RETROSPECTIVE ULTRASONOGRAPHIC EVALUATION OF ADRENAL LESIONS IN 26 DOGS

A review was performed of ultrasonographic findings in 26 dogs with confirmed adrenal lesions. Adrenal shape, size, echogenicity, laterality, and the presence of vascular invasion were evaluated. Histopathologic diagnoses were obtained in all dogs. Adrenal lesions were confirmed as pheochromocytomas (9), adenocarcinomas (6), a poorly differentiated blastoma (l), bilateral adrenal metastases of a carcinoma (l), adenomas-one of which was bilateral-(4) and hyperplasia (6). Size and shape were extremely variable and not specific to lesion type. There was a tendency for pheochromocytomas (7), adenocarcinomas (5) and poorly differentiated blastoma (1) to be rounded masses. Adenomas (4), hyperplasia (7) and adrenal metastases (2) presented predominantly as nodules. No specificity in echogenicity was noted. Mineralization and bilaterality were present in both benign and malignant lesions. Vascular extension or the presence of a thrombus were suggestive but not specific signs of malignancy. Based on our prelimiary study, ultrasonography is an effective method for localizing adrenal lesions and is helpful in assessing their extension. However, no definitive differentiation between benign and malignant lesions was possible using ultrasonographic criteria alone.     

ULTRASOUND EVALUATION OF SMALL BOWEL THICKNESS COMPARED TO WEIGHT IN NORMAL DOGS

The use of ultrasound to measure small bowel thickness is an important part of any ultrasound examination of the abdomen. Increased thickness of the intestinal wall is a hallmark for the detection of diseases ranging from inflammatory bowel disease to neoplasia. Our subjective impression has been that dogs with no clinical signs of gastrointestinal disease often have sonographic measurements greater than published norms. The purpose of this study was to prospectively reevaluate these norms. The clinical history on all dogs receiving an abdominal ultrasound examination was evaluated for signs of gastrointestinal disease. Those without clinical signs were entered into this study. The documentation of body weight, breed, jejunal thickness, and duodenal thickness was made in 231 dogs. Dogs were placed into five groups based on their weight. Sixty-nine breeds were represented with weight ranging from 2.1 to 64 kg. A statistically significant (P < or = 0.05) correlation between body weight and both jejunal and duodenal thickness was observed. We also found that the maximum thickness in both jejunum and duodenum in healthy dogs was larger than previously reported. These data indicate norms for the jejunum of < or = 4.1 mm for dogs up to 20 kg, < or = 4.4 mm for dogs between 20 and 39.9 kg, and < or = 4.7 mm for dogs over 40 kg. The data indicate norms for the duodenum < or = 5.1 mm for dogs up to 20 kg, < or = 5.3 kg for dogs between 20 and 29.9 kg, and < or = 6.0 mm for dogs over 30 kg.     

ULTRASONOGRAPHIC PARAMETERS OF NORMAL CANINE ADRENAL GLANDS: COMPARISON TO NECROPSY FINDINGS

Ultrasonographic evaluation of the adrenal glands was performed in 14 fasted healthy adult dogs. Frequency of visualization was 100% for both the left and right adrenal glands. Moderate correlation was present between Ultrasonographic and gross measurements of thickness for both left (r_s= 0.727; p < .005) and right (r_s= 0.537; p < .05) adrenal glands. However, no correlation was found between Ultrasonographic and gross measurements for length or width of either adrenal gland. Differentiation of adrenal cortex and medulla was possible in 79% of left adrenal glands and 64% of right adrenal glands. The echogenicity of the adrenal glands was less than that of the renal cortex in all dogs. Factors which made evaluation of the adrenal glands more difficult included pyloric gas, intestinal gas, and deep-chested body conformation.     

ULTRASONOGRAPHIC DETECTION OF ADRENAL GLAND TUMOR AND URETEROLITHIASIS IN A GUINEA PIG

A 5-year-old guinea pig was presented to the University of Berne Small Animal Radiology Department for an ultrasound examination of the abdomen to confirm a suspected diagnosis of Cushing's syndrome. The patient had bilateral alopecia, was apathic and obese. Ultrasonographically, a tumor of the left adrenal gland, obstruction of the left ureter by an ureterolith, as well as hydronephrosis of the left kidney were detected. During surgery to relieve the ureteral obstruction the adrenal gland tumor was removed. The guinea pig died post-operatively due to blood loss. The left adrenal gland tumor was found histopathologically to be an adenoma and the right adrenal gland also had multiple small adenomas, but grossly appeared normal. The ureterolith was analyzed and found by x-ray diffraction to consist of calcium carbonate.     

ULTRASONOGRAPHIC EVALUATION OF THE PROSTATE IN HEALTHY INTACT DOGS

Sagittal and transverse ultrasonographic images of the prostate gland were obtained in 100 healthy adult intact male dogs. Prostatic length, width, and height on transverse and sagittal images as well as the presence of prostatic cysts were determined. Linear regression and correlation analysis were performed between prostatic parameters (length, width, height on sagittal and transverse images, and estimated volume) and parameters related to body size (body weight, body height, left kidney length and aortic diameter) and age of the dogs. Significant positive correlations were found between all prostatic parameters and parameters related to body size and age. Maximum predicted values for prostatic parameters for a given body weight and age were determined based on the upper limit of the 95% confidence interval of the mean predicted values. Such values should represent a useful tool for ultrasonographic evaluation of the prostate in the dog. Prostatic cysts were found in 14% of the dogs.     

CHANGES IN ULTRASONOGRAPHIC APPEARANCE OF ADRENAL GLANDS IN DOGS WITH PITUITARY-DEPENDENT HYPERADRENOCORTICISM TREATED WITH TRILOSTANE

Trilostane, a 3beta-hydroxysteroid dehydrogenase inhibitor, has been used successfully over the last few years for the treatment of canine pituitary-dependent hyperadrenocorticism. In a prospective study of 19 dogs with pituitary-dependent hyperadrenocorticism, the adrenal glands were measured before and at least 6 months after initiation of trilostane therapy. Right adrenal gland length and caudal pole thickness and left adrenal gland caudal pole thickness increased significantly (p < or = 0.05); there was no significant change in left adrenal gland length. Enlargement of adrenal glands during trilostane therapy may occur as a result of suppression of the negative feedback mechanism affecting cortisol production.     

CLINICAL AND ULTRASONOGRAPHIC CHARACTERISTICS OF SALIVARY MUCOCELES IN 13 DOGS

Salivary mucocele is one of the causes of submandibular swelling in dogs and is due to a collection of mucoid saliva that has leaked from a damaged salivary gland. The purpose of this case series report was to describe the clinical and ultrasonographic characteristics of confirmed salivary mucoceles in 13 dogs admitted to the Faculty of Veterinary Medicine at Cairo University. The final diagnosis of salivary mucocele was based on aspirate cytology for all dogs and additional surgical excision for seven dogs. For dogs admitted from 2 weeks to 1 month from the onset of clinical signs, the cervical mucocele appeared as a round echogenic structure with a large volume of central anechoic content. The wall was a clearly identified hyperechoic structure surrounding the gland. For dogs admitted between 1 to 2 months from the onset of clinical signs, the volume of anechoic material appeared less than that seen in the acute cases. The overall appearance of the salivary mucocele was heterogenous. For dogs admitted after 2 months from the onset of clinical signs, the salivary mucocele appeared grainy or mottled, with a heterogenous appearance and a further decrease in anechoic content. For one dog that presented after 3 months from the onset of clinical signs, the salivary mucocele was hard on palpation and appeared hyperechoic with distal acoustic shadowing. Findings from this study indicated that ultrasonographic characteristics of salivary mucoceles in dogs vary depending on the chronological stage of the disease.     

RETROSPECTIVE REVIEW OF THE ULTRASONOGRAPHIC FEATURES OF ADRENAL LESIONS IN 21 FERRETS

Clinical signs and follow-up information were recorded. Histopathologic diagnoses were obtained for 25 adrenal glands in 21 ferrets. Adrenal lesions included ten adenocarcinomas, nine adenomas, one hyperplasia and one cortical cyst. Four adrenal glands (all right-sided) were diagnosed as unspecified adrenal tumors but lacked a definite histopathologic diagnosis (adenoma vs. adenocarcinoma) due to incomplete surgical resection and consequent small sample sizes. Bilateral adrenal lesions were identified in 4 ferrets (19%). Adrenal shape, size, echogenicity, laterality, and the presence of vascular invasion were evaluated with ultrasound. Size and shape were variable and not specific to lesion type. Both benign and malignant adrenal tumors (adenomas, adenocarcinomas) appeared most often as masses with increased thickness and a normal length (11/23), less frequently as larger masses with increased thickness and length (4/23) or as nodules focally deforming the normal adrenal shape (6/23). The only cortical cyst appeared as a nodule. Three adrenal glands had a normal size and shape and were diagnosed as adenomas (2) or hyperplasia (1). Therefore treatment may be warranted based solely on clinical signs if adrenal glands are ultrasonographically normal. Vascular invasion was not identified ultrasonographically. However, focal absence of periglandular fat resulting in contact of 8 adrenal glands with either caudal vena cava (6), aorta (1) or liver (1) identified ultrasonographically, correlated with incomplete surgical resectability (6/8) and histopathologic diagnoses of carcinoma (4/8) or unspecified tumors (4/8). Therefore, a focal absence of periglandular fat between the adrenal gland and the large vessels or liver, deviation or compression of the large vessels by the adrenal lesion may indicate malignancy. Adrenal tumors (benign and malignant) were often associated with a prominent uterus, uterine stump or prostate with or without prostatic cysts.     

COMPARISON OF COMPUTED TOMOGRAPHIC AND PATHOLOGIC FINDINGS IN 17 DOGS WITH PRIMARY ADRENAL NEOPLASIA

The CT appearance of canine adrenal masses has been reported, but associations between imaging features and pathologic features of these lesions have not been investigated in detail. The purpose of this study was to test associations between different types of adrenal neoplasia and their CT and pathologic features. A retrospective cross‐sectional study was performed and inclusion criteria were histologic diagnosis of primary adrenal neoplasia, contrast‐enhanced CT examination of the abdomen and surgical resection of the mass or necropsy examination. For all included dogs, CT images and histopathologic specimens were reviewed independently by two veterinary radiologists and a veterinary pathologist, respectively. Seventeen dogs met inclusion criteria. Diagnoses were adenocarcinoma in nine (53%) dogs, pheochromocytoma in five (29%) dogs, and adenoma in three (18%) dogs. Pheochromocytoma was associated with CT signs of vascular invasion (likelihood ratio = 4.8, 95% CI = 1.3–18.3, P = 0.03) and macroscopic vascular invasion (likelihood ratio = 9.6, 95% CI = 1.4–65.9, P = 0.02). There was excellent agreement between signs of vascular invasion in CT images and vascular invasion at surgery or necropsy (kappa = 0.86, P = 0.001). A peripheral contrast‐enhancing rim in delayed postcontrast CT images was associated with fibrous encapsulation of the tumor (kappa = 0.53, P = 0.05), and a heterogeneous pattern of contrast distribution in delayed postcontrast CT images was associated with adrenal hemorrhage or infarction on histological examination (kappa = 0.45, P = 0.05). Findings indicated that CT enabled assessment of adrenal neoplasia features that reflected their biological behavior and pathological findings, however overlapping characteristics between tumor types limited the potential for reliably distinguishing them based on CT alone.     

ULTRASONOGRAPHY OF ADRENAL GLANDS IN NORMAL FERRETS

The adrenal glands of 20 normal ferrets were imaged with ultrasound. Of the forty glands, only 4 (three right and one left) could not be clearly identified. Mean (±standard deviation) dimensions of the right (7.6 ± 1.8 mm length by 2.6 ± 0.4 mm width) and left (7.2 ± 1.8 mm length by 2.8 ± 0.5 mm width) glands were similar. Both adrenal glands were wider (p<0.05) sonographically in males than females. Measured length and width of the right gland positively correlated (p<0.05) with body weight. The glands had a hypoechoic outer zone and hyperechoic central region, were elongate to avoid in shape and located medial and, variably, at the level of the cranial pole of the ipsilateral kidney. This study demonstrates that normal adrenal glands can be imaged in ferrets.     

CONTRAST‐ENHANCED ULTRASONOGRAPHY OF THE NORMAL CANINE ADRENAL GLAND

Contrast‐enhanced ultrasonography is useful in differentiating adrenal gland adenomas from nonadenomatous lesions in human patients. The purposes of this study were to evaluate the feasibility and to describe contrast‐enhanced ultrasonography of the normal canine adrenal gland. Six healthy female Beagles were injected with an intravenous bolus of a lipid‐shelled contrast agent (SonoVue^®). The aorta enhanced immediately followed by the renal artery and then the adrenal gland. Adrenal gland enhancement was uniform, centrifugal, and rapid from the medulla to the cortex. When maximum enhancement was reached, a gradual homogeneous decrease in echogenicity of the adrenal gland began and simultaneously enhancement of the phrenicoabdominal vessels was observed. While enhancement kept decreasing in the adrenal parenchyma, the renal vein, caudal vena cava, and phrenicoabdominal vein were characterized by persistent enhancement until the end of the study. A second contrast enhancement was observed, corresponding to the refilling time. Objective measurements were performed storing the images for off‐line image analysis using Image J (ImageJ^©). The shape of the time–intensity curve reflecting adrenal perfusion was similar in all dogs. Ratios of the values of the cortex and the medulla to the values of the renal artery were characterized by significant differences from initial upslope to the peak allowing differentiation between the cortex and the medulla for both adrenal glands only in this time period. Contrast‐enhanced ultrasonography of the adrenal glands is feasible in dogs and the optimal time for adrenal imaging is between 5 and 90 s after injection.     

ULTRASONOGRAPHIC FEATURES OF UTERUS MASCULINUS IN SIX DOGS

Uterus masculinus (persistent Mullerian duct) is a vestigial embryological remnant of the paramesonephric duct system in males and has been associated with clinical signs such as dysuria, incontinence, tenesmus and urethral obstruction in dogs. The radiological appearance of cystic uterus masculinus in dogs has been described previously with the aid of retrograde positive or negative contrast cystography. The purpose of this retrospective study was to describe ultrasonographic features of confirmed or presumed uterus masculinus in a group of dogs with confirmed or presumed disease. Ultrasonographic findings were recorded based on a consensus opinion of two readers. A uterus masculinus was defined as cylindrical when no lumen was observed and tubular when it had lumen that was filled with anechoic fluid. Six dogs met the inclusion criterion with a mean age of 8 years and 9 months. Uterus masculinus appeared as single (four dogs) or two (two dogs) horn‐like, tubular (four dogs) or cylindrical (two dogs) structures, originating from the craniodorsal aspect of the prostate gland and extending cranially. The walls of the uterus masculinus were isoechoic to the urinary bladder wall. The diameter of the observed uterus masculinus varied from 0.3 cm to 1 cm. The length of the uterus masculinus varied from 2 cm to 6.5 cm but the cranial terminal end was not identified in two dogs. Concomitant prostatomegaly was seen in five dogs (83.3%) and urinary tract infection was noted in three dogs (50%). Findings indicated that uterus masculinus should be included as a differential diagnosis for male dogs with these ultrasonographic characteristics.     

COMPUTED TOMOGRAPHIC QUANTIFICATION OF CANINE ADRENAL GLAND VOLUME AND ATTENUATION

We conducted a retrospective study in presumed normal dogs to determine the adrenal gland attenuation and volume values. Multidetector computer tomography (MDCT 16) analysis of the gland was carried out in 48 adult dogs without evidence of adrenal gland disease that underwent CT examination for acute spinal injuries. The mean nonenhanced attenuation value +/- SD of the left adrenal gland was 36.0 +/- 5.3 HU (range: 22.0-42.0 HU). The mean nonenhanced attenuation value +/- SD of the right gland was 34.3 +/- 7.0 HU (range: 20.4-48.6HU). The mean enhanced attenuation value +/- SD were: left gland 101.5 +/- 10.6HU (range: 86.8-128.0 HU), and right gland 97.4 +/- 12.4 HU (range: 58.9-123.6 HU). The mean CT volume +/- SD were: left gland was 0.60 cm3 (range: 0.20-0.95; SD 0.17), and right gland (0.55cm3, range: 0.22-1.01; SD 0.19). Attenuation values and volume data were related to age, weight, and gender, using ANOVA. There was no statistically significant difference between the left and right side or in adrenal measurements, because of body weight class effects. The animal effect was the most important source of variation for all adrenal measurements. Based on our study, CT is an effective method for assessing adrenal characteristics in the dog. Normative CT data are provided to allow estimation of normal adrenal gland size and volume.     

TRANSRECTAL ULTRASONOGRAPHY OF THE LEFT ADRENAL GLAND IN HEALTHY HORSES

Little information is available on medical imaging of the adrenal glands in horses. We investigated the feasibility of transrectal ultrasonography to characterize the normal equine adrenal gland. Transrectal ultrasonography was performed in 25 healthy horses using a 7.5 MHz linear array probe at a displayed depth of 8 cm. Transrectal ultrasonography of the right adrenal gland was not feasible. For the left adrenal gland, the left kidney, the abdominal aorta, the left renal artery, the left renal vein, and the cranial mesenteric artery were used as landmarks. The size of the left adrenal gland was variable, but it generally appeared as a long, flat structure with a hyperechoic medulla surrounded by a hypoechoic cortex. The most cranial part of the gland could not be delineated appropriately in 11 horses (44%). The mean (±SD) thickness of the gland and medulla was 0.66±0.15 cm (n=25) and 0.28±0.09 cm (n=25) near the caudal pole, 0.87±0.25 cm (n=14) and 0.40±0.18 cm (n=12) near the cranial pole, and 0.89±0.18 cm (n=25) and 0.36±0.13 cm (n=25) in the middle of the gland, respectively. The mean (±SD) length of the entire adrenal gland and of the medulla was 6.22±0.77 cm (n=14) and 5.45±0.71 cm (n=6), respectively. Transrectal ultrasonography allowed adequate visualization of the left adrenal gland in horses.     

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.     

ULTRASONOGRAPHIC EVALUATION OF THE PARATHYROID GLANDS IN HYPERCALCEMIC DOGS

Two hyperplastic parathyroid glands and three solitary parathyroid adenomas were identified using high-resolution ultrasonography in five adult dogs with persistent hypercalcemia. Ultrasonographic features of parathyroid adenomas included visualization of a round or oval, 5 mm or larger, hypoechoic mass in the cranial pole of one thyroid lobe. Each mass had well-defined margins between the thyroid gland and parathyroid adenoma, reduced echogenicity of the adenoma compared to surrounding thyroid parenchyma, and distal enhancement. Ultrasonographic features of the hyperplastic parathyroid glands included hypoechogenicity, compared to surrounding thyroid parenchyma, and a size of approximately 2 mm. Hyperplastic parathyroids were well marginated in one dog and poorly marginated in another dog.     

ULTRASONOGRAPHIC APPEARANCE OF THE INTRAVASCULAR TRANSIT OF AGITATED SALINE IN NORMAL DOGS FOLLOWING ULTRASOUND GUIDED PERCUTANEOUS SPLENIC INJECTION

Portosystemic shunts (PSSs) allow portal blood to bypass the liver and enter the systemic circulation. Definitive diagnosis requires surgical identification, positive contrast portography, ultrasonography, or scintigraphy. This study was designed as a preliminary step to developing an alternative/adjuvant protocol to these imaging modalities. The main goals were to establish a technique for ultrasound‐guided percutaneous trans‐splenic injection of agitated saline, to evaluate the feasibility of performing the test to explore the postsplenic portal vasculature highlighted by the microbubbles, and to ascertain whether agitated saline microbubbles cross the sinusoidal barrier. Agitated saline was injected into the spleen of 20 healthy sedated dogs under sonographic guidance. The transducer was then repositioned to visualize the portal vein, the caudal vena cava, and the right atrium through different acoustic windows. Satisfactory results were achieved in all dogs. The microbubbles were visualized in all dogs as small intense echo signals within the portal vein at the level of the porta hepatis immediately after injection. In 18 out of 20 dogs, the echogenic signal of the microbubbles disappeared immediately once within the hepatic parenchyma, whereas in two dogs, the echoes from the microbubbles lasted for several seconds within the intrahepatic portal vasculature. The absence of microbubbles beyond the sinusoidal barrier in all of the healthy dogs included in this study makes trans‐splenic injection of agitated saline a candidate as an adjuvant technique for the diagnosis of PSS, being easy to perform and repeat, as well as safe and technically feasible.     

SONOGRAPHIC SIGNS OF GASTRODUODENAL LINEAR FOREIGN BODY IN 3 DOGS

This article describes the sonographic signs identified in three dogs with confirmed gastroduodenal linear foreign bodies. The sonographic signs included the following; an abnormal tortuous path of the descending duodenum, the presence of a hyperechoic linear structure within the duodenal lumen which was carefully followed orally to the pylorus. The presence of a mass with strong acoustic shadow within the pylorus may also be imaged. The normal intestinal layers were present in the duodenal wall. In real time, the intestinal path was followed through many "hairpin" turns, and during this process the lumen was observed for identification of a linear structure. Secondary sequelae of gastrointestinal perforation were more difficult to identify with confidence in the cases presented.     

ULTRASONOGRAPHIC EVALUATION OF RENAL SIZE IN DOGS WITH ACUTE ALLOGRAFT REJECTION

The purpose of this study was to determine the best method to ultrasonographically monitor renal size changes associated with acute allograft rejection in dogs. Qualitative changes in renal cortical and medullary echogenicity were also evaluated, although this was not a major focus of the study. Four unrelated, mixed-breed dogs underwent bilateral nephrectomies and heterotopic renal allograft transplantation. Ultrasound examinations of transplanted kidneys were initiated at 3 days after surgery and continued at 2–3 day intervals until death (38±2 days). Ultrasound measurements of kidney length, width, height, cross-sectional area, and estimated volume were used to assess relative changes in renal size associated with transplantation and rejection. Transplanted kidneys had a rapid increase in volume and cross-sectional area that averaged 103% and 83% above baseline levels, respectively, by 17 days after transplantation. The increased size was attributed to a combination of hypertrophy and acute rejection, the latter of which was confirmed at postmortem. Kidney volume decreased to approximately 35% above baseline volume by day 34 as rejection became more advanced. Qualitative changes associated with rejection included medullary enlargement with decreased echogenicity early in the study, followed by increased cortical thickness and echogenicity with poor cortical medullary definition in the latter stages of the survival period. It was concluded that relative changes in renal allograft size can be easily monitored with ultrasound. In regard to linear measurements, changes in renal width were more pronounced than changes in height or length with acute rejection. Therefore measurements that incorporate the width, namely volume or cross-sectional area, appear to be the most sensitive for monitoring changes in allograft size. Renal cross-sectional area measurements are preferred because they are simple to perform using the automated calculation capability of most newer ultrasound units.