Presenter – Professor Mike Herrtage MA, BVSc, DVR, DVD, DSAM, DECVIM, DECVDI, MRCVS, Professor of Small Animal Medicine and Dean of the Cambridge Veterinary School
A webinar citing real life cases is by far the best way for me to take what I have learnt in CPD back to the consulting room. This is exactly what Professor Mike Herrtage did in last week’s webinar covering diagnostic imaging. He offered a selection of cases which all presented with various ailments, and gave us the opportunity to see some real time ultrasound associated with these cases, along with further information obtained from other diagnostics. Radiography also played a role in some of the cases but ultrasound was the main tool discussed.
I do, however, have a bit of a problem. Trying to give you any kind of idea of the knowledge I took away from this webinar within a blog is not really possible. Attempting to describe an ultrasound just isn’t going to do the job – the visual elements to this particular webinar are essential. You really need to watch this webinar to make the most out of it and all I can do is give you some tasters to try and tempt you into taking a precious hour out of your busy day to log in and take a look!
Professor Herrtage’s first case was a 10yr old Russian Blue with vomiting, lethargy and cranial abdominal pain. Bloods demonstrated a mild increase in bilirubin and ALT. The real time ultrasound showed a number of hypoechogenic areas within the liver, one of which was a markedly distended gall bladder. A coiled hypoechogenic structure also ran through the liver and Professor Herrtage was keen to demonstrate how colour flow doppler could help to distinguish this from being either the common bile duct or a blood vessel. Once again, you really need to visualise this on the webinar to benefit from it – and at the same time you can find out the final diagnosis which I intend not to give away.
A case that was perhaps a little less taxing to assume a diagnosis was a four month old miniature schnauzer with lethargy, inappetance and episodes of apparent blindness. A series of bloods were taken, with the most significant changes being elevated bile acids pre and post prandial. I’ve no doubt that a diagnosis of ‘portosystemic shunt’ is now likely to be the foremost contender in most of your minds – and you are right, this was the diagnosis made.
This case report gave Professor Herrtage the opportunity to give us an understanding about how these rogue vessels are found with ultrasound which, at least in my case, I have always felt was beyond my capacity as a general practitioner and have left to referral centres. This is probably still the case but I know for my next portosystemic shunt patient I may well be able to put a few more pieces into the puzzle before referring away.
Professor Herrtage discussed a number of other cases and some further useful techniques, and I hope I have whetted your appetite enough to sit down, put your feet up and enjoy.
The Stethoscope (MRCVS)