CORRELATIVE ULTRASOUND ANATOMY OF THE FELINE BRACHIAL PLEXUS AND MAJOR NERVES OF THE THORACIC LIMB

Brachial plexus avulsions commonly occur in cats due to traumatic injuries involving the shoulder. Ultrasound may be an effective method for detecting injured nerves. Additional applications may include characterization of brachial plexus neoplasms and guidance of anesthetic nerve blocks. Aims of this study were to describe ultrasonographic approaches and the normal appearance of this plexus and other major nerves of the thoracic limb in cats. Eight feline cadavers were used to determine anatomic landmarks, obtain cross‐sectional anatomic images of the target nerves, and compare these with ultrasound images. An ultrasonographic study was performed in five fresh feline cadavers to assess the brachial plexus and its major components at the levels of the axilla and proximal, middle and distal (lateral and medial approaches) humeral regions. Five healthy adult cats were recruited for an in vivo ultrasonographic study using the same protocol described for the cadaver ultrasonographic study. The roots of the brachial plexus appeared as a cluster of small, round hypoechoic structures surrounded by a hyperechoic rim in the axillary approach. The radialis, medianus, and ulnaris nerves were individually visualized on proximal and middle humeral approaches. The medianus and ulnaris nerves were easily identified on the medial aspect of the humerus in the distal approach. The superficial branch of radialis nerve was seen on the lateral aspect of the distal humerus approach. The nerves appeared as oval‐to‐round hypoechogenic structures with a hyperechogenic rim. Future studies are needed to compare findings from this study with those in cats with confirmed brachial plexus injuries or other lesions.     

ULTRASONOGRAPHIC ANATOMY OF THE CANINE ELBOW

To produce detailed ultrasonographic images of the soft tissue structures around the canine elbow joint, a series of greyhound cadaver limbs were scanned both intact and dissected in a water bath. Suitable transducer positions and bone landmarks are described and the ultrasonographic appearance of the lateral collateral ligament, anconeal process, triceps tendon, origin of olecranon ligament, biceps tendon insertion, medial collateral ligament, and medial coronoid process are illustrated. Improved understanding of the anatomy of the canine elbow will support clinical ultrasonography of this region.     

ULTRASONOGRAPHIC ANATOMY OF THE NORMAL CANINE CALCANEAL TENDON

To provide a series of detailed ultrasonographic images of the canine calcaneal tendon, greyhound cadaver pelvic limbs were scanned with a high-resolution transducer, and images compared with dissected specimens. The three components of the calcaneal tendon are the tendons of insertion of the gastrocnemius, superficial digital flexor, and a conjoined tendon formed by tendons from the biceps femoris, semitendinosus, and gracilis. Each of these three tendons was visible in transverse ultrasound images, each measuring 2.4-3.2-mm thick at mid-calcaneal tendon. Improved understanding of the anatomy of the calcaneal tendon will support clinical ultrasonography of this region.     

ULTRASONOGRAPHIC EVALUATION OF BRACHIAL PLEXUS TUMORS IN FIVE DOGS

Five dogs with unilateral thoracic limb lameness, neurologic deficits, muscle atrophy, and pain, or a combination of these signs, were examined using ultrasonograghy. Large, hypoechoic tubular masses that displaced vessels and destroyed the normal architecture were found in each dog. The affected axilla of each patient was then imaged with computed tomography or magnetic resonance to fully assess the extent of the masses. We describe the use of ultrasound in screening patients for brachial plexus tumors.     

ULTRASONOGRAPHIC ASSESSMENT OF THE CANINE SCIATIC NERVE

To describe the ultrasonographic technique for investigation of the canine sciatic nerve, four canine cadaver pelvic limbs, two live healthy dogs, and five canine patients with suspected peripheral sciatic nerve lesions were examined with a high-resolution linear ultrasound transducer. The caudal part of the lumbosacral trunk and the origin of the sciatic nerve were visualized through the greater ischiatic foramen. The two components of the sciatic nerve, common peroneal and tibial nerves, were distinguished along the entire length of the nerve, until they branched at the level of the distal femur. In healthy live dogs they appeared as two adjacent hypoechoic tubular structures with internal echotexture of discontinuous hyperechoic bands, surrounded by a thin rim of highly echogenic tissue. The common peroneal component had a smaller diameter and was on the cranial aspect of the tibial component. An ultrasonographic lesion compatible with a peripheral nerve sheath tumor was found in one dog. Improved understanding of the ultrasonographic anatomy of the sciatic nerve supports clinical use of this modality.     

MAGNETIC RESONANCE IMAGING CHARACTERISTICS OF PERIPHERAL NERVE SHEATH TUMORS OF THE CANINE BRACHIAL PLEXUS IN 18 DOGS

Magnetic resonance imaging (MRI) examinations from 18 dogs with a histologically confirmed peripheral nerve sheath tumor (PNST) of the brachial plexus were assessed retrospectively. Almost half (8/18) had a diffuse thickening of the brachial plexus nerve(s), six of which extended into the vertebral canal. The other 10/18 dogs had a nodule or mass in the axilla (1.2-338 cm3). Seven of those 10 masses also had diffuse nerve sheath thickening, three of which extended into the vertebral canal. The majority of tumors were hyperintense to muscle on T2-weighted images and isointense on T1-weighted images. Eight of 18 PNSTs had only minimal to mild contrast enhancement and many (13/18) enhanced heterogeneously following gadolinium DTPA administration. Transverse plane images with a large enough field of view (FOV) to include both axillae and the vertebral canal were essential, allowing in-slice comparison to detect lesions by asymmetry of structures. Higher resolution, smaller FOV, multiplanar examination of the cervicothoracic spine was important for appreciating nerve root and foraminal involvement. Short tau inversion recovery, T2-weighted, pre and postcontrast T1-weighted pulse sequences were all useful. Contrast enhancement was critical to detecting subtle diffuse nerve sheath involvement or small isointense nodules, and for accurately identifying the full extent of disease. Some canine brachial plexus tumors can be challenging to detect, requiring a rigorous multiplanar multi-pulse sequence MRI examination.     

ULTRASONOGRAPHIC ANATOMY OF THE NORMAL CANINE KIDNEY*

Radiographic and ultrasonic examinations were performed in 12 normal dogs. Initial ultrasound examinations were performed in normally hydrated dogs. The ultrasonic appearance of the diuresed kidney was evaluated after excretory urography and intramuscular administration of furosemide. The dogs were euthanized for anatomic correlation with the sonographic appearance of the kidneys. Renal cortex, medulla, pelvic diverticula, intrarenal vessels, renal pelvis, and renal sinus fat were identified sonographically. Kidney enlargement during diuresis was due to increase renal medullary size. Veterinary Radiology, Vol. 25, No. 4, 1984; pp 173–178.     

ULTRASONOGRAPHIC ANATOMY OF THE NORMAL CANINE STIFLE

Ultrasonographic examination of the normal canine stifle joint was performed to characterize its normal anatomy. Stifles of four normal adult dogs were imaged in sagittal and transverse planes and each anatomic structure visualized was recorded. Normal anatomic structures consistently seen included the patellar tendon, medial and lateral menisci, the cranial cruciate ligament and femoral condyle cartilage. The caudal cruciate ligament was visualized in two dogs. Collateral ligaments and meniscal ligaments were not visualized. The dogs were then euthanized and each stifle was isolated. Following removal of superficial muscles and skin, each stifle was imaged in a water bath to definitively identify the structures that had previously been visualized on the live dogs. The ultrasonographic appearance of the isolated stifle specimens was similar to that found in live dogs. The results of this study indicate that ultrasound can be used to image the normal anatomy of the canine stifle. The echogenicity of the patellar ligament, cruciate ligaments, menisci and articular cartilage was similar to that previously reported in equine stifles and human knees.     

NORMAL ULTRASONOGRAPHIC ANATOMY OF THE CANINE NECK

High-resolution, real-time ultrasonographic examinations of the neck were performed on eight normal dogs maintained under general anesthesia. Water-soluble dye was injected into imaged structures under sonographic guidance in two dogs. The anatomy of the neck was verified at postmortem by visualization of dye deposited in the injected structures. Anatomical mapping was then completed by performing complete cervical ultrasound examinations in the remaining six dogs. Normal ultrasonographic anatomy of the canine neck and major anatomic landmarks useful in clinical imaging are described.     

ANATOMY OF THE CANINE ORBITAL REGION

Computed tomography (CT) was used to study the normal anatomy of the orbital region in one Beagle. Direct transverse and reformatted dorsal, sagittal, and oblique plane images were used to distinguish various soft tissue structures. Intraorbital fat provided a natural contrast against which extraocular muscles and nerves could be discerned. The noninvasive nature and the multiplanar imaging capabilities of CT provided a means by which the orbital contents could be precisely localized and differentiated from one another.     

ULTRASONOGRAPHIC FEATURES OF CANINE LIPOMAS

The purpose of this study was to evaluate the ultrasonographic features of canine lipomas. A group of 94 dogs with a soft tissue mass was considered. All dogs were examined ultrasonographically and cyto/histologic examination was performed. Twenty-four dogs, whose mass was diagnosed as a lipoma, were selected. Fifty-five lipomas were present on the 24 dogs. Fifty-one lipomas were superficial and located subcutaneously. Four lipomas were deep and located in the paratesticular region. Ultrasonographically, lipomas appeared as oval, well-defined, encapsulated, striated masses.     

MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF LYMPHOMA INVOLVING THE BRACHIAL PLEXUS IN A CAT

An 11-year-old, neutered, female Domestic Long Hair cat had a 3-week history of left forelimb lameness. Conscious proprioception and postural reflexes were absent on the left thoracic limb. The cat had slightly reduced placing and hopping responses on the left pelvic limb, absent cutaneous trunci muscle reflex on the left side, and left triceps muscle atrophy. Magnetic resonance imaging revealed a 2 x 2 x 2 cm mass in the region of the left brachial plexus. The cat was treated by left forelimb amputation and hemilaminectomy. Histopathology of the brachial plexus revealed lymphoma.     

ULTRASONOGRAPHIC CHARACTERISTICS OF THE ABDOMINAL ESOPHAGUS AND CARDIA IN DOGS

Differential diagnoses for regurgitation and vomiting in dogs include diseases of the gastroesophageal junction. The purpose of this cross‐sectional study was to describe ultrasonographic characteristics of the abdominal esophagus and gastric cardia in normal dogs and dogs with clinical disease involving this region. A total of 126 dogs with no clinical signs of gastrointestinal disease and six dogs with clinical diseases involving the gastroesophageal junction were included. For seven euthanized dogs, ultrasonographic features were also compared with gross pathology and histopathology. Cardial and abdominal esophageal wall thicknesses were measured ultrasonographically for all normal dogs and effects of weight, sex, age, and stomach filling were tested. Five layers could be identified in normal esophageal and cardial walls. The inner esophageal layer was echogenic, corresponding to the cornified mucosa and glandular portion of the submucosa. The cardia was characterized by a thick muscularis, and a transitional zone between echogenic esophageal and hypoechoic gastric mucosal layers. Mean (±SD) cardial wall thicknesses for normal dogs were 7.6 mm (±1.6), 9.7 mm (±1.8), 10.8 mm (±1.6), 13.3 mm (±2.5) for dogs in the <10 kg, 10–19.9 kg, 20–29.9 kg and ≥30 kg weight groups, respectively. Mean (±SD) esophageal wall thicknesses were: 4.1 mm (±0.6), 5.1 mm (±1.3), 5.6 mm (±1), and 6.4 mm (±1.1) for the same weight groups, respectively. Measurements of wall thickness were significantly correlated with dog weight group. Ultrasonography assisted diagnosis in all six clinically affected dogs. Findings supported the use of transabdominal ultrasonography as a diagnostic test for dogs with suspected gastroesophageal disease.     

ULTRASONOGRAPHIC DESCRIPTION OF CANINE MASTITIS

Ultrasonographic images were acquired of the mammary glands of 40 bitches with physiologically lactating (n = 20) or inflamed glands (n = 20). Echogenicity, structure, homogeneity, thickness, and distinguishability of each tissue layer were assessed. Additionally, overall echogenicity was noted. In the normal lactating gland, different tissues could be differentiated easily. The parenchyma was, without exception, separated from adjacent tissues and was visible as medium echogenic tissue with a coarse-grained structure. The tissue always had some echogenic lines and anechoic areas and was slightly heterogeneous. The loss of distinct layering of the tissue was characteristic of an inflamed mammary gland and inflamed regions had reduced echogenicity. Additionally in five bitches with mastitis, the ultrasound examination was repeated five times for documentation of the progress of the illness and associated changes, supplemented with a color Doppler sonogram to assess changes in blood vessel density. Information from the examinations carried out via B-mode did not allow treatment success to be predicted. Two bitches with reduced blood vessel density centrally had a poor outcome whereas three bitches with increased blood vessel density had a good outcome. Thus, Doppler sonography might be a useful tool to obtain information of the prognosis in acute canine mastitis.     

ULTRASONOGRAPHY OF THE NORMAL CANINE GASTROINTESTINAL TRACT

The normal sonographic appearance of stomach, small bowel, and colon was determined in normal dogs of small, medium, and large breeds. In all dogs studied, the stomach wall ranged from 3 mm to 5 mm in thickness, and the small and large bowel wall ranged from 2 mm to 3 mm in thickness. Peristalsis was routinely observed in the stomach and small bowel, but not in the colon. Ultrasonic identification of five gastrointestinal wall layers corresponding to the mucosal surface, mucosa, submucosa, muscularis propria, and subserosa/serosa was possible. Specific segments of the gastrointestinal (GI) tract were isolated and scanned in a water bath. In one dog, ultrasonic and histologic findings were compared and confirmed the anatomical identification found with ultrasound. Similarities and differences between the ultrasonic appearance of the GI tract of humans and small animals are discussed.     

ULTRASONOGRAPHIC DIAGNOSIS OF CANINE HYDROCEPHALUS

The brains of 23 canine patients and six random-source dogs were examined ultrasonographically through the bregmatic fontanelle or a surgical craniotomy. Fifteen dogs had abnormal neurologic signs; the others were normal on neurologic examination. Untrasound results were compared with signalment, clinical signs, electroencephalography, computed tomography, radiology and histopathology. The purposes of the study were to demonstrate the use of ultrasound for the diagnosis of canine hydrocephalus and to determine whether there is a relationship between ventricular size and clinical signs. Lateral ventricles were considered enlarged if lateral ventricular height, ventricle-mantle ratio, or ventricle-hemisphere ratio, at the level of or caudal to the interthalamic adhesion in the transverse plane, exceeded 0.35 cm, 0.25 or 0.19, respectively. Of the 29 dogs examined, 14 had enlarged lateral ventricles and abnormal neurologic signs. Five dogs had enlarged lateral ventricles but appeared neurologically normal (occult hydrocephalus). Correlation was poor between ventricular size and clinical signs.     

ULTRASONOGRAPHIC ANATOMY OF THE NORMAL CANINE SPINAL CORD AND CORRELATION WITH HISTOPATHOLOGY AFTER INDUCED SPINAL CORD TRAUMA

Prior to trauma, intraoperative ultrasound of the spinal canal in 31 normal dogs was performed through a hemilaminectomy in the left pedicle of L2. A ventral compressive model of spinal cord injury was performed as part of a clinical drug trial. Maximum ultrasonographic spinal cord diameter ranged from 4.9–7.2 mm (5.7 × 0.6). Significant positive correlation (p = 0.023, r = 0.49) was found between age and spinal cord diameter. The dura mater was a separate, well-defined, echogenic horizontal line in 28 (90%) dogs, dorsally, and in 29 (94%) dogs, ventrally. Cerebrospinal fluid was anechoic. Eighteen (58%) dogs had a well-defined anechoic dorsal subarachnoid space, whereas 22 (71%) had a well-defined ventral space. Pia mater was thin but strongly echogenic and covered spinal cord. Central canal was a double hyperechoic line in 17 (55%) dogs and a single-line in 14 (45%) dogs. A difference in the ultrasonographic appearance between gray and white matter was not seen. Epidural fat and connective tissue was a lobular echogenic material in the ventral epidural space. The periosteal-vertebral body interface was seen as a bright curvilinear echo with distal acoustic shadowing. Spinal cord parenchyma could be classified subjectively into four groups based upon ultrasonographic appearance. Spinal cord parenchyma had a uniform hypoechogenicity in 8 (27%) dogs (Group 1), subtle low level echoes in 7 (23%) dogs (Group 2), multiple clusters of defined echogenic foci in 12 (37%) dogs (Group 3), and multiple sharply-defined linear echoes in 4 (13%) dogs (Group 4). There was a significant relationship between pre-trauma ultrasonographic appearance of the spinal cord and histopathology 21 days after trauma. One (13%) dog in Group 1, 4 (57%) dogs in Group 2,10 (91%) dogs in Group 3, and 3 (75%) dogs in Group 4 had malacia on histological evaluation. Therefore, dogs with echogenic spinal cords or linear echoes within cord parenchyma were significantly more likely to develop malacia rather than Wallerian degeneration after induced spinal cord trauma (p = 0.002). Spinal cord echogenicity may indicate vascularity in a segment of spinal cord and might be prognostic following spinal cord trauma. No complications were found related to intraoperative ultrasound. Hematoma or fibrous tissue formation appeared to impede percutaneous ultrasound of the spinal cord in dogs re-evaluated forty-eight hours and one week after surgery.     

ULTRASONOGRAPHIC PERCUTANEOUS ANATOMY OF THE CAUDAL LUMBAR REGION AND ULTRASOUND‐GUIDED LUMBAR PUNCTURE IN THE DOG

Subarachnoid lumbar puncture is used commonly in the dog for cerebrospinal fluid collection and/or myelography. Here in we describe the percutaneous ultrasound anatomy of the lumbar region in the dog and a technique for ultrasound‐guided lumbar puncture. Ultrasound images obtained ex vivo and in vivo were compared with anatomic sections and used to identify the landmarks for ultrasound‐guided lumbar puncture. The ultrasound‐guided procedure was established in cadavers and then applied in vivo in eight dogs. The anatomic landmarks for the ultrasound‐guided puncture, which should be identified on the parasagittal oblique ultrasound image are the articular processes of the fifth and sixth lumbar vertebrae and the interarcuate space. The spinal needle is directed under ultrasound‐guidance toward the triangular space located between the contiguous articular processes of the fifth and sixth lumbar vertebrae and then advanced to enter the vertebral canal. Using these precise ultrasound anatomic landmarks, an ultrasound‐guided technique for lumbar puncture is applicable in the dog.