Why should you consider three view abdominal radiographs of your vomiting veterinary patients?
We have all been there. You are slammed with a ton of appointments and you’re already halfway through completely missing your lunch break. Of course, Lucky the Labradoodle shows up, has been “vomiting for a few days,” and the owner has “no idea if Lucky could have gotten into anything.”
Luckily for you, said owner understands the importance and value of diagnostics, and you get authorization for lab work and radiographs. Now, do you take three views or two? It may be easier to just get your standard two views and move on. Take a deep breath and ask your technician (ever so nicely) to take a left lateral view as the third image.
Right Lateral, Left lateral, ventrodorsal. Say it with me. Right lateral, Left lateral, Ventrodrosal. It could be your new mantra.
The abdomen, and specifically the gastrointestinal tract, is prone to artifact of summation. Taking those extra moments to take a third view can benefit the patient and decrease your level of stress and frustration.
Historically, the right lateral view is helpful in evaluating cases of suspected gastric dilatation and volvulus (GDV). The left lateral view is helpful for evaluating the pylorus for foreign material, linear foreign bodies anchored to the pylorus, and checking whether the pylorus is patent to gas. All three views play an important role in evaluating a vomiting patient.
Gas will distribute to the fundus on the right lateral view and redistribute to the pylorus and duodenum on the left lateral view. Combined with the ventrodorsal view, this gives you a better overall image of the stomach and gas can often contrast with foreign material in the pylorus.
When correlated with right and left lateral views, the ventrodorsal view is also helpful in evaluation of the colon, the right cranial abdomen, and localization of an area of suspicion within the gastrointestinal tract.
Three views of the abdomen can also help increase confidence that a pet is NOT obstructed or when a linear foreign body is tethered to the stomach.
Barriers to obtaining three views
To avoid uncomfortable conversations regarding fees, your practice’s radiography pricing may be worth reviewing. Depending on how the fees are structured, creating an abdominal radiography package to include three views can be helpful. For example, if your practice charges per view/image, or if the standard abdominal radiography charge only includes two views, consider creating an abdominal radiograph package to include three views.
Offering a package that includes interpretation by a board-certified veterinary radiologist is invaluable to your practice. The advancement of teleradiology gives you access to specialists with just a few clicks of a mouse. For those tough cases, guidance from a board-certified veterinary radiologist gives you and your clients peace of mind. Providing a radiologist with three views of the abdomen will generally allow for more accurate reporting as well.
Staff safety and patient comfort should be top priority and implementing light sedation and/or pain control can benefit all parties involved. Many referral and specialty hospitals have set protocols to sedate all patients getting radiographed.
You may be wondering, “So, what happened with Lucky?”.
Here are the right lateral (below, left) and ventrodorsal (below, right) views of Lucky’s abdomen. What is your assessment?
Click on the images to enlarge
Now, here is the left lateral view (below)...
On the left lateral view, gas contrasts with soft tissue opaque material, which persists in the pylorus and proximal duodenum.
Best seen on the left lateral view, small intestinal segments are plicated with adjacent intraluminal soft tissue opaque material striated with gas.
These findings were a result of proximal to mid-jejunal mechanical obstruction secondary to textile foreign body ingestion, with a linear component and tethering to the stomach.
Obtaining the third view of the abdomen provided a more accurate diagnosis that this was a surgical abdomen.
So, why should you consider taking three view abdominal radiographs? It may not always be necessary, but it is good medicine that can benefit our patients. Isn’t that what we all strive for?
Come back next time when we tackle the topic of three view thoracic radiography…
-Jessica Garcia-Fink DVM