published 2014 by John Wiley & Sons, Inc.

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316 APPENDIX III

Terminology and Glossary

Abdominal fluid scoring system: Applied fluid scor- ing system in which each positive site, called the abdominal fluid score (AFS), is scored as a 1 with a maximum score of 4. Under this system, dogs with a score of AFS-1, 2 rarely become anemic from their intra-abdominal hemorrhage(if there is no pre-exist- ing anemia). Dogs with a score of AFS 3, 4 predictably become anemic, with 20%–25% of these dogs requiring a blood transfusion due to severe anemia (packed cell volume [PCV] less than 25%). When AFS-3, -4 dogs present close to the time of their injury, almost all have compensated with normal PCVs despite large-volume hemorrhage more commonly becoming anemic on serial examinations (routinely performed four hours post-admission in all stable dogs and sooner in unstable dogs). The AFS in cats is unreliable for predicting anemia, but is helpful in tracking ongoing or resolving hemorrhage and effusions. AFAST 3 : Abdominal FAST 3 is made up of target- organ views rather than external locations as follows:

diaphragmatico-hepatic view (DH), spleno-renal view (SR), cysto-colic view (CC), and hepato-renal view (HR). Note that these AFAST 3 sites similarly parallel the following veterinary FAST external views: subxiphoid, left flank, midline over the bladder (prepubic) and right flank. A-lines: Equidistant parallel lines that originate from the pulmonary surface or from a strong air-ultra- sound interface when pneumothorax is present. A-lines represent air reverberation artifact. B-lines: Synonymous with ultrasound lung rockets (ULRs). B-lines indicate the presence of interstitial fluid immediately next to aerated lung. They indicate “wet lung,” or the presence of interstitial edema or lung contusions in trauma patients, and rule out PTX at that respective point of evaluation on the thorax. B-lines are hyperechoic, laser-like streaks that do not fade, extending from the pulmonary surface to the far field, and obliterating A-lines. B-lines oscillate with the to-and-fro motion of inspiration and expiration. CFAST 3 : Combination FAST 3 is the term used when AFAST 3 and TFAST 3 are used in tandem. COAST 3 : Cageside organ assessment with sonog- raphy for trauma, triage and tracking (monitoring). It is an alternate term to focused or cageside organ exams. For example, one may say that a COAST 3 (or focused or cageside) Gallbladder exam was performed. Complete (or formal) abdominal ultrasound: This term should be used in lieu of “diagnostic abdominal

ultrasound” because the abbreviated focused, cage- side, or COAST 3 exams; the FAST 3 exams; and the Vet BLUE lung scan are also potentially diagnostic. Complete (or formal) echocardiography: This term should be used in lieu of “diagnostic echocardiog- raphy” because the abbreviated focused, cageside or COAST 3 exams; the FAST 3 exams; and the Vet BLUE lung scan are also potentially diagnostic. Dry lung: When A-lines with a glide sign are pre- sent, the lung is considered to be “dry lung” at that respective point of evaluation on the thorax. When there are A-lines without a glide sign, that respective point represents pneumothorax. FAST: Focused assessment with sonography for trauma. FAST 3 : Focused assessment with sonography for trauma, triage, and tracking (monitoring). FAST-ABCDE: New FAST format in which “A” stands for airway (upper), “B” stands for breathing (lower airway), “C” stands for circulation, “D” stands for disability (neurological survey using optic nerve sheath diameter), and “E” stands for exposure (serial examinations). FAST-ABCDE is similar to GFAST 3 ; it uses AFAST 3 , TFAST 3 , and Vet BLUE, with add-on surveys of the eye, upper airways, and heart. It also is used in similar situations as GFAST 3 . Fluid sign (Ff): Vet BLUE sign when there is free fluid at that lung lobe region. Focused ultrasound exam: Alternate term to cage- side or COAST 3 that represents a focused abbrevi- ated exam interrogating a specific organ. For example, one may say that a Focused Gallbladder exam was performed. Gator sign: The basic intercostal orientation for all lung ultrasound is the gator sign, which resembles a partially submerged alligator peering over the water at the sonographer. The eyes of the gator are the rib heads and the bridge of the nose represents the inter- costal space in between where the pulmonary- pleural line is located. The pulmonary-pleural line (PP-line), or bright white proximal line, is where the normal to-and-fro motion of the lung glides along the thoracic wall called the “glide sign.” GFAST 3 : Global FAST 3 is the term used when CFAST 3 and Vet BLUE are used in tandem. Glide sign: The to-and-fro motion with inspiration and expiration of the lung sliding along the pulmo- nary-pleural interface when pneumothorax is not present at that respective point on the thorax. The veterinary term glide sign is referred to as “lung sliding” in the human literature. Lung point: The location where the lung recontacts the thoracic wall either by the recognition of a “glide

317 APPENDIX III

sign” or ULRs (also called B-lines) or a “lung pulse.” The lung point confirms the presence of PTX and subjectively allows for the assessment of the degree or severity of PTX from its distance away from the chest tube site (partial vs. massive). For example,

a short distance (upper third of the thorax) suggests

a trivial or mild (partial) PTX, whereas a longer dis-

tance (middle to lower third) suggests a moderate to severe (massive) PTX. Lung pulse: The lung pulse is where a glide sign or ULRS (also called B-lines) are observed that are not in concert with the to-and-fro of inspiration or expi- ration, but rather are observed to move in concert with the heartbeat. This generally represents severe collapsed or consolidated lung. MUG-DPL: Modified ultrasound-guided diagnostic peritoneal lavage. Mushroom view: The right parasternal left ventric- ular short-axis view just below the mitral valve that appears like a mushroom. The view is used subjec- tively for patient volume status. Nodule sign (Nd): This Vet BLUE lung ultrasound sign is a homogeneous relatively anechoic (or of low echogenicity) round (nodular) region with a hyper- echoic border along its far side, suggesting a nodule(s) within that lung lobe region’s periphery. The finding of the nodule(s) sign likely represents either neoplasia or granuloma(s), abscess(es), and possibly other forms of lung consolidation. Pneumothorax (PTX): A-lines without a glide sign are the hallmark of PTX. When PTX is suspected, a lung point should be searched for to determine the degree (or severity) of PTX. When A-lines are not present in the absence of a glide sign, lung consol- idation or other pleural space conditions are likely. Shred sign (Sh): This Vet BLUE lung sign is an irreg- ular deviation from the normal expected linear con- tinuity of the PP-line representing lung consolidation. Moreover, within the shred sign, there is evidence of lung aeration with hyperechoic “sparkling” or other air-related artifacts such as comet tails or ULRS within the shred area. A descriptive analogy likens the shred sign to thunderstorm clouds rolling across the screen (partially aerated consolidated lung) with flashes of lightening distal to the shred (ultrasound

lung rockets representing interstitial edema). Causes of lung consolidation should most commonly be considered types of pneumonia in non-trauma cases. T 3 : Abbreviation for trauma, triage, and tracking (mon- itoring) that encompasses all subsets of patients to benefit from the abdominal or thoracic FAST exams and the cageside organ assessment exams (COAST 3 ). TFAST 3 : Thoracic FAST 3 is a five-point thoracic scan that includes bilaterally the chest tube sites (CTS) and pericardial sites (PCS) and the single diaphrag- matico-hepatic (DH) view. Tissue (Ti): The Vet BLUE lung sign that appears like liver (hepatization) with no “sparkling” or obvious air artifacts. It indicates a more severe form of lung consolidation than the shred sign because the air- ways are filled with fluid or solids (airless). Causes of severe lung consolidation should be considered. Ultrasound lung rockets (ULRs): Synonymous with B-lines. ULRs indicate the presence of interstitial fluid immediately next to aerated lung. ULRs indi- cate wet lung or the presence of interstitial edema. Their presence also rapidly rules out PTX at that respective point of evaluation on the thorax. ULRs are hyperechoic, laser-like streaks that do not fade extending from the pulmonary surface to the far field, obliterating A-lines. ULRs oscillate with the to-and-fro motion of inspiration and expiration. Vet BLUE lung scan (Vet BLUE): Blue (cyanosis) refers to respiratory distress, and BLUE is an acronym for bedside lung ultrasound exam. The Vet BLUE is a regionally-based lung scan that includes the caudal dorsal (cdll), perihilar (phll), middle (mdll), and cranial lung lobe (crll) regions for rapid detection of lung pathology. Serial Vet BLUE exams may be used to monitor response to therapy in place of thoracic radio- graphs in many lung conditions. The regional format is consistent with the manner in which veterinarians interpret lung findings on thoracic radiographs. Wet lung: The presence of ultrasound lung rockets (ULRs) or B-lines generally represent forms of inter- stitial edema including pulmonary contusions in trauma cases and forms of interstitial edema in non- trauma. Representing interstitial edema, ULRs or B-lines precede more serious lung edema (alveolar flooding) represented by the shred and tissue signs.