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Seeing the Unseen: Advanced Ultrasound Key to Unlocking a Medical Mystery

By: Ashley Berke Published: Aug 7, 2017

Rapper at homeVeterinarians often joke that the animals they own wind up with the most peculiar health problems. Thankfully, these experienced owners are equipped with expert knowledge to treat such issues. Sometimes, however, a medical mystery can stump even the most skilled owner.

For Dr. Nicole Scherrer, Clinical Assistant Professor of Ophthalmology, New Bolton Center’s new ultrasound machine was the key to diagnosing an uncommon injury in her horse, Rapper.

One evening in April, the four-year-old Thoroughbred gelding returned from the pasture with a small nick on the inside of his right fetlock. “There was a lot of swelling,” said Scherrer. Assuming it was cellulitis, she treated him accordingly. Unfortunately, Rapper’s condition did not improve.

An ultrasound performed in the field did not reveal any abnormalities, so Scherrer decided to bring Rapper to New Bolton Center for additional tests.

“We started with radiographs, but everything looked normal,” she said. “We then went to ultrasound, and luckily Dr. Reef was there with brand new, highly advanced equipment.”

Vascular Visualization

The Toshiba Aplio i800, New Bolton Center’s new ultrasound machine, enables visualization of micro-vascular flow never before seen with diagnostic ultrasound.

“We’re entering a whole new generation of image clarity and detail,” said Dr. Virginia Reef, Chief of the Section of Imaging. “We can now look at tiny vessels to see if there is blood flow in tissues that we could never see before. This is really useful for cases that are more challenging to diagnose.”

This certainly was the case for Rapper. With the advanced ultrasound, Scherrer finally had a diagnosis. And it was a rather uncommon finding.

“A small tear in the joint capsule caused an ‘outpouching’ of joint fluid, which is what led to the swelling,” Scherrer explained. “Of course this happened to a veterinarian’s horse,” she joked. 

Since this was a soft-tissue injury, it would not have shown up on a radiograph. And less advanced ultrasound machines simply do not have the resolution to show this level of detail. “The tear was only millimeters long,” said Scherrer.

Reef explained that the ultrasound has a brand new beam former, which enables the image to be processed in such a way that there is much more clarity. The difference was clear to Scherrer.

“The images were just pristine,” she said. “It was as if they were taking a picture of the inside of Rapper’s leg with a beautiful camera. It was amazing to watch. The details on this ultrasound are phenomenal.”

Reef is proud that Penn Vet’s New Bolton Center is the first veterinary hospital to own this equipment. Following a demonstration from Toshiba, Reef insisted they leave the machine behind. “I simply wouldn’t let them leave with it!” she said with a smile. After a few days to work out the logistics, Toshiba acquiesced.

Since then, Reef and her team have been eagerly exploring the machine’s capabilities, including 3D ultrasound. 

“The image quality is so much better; we’re seeing things we’ve never seen before. With this kind of resolution, we are more likely to come up with more specific diagnoses for our patients. We can see deeper into the abdomen than ever before. It may even be more sensitive to the stage of tendon injury and repair.”

Certainly the machine will serve as an exceptional teaching tool. And it has exciting potential for research and translational applications. 

“Human hospitals don’t even have this yet,” said Reef. “This is truly the latest technology on the market.”

A contrast arthrogram taken of Rapper's fetlock shows (at arrows) the contrast leaking out of the joint under the skin. Rest for Rapper

To confirm the findings from the ultrasound, Rapper underwent a contrast arthrogram, a diagnostic test to examine the inside of a joint.

“The test clearly confirmed our findings,” said Reef. The image showed the contrast leaking out of the joint under the skin.

Thus began two months of stall rest for Rapper.

“I’m always astounded by the ways that horses can hurt themselves,” said Scherrer. “To have a diagnosis in this tricky case was so great. This could have gone on for a long time and could have gotten a lot worse, but we had a diagnosis within two hours.”

By mid-June, Rapper had healed and was ready to be ridden again. “He’s doing great,” said Scherrer, who added that the entire experience was eye opening as a clinician-client.  

“It’s important for me to experience New Bolton Center as an owner because it makes me a better clinician,” she said. “The anticipation that goes along with being a hospital client, the concern for your horse, the financial concerns – all of this helps me keep things in perspective.”