IMAGING DIAGNOSIS—USE OF MULTIPHASIC CONTRAST‐ENHANCED COMPUTED TOMOGRAPHY FOR DIAGNOSIS OF MESENTERIC VOLVULUS IN A DOG

A 4‐year‐old German shorthaired pointer presented with collapse and hematochezia. Radiographs showed gas and fluid‐distended small intestines and loss of serosal detail. Ultrasound examination showed hypomotile, fluid‐distended small intestines, and thrombosed jejunal veins. Multiphasic contrast‐enhanced computed tomography was performed and showed a CT “whirl sign,” an important but nonspecific sign of intestinal volvulus in human patients. At surgery, the majority of the small intestine was entangled in the volvulus and showed black discoloration. The patient was euthanized. Postmortem evaluation yielded a diagnosis of jejunoileal mesenteric volvulus secondary to a congenital omphalomesenteric duct remnant.     

Migration of retrobulbar wooden foreign body between diagnostic imaging and surgical extraction in a German shepherd dog

A 2‐year‐old, male castrated German shepherd dog was presented to the University of Tennessee Veterinary Medical Center (UTVMC) with periorbital swelling and conjunctival mucopurulent discharge 2 days following removal of a twig from the medial canthus by the owner. Diagnostic imaging was pursued due to the suspicion of a retrobulbar foreign body (FB). A cylindrical FB approximately 3.0 cm in length and 1.0 cm in diameter with concentric rings, suspected to be wooden material, was identified on computed tomography (CT) imaging. An attempt to remove the FB via a stab incision using ultrasound guidance was unsuccessful, and postmanipulation ultrasound confirmed the FB position was unchanged. An exploratory orbitotomy was performed, using the acquired CT images for guidance in locating the FB; however, the FB was not present at the predicted site. The CT imaging was repeated and showed that the FB had migrated rostrally approximately 3.0 cm, compared to the originally acquired study and its same location during attempted ultrasound‐guided removal. A combination of CT‐guided needle placement and contrast injection was then used with repeat imaging in an attempt to better localize the FB and its soft tissue tract. The dog was taken back into the operating room, and the wooden FB was successfully removed.     

INTRAARTERIAL INJECTION OF IODINATED CONTRAST MEDIUM FOR CONTRAST ENHANCED COMPUTED TOMOGRAPHY OF THE EQUINE HEAD

Minimizing the volume of contrast administered for contrast‐enhanced computed tomography (CT) of the equine head is desirable for reducing costs and risks of adverse reactions, however evidence‐based studies on the effects of varying volumes on image quality are currently lacking. The objective of the current study was to determine whether low‐volume intraarterial administration of contrast medium would result in an equivalent image quality and tissue attenuation vs. high‐volume intravenous bolus administration. A prospective cross‐over experimental design was used in a sample of six horses. After anesthetic induction, the right carotid artery was exposed surgically and catheterized. Four CT scans of the cranium were performed for each horse: baseline, immediately following intraarterial contrast injection, five‐min postinjection (return to baseline) and a final scan after intravenous contrast administration. Soft tissue attenuation in predetermined regions of interest (ROI); and length, width, and height measurements of the pituitary gland were recorded at each time point. Horses were euthanized and measurements of the pituitary gland were repeated postmortem. No adverse reactions to contrast administration were observed. Intraarterial and intravenous administration of contrast medium resulted in significantly greater soft tissue enhancement of some brain ROI's and the pituitary gland vs. baseline values. Pituitary gland measurements made on postcontrast CT images did not differ from those obtained during postmortem examination. Findings indicated that low‐dose intraarterial administration of contrast material in the equine head resulted in comparable soft tissue enhancement vs. high volume intravenous administration.     

IMAGING DIAGNOSIS—MULTIMODALITY FINDINGS IN AN ADULT DOG WITH PRIMARY SARCOMA OF THE PULMONARY ARTERY AND MYOCARDIAL METASTASES

Intravascular pulmonary artery sarcomas in combination with myocardial metastasis are rare in dogs. We describe the radiographic, echocardiographic, and electrocardiographic‐gated (ECG‐gated) computed tomographic angiography (CTA) findings in a dog with pulmonary artery sarcoma. All imaging studies demonstrated severe main pulmonary artery enlargement. Echocardiography and ECG‐gated CTA revealed a mass occluding the lumen of the right pulmonary artery. In addition, CTA revealed focal left ventricular myocardial contrast enhancement and parenchymal lung changes. Postmortem examination confirmed the presence of a large thrombus associated with arteriosclerosis and an intravascular sarcoma in the right pulmonary artery with metastases to the myocardium, lungs and brain.     

CONTRAST-ENHANCED COMPUTED TOMOGRAPHIC IMAGING OF THE AUDITORY TUBE IN MESATICEPHALIC DOGS

Computed tomography after contrast medium injection was performed in three mesaticephalic canine cadavers to image the auditory tube. Cadavers were positioned in lateral recumbency for imaging. A myringotomy incision was made in the left tympanic membrane of each dog, and contrast medium was infused into the ear canal and middle ear through a balloon-tip catheter. With this method, contrast medium filled the left bulla and auditory tube in all three cadavers. Computed tomography following contrast medium injection was effective for evaluation of the canine auditory tube. Future studies are required to determine the usefulness, as well as the safety, of this procedure in the evaluation of the auditory tube in other breeds of dogs as well as dogs with otitis     

THE EFFECTS OF PATIENT POSITIONING AND SLICE SELECTION ON CANINE ACETABULAR ANGLE ASSESSMENT WITH COMPUTED TOMOGRAPHY

Acetabular angles (AAs) and dorsal acetabular rim angles acquired by computed tomographic (CT) imaging have been used to assess patient response to juvenile pubic symphysiodesis surgery. The purpose of this study was to evaluate the effects of patient positioning and slice selection on these angles, and an attempt was made to devise a repeatable method of measuring these angles that would eliminate positioning effects. We found significant variation in AAs with small differences in pelvic tilt and slice selection. Dorsal acetabular rim angles were not affected. As a result of positioning differences from one CT study to the next, every attempt should be made to standardize pelvic tilt, or eliminate its effect on AAs by standardizing gantry angle in relation to an anatomic landmark that will not change over time. The floor of the sacral vertebral canal may be a reasonable landmark for this purpose and deserves further study.     

A COMPARISON OF THE ROSTROCAUDAL OPEN MOUTH AND ROSTRO 10° VENTRO-CAUDODORSAL OBLIQUE RADIOGRAPHIC VIEWS FOR IMAGING FLUID IN THE FELINE TYMPANIC BULLA

Fluid within the tympanic bulla is an indication of middle ear disease. Radiography has a relatively low accuracy for the detection of soft tissue opacification in the tympanic bulla, and the most useful radiographic projection, the rostrocaudal open mouth (RCd (open mouth)), is technically difficult to perform in dogs and cats. An alternative projection for the feline tympanic bulla, the rostro 10 degrees ventro-caudodorsal oblique (R10 degrees V-CdDO), was compared to the RCd (open mouth) in 41 feline cadaver heads with the tympanic bullae randomly filled with KY jelly. Computed tomography was used as the gold standard. Each tympanic bulla was recorded as being positive or negative for soft tissue opacification. Although there was no significant difference between the accuracy of the two views, the R10 degrees V-CdDO was subjectively more accurate and easier to perform, and in a live patient may be performed without the need for general anesthesia. The R10 degrees V-CdDO projection is a good alternative to the RCd (open mouth) projection for detecting otitis media in the cat.     

ACQUIRED PORTAL COLLATERAL CIRCULATION IN THE DOG AND CAT

We describe patterns of acquired portal collateral circulation in dogs and in a cat using multidetector row computed tomography angiography. Large portosystemic shunts included left splenogonadal shunts in patients with portal hypertension. Small portal collaterals were termed varices; these collaterals had several patterns and were related either to portal vein or cranial vena cava obstruction. Varices were systematized on the basis of the venous drainage pathways and their anatomic location, namely left gastric vein varix, esophageal and paraesophageal varices, gastroesophageal and gastrophrenic varices, gallbladder and choledocal varices, omental varices, duodenal varices, colic varices, and abdominal wall varices. As reported in humans and in experimental dog models, esophageal and paraesophageal varices may result from portal hypertension that generates reversal of flow, which diverts venous blood in a cranial direction through the left gastric vein to the venous plexus of the esophagus. Blood enters the central venous system through the cranial vena cava. Obstructions of the cranial vena cava can lead to esophageal and paraesophageal varices formation as well. In this instance, they drain into the azygos vein, the caudal vena cava, or into the portal system, depending on the site of the obstruction. Gallbladder and choledocal varices, omental varices, duodenal varices, phrenico-abdominal varices, colic varices, abdominal wall varices drain into the caudal vena cava and result from portal hypertension. Imaging plays a pivotal role in determining the origin, course, and termination of these vessels, and the underlying causes of these collaterals as well. Knowledge about these collateral vessels is important before interventional procedures, endosurgery or conventional surgery are performed, so as to avoid uncontrollable bleeding if they are inadvertently disrupted.