Ultrasound or Radiographs (x-rays) – What’s The Difference?
Unlike radiographs, ultrasound uses sound waves to generate a picture of the internal organs. Ultrasound is completely safe and painless and does not require anesthesia or sedation in most cases.
Ultrasound may be recommended after a physical examination, blood test or x-ray indicates an underlying problem. Ultrasound is commonly used in both veterinary and human medicine for a wide variety of problems, including diseases of the liver, kidneys, bladder, stomach, intestines, pancreas, heart, and other organs. As with people, it can be used safely during pregnancy.
Ultrasound can “see” many things that can’t be seen on x-rays. For example, if there is fluid build-up in the chest or abdomen, the organs can’t be seen clearly on x-ray because fluid and tissue have the same density. However, they appear quite clearly on ultrasound, because we can see through the fluid. In addition, while x-rays are helpful to see the shapes and sizes of the internal organs, ultrasound can get a picture of the internal structure.
If an x-ray shows an enlarged heart, we can’t tell from the x-ray if the walls of the heart are thick with narrowed heart chambers (where the blood flows) or if the walls are thin and weak with big chambers or if there is fluid build-up between the heart and the sac that surrounds it. Ultrasound can readily give us this information, which is critical, as these scenarios represent different types of heart disease, with different prognoses and treatments.
Ultrasound is not effective at seeing through air or bone, so it does not replace x-rays but rather is complementary. In some cases both x-rays and ultrasound are needed in order to get a complete picture of what is going on with a patient.
Ultrasound equipment is specialized and quite expensive, so not all veterinary hospitals have an ultrasound machine. Many hospitals have specialists that come to perform the examinations. Other hospitals refer their patients to a hospital that can provide this level of care. In some cases of complex heart disease, evaluation by a veterinary cardiologist may be needed.
Due to the specialized nature of ultrasonic exam and evaluation, it is critical to have a veterinarian who is experienced in obtaining and reading ultrasound images to perform the examination, and make this information apply to each patient in a meaningful way in terms of prognosis and treatment recommendations.
What happens during an ultrasound?
The hair over the area to be evaluated will be shaved, as hair will interfere with the images. A gel (water soluble and safe) will be applied to the skin to help the sound waves generate a good picture. A transducer (similar in size and shape to a TV remote control) is placed on the patient’s skin and slowly moved around over the area to be examined. The ultrasound is computerized, so it can be used to accurately measure the tissues as needed. In addition, images can be stored electronically.
In order to perform a thorough exam, the patient needs to stay relatively still, though some wiggling is fine. Although some cats may be slightly anxious initially, most relax and remain calm once they realize that nothing painful is happening. For cats that are very anxious, your veterinarian may recommend a sedative.
What should I do to prepare for the ultrasound procedure?
Please do not feed your cat for 8-12 hours prior to the examination. Water is permitted. In the case of an abdominal ultrasound, an empty stomach allows for proper imaging of the area near the stomach. There are some diseases/situations where food should NOT be withheld; contact your veterinarian for specific instructions. If your cat is having an abdominal ultrasound, please try not to let your pet urinate for the 3 hours prior to your appointment. This will help get a better picture of the bladder.
What will the ultrasound tell us?
An ultrasound examination will provide a lot of information about your cat’s health. Together with the internist, we look at information from lab tests, x-rays, examinations and medical history to make medical recommendations.
- A specific diagnosis: often ultrasound can provide us with a diagnosis (or a reason for your cat’s illness).
- A Partial diagnosis: While ultrasound shows us the shapes and consistencies of the internal organs, it cannot see microscopic changes. This means that while an ultrasound examination can identify abnormal tissue, including growths, it cannot always determine if the tissue is cancerous or what type of cancer it is. For some patients, this information will affect how they are treated and a biopsy may be recommended. In some cases, this biopsy may be performed as an ultrasound guided needle sample under light anesthesia. In other cases, a surgical biopsy is needed.
- No Diagnosis/ Disease Exclusion: For some patients, the organ changes are not visible enough to pinpoint the problem. We are able to exclude (or rule out) certain diseases, but are left with a list of possible diseases that are causing your cat’s illness. This can be both relieving and frustrating. We will discuss options for therapies based on the available information and will recommend the best path for additional testing to obtain a diagnosis if indicated and desired.
If you have additional questions about whether ultrasound or x-rays are appropriate for your cat, please contact your veterinarian.
The Decision to Euthanize: When is it Time?
This actual scenario played out in my practice today….Chaka, a once stunning Balinese girl was waiting for an exam and blood tests when I arrived at the clinic this morning. Today Chaka looked like a skeleton with matted hair. Her eyes appeared sunken from dehydration and she struggled to breathe. Her Dad, Steve, has always been receptive to all the medical recommendations I’ve made over the years. Sweet Chaka has had more than her share of medical problems, many of which were chronic and required ongoing treatment.
Steve was devoted to her nursing care and follow up visits. Her list of maladies included inflammatory bowel disease that years later transformed into lymphoma (cancer), fatty liver disease treated with a feeding tube, hyperthyroidism and a life-threatening adverse reaction to the drug used to treat the hyperthyroidism. Her last medical crisis happened a year and a half ago. After a blood transfusion and intensive care, we started chemotherapy and much to our amazement, Chaka responded favorably and rallied once again! Steve and Chaka enjoyed another long stretch of blissful feline-human camaraderie.
Today I discovered a heart murmur and a chest full of fluid on x-rays…I quickly called Steve to discuss Chaka’s condition and asked him to come down to the hospital right away. Chaka was looking worse by the moment. My assessment led me to conclude that it was time for the discussion with Steve about sparing Chaka from further suffering. I ran over the options in my mind one more time and reaffirmed that none of the procedures and treatments I could offer for Steve’s approval were likely to lead to good quality time for this kitty. Steve was initially resistant to the idea of euthanasia. He said he wanted Chaka to “go naturally”. I explained that cats do not leave this earth gracefully; that they stubbornly cling to life and can suffer for days. In my opinion it has become our sacred responsibility to make the choice to let go when there is little or no hope for recovery. After all, when felines chose to live inside our homes and we agreed to provide them with safety and food, they ceased to be exposed to predators or severe elements that would have quickly ended their lives when they were sick or weak.
When a terminally ill or aged cat has been under ongoing veterinary care and close monitoring stops eating, chooses to hide in the closet or under your bed, stops using the litter box or no longer seeks affection from the family, it is time to consider euthanasia. In short, the unique daily routine you and your cat have shared has become severely altered. Your veterinarian may still discuss medical procedures and treatments that could prolong kitty’s life. However, the final decision is up to you, the pet parent. It’s best to discuss with family members and friends at what point you will choose euthanasia as the time approaches. Your veterinarian will provide support and counsel through the process. As feline health care givers, we are committed to assisting you with humane end of life care and decision-making
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