What are your most difficult views as a sonographer?

Sonopath Forum

What are your most difficult views as a sonographer?

Sonography in any species is a pretty cool thing you have to admit, but at times it can be a frustrating affair. Whether your patient is the size of a kitten or bigger than you are, you still have to get all of those diagnostic views to efficiently evaluate what is going on with the patient. Sometimes in the most “perfect” patient we can run into some imaging hurdles.

As a sonographer, what are your most difficult views or areas to image?

My personal struggles have been:

  • Deep chested dogs for the aortic outflow view, Boxers, Shepherds, Dobies.
  • “Large” (fat) cats for aortic outflow views.
  • Right adrenal glands, usually on the deep chested breeds once again.
  • Acquiring the adequate depth and focal points during sonographic evaluation of ACL tears.

We would love all of our community members to add their difficult views, and how you overcame the struggle or if you are still having trouble in certain areas? At SonoPath we relish in learning from others and teaching solutions to imaging problems so please comment! Thx!



Well I had that 120# deep

Well I had that 120# deep chested Dobie echo this morning and the (1) apical view is definitely on my list for my most difficult views to get on these body types – need a technique that does not take superhuman strength so I can get the view AND do aortic doppler at the same time:). He was tough to maneuver so I really didn’t want to ask the techs to flip him around to try a right parasternal view (even if that’s possble). Any way to get it with the dog standing?

(2) recognizing and optimizing the ileocecal valve, especially in dogs

(3) How to optimize cardiac images on big barrel chested dogs such as bulldogs

Hey KV CVT try this next time on a big dog right kidney and adrenal – stand him up, turn him around to face away from you. Put the probe right there on the right side, at the notch of the last rib, aiming somewhat above the left shoulder to find the right kidney. Then lift the tail of the probe to image the vena cava and aorta, and the RADR. I’ve done this several times especially on giant breeds. The first time, I tried it as a last resort when I couldn’t even image the RK, and BOOM there it was. I went “huh”( just like George did on Seinfeld when he found out his fiance was done in by simply licking envelopes after he had tried numerous ways to call off his wedding:)


KV CVT SonoPath

Haha! I do usually flip the

Haha! I do usually flip the bigger guys/gals but I do second guess flipping as I always feel bad if the animal is either nervous/aggressive or painful sometimes the flip (despite the techs being gentle as always) can get the patient riled up. Sometimes they are so deep chested that even after flipping the patient away that pesky right kidney is sitting pretty up in the intercostal area and I am never happy with those images. I want a “pretty” right kidney! 🙂


Standing a dog up has saved

Standing a dog up has saved me ,for finding that right kidney. (I like the reference to Seinfeld). 🙂

KV CVT SonoPath

LOL! That’s great! 🙂

LOL! That’s great! 🙂


It’s not a flip, it’s from a

It’s not a flip, it’s from a standing position, and the animal (and the techs) are usually relieved that they can let the animal stand. And usually by that time I’m elated to get a kidney and adrenal I can measure:) . And go intercostal if needed, it will usually flatten out the kidney; the right adrenal is then usually at 5-7 cm though. 

KV CVT SonoPath

Really? I have never done any

Really? I have never done any standing scanning.


I do standing as well. I find
I do standing as well. I find the R kidney drops a bit, but usually intercostal does the trick unless very large kidneys in large breeds.
I use standing for that and also for very painful dogs ( when they are very sore even under sedation)
I scan usually on lateral but! I scan in whatever position I need to get the views…
I struggle with left apical view in general. My MR barely get to 5m/s, and Aortic flow is also a struggle.
Many times the struggles with Right adrenal Are solved with a bit of torb, when you have a much more relaxed abdominal wall.

KV CVT SonoPath

I’m a total Torb fan, other

I’m a total Torb fan, other than the fact that it does sting. That part stinks, but a relaxed patient is so nice for both of us! Less stress on them and an easier time for scanning. I will have to try that right kidney approach standing! 🙂



I have a lot of issues with

I have a lot of issues with intercostal views.

I was wondering what probe you use. I have an Esaote MyLab30 Gold and my probe really does not give me much real estate between rib shadowing.

I still have problems getting into the liver hilus and R adrenal can be challenging- especially intercostal

Sometimes sub xyphoid can be another option for aortic outflow. I also have trouble getting the tricuspid on the L apical view.

One of these days I am going to attend one of the SDEP programs



Regarding the apical and low

Regarding the apical and low velocity ensure you drop your frequency… and have a low frequency probe otherwise the velocity on doppler will be underestimated. The 6s does this on the logic e inevitably underestimates the MR velocity (any velocuity for that matter) unless you lower the frequency to 6 mHz or move to the 3s. I always recommend getting the 3s probe even if the Sound sales dont push it and ithe sales pitch often comes over like you just need the 6s to keep the price low and competitive. You need all 4 probes for the logic system… 6s for 40# or less and low frequency for doppler and the 3 s for anything bigger. I’ve actually scored the 3 s probe a number of times o ebay (With help from Kelly my tech using her Sicilian bargain eye lol) for about $1000-1500 and have had great luck. Its usually one of those probes kept in a drawer like an old morotcycle in a garage that the wife wont let the husband ride any more once the kids come:)… 6000 miles and showroom new for a cheap price to pay for the minivan…I love a good deal!

Torbutrol for everything needing a workup and sonogram…. frees people up, patients are happy, and no body wall tension to mess with image quality. You are very right Diane.

Regarding intercostal views Randy its the microconvex probe and manual maneuvers and find the window to the parenchyma and maximze it. This technque is explained in the sdep 17 point download if you don’t have it….


may save you a trip to a seminar… not that we wouldnt want to see you:)

FYI our next adep abdomen will be in Mount Arlington NJ (30 min form ewr) October 21-23, 2016. We had a wait list last time so added another date….:)

Registration will be on this link shortly


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