I have been asked a lot lately on following the common bile duct. Essentially the ability to image the portal hilus and the CBD to the D-pap is one of those maneuvers that separates big boy scanning from ham and egg scanning. I say this because you don’t want to be the first person of a second opinion and CBD pathology is one of those second opinion locations that I find pathology in often when second opions find theior way under my probe. Stones, bile clots, cbd tumors, striuctures, cholangitis, duodenal mural pathology….. this is a common “ADR” clinical patient site of the answer.
I have been asked a lot lately on following the common bile duct. Essentially the ability to image the portal hilus and the CBD to the D-pap is one of those maneuvers that separates big boy scanning from ham and egg scanning. I say this because you don’t want to be the first person of a second opinion and CBD pathology is one of those second opinion locations that I find pathology in often when second opions find theior way under my probe. Stones, bile clots, cbd tumors, striuctures, cholangitis, duodenal mural pathology….. this is a common “ADR” clinical patient site of the answer. Try scanning in a sedated patient and zoom in here with your microconvex using manual passive pressure with your scanning hand then use the high res linear probe…. then the world of the portal hilus opens up a ton of new things to see. The CBD to the D-Pap is essential in every case especially ADR patients that have “pancreatitis type signs”…. its often the CBD pathology thats the real problem or part of it and a large % do not have bilirubin elevations just like our surgical biliary study showed at ECVIM 2009.
http://sonopath.com/resources/research-publication
Clinical Parameters in Dogs with Sonographically Diagnosed Surgical Biliary Disease.
Task at hand find your D-pap in the next 5 adbominal cases you scan… then count the times you find pathiology there in the next 6 months… you will wonder what you have been missing all these years… I know I did 🙂