BY NICOLA ELLEROA; ALESSANDRA MAGGIA; VALERIA BUSONIB; ILARIA IMPOSIMATOA; CAROLINA CASTAGNETTIA; ALLIAI LANCIA; JOLE MARIELLAA; FRANCESCA FRECCEROA;
TABLES AND IMAGES: THE AUTHORS
This study aimed to develop a standardized ultrasound (US) protocol using selected thoracic and abdominal acoustic windows, to assess its feasibility and applicability in healthy foals, and to evaluate its usefulness for detecting common thoracic and abdominal conditions in sick foals
The Focused US (FUS) protocol included 12 thoraco-abdominal windows (4 right-side, 3 ventral, 5 left-side) using a curved-array probe. It was applied to cohorts of healthy (n = 17) and sick (n = 23) foals by a veterinary clinician with limited US experience. The FUS showed good feasibility and applicability, with clear visualization of target abdominal structures. Diagnostic usefulness was high for identifying gastrointestinal disease and peritoneal effusions. However, several challenges emerged: the need to change recumbency, the relatively large number of US windows, the need for staff to restrain foals, and the prioritization of other diagnostic or therapeutic procedures in sick foals.
A shortened Foal Oriented Compressed US (FOCUS) protocol was developed, including 7 thoraco-abdominal windows from a single right recumbency (4 right-side, 3 ventral), and was tested in healthy (n = 3) and sick (n = 3) foals by three clinicians with varying levels of experience. The FOCUS proved significantly faster than FUS, with a short acquisition time (median 7 min, range 3–10 min). Main limitations include single-operator image acquisition, the small cohort of sick foals assessed using FUS, and limited evaluation of the FOCUS protocol. In conclusion, FUS can be performed by veterinarians without extensive US experience. However, in emergency settings, FOCUS may be preferred due to its greater time efficiency.
1. Introduction
Point-of-care ultrasound (POCUS) exams are time-sensitive and goal-oriented assessments that provide answers to targeted clinical questions based on a patient's clinical signs (Busoni et al., 2011, Vincze et al., 2019, Eberhardt and Schwarzwald, 2022, Bevevino et al., 2023, Corrie et al., 2024, Leduc et al., 2024). The POCUS protocols are increasingly used in human and veterinary medicine due to advances in technology and training (Baston et al., 2019, Norman, 2024). In the adult equine patient, POCUS protocols have been proposed to assess the abdomen in horses with colic (FLASH - fast localized abdominal sonography of horses) (Busoni et al., 2011, Corrie et al., 2024), cardiac and respiratory diseases (CRASH - cardiorespiratory assessment of horses) (Eberhardt and Schwarzwald, 2022, Bevevino et al., 2023), and high-risk pregnancies (REP - rapid examination protocol) (Vincze et al. 2019). Because of differences in ultrasound (US) anatomy and organ systems function between adult horses and foals (Aleman et al. 2002), protocols developed in adults may not be applicable to foals. The US is noninvasive, well tolerated, and can be easily performed on the foal (Porter and Ramirez, 2005, Sprayberry, 2015). Abdominal and thoracic disorders represent a large proportion of diseases encountered in neonatal foals and US is an easily available first-line modality capable of diagnosing most of them (Neal, 2003, McAuliffe, 2004, Porter and Ramirez, 2005, Bain, 2012, le Jeune and Whitcomb, 2014, Sprayberry, 2015, Cribb and Arroyo, 2018). To the best of our knowledge, POCUS protocols have not been described in equine neonatal medicine.
The present study aimed to develop a standardized US protocol based on selected thoracic and abdominal acoustic windows, evaluate its feasibility and applicability for describing the appearance of normal organs in a cohort of healthy foals and for detecting common thoracic and abdominal conditions in a cohort of sick foals. We hypothesized that selecting appropriate ultrasonographic windows would allow the development of a practical, focused, and standardized short US protocol capable of detecting common abdominal and thoracica bnormalities in neonatal foals with minimal invasiveness...
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