Article reprinted with permission of DVM360 – June 30, 2015. DVM360 MAGAZINE is a
copyrighted publication of Advanstar Communications inc. All rights reserved
Figure 2: The four areas evaluated on the FAST technique:
diaphragmatic-hepatic (DH), spleno-renal (SR), cysto-colic (CC)
and hepato-renal (HR).
lateral recumbency to evaluate four specific sites
within the abdomen (Figure 2):
1. Diaphragmatic-hepatic (DH)
Figure 1: A radiograph from a 8.5-year-old spayed female English
springer spaniel. Note the mild gas and fluid dilation of the
stomach. The small bowel appears empty to mildly thickened or
mildly fluid dilated. There is moderate remodeling of both hips
with thickened femoral necks. Diagnostic impressions: Increased
fluid in the stomach may be due to gastritis or pancreatitis. There
is no evidence of foreign material or obstruction. Incidental
moderate chronic hip arthritis is present.
become so important in both human and veterinary
medicine? There are clear limitations and concerns
when moving a critically ill patient to radiology
where it needs to be taped, sand-bagged or manually
restrained to obtain diagnostic imaging results.
Human and veterinary studies have demonstrated that
radiographic serosal detail is not sensitive or specific
at detecting abdominal fluid after blunt trauma (Figure
1). 1,2
2. Spleno-renal (SR)
3. Cysto-colic (CC)
4. Hepato-renal (HR)
The sites are evaluated in a clockwise motion as
you look for evidence of effusion, which is typically
identified as anechoic (black) areas around the
identified organ structures (Figure 3). Remember, this
is a quick and dirty evaluation. Shaving the patient
is not required. A little alcohol or ultrasound gel is
sufficient, although it is important to remember to
avoid alcohol if the patient is critical and may require
defibrillation (or has injuries including abrasions or
lacerations).
Ultrasonography is thought to be a more ideal
initial imaging modality as it can be performed
simultaneously while other assessments are being
performed and while resuscitative measures are
provided. Importantly, there is no requirement to be
a fancy board-certified radiologist to perform the
ultrasound procedure. Non-radiologist veterinarians
can be quickly trained to performed the AFAST 3
ultrasound to make life-saving clinical decisions.
How does it work?
Now that I have your attention and before you head
to eBay for an ultrasound machine, let’s discuss how
to perform the AFAST3. The patient is placed in right
Figure 3: An ultrasonogram from a 10-year-old spayed female
American bulldog. Multiple hypoechoic masses are seen
throughout the liver measuring 1 to 4 cm. Mild effusion is
present, seen here with an anechoic appearance.
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