Figure 1: Liver Torsion (Ultrasound Image)
This 1yr Mastiff MI was presented initially for vehicular trauma resulting in brachial plexus avulsion. The right foreleg was not functional neurologically and was amputated. The day after amputation, the patient became lethargic and exhibited abdominal pain. Radiographs revealed peritoneal effusion (modified transudate).

Ultrasonography was performed to determine the cause of effusion and revealed a single liver lobe that appeared enlarged with a mottled appearance and minimal vascular flow detected with Doppler. Based on these findings, a liver lobe torsion was suspected and confirmed at surgery.

Liver lobe torsion is rare but are usually spontaneous, present with abdominal pain, peritoneal effusion, and may progress to shock. The torsion may result in significant necrosis with or without bacterial infection.

Figure 2: Temporomandibular joint fractures (CT image)
This 3yr DSH MC suffered head trauma after being hit by a car. Epistaxis and blood in the ear canals was identified, signifying nasofrontal and tympanic bullae cavity trauma. Skull radiographs did not identify specific fractures, but temporomandibular joint (TMJ) fractures were suspected based on crepitus on palpation and when opening the mouth.

Computed tomography of the entire skull was performed to evaluate for fractures. Multiple nasal and maxillary bone fractures were identified with minimal displacement. There were comminuted fractures of the left mandibular fossa of the temporal bone and articular process of the mandible, with minimal displacement.

Treatment of TMJ fractures depends on many factors.

Figure 3: Parathyroid tumor (Ultrasound image)
A severe polydypsia and polyuria prompted this pet to be evaluated by the primary veterinarian. Biochemical evaluations revealed elevated calcium, dilute urine, and elevated parathyroid hormone.

Imaging of the thyroid and parathyroid glands can be achieved with high-frequency transducers by experienced ultrasonographers with a thorough knowledge of the regional anatomy. The normal parathyroid glands appear as small, round hypoechoic structures immediately adjacent to the more hyperechoic, fusiform-shaped thyroid gland. Abnormal parathyroid glands appear enlarged but generally remain hypoechoic and round in shape. Doppler is essential in differentiating the abnormal parathyroid from the adjacent carotid artery, which can also appears hypoechoic and round. Both left and right parathyroid glands should be evaluated and measured.

An abnormal right parathyroid gland was removed surgically and histopathology revealed adenoma. Immediate post-operative care is intense but the prognosis is generally very good, as the majority of parathyroid tumors are benign adenomas.

Figure 4: Adrenal Tumor (CT Image)
A diagnosis of hyperadrenocorticism prompted an abdominal ultrasound to evaluate the liver and adrenal glands in this 7 year old Labrador Retriever FS. A mass associated with the right adrenal was suspected and the CT examination of the cranial abdomen was performed prior to surgical exploration.

A mass medial to the cranial pole of the right kidney was identified. This mass extended into the lumen of the caudal vena cava, making surgical resection a very complicated effort, which was declined by the owner.

Figure 5: Ureteral Calculus (US Image)
A 4 year old DSH MC was presented for urethral obstruction. He had a previous cystotomy for removal of bladder calculi. Radiographs at this recent presentation revealed calculi in the penile urethra, kidneys, and possibly in the urinary bladder or a distal ureter. An ultrasound examination was performed to better evaluate the kidneys and ureters. There was moderate dilation of the left renal pelvis and left ureter, and a small hyperechoic structure was identified in the distal left ureter near its junction with the urinary bladder.

Surgical removal of the ureteral calculus, in addition to a perineal urethrostomy, was performed. Subsequent ultrasound re-checks showed decreasing dilation of the left renal pelvis and ureter.

Figure 6: Cholecystitis (US Image)
This 4 year old Cairn Terrier FS presented for vomiting and abdominal pain that did not respond to aggressive medical management. Liver enzymes and bilirubin were elevated. An abdominal ultrasound revealed an enlarged gall bladder with echogenic contents that did not move with a change in the patient’s position. The liver and omentum surrounding the gall bladder was hyperechoic, indicating regional inflammation (hepatitis, peritonitis).

Surgical exploration was performed and an inflamed, partially necrotic gall bladder was removed and submitted for histopathological evaluation and culture. No bacterial growth was identified, but cholecystitis was the ultimate diagnosis. The patient recovered uneventfully. Re-check ultrasound examinations showed resolution of the regional peritonitis and hepatitis.