ULTRASONOGRAPHIC APPEARANCE OF FELINE ALIMENTARY LYMPHOMA

Abdominal ultrasonography was performed in seven cats with intestinal lymphoma and four cats with gastric lymphoma. Ultrasonographic abnormalities included the presence of a hypoechoic mass associated with the gastrointestinal tract, focal or diffuse thickening of the gastric wall, symmetric thickening of the bowel wall, loss of the normal layered appearance of the gastrointestinal wall, and abdominal lymphadenopathy. The thickness of the stomach wall ranged from 8 to 22 mm in cats with gastric lymphoma, and the thickness of the bowel wall ranged from 5 to 20 mm in cats with intestinal lymphoma. Fine needle aspiration of a gastrointestinal lesion was performed without complication in six cats, and was diagnostic for lymphoma in five out of six. Results of this study indicate that ultrasonography is an effective noninvasive means of identifying lesions consistent with alimentary lymphoma in cats.     

IMAGING DIAGNOSIS—MUSCULAR HYPERTROPHY OF THE SMALL INTESTINE AND PSEUDODIVERTICULA IN A HORSE

A 14‐year‐old Thoroughbred gelding was presented for chronic colic and weight loss. Transcutaneous and transrectal abdominal ultrasonography revealed distended, thickened small intestine with primary thickening of the muscularis and a focally more thickened loop with an echoic structure crossing the wall from the mucosa to the serosa. Visualization of diffuse thickening of the muscularis (muscular hypertrophy of the small intestine) and a focal lesion (pseudodiverticulum) helped clinicians make informed decisions. This case illustrates the importance of transabdominal and transrectal ultrasonography in horses with chronic colic and the relevance of considering the abnormalities in layering pattern of the intestinal wall.     

Ultrasonographic intestinal muscularis thickening in dogs with histologically confirmed inflammatory bowel disease: 13 cases (2010–2021)

Ultrasonographic intestinal muscularis thickening has not been described as an imaging feature of canine inflammatory bowel disease. In this retrospective case series, patients were identified by searching sonographic reports for “muscularis” and/or “muscular layer.” Patients were included if small intestinal muscularis thickening was reported, and sonographic images and histopathological samples of the small intestine were available for review. Cases with small intestines nodules, masses, or complete loss of wall layering were excluded. Sonographic images were retrospectively evaluated for jejunal muscularis layer thickness, and ratios of intestinal layer measurements were performed. Histological samples were retrospectively reviewed. Thirteen dogs met inclusion criteria: all dogs had sonographic intestinal muscularis thickening relative to the submucosa (>1.0, range of 1.3–2.5), and most dogs had muscular layer thickness above normal published ranges (11/13; all 13/13 above the weight-specific mean). More than half of the patients had overall normal wall thickness (11/13) and several had normal mucosal echogenicity (6/13). Therefore, in some dogs, the only sonographic abnormality in the small intestine was muscularis thickening. No dogs had lymphadenomegaly. Endoscopic partial-thickness (n = 11, duodenum and/or ileum) or surgical full-thickness (n = 2) samples confirmed inflammatory bowel disease. Direct comparison between jejunum sonographic characteristics and histology features was limited due to both partial thickness biopsies and lack of direct comparison between anatomical locations of ultrasonographic assessment and biopsy site. However, no cases that met the inclusion criteria had normal small intestinal histology. Comparable to cats, dogs with ultrasonographic intestinal muscularis thickening may have inflammatory bowel disease, and further workup for enteropathy is indicated.     

ULTRASONOGRAPHY OF INTESTINAL MAST CELL TUMORS IN THE CAT

The sonographic features of intestinal mast cell tumors (MCT) were reviewed in 14 cats. The mean age was 13.4 ± 2.5 years. There were 16 focal intestinal tumors and one diffuse submucosal infiltrate. The most common pattern was focal, hypoechoic wall thickening that was noncircumferential and eccentric (9/16 tumors) or circumferential, asymmetric, and eccentric (5/16 tumors). Nine of the cats had lesions in the jejunum or duodenum, four were at the ileocecocolic junction, and one cat had a colonic mass. Six MCTs had altered but not loss of wall layering, and the most commonly affected layer on ultrasound examination was the muscularis propria. Nine cats had enlarged abdominal lymph nodes, and seven were due to metastatic disease. Metastatic disease was not routinely detected by ultrasound in the liver (1/4 cats) or the spleen (0/3 cats). Concurrent small cell (T cell) lymphoma was present in four of 14 cats (29%).     

ULTRASONOGRAPHIC APPEARANCE AND ETIOLOGY OF CORRUGATED SMALL INTESTINE

An ultrasound pattern of corrugated, and sometimes thickened, bowel wall has been associated with pancreatitis and small intestinal lymphangiectasia. In a retrospective study, records of dogs and cats with an ultrasound diagnosis of corrugated bowel were examined for age, breed, gender, presenting complaint, abdominal radiographic results, and final diagnosis. Eighteen dogs and six cats had an ultrasound diagnosis of corrugated bowel. The final diagnosis was pancreatitis (12 of 24), peritonitis (4 of 24), enteritis (2 of 24), pancreatic neoplasia (2 of 24), diffuse abdominal neoplasia (1 of 24), lymphocytic-plasmacytic enteritis (1 of 24), thrombosis/infarction (1 of 24), and protein-losing enteropathy and acute renal failure (1 of 24). The presence of bowel wall corrugation, although a nonspecific finding, should alert one-to the possibility of pancreatitis, enteritis, peritonitis, neoplasia, or bowel wall ischemia.     

DIAGNOSTIC VALUE OF ULTRASONOGRAPHY IN DIFFERENTIATING ENTERITIS FROM INTESTINAL NEOPLASIA IN DOGS

One hundred and fifty dogs with histopathologically confirmed intestinal disease were evaluated retrospectively. Sixty-one dogs had enteritis and 89 dogs had intestinal neoplasia. Ultrasonographic findings including the thickness and distribution of the intestinal lesion, the integrity of intestinal wall layering, regional lymph node thickness, the location of the intestinal segment involved, and regional motility were evaluated. Dogs with intestinal tumor had wall thickness (1.5 cm) significantly greater than dogs with NSE lesions (0.6 cm; p < 0.001). Ninety-nine percent of dogs with intestinal tumor had loss of wall layering while 88% of dogs with NSE had normal or altered wall layering (p < 0.001). Dogs with NSE were significantly more likely to have diffuse lesion (72%) than dogs with intestinal tumor (2%; p < 0.001). Lymph node median thickness in 24/61 dogs with NSE was 1.00 cm. The median thickness of the lymph nodes in 56/89 dogs with intestinal tumors was 1.9 cm. A multivariate analysis showed that loss of wall layering alone was an excellent predictive factor in differentiating intestinal tumor from NSE. In our population, dogs with loss of intestinal wall layering were 50.9 times more likely to have a tumor than enteritis.     

Disseminated histoplasmosis in a cat in Europe

A cat was presented with a history of vomiting, decreased appetite and weight loss. Abnormal findings were poor body condition, pale mucous membranes, dehydration and a palpable abdominal mass. Abdominal ultrasound showed lymph node enlargement, a mass of uncertain origin, thickening of the muscularis layer of the small bowel, focal thickening of the ileum with loss of layering and free peritoneal fluid. Cytology revealed a piogranulomatous infiltrate and numerous macrophages containing oval or round yeast-like cells 2 to 5 µm diameter with a central, spherical, lightly basophilic body surrounded by a clear halo, compatible with Histoplasma capsulatum, within the cytoplasm. Post-mortem examination revealed cavity effusions, granulomatous nodules in lungs, intestine and omentum, thickened intestinal walls and intestinal perforation. Staining with Grocott and immunohistochemistry (IHC) revealed numerous organisms within the granulomatous reaction. H. capsulatum has a worldwide distribution in temperate and subtropical climates. To the author’s knowledge, this is the first report of feline histoplasmosis in Europe.     

Radiographic features of congenital segmental dilation of the intestine in a german shepherd dog

A 10‐week‐old spayed female German Shepherd Dog was presented for acute vomiting and diarrhea. There was no reported foreign body or toxin ingestion. Radiographs showed a severely (～11 × 7 cm), focally distended right abdominal intestinal segment containing gas and soft tissue material. Other small intestinal segments were segmentally gas distended. Celiotomy identified a ～9 cm focally dilated segment at the jejunoileal junction with no aborad luminal obstruction. Resection and anastomosis of the dilation was performed. Histopathology showed mild mucosal inflammation, but otherwise normal wall layering and autonomic ganglia. Radiographic and histopathologic findings were consistent with congenital segmental dilation of the intestine.     

Two-dimensional grayscale ultrasound and spectral Doppler waveform evaluation of dogs with chronic enteropathies

Sonography is an important diagnostic tool to examine the gastrointestinal tract of dogs with chronic diarrhea. Two-dimensional grayscale ultrasound parameters to assess for various enteropathies primarily focus on wall thickness and layering. Mild, generalized thickening of the intestinal wall with maintenance of the wall layering is common in inflammatory bowel disease. Quantitative and semi-quantitative spectral Doppler arterial waveform analysis can be utilized for various enteropathies, including inflammatory bowel disease and food allergies. Dogs with inflammatory bowel disease have inadequate hemodynamic responses during digestion of food. Dogs with food allergies have prolonged vasodilation and lower resistive and pulsatility indices after eating allergen-inducing foods.     

Postoperative ultrasonographic appearance of uncomplicated enterotomy or enterectomy sites in dogs

The ultrasonographic findings in 20 dogs with 25 healing enterotomy and enterectomy sites resulting from the removal of foreign material or correction of intussusceptions are presented. In this prospective study, dogs had preoperative abdominal ultrasound examinations followed by sequential sonographic examinations on the first, third, sixth, and 10th days postenterotomy or enterectomy with an additional sonographic examination after 20 days postoperatively. Documented sonographic features included length and maximal intestinal wall thickness of the enterotomy or enterectomy sites, echogenicity of omental/mesenteric fat, amount of free gas and abdominal effusion, and gastrointestinal motility. Sonographically, 57% of enterotomies and 100% of enterectomies were visualized. Pneumoperitoneum, hyperechoic omental/mesenteric fat, and abdominal effusion did not appreciably hamper evaluation of the intestinal surgical site. Absent wall layering at the surgical site was noted in 96% of dogs at day 1 postoperatively. At the final sonographic examination, wall layering remained altered to absent in 100% of dogs and normal thickness was noted in only 20% of dogs. The median maximal wall thickness was 7 and 8 mm for enterotomies and enterectomies respectively, which occurred between days 1 and 3 and days 3 and 6 postoperatively. Effusion and increased echogenicity of omental/mesenteric fat localized to the surgical site were noted in 42% and 60% of dogs respectively at day 1 postoperatively, with resolution noted between days 3 and 10 postoperatively in 92% and 80% of dogs. Generalized abdominal effusion and pneumoperitoneum were seen in 100% of dogs immediately postoperatively and resolved in 80% by day 10.     

THE SONOGRAPHIC APPEARANCE OF INTESTINAL MUCOSAL FIBROSIS IN CATS

The medical records of 11 cats with full‐thickness intestinal biopsies and histopathologic confirmation of segmental mucosal fibrosis were reviewed. All cats received an abdominal ultrasonographic evaluation. The sonographic feature of a small intestinal mucosal hyperechoic band paralleling the submucosa was present in all cats. Other intestinal sonographic findings included wall thickening, and altered wall layering (increased mucosal echogenicity, thickened submucosa, and/or muscularis layer). None of the cats had complete loss of wall stratification. All cats had clinical signs related to the gastrointestinal (GI) tract at the time of presentation. Three of the 11 cats had palpably thickened small intestinal loops, 3/11 abdominal pain, and 2/11 abdominal fluid. Histopathologically, mucosal fibrosis was associated with inflammatory cell infiltrates in all cats. In those cats with histopathologic evidence of mural fibrosis, all cats had a visible hyperechoic band through several intestinal segments. We speculate that the hyperechoic mucosal band represents the zone of mucosal fibrosis. Independently and prospectively, we reviewed the clinical presentation of 35 cats having this visible hyperechoic mucosal band on ultrasound. Twenty‐four of these 35 cats had clinical signs related to the digestive system at the time of record. Our study suggests that the hyperechoic mucosal band represents fibrosis, and in presence of concurrent GI signs, further diagnostic tests may be warranted.     

Long-term prospective evaluation of intestinal anastomosis using stainless steel staples in 14 dogs

This prospective clinical study evaluated the use, complications, and clinical and ultrasonographic follow-ups of end-to-end intestinal anastomoses with skin staples in naturally occurring diseases in canine small and large intestines. Intestinal anastomoses were performed in 14 dogs and pre-, peri-, and postoperative data were recorded. Postoperative clinical and ultrasound evaluations were performed at regular intervals for 1 year. The mean time taken to construct the anastomosis was 5 min. There were no intraoperative complications. Hemorrhage and colonic stricture were the main postoperative complications. Staple loss occurred in 2 cases. Absence of wall layering and focal wall thickening were observed in all cases at each ultrasonographic follow-up. Hyperechoic fat was observed in all but 1 of the cases at month 1. Nine dogs were alive with normal digestive function at the end of the study. The skin stapler technique enabled rapid construction of consistent anastomoses with inexpensive stapling material.     

Intestinal volvulus and stricture associated with a leiomyoma in a green turtle (Chelonia mydas).

A previously stranded 30-kg female green turtle (Chelonia mydas) was referred to the Veterinary Medical Teaching Hospital at the University of Florida following a 2-mo history of anorexia, intermittent regurgitation, decreased fecal production, and positive buoyancy of the right side. Radiographs confirmed gaseous distension of bowel loops suggestive of intestinal obstruction. The coelom was surgically approached through a plastron osteotomy, and a 540 degrees volvulus of the small intestine was identified and derotated. An intestinal stricture was present at the site of the volvulus, and segments of bowel orad to the stricture were greatly distended. Following resection of abnormal bowel, the osteotomy was stabilized using self-tapping screws and figure-eight wire, and the defect was sealed with fiberglass cloth and fast-drying epoxy resin. A leiomyoma associated with the focal stricture was identified by histology. Appetite and defecation returned to normal. Six months after surgery, the turtle had regained normal buoyancy and showed no further clinical signs of gastrointestinal obstruction.     

SURVEY OF THE USE OF RADIOGRAPHY VS. ULTRASONOGRAPHY IN THE INVESTIGATION OF GASTROINTESTINAL FOREIGN BODIES IN SMALL ANIMALS

A question frequently asked by clinicians who are treating small animals suspected of having gastrointestinal foreign bodies is whether one imaging test such as survey radiography or ultrasonography is sufficient to make the diagnosis. A study was undertaken to try and answer this question. Survey abdominal radiography and ultrasonography was performed on 16 small animals (11 dogs, five cats) with clinical signs of an obstruction because of a confirmed gastrointestinal foreign body. The majority of the foreign bodies (14/16) were confirmed by surgical removal and were located in the small intestine. A gastric foreign body was retrieved endoscopically and a colonic foreign body was passed in the feces. Radiographically identifiable foreign bodies were evident in nine animals. Small intestinal overdistension was present radiographically in seven animals. Ultrasonography detected a foreign body in all 16 animals. The foreign bodies were identified by their distal acoustic shadowing and variable degrees of surface reflection. An intestinal perforation was detected sonographically but not radiographically. The value of additional sonographic findings including thickening of the gastrointestinal wall and loss of layering, free peritoneal fluid, and lymphadenopathy in these animals is discussed. The findings in this series suggest that in a small animal with a gastrointestinal foreign body, ultrasonography alone could be used to make the diagnosis and may be a more appropriate choice than survey radiography.     

The equine teniae coli: An electrophysiological study

Previous morphological studies of the equine teniae coli (intestinal bands) have shown them to be highly innervated. In this study, EMG electrodes were placed in the wall of the left ventral colon in order to determine whether intestinal bands serve as major conduits of myo-electrical activity. Specifically, electrodes were implanted in the lateral mesocolic band and the adjacent tenia-free bowel of 6 horses. In 3 of these horses, a 1 cm length of the intestinal band was excised to determine if a lesion of this size would ablate local waves of depolarization. Our results indicate that sequential EMG activity persisted despite this small, focal excision. The persistence of sequential EMG activity might reflect the importance of constantly regenerating stimuli to the intestinal motility of the horse. Whether making similar or somewhat larger lesions in all four teniae of the left ventral, colon would more definitively disrupt normal pelvic flexure peristalsis will require further research.     

Evaluation of fluorescein dye as an indicator of small intestinal viability in the horse

In 6 horses, 2 types of ischemic lesions were created in small intestinal segments by selective ligation of vessels and intestinal wall for 1, 2, or 3 hours. After confirming the ischemia by IV injection of sodium fluorescein, the ligatures were released. Five minutes later, the fluorescent patterns were documented photographically. Observed patterns ranged from normal (identical to that observed in unaffected bowel) to a patchy distribution of non-fluorescence (indicating incomplete perfusion). None of the experimental segments was normal when reevaluated 1 month later. The typical appearance included fibrosis, adhesions, and thickening of the bowel wall. It was concluded that IV injection of fluorescein can be used to indicate perfusion of the intestine, but that this is not the only criterion for determining clinical outcome in cases of intestinal ischemia in horses.     

Penetration of the small intestine by an unusual foreign body resulting in colic in a horse: A case report

A nine-year-old Arabian gelding was evaluated for acute abdominal pain. Based on clinical signs and the results of the diagnostic work-up, surgical exploration of the abdominal cavity was performed. An adhesion was found involving a section of jejunum, its mesentery, and the omentum. Passage of gas and/or ingesta was obstructed at that point. On closer examination of the involved bowel, a porcupine quill which had perforated throught the intestinal wall from the lumen was identified. This was believed to have been the inciting cause for the formation of the adhesion and subsequent intestinal obstruction.     

Ultrasound as a diagnostic tool in the investigation of a pony with intestinal lymphoma

A 21‐year‐old New Forest pony presented for evaluation of lethargy and colic. Transcutaneous abdominal ultrasonography revealed a cavitary, thick walled, mass‐like lesion that appeared continuous with the small intestine. The thick walls of the mass‐like lesion were of heterogeneous echogenicity with hyperechoic foci extending from the hyperechoic luminal surface to within the wall and there was loss of normal wall layering. These findings were confirmed grossly at exploratory celiotomy and histopathological examination of affected tissues confirmed lymphoma. The ultrasound findings facilitated a preoperative presumptive diagnosis that allowed informed decision‐making and aided case management.     

Ultrasonographic findings in a basenji with immunoproliferative enteropathy

The ultrasonographic findings in a one-and-a-half-year-old female basenji with immunoproliferative enteropathy are described. On ultrasonographic examination, generalised thickening of the small bowel wall was found, ranging between 4 and 6 mm. The normal layered appearance of the intestinal wall was replaced by three distinct layers; an innermost enlarged hyperechogenic layer; an enlarged poor echogenic layer, and an outer hyperechogenic layer. These findings are consistent with the histopathological appearance of this particular chronic inflammatory bowel disease, since the inner layer probably represents the infiltrated mucosa, the middle layer the infiltrated lamina propria and the outer layer the serosa. Thus, the ultrasonographic finding of generalised thickening of the intestinal wall in a basenji presenting with chronic diarrhoea, weight loss, anorexia or vomiting is strongly indicative of immunoproliferative enteropathy.