ULTRASONOGRAPHY OF THE NORMAL FELINE PANCREAS AND ASSOCIATED ANATOMIC LANDMARKS: A PROSPECTIVE STUDY OF 20 CATS

The sonographic appearance of the feline pancreas and associated anatomic landmarks including the pancreatic duct, duodenum, duodenal papilla, portal vein, and gastric lymph node were evaluated in 20 healthy, awake cats. The pancreas appeared nearly isoechoic to surrounding mesenteric tissues, isoechoic to slightly hyperechoic to adjacent liver lobes, and hypoechoic to the spleen. The mean thickness measurements for the right pancreatic lobe, body, and left pancreatic lobe were 4.5 mm (range 2.8-5.9), 6.6 mm (range 4.7-9.5), and 5.4 mm (range 3.4-9.0), respectively. The pancreatic duct was consistently visualized in the left pancreatic lobe and had a mean thickness of 0.8 mm (range 0.5-1.3). It could be differentiated from the pancreatic vessel, by its central location, and the duct's lack of Doppler flow signal. The duodenum was used as a landmark to identify the right lobe of the pancreas. The mean duodenal wall thickness measurement was 2.8 mm (range 2.1-3.8) in sagittal section, and 3.0 mm (range 2.2-4.4) in transverse section. The duodenal papilla was identified in 4 of 20 cats. It ranged in size from 2.9 to 5.5 mm in width, and had a maximum height of 4.0 mm in transverse section. The portal vein was used as a consistent anatomic landmark for identification of the left lobe and body of the pancreas. The mean diameter of the portal vein at the level where the pancreatic body joins the left pancreatic lobe was 4.3 mm (range 2.7-5.9) when viewed in sagittal section, and 4.5 mm (range 3.6-6.1) in transverse section. The gastric lymph node was identified cranial and ventromedial to the pyloroduodenal angle in 6 of 20 cats. It had an asymmetrical shape with a larger caudal pole in five of the six cats. The largest dimensions of the gastric lymph node were 10 mm in length, and 6 mm in width for the larger caudal pole, and 5.1 mm in width for the smaller cranial pole.     

ENDOSCOPIC ULTRASOUND OF THE CANINE ABDOMEN

The aim of this study was to develop a standardized procedure for examination of the canine abdomen using endoscopic ultrasound and to describe the organs and structures that could be identified transgastrically. The abdomen of four healthy dogs and two cadavers were examined with endoscopic ultrasound. Five anatomic landmarks were used for standardized imaging of the cranial abdomen. These were the portal vein, splenic head and body, duodenum, left kidney, and aorta. High-resolution images of the following organs and structures could be made: distal esophagus, gastric wall from the cardia to the pylorus, liver, caudal vena cava, hepatic lymph nodes, liver hilus, and associated vessels, trifurcation of the celiac artery as well as the path of its branches and the left pancreatic limb and body. Structures that were more difficult to image were the distal duodenum and right pancreatic limb, the entire jejunum, ileum, and cecum as well as the tail of the spleen. Endoscopic ultrasound allowed excellent visualization of the gastric wall and regional structures without interference with gas artefacts. Centrally located organs such as the pancreas could be well examined transgastrically with endoscopic ultrasound without interference by overlying intestinal segments as is common with transabdominal ultrasound.     

ULTRASONIC EXAMINATION OF THE PANCREAS IN HEALTHY COWS

The purpose of this study was to describe the ultrasonographic appearance of the normal bovine pancreas and to establish reference values for healthy cattle. Ultrasonographic examinations were performed on the right side of 20 healthy cows. Ultrasonographically the body and right limb of pancreas appeared as a triangle-shaped structure associated with the liver, portal vein, right kidney, and duodenum. In comparison to normal liver, the pancreas appeared isoechoic or slightly more echogenic. The right lobe of the pancreas was evaluated from the right flank to the eleventh intercostal space, and the body of the pancreas was visualized from the twelfth to the tenth intercostal space. The left lobe of the pancreas could not be seen because of its dorsomedial location. In 9 cows, the accessory pancreatic duct was located near the right lobe of the pancreas and appeared as two parallel echogenic lines with a hypoechogenic area between them. The diameter of the accessory pancreatic duct varied from 6 to 8 mm. The pancreaticoduodenal vein was seen in 5 cows. The diameter of the pancreaticoduodenal vein varied from 3 to 4 mm. The ultrasonographic characteristics determined in this study may serve as a reference in the evaluation of cows with suspected pancreatic disease.     

Gross Anatomy of the Pancreatic Lobes and Ducts in Six Breeds of Domestic Ducks and Six Species of Wild Ducks in China

A previously unreported pancreatic duct was found by Liu (1989) in Pekin ducks. This duct has now been consistently found in six breeds of domestic ducks and six species of wild ducks in China. For purposes of Nomina Anatomica Avium it is hereby called the ‘first pancreatic duct’(Ducius pancreaticus primus) since it enters the duodenum at or near the flexure where the descending duodenum becomes the ascending duodenum. All other pancreatic ducts enter the duodenum later, closer to where it joins the jejunum. This first pancreatic duct drains the caudal extremity of the dorsal lobe of the pancreas and can be easily exteriorized for experimental purposes. Within the parenchyma of the dorsal lobe of the pancreas this duct communicates with the dorsal pancreatic duct. In the present study of the gross anatomy of the pancreatic lobes of domestic and wild Chinese ducks we describe and illustrate variations in position and number of all biliary and pancreatic ducts.     

Dimensional ultrasonographic relationship of the right lobe of pancreas with associated anatomic landmarks in clinically normal dogs

The purpose of this prospective study was to establish the ultrasonographic characteristics of the dimension of the right pancreatic lobe with that of the associated anatomic landmarks in healthy dogs. Ultrasonographic examinations were performed on 25 dogs. The thickness of the right pancreatic lobe was compared with that of mural thickness of duodenum, diameter of duodenum, pancreatic duct, abdominal aorta, portal vein, caudal vena cava, and length and width of the right kidney and right adrenal gland. The correlation between each pancreatic parameter and the dimensions of the anatomical landmarks were assessed using linear regression analysis and Pearson’s correlation coefficient (r) test. Significant, but weak linear correlations were observed between thickness of right pancreatic lobe with that of duodenum mural thickness (r=0.605, R²=0.339, P=0.001); duodenum diameter (r=0.573, R²=0.299, P=0.003); and right adrenal gland length (r=0.508, R²=0.052, P=0.01). There was no significant dimensional relationship with other selected anatomic landmarks. The ratio between the thickness of right pancreatic lobe and the mural thickness of duodenum, diameter of duodenum and length of right adrenal gland were 2.88 ± 0.53, 1.27 ± 0.27 and 0.81 ± 0.15, respectively. Calculating the ratio of thickness of the right pancreatic lobe with the dimension of significantly correlated anatomic landmarks is a useful and simple method for evaluating the size of the right pancreatic lobe in dogs in clinical practice.     

A new dissection technique for approach to right-sided intrahepatic portosystemic shunts: anatomic study and use in three dogs

OBJECTIVE : To determine the feasibility of indirect suture passage around the right portal vein for attenuation of right-sided intrahepatic portosystemic shunts (IHPSS). STUDY DESIGN : Anatomic study of cadavers and prospective evaluation of clinical cases. ANIMALS : Nine canine cadavers (median weight, 20.5 kg) and 6 client-owned dogs suspected of having right-sided IHPSS. METHODS : Silicone casts of the caudal vena cava and pre- and intrahepatic portal veins were made in fresh canine cadavers. A suture was passed dorsal to the portal vein above and below its bifurcation and pulled laterally so that it surrounded the right portal vein. The number and size of portal and caudal vena cava branches that interfered with the suture passage were recorded. Intra- and postoperative complications were evaluated in 3 dogs with right-sided IHPSS and 3 dogs suspected of having right-sided IHPSS that had right portal vein dissection and occlusion using this technique. RESULTS : Suture passage and placement around the right portal vein were easily accomplished in all 9 specimens. A 1 mm branch from the dorsal surface of the right portal vein was included in the encircling ligature in 4 specimens. The dissection technique was used successfully in 3 dogs with right-sided IHPSS and 2 other clinical cases. The portal branch to the papillary process of the caudate lobe interfered with suture placement in 1 dog with a central IHPSS. CONCLUSIONS : Indirect suture passage for ligation of the right portal vein can be successfully performed in normal dogs and dogs with congenital portosystemic shunts. CLINICAL RELEVANCE : Hemorrhage, vascular trauma, and surgery time may be reduced using this technique for attenuation of right-sided IHPSS.     

Triple phase computed tomography of the pancreas in healthy cats

While the availability and use of computed tomography (CT) continues to grow, no study has described the size and multiphase CT appearance of the normal feline pancreas. This information is important to not only allow more accurate identification and differentiation of disease, but it may also be useful in assessing pancreatic function. In this prospective analytical study, we described a triple phase CT protocol of the pancreas for use in sedated cats and the attenuation, enhancement pattern, size, and volume of the pancreas for a group of healthy cats. Fifteen healthy cats were enrolled in the study and a standardized protocol for acquiring arterial, portal, and delayed phase CT images of the pancreas was developed and described. The pancreas was hypo to isoattenuating to both the liver and spleen in all phases in the majority of cats with a homogenous enhancement pattern noted in all 15. Mean pancreatic attenuation was 48, 79, 166, and 126 Hounsfield units (HU) respectively on precontrast, arterial, portal, and delayed phase images. In addition, mean height, length, and width of the left lobe of the pancreas were larger than the right lobe in all 15 cats. There were no associations between volume and volume: body weight ratio with age (P = 0.6518, P = 0.6968) or sex (P = 0.7013, P = 0.2043). This baseline information may be beneficial for use in future studies characterizing pancreatic disease in cats as well as future research studies evaluating pancreatic endocrine function.     

HELICAL COMPUTED TOMOGRAPHIC ANGIOGRAPHY OF THE NORMAL CANINE PANCREAS

Helical abdominal computed tomography (CT) was performed in nine normal beagle-mix dogs. Following cephalic vein injection of ionic iodinated contrast medium via power injector (rate 5 ml/s) dual-phase CT was performed in all dogs. A delayed scan was performed in five dogs between 5 and 13 min after the contrast medium injection. The median time of appearance of contrast medium in the aorta and gastroduodenal artery was 6.3 and 7 s, post start injection and 12 and 12.2 s in the gastroduodenal and portal vein, resulting in a purely arterial pancreatic time window of 5-6s. Pancreatic veins and parenchyma remained enhanced until the end of the dynamic scan (40s). The pancreatic parenchyma showed heterogeneous arterial and homogenous venous contrast enhancement which was slightly hypoattenuating compared to the liver. Delayed scans provided best delineation of the pancreas from the liver. The common bile duct could be identified ventral and to the right of the portal vein joining the dorsomedial aspect of proximal duodenum. Because of the very short time window and variable onset of pure arterial enhancement careful planning of dual-phase studies with previous dynamic CT is recommended. Dual-phase CT angiography enables assessment of the arterial supply, parenchymal perfusion and venous drainage of the canine pancreas.     

Immunocytochemical component of endocrine cells in pancreatic islets of horses

The endocrine cell components in the pancreatic islets of the following 4 pancreatic regions of the horse were investigated by immunohistochemical methods: lobus pancreatis sinister (left lobe); lobus pancreatis dexter (right lobe); and 2 regions of Corpus pancreatis (body), the duodenal lobe which lies along the cranial duodenal flexure and descending duodenum, and the intermediate lobe which is situated around the portal vein. The islets in the left and intermediate lobes contained a central mass of glucagon cells surrounded by insulin cells, a few somatostatin cells and sporadic pancreatic polypeptide (PP) cells. On the other hand, the islets in the duodenal lobe were small in size compared with the other 3 regions, and were predominant in insulin and pancreatic polypeptide (PP) cells, but almost lacked in glucagon cells. These findings suggested that the duodenal lobe was derived from the ventral pancreatic primordium, and the left and intermediate lobes were originated from the dorsal pancreatic primordium. In the right lobe, the composition and distribution of the islet cells were almost the same as those in the left and intermediate lobes, but there were several lobules containing numerous PP cells as seen in the duodenal lobe.     

Quantification of the effect of various patient and image factors on ultrasonographic detection of select canine abdominal organs.

We assessed factors that affected ultrasonographic visualization of the pylorus, duodenal papilla, pancreas, adrenal glands, and jejunal and medial iliac lymph nodes in the dog. An abdominal ultrasonographic examination was performed on 100 canine patients, equally divided between two facilities. The pylorus was visible in 64% of the dogs, the major duodenal papilla in 42%, the left pancreatic lobe in 56%, the body of the pancreas in 60%, the right pancreatic lobe in 87%, the left adrenal gland in 91%, the right adrenal gland in 86%, the medial iliac lymph nodes in 54%, and the jejunal lymph nodes in 51%. The parameters that negatively influenced the visibility of these organs were the presence of air or food in the gastrointestinal tract (pancreas, duodenal papilla), age (lymph nodes), and body weight (pancreas, duodenal papilla). The parameters that positively influenced their visibility were the presence of air or food in the gastrointestinal tract (lymph nodes), body weight (lymph nodes), body condition score (right adrenal gland), and inherent image quality (left pancreatic lobe). There was a significant difference between the two institutes for the visualization of the pylorus, pancreas, and lymph nodes, which was probably related to different body positions used for scanning in each institution.     

Establishment of optimal scan delay for multi-phase computed tomography using bolus-tracking technique in canine pancreas

To establish a protocol for a multi-phase computed tomography (CT) of the canine pancreas using the bolus-tracking technique, dynamic scan and multi-phase CT were performed in six normal beagle dogs. The dynamic scan was performed for 60 sec at 1-sec intervals after the injection (4 ml/sec) of a contrast medium, and intervals from aortic enhancement appearance to aortic, pancreatic parenchymal and portal vein peaks were measured. The multi-phase CT with 3 phases was performed three times using a bolus-tracking technique. Scan delays were 0, 15 and 30 in first multi-phase scan; 5, 20 and 35 in second multi-phase scan; and 10, 25 and 40 sec in third multi-phase scan, respectively. Attenuation values and contrast enhancement pattern were analyzed from the aorta, pancreas and portal vein. The intervals from aortic enhancement appearance to aortic, pancreatic parenchymal and portal vein peaks were 3.8 ± 0.7, 8.7 ± 0.9 and 13.3 ± 1.5 sec, respectively. The maximum attenuation values of the aorta, pancreatic parenchyma and portal vein were present at scan sections with no scan delay, a 5-sec delay and a 10-sec delay, respectively. When a multi-phase CT of the canine pancreas is triggered at aortic enhancement appearance using a bolus-tracking technique, the recommended optimal delay times of the arterial and pancreatic parenchymal phases are no scan delay and 5 sec, respectively.     

Effect of body position on ultrasonographic estimations of bladder volume

A study was undertaken to determine the effect of body position on ultrasonographic bladder measurements and volume estimations. Of the 42 dogs studied, 15 were fresh canine cadavers without urological disease and the remaining 27 were undergoing investigations for disorders of the lower urinary tract. Bladder volume was estimated using a formula described previously. Irrespective of whether all dogs were considered together or only live animals were included, measurements made in dorsal recumbency tended to underestimate bladder volume while those made in right lateral recumbency resulted in overestimation. This was due to significant differences in all linear measurements, apart from width, between body positions. Measurements in right lateral recumbency were higher than those in dorsal recumbency. In all animals and in living dogs alone, bladder measurements in dorsal recumbency appeared to give a more accurate estimation of actual bladder volume.     

Diseased dogs isoamylases in clinically normal and diseased dogs

Isoamylases in normal canine sera were separated on cellulose acetate membranes using a discontinuous buffer system without EDTA. Four peaks of amylase activity were present in 17 of 24 sera. Normal values were established. The majority of activity was present in Peak 4 (cathodal isoamylase). Tissue extracts of pancreas, duodenum, kidney, lung, testis, spleen and uterus-ovaries contained Peak 4 isoamylase. Liver and salivary gland lacked all isoamylase activity. Pancreas contained Peak 3 in addition to Peak 4 isoamylase. A tissue origin for Peaks 1 and 2 was not identified. An overall lack of resolution resulted from the inclusion of EDTA in the electrophoresis buffer system. This may account for previous findings suggesting that pancreatic amylase is not present in normal canine serum. An increase in the Peak 3 isoamylase was present in dogs with pancreatitis while dogs with pancreatic atrophy had a decrease in all isoamylases. Total amylase activity was significantly (p < 0.05) decreased in dogs with pancreatic atrophy.     

Computed Tomography Atlas of the Normal Cranial Canine Abdominal Vasculature Enhanced by Dual‐phase Angiography

This study was performed to provide a detailed atlas of the normal arterial and venous canine vasculature in the cranial abdomen by dual‐phase computed tomographic angiography. Five adult beagles were positioned in dorsal recumbency on a multislice helical CT scanner. An unenhanced survey CT scan from the diaphragm to the pelvic inlet was performed. Bolus‐tracking software was used for the dual‐phase angiogram, and contrast medium was administered in a cephalic vein. The arterial phase was scanned from the mid‐abdomen to the cranial aspect of the diaphragm; the portal phase was scanned a few seconds after the arterial phase in the opposite direction. The DICOM studies from all dogs were analysed. Representative images were selected and anatomic structures labelled. Maximum intensity projections and three‐dimensional images were generated using software techniques. A detailed atlas of the venous and arterial vasculature of the cranial canine abdomen was created with the help of bolus‐tracking dual‐phase computed tomographic angiography (CTA). Practitioners can use this anatomic atlas with its detailed venous and arterial phase CT angiograms of the canine cranial abdomen to compare normal versus abnormal vascular anatomy.     

Hilar Liver Resection in Dogs

Objective— To describe hepatic vasculobiliary anatomy important to hilar liver lobe resection in the dog.
Study Design— Experimental study.
Animals— Canine cadavers (n=7).
Methods— The vasculobiliary system of 7 fresh canine livers was injected with a polymer. The parenchyma was dissected at the level of the hilus to determine the vascular and biliary supply to each liver lobe, and then macerated with a corrosion preparation. The information gathered was used to describe a surgical approach for hilar liver lobe resection.
Results— Each liver lobe had a single hepatic artery and biliary duct. The location of these structures was consistent, although minor variations existed (dorsal versus ventral to the lobar portal vein) in the left lateral lobe and papillary process in 2 specimens. Most liver lobes (34/49) were supplied by 1 lobar portal vein and drained by 1 lobar hepatic vein (39/49). The location of the portal and hepatic veins was consistent among specimens.
Conclusions— The left division is the most mobile of the liver lobes and each lobe can be removed separately or en bloc. Because of the location of the hepatic veins, the central division is best removed as a single unit. The right lateral lobe can be removed individually or together with the caudate process. The papillary process is removed by itself.
Clinical Relevance— A hilar liver lobectomy technique can provide an alternative approach to conventional procedures for tumors that encroach upon the hilus of the liver.     

DYNAMIC COMPUTED TOMOGRAPHY OF THE PANCREAS IN NORMAL DOGS AND IN A DOG WITH PANCREATIC INSULINOMA

To establish optimal imaging conditions for enhanced computed tomography (CT) for canine pancreatic tumors, 10 healthy beagles were subjected to dynamic CT. This technique was then applied to a dog with suspected insulinoma. The changes in mean peak enhancement and the delay time of the aorta and pancreas were determined. In normal beagles, maximal arterial and pancreatic CT enhancement was observed at 15 +/- 2 s (795 +/- 52 Housfield unit [HU]) and 28 +/- 9 s (118 +/- 16HU) after contrast medium injection, respectively. Multiphase enhanced CT was performed in a pug with suspected insulinoma using the CT protocol defined for the normal beagles with some parameters modified; the images were acquired at the arterial (14 s after contrast medium injection), pancreatic (after 28 s), and equilibrium (after 90 s) phases; scanning was followed by exploratory laparotomy. CT images were characterized by an enhanced mass in the left pancreatic lobe at the arterial phase, during which the difference between the CT values of the mass and normal pancreas was the highest. Histopathologic diagnosis of the pancreatic mass was insulinoma. Thus, it appears that enhanced CT imaging can be used to delineate the pancreas from a pancreatic mass, and it may be helpful in deciding the need for surgery.     

Effect of body position on cranial migration of epidurally injected methylene blue in recumbent dogs

OBJECTIVE: To determine the relationship between different body positions during recumbency on the cranial migration of epidurally injected methylene blue in canine cadavers. SAMPLE POPULATION: 21 fresh cadavers of clinically normal adult female mixed-breed dogs. PROCEDURE: Dogs were randomly assigned to the following 3 groups: dogs remaining in right lateral recumbency (n = 7), dogs rotated from left to right lateral recumbency (7), and dogs rotated from dorsal to right lateral recumbency (7). Each dog received an epidural injection of 0.05% methylene blue (0.1 mL/kg) at the lumbosacral space. A dorsal laminectomy of the vertebral column was made, and cranial extent of methylene blue in 4 quadrants (right lateral, left lateral, ventral, and dorsal) was determined by examining dura mater staining. RESULTS: No significant difference was found among groups in regard to body weight or body condition score. Epidural cranial migration of methylene blue in the right lateral quadrant was significantly greater in dogs that remained in right lateral recumbency than in dogs that were rotated from left to right lateral recumbency. No significant difference was found within groups for epidural cranial migration of methylene blue between each quadrant. No significant relationship was found between body weight or body condition score and epidural cranial migration of methylene blue. CONCLUSIONS AND CLINICAL RELEVANCE: Body positioning and amount of recumbency time influence cranial migration of epidurally injected methylene blue. If greater cranial migration of an epidurally administered drug is desired, placing the patient in lateral recumbency with the surgical site on the dependent side may precede surgery.     

Sonographic evaluation of the normal and abnormal pancreas

Pancreatic disorders in dogs and cats are recognized with increasing frequency, and abdominal ultrasonography has assumed an important role in their diagnosis. The normal pancreas is a small, inconspicuous organ of comparable echogenicity to surrounding mesentery and may be difficult to identify. Therefore, knowledge of anatomic landmarks such as portal vein and contributing vessels, duodenum, and stomach is necessary to facilitate identification and examination. Pancreatic diseases and abnormalities frequently investigated by means of ultrasonography include pancreatitis, pseudocysts, abscesses, neoplastic lesions, and nodular hyperplasia. Disorders less commonly seen include exocrine pancreatic insufficiency, pancreatolithiasis, congenital anomalies, and pancreatic edema. Unfortunately, ultrasonographic findings in various pancreatic disorders overlap, and incidental findings or age-related changes may mimic pancreatic disease. On the other hand, pancreatic disorders may not cause changes in ultrasonographic appearance. Ultrasonographic findings, therefore, have to be judged in light of signalment, history, and laboratory data. Cytology or histopathology may be needed to establish a definite diagnosis. Despite these limitations, ultrasonography is useful in diagnosing pancreatic disease, guiding aspirates and biopsies, and monitoring response to treatment.