Abdominal ultrasound more commonly leads to the diagnosis of underlying comorbidities when compared to thoracic radiographs in dogs undergoing tibial plateau leveling osteotomy.

Abdominal ultrasound detects new comorbidities far more often than thoracic radiographs in preoperative TPLO patients.

This retrospective, multi-institutional study evaluated the diagnostic yield of preoperative abdominal ultrasound versus thoracic radiographs in systemically healthy dogs undergoing tibial plateau leveling osteotomy (TPLO). Medical records from two private-practice facilities were reviewed over a three-year period (June 2019–June 2022), identifying 258 client-owned dogs of various breeds. Of these, 116 dogs (45.0%) received thoracic radiographs only, 10 (3.9%) received abdominal ultrasound only, and 61 (23.6%) received both modalities preoperatively. New comorbidities were identified in 13.8% of dogs that underwent thoracic radiographs compared to 70% of dogs that underwent abdominal ultrasound. Multivariate analysis revealed that abdominal ultrasound was 163 times more likely to lead to a new comorbidity diagnosis than thoracic radiographs. Dogs over 12 years of age had a significantly higher likelihood of receiving a new diagnosis regardless of imaging modality. These findings suggest that abdominal ultrasound offers substantially greater diagnostic utility as a preoperative screening tool in this patient population compared to the more traditionally employed thoracic radiographs. Clinicians performing preoperative workups for elective orthopedic procedures such as TPLO should consider prioritizing abdominal ultrasound, particularly in geriatric patients, to improve detection of occult systemic disease that may influence anesthetic and surgical planning.

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