February 2026
In this VETgirl online veterinary continuing education blog, Drs. Natasha Yeh and Christopher Kennedy, DACVECC, DECVECC explore common mistakes in veterinary-focused cardiac ultrasound (FCU). They highlight pitfalls such as misinterpretation, over-reliance on ultrasound alone, and artifacts, emphasizing the importance of clinical integration and cautious interpretation for accurate diagnosis and patient care.

Do you need to brush up on what FCU is and how to identify it? Check out more blogs by Drs. Natasha Yeh and Christopher Kennedy, DACVECC, DECVECC on FCU HERE!

Common Mistakes in Focused Cardiac Ultrasound

By Drs. Natasha Yeh and Christopher Kennedy, DACVECC, DECVECC

The advent of point-of-care ultrasound (POCUS) modalities has been a game-changer in emergency medicine. They can help us efficiently reach a diagnosis and identify the need for immediate interventions. Interestingly, failure to perform POCUS, rather than mistakes made during its use, is the primary reason for POCUS-related legal complaints in human medicine.1

Mistakes do happen, however. In this post, we will review some of the mistakes made in focused cardiac ultrasound (FCU) in hopes that you will recognize them when they occur in practice. As has been emphasized throughout this series, it is important to remember that FCU ≠ echocardiography, which remains rooted in the realm of cardiology. When in doubt, consultation with your local cardiologist is recommended.

Led Down the Garden Path

“To be deceived or enticed into believing something that is untrue.”

FCU is efficient: one finding leads to another, which leads to another; before you know it, you have followed your paradigm to its logical conclusion, made your diagnosis and selected your intervention. The garden path analogy applies when you take a wrong turn and follow that path to its logical – and clinically incorrect or irrelevant – conclusion. In this scenario, you can end up somewhere far from the truth and it can take a while to get back there. Remember to pause, think and consider your steps before merrily walking down that path.

Exclusive Relationships

One human, one ultrasound: a beautiful match! Unfortunately, much like measuring lactates, FCU is only one piece of the clinical puzzle. Mistakes are made when FCU is used exclusively to dictate management at the expense of other vital information, such as the history, physical exam with serial re-assessment, and other diagnostic results. The key to using FCU appropriately is clinical integration (i.e., how does your FCU fit with the other data points in the entirety of the case?).

 

Misplaced Faith

Two errors fall within this category: misinterpretation and overinterpretation. Misinterpretation is simple, you see something and you misinterpret what it is or what it means. Over-interpretation occurs when you see something and overemphasize its meaning. A classic example is B-lines in lung ultrasound or perceived left atrial enlargement in FCU. Some number of B-lines can be normal2 and B-lines can be created by turning up the gain.3 Left atrial enlargement can be misinterpreted or overinterpreted. Misinterpretation can occur with subjective assessment (“eyeballing”) or through acquisition and measurement error. Overinterpretation occurs when a patient truly has left atrial enlargement, but it is not their primary problem, for example a patient clinically affected by aspiration pneumonia with concurrent stage B2 left-sided cardiac disease. In both scenarios – B-lines and left atrial enlargement – the patient is at risk of receiving inappropriate treatments.

The Dunning-Kruger graph illustrates that people with limited knowledge often overestimate their abilities, while experts are more aware of their limitations.

Registry of Missing People

Ultrasound has enabled us to see more than ever. We can see the heart beating in real time (🤯). But what about the things that you didn’t see? All ultrasound modalities are limited by the skill and experience of the operator, as well as the imaging windows and quality of images obtained. Sometimes, the challenge isn’t identifying a problem, it’s missing one. We can see what we can see, but we cannot know what we didn’t see. For instance, consider missing a right atrial mass in a dog with pericardial effusion. At our facility, our cardiology wizards often identify masses that weren’t initially identified via FCU in the emergency room.

UFOs – do you believe in ghosts?

Ultrasound artifacts and their genesis is a fascinating world of sound waves and physics.4 For this problem, rather than not seeing things that matter, the problem is seeing things that do not exist. Obviously, if interpretations and clinical decision making are based on things that are not really there, this can lead to serious errors. To combat this problem, optimize your settings (i.e., recall blog #2 where we talked about knobology). An optimized image will help reduce artifacts. Specifically, avoiding over-gaining and turning down the room lights can have huge impacts on the quality of images and help avoid the phenomenon of ultrasound ghost!

References

  1. Russ B, Arthur J, Lewis Z, Snead G. A review of lawsuits related to point-of-care emergency ultrasound applications. J Emerg Med. 2022 Nov;63(5):661-72. doi: 10.1016/j.jemermed.2022.04.020.
  2. Boysen S, Chalhoub S, Gommeren K. The essentials of veterinary point of care ultrasound: pleural space and lung. Milan: Edra Publishing; 2022. p. 47-8.
  3. Matthias I, Panebianco NL, Maltenfort MG, et al. Effect of machine settings on ultrasound assessment of B-lines. J Ultrasound Med. 2020 Dec 2;40(10):2039-46. doi: 10.1002/jum.15581.
  4. Huang SJ. Ultrasound physics. In: Slama M, editor. Echocardiography in ICU. Cham: Springer; 2020. p. 1-22. doi: 10.1007/978-3-030-32219-9_1.

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