APPENDIX III

Abbreviations, Terminology,
and Glossary

Abbreviations
AFAST:
AFAST3:

AFS:
ALI:
A-lines:
Ao:
ARDS:
AXR:
B-lines:
BLUE:
CC:
cdll:
CPE:
crll:
CT:
CTS:
DCM:
DH:
DPL:
ECG:
FAST:
Ff:
GI:
HCM:
HR:

IVS:
LA:
LA:Ao:
LV:
LVFW:
mdll:
MUG-DPL:
MVD:
NCPE:
Nd:
PCE:
PCS:
PE:
phll:
PP-line:
PTX:
RV:
RVFW:
Sh:
SQE:
SR:
T3:
TFAST:

Abdominal focused assessment with

sonography for trauma
Abdominal focused assessment with
sonography for trauma, triage, and
tracking (monitoring)
Abdominal fluid score
Acute lung injury
Reverberation artifact
Aortic
Acute respiratory distress syndrome
Abdominal radiographs
Same as ULRs
Bedside lung ultrasound exam
Cysto-colic
Caudo-dorsal lung lobe region
Cardiogenic pulmonary edema
Cranial lung lobe region
Computed tomography
Chest tube site
Dilated cardiomyopathy
Diaphragmatico-hepatic
Diagnostic peritoneal lavage
Electrocardiography
Focused assessment with sonography
for trauma
Free fluid sign
Gastrointestinal
Hypertrophic cardiomyopathy
Hepato-renal

TFAST3:

Ti:
TXR:
ULRs:

Interventricular septum
Left atrial
Left atrial to aortic ratio
Left ventricular
Left ventricular free wall
Middle lung lobe region
Modified ultrasound-guided DPL
Mitral valve disease
Non-cardiogenic pulmonary edema
Nodule(s) sign
Pericardial effusion
Pericardial site
Pleural effusion
Perihilar lung lobe region
Pulmonary-pleural line
Pneumothorax
Right ventricular
Right ventricular free wall
Shred sign
Subcutaneous emphysema
Spleno-renal
Trauma, triage and tracking (monitoring)
Thoracic focused assessment with
sonography for trauma
Thoracic focused assessment with sonography for trauma, triage, and tracking
(monitoring)
Tissue sign
Thoracic radiographs
Ultrasound lung rockets (same as
B-lines)

Focused Ultrasound Techniques for the Small Animal Practitioner, First Edition. Edited by Gregory R. Lisciandro.
2014 John Wiley & Sons, Inc. Published 2014 by John Wiley & Sons, Inc.

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APPENDIX III

Terminology and Glossary

Abdominal fluid scoring system: Applied fluid scoring system in which each positive site, called the
abdominal fluid score (AFS), is scored as a 1 with a
maximum score of 4. Under this system, dogs with a
score of AFS-1, 2 rarely become anemic from their
intra-abdominal hemorrhage(if there is no pre-existing anemia). Dogs with a score of AFS 3, 4 predictably
become anemic, with 20%25% of these dogs
requiring a blood transfusion due to severe anemia
(packed cell volume [PCV] less than 25%). When
AFS-3, -4 dogs present close to the time of their injury,
almost all have compensated with normal PCVs
despite large-volume hemorrhage more commonly
becoming anemic on serial examinations (routinely
performed four hours post-admission in all stable
dogs and sooner in unstable dogs). The AFS in cats is
unreliable for predicting anemia, but is helpful in
tracking ongoing or resolving hemorrhage and
effusions.
AFAST3: Abdominal FAST3 is made up of targetorgan views rather than external locations as follows:
diaphragmatico-hepatic view (DH), spleno-renal
view (SR), cysto-colic view (CC), and hepato-renal
view (HR). Note that these AFAST3 sites similarly
parallel the following veterinary FAST external
views: subxiphoid, left flank, midline over the
bladder (prepubic) and right flank.
A-lines: Equidistant parallel lines that originate from
the pulmonary surface or from a strong air-ultrasound interface when pneumothorax is present.
A-lines represent air reverberation artifact.
B-lines: Synonymous with ultrasound lung rockets
(ULRs). B-lines indicate the presence of interstitial
fluid immediately next to aerated lung. They indicate
wet lung, or the presence of interstitial edema or
lung contusions in trauma patients, and rule out PTX
at that respective point of evaluation on the thorax.
B-lines are hyperechoic, laser-like streaks that do not
fade, extending from the pulmonary surface to the far
field, and obliterating A-lines. B-lines oscillate with
the to-and-fro motion of inspiration and expiration.
CFAST3: Combination FAST3 is the term used when
AFAST3 and TFAST3 are used in tandem.
COAST3: Cageside organ assessment with sonography for trauma, triage and tracking (monitoring).
It is an alternate term to focused or cageside organ
exams. For example, one may say that a COAST3 (or
focused or cageside) Gallbladder exam was
performed.
Complete (or formal) abdominal ultrasound: This
term should be used in lieu of diagnostic abdominal

ultrasound because the abbreviated focused, cageside, or COAST3 exams; the FAST3 exams; and the Vet
BLUE lung scan are also potentially diagnostic.
Complete (or formal) echocardiography: This term
should be used in lieu of diagnostic echocardiography because the abbreviated focused, cageside or
COAST3 exams; the FAST3 exams; and the Vet BLUE
lung scan are also potentially diagnostic.
Dry lung: When A-lines with a glide sign are present, the lung is considered to be dry lung at that
respective point of evaluation on the thorax. When
there are A-lines without a glide sign, that respective
point represents pneumothorax.
FAST: Focused assessment with sonography for
trauma.
FAST3: Focused assessment with sonography for
trauma, triage, and tracking (monitoring).
FAST-ABCDE: New FAST format in which A
stands for airway (upper), B stands for breathing
(lower airway), C stands for circulation, D
stands for disability (neurological survey using optic
nerve sheath diameter), and E stands for exposure
(serial examinations). FAST-ABCDE is similar to
GFAST3; it uses AFAST3, TFAST3, and Vet BLUE, with
add-on surveys of the eye, upper airways, and heart.
It also is used in similar situations as GFAST3.
Fluid sign (Ff): Vet BLUE sign when there is free
fluid at that lung lobe region.
Focused ultrasound exam: Alternate term to cageside or COAST3 that represents a focused abbreviated exam interrogating a specific organ. For
example, one may say that a Focused Gallbladder
exam was performed.
Gator sign: The basic intercostal orientation for all
lung ultrasound is the gator sign, which resembles a
partially submerged alligator peering over the water
at the sonographer. The eyes of the gator are the rib
heads and the bridge of the nose represents the intercostal space in between where the pulmonarypleural line is located. The pulmonary-pleural line
(PP-line), or bright white proximal line, is where the
normal to-and-fro motion of the lung glides along
the thoracic wall called the glide sign.
GFAST3: Global FAST3 is the term used when CFAST3
and Vet BLUE are used in tandem.
Glide sign: The to-and-fro motion with inspiration
and expiration of the lung sliding along the pulmonary-pleural interface when pneumothorax is not
present at that respective point on the thorax. The
veterinary term glide sign is referred to as lung
sliding in the human literature.
Lung point: The location where the lung recontacts
the thoracic wall either by the recognition of a glide

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APPENDIX III

sign or ULRs (also called B-lines) or a lung pulse.

The lung point confirms the presence of PTX and
subjectively allows for the assessment of the degree
or severity of PTX from its distance away from the
chest tube site (partial vs. massive). For example,
ashort distance (upper third of the thorax) suggests
a trivial or mild (partial) PTX, whereas a longer distance (middle tolower third) suggests a moderate to
severe (massive) PTX.
Lung pulse: The lung pulse is where a glide sign or
ULRS (also called B-lines) are observed that are not
in concert with the to-and-fro of inspiration or expiration, but rather are observed to move in concert
with the heartbeat. This generally represents severe
collapsed or consolidated lung.
MUG-DPL: Modified ultrasound-guided diagnostic
peritoneal lavage.
Mushroom view: The right parasternal left ventricular short-axis view just below the mitral valve that
appears like a mushroom. The view is used subjectively for patient volume status.
Nodule sign (Nd): This Vet BLUE lung ultrasound
sign is a homogeneous relatively anechoic (or of low
echogenicity) round (nodular) region with a hyperechoic border along its far side, suggesting a
nodule(s) within that lung lobe regions periphery.
The finding of the nodule(s) sign likely represents
either neoplasia or granuloma(s), abscess(es), and
possibly other forms of lung consolidation.
Pneumothorax (PTX): A-lines without a glide sign
are the hallmark of PTX. When PTX is suspected, a
lung point should be searched for to determine the
degree (or severity) of PTX. When A-lines are not
present in the absence of a glide sign, lung consolidation or other pleural space conditions are likely.
Shred sign (Sh): This Vet BLUE lung sign is an irregular deviation from the normal expected linear continuity of the PP-line representing lung consolidation.
Moreover, within the shred sign, there is evidence of
lung aeration with hyperechoic sparkling or other
air-related artifacts such as comet tails or ULRS
within the shred area. A descriptive analogy likens
the shred sign to thunderstorm clouds rolling across
the screen (partially aerated consolidated lung) with
flashes of lightening distal to the shred (ultrasound

lung rockets representing interstitial edema). Causes

of lung consolidation should most commonly be
considered types of pneumonia in non-trauma cases.
T3: Abbreviation for trauma, triage, and tracking (monitoring) that encompasses all subsets of patients to
benefit from the abdominal or thoracic FAST exams
and the cageside organ assessment exams (COAST3).
TFAST3: Thoracic FAST3 is a five-point thoracic scan
that includes bilaterally the chest tube sites (CTS)
and pericardial sites (PCS) and the single diaphragmatico-hepatic (DH) view.
Tissue (Ti): The Vet BLUE lung sign that appears like
liver (hepatization) with no sparkling or obvious
air artifacts. It indicates a more severe form of lung
consolidation than the shred sign because the airways are filled with fluid or solids (airless). Causes
of severe lung consolidation should be considered.
Ultrasound lung rockets (ULRs): Synonymous with
B-lines. ULRs indicate the presence of interstitial
fluid immediately next to aerated lung. ULRs indicate wet lung or the presence of interstitial edema.
Their presence also rapidly rules out PTX at that
respective point of evaluation on the thorax. ULRs
are hyperechoic, laser-like streaks that do not fade
extending from the pulmonary surface to the far
field, obliterating A-lines. ULRs oscillate with the
to-and-fro motion of inspiration and expiration.
Vet BLUE lung scan (Vet BLUE): Blue (cyanosis) refers
to respiratory distress, and BLUE is an acronym for
bedside lung ultrasound exam. The Vet BLUE is a
regionally-based lung scan that includes the caudal
dorsal (cdll), perihilar (phll), middle (mdll), and cranial
lung lobe (crll) regions for rapid detection of lung
pathology. Serial Vet BLUE exams may be used to
monitor response to therapy in place of thoracic radiographs in many lung conditions. The regional format
is consistent with the manner in which veterinarians
interpret lung findings on thoracic radiographs.
Wet lung: The presence of ultrasound lung rockets
(ULRs) or B-lines generally represent forms of interstitial edema including pulmonary contusions in
trauma cases and forms of interstitial edema in nontrauma. Representing interstitial edema, ULRs or
B-lines precede more serious lung edema (alveolar
flooding) represented by the shred and tissue signs.