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.     

ULTRASONOGRAPHY OF HISTOLOGICALLY NORMAL PARATHYROID GLANDS AND THYROID LOBULES IN NORMOCALCEMIC DOGS

The purpose of this study is to characterize the sonographic appearance of canine parathyroid glands using high‐resolution ultrasonography. Ten cadaver dogs were studied after euthanasia for reasons not relating to the parathyroid. The cervical region was examined using a 13–5 MHz linear transducer in right and left recumbency. Ultrasonographic features of the parathyroid and thyroid glands were compared with the gross and histopathologic findings. Thirty‐five structures were identified sonographically as parathyroid glands but only 26 of 35 glands (74% positive predictive value) were proven to be normal parathyroid glands histopathologically. Of the nine false positives, five (14%) were proven to be lobular thyroid tissue. The remaining four (11%) structures were visible grossly or found histopathologically. There were no statistical differences between ultrasonographic and gross measurements of the parathyroid glands. The average size as seen sonographically was 3.3 × 2.2 × 1.7 mm and the average gross size was 3.7 × 2.6 × 1.6 mm (length, width, height). The average size of the thyroid lobules assessed sonographically was 2.3 × 1.6 × 0.8 mm (length, width, height). Normal parathyroid glands can be identified using high‐resolution ultrasonography. But some thyroid lobules will be misinterpreted as parathyroid glands; this will result in false positives when identifying parathyroid glands with ultrasonography.     

Primary hyperparathyroidism in dogs and cats

The most common cause of primary hyperparathyroidism in dogs and cats is a solitary adenoma involving an extracapsular parathyroid gland. The prognosis is excellent if the affected parathyroid gland is removed. Nonsurgical methods are discussed, although there are no current data to support any benefit over conventional surgery. The common postoperative complication to consider is hypocalcemia. Hypocalcemia can be successfully managed in these animals if it is anticipated and treated promptly.     

Ultrasonographic size of the canine parathyroid gland may not correlate with histopathology

Accurate ultrasonographic differentiation of normal versus abnormal parathyroid glands is important for clinical workup and presurgical screening in dogs with hypercalcemia. In previous published studies, size has been the only ultrasonographic criterion correlated with histologic diagnoses of abnormal parathyroid glands. In this retrospective, cross‐sectional study, the medical records of dogs with ultrasonographic examinations of the parathyroid glands and histologic diagnoses of parathyroid gland hyperplasia, adenoma, and adenocarcinoma were evaluated. Ultrasonographic characteristics were recorded for each gland and compared among histologic diagnosis groups. A total of 49 dogs and 59 parathyroid glands were sampled and assigned to the following groups for analyses: adenoma (n = 24), hyperplastic (n = 20), and adenocarcinoma (n = 15). There were no associations with dog age, sex, weight, breed; or gland laterality, location, ultrasonographic shape, or echogenicity among histologic diagnosis groups (P > .05). Parathyroid gland adenocarcinomas were found to be less likely to have a homogeneous echotexture on ultrasonographic evaluation, with hyperplastic glands being smaller (P = .022) and adenocarcinomas being larger (P = .042). While 3 mm was the optimum cutoff for differentiating hyperplastic and neoplastic parathyroid glands in this sample of dogs, values varied widely within groups and there were overlapping values between groups. Therefore, authors caution against using ultrasonographic size as a sole criterion for differentiating hyperplasia from neoplasia and normal versus abnormal parathyroid glands.     

ANALYSIS OF FACTORS AFFECTING OUTCOME OF ULTRASOUND‐GUIDED RADIOFREQUENCY HEAT ABLATION FOR TREATMENT OF PRIMARY HYPERPARATHYROIDISM IN DOGS

Radiofrequency (RF) parathyroid ablation is a noninvasive treatment for hyperparathyroidism in dogs. There are no published data assessing factors associated with RF parathyroid ablation success or failure in order to guide patient selection and improve outcome. The purpose of this retrospective analytical study was to determine whether imaging findings, biochemical data, or concurrent diseases were associated with RF heat ablation treatment failure. For inclusion in the study, dogs must have had a clinical diagnosis of primary hyperparathyroidism, undergone cervical ultrasound and RF ablation of abnormal parathyroid tissue, and must have had at least 3 months of follow‐up information available following the date of ultrasound‐guided parathyroid ablation. Dogs were grouped based on those with recurrent or persistent hypercalcemia and those without recurrent or persistent hypercalcemia following therapy. Parathyroid nodule size, thyroid lobe size, nodule location, and presence of concurrent disease were recorded. Recurrence of hypercalcemia occurred in 9/32 dogs that had ablation of abnormal parathyroid tissue (28%) and one patient had persistent hypercalcemia (3%) following parathyroid ablation. Nodule width (P = 0.036), height (P = 0.028), and largest cross‐sectional area (P = 0.023) were larger in dogs that had recurrent or persistent hypercalcemia following ablation. Hypothyroidism was more common in dogs with recurrent disease (P = 0.044). Radiofrequency ablation was successful in 22/32 (69%) dogs. Larger parathyroid nodule size and/or concurrent hypothyroidism were associated with treatment failure in dogs that underwent ultrasound‐guided RF parathyroid nodule ablation.     

DOHUBLE-PHASE PARATHYROID SCINTIGRAPHY IN DOGS USING TECHNETIUM-99M-SESTAMIBI

The purpose of this study was to evaluate the utility of double-phase parathyroid scintigraphy using 99mTc-sestamibi for detecting and localizing hyperfunctioning parathyroid glands in hypercalcemic dogs. Fifteen hypercalcemic dogs that underwent parathyroid scintigraphy were included in this study: 3 dogs with hypercalcemia of malignancy, and 12 dogs with hyperfunctioning parathyroid tissue (parathyroid adenoma or parathyroid hyperplasia). The presence of parathyroid adenoma or parathyroid hyperplasia was documented by histopathologic examination. In 3 dogs with hypercalcemia of malignancy, parathyroid scintigraphy was negative for hyperfunctioning parathyroid tissue and the scans were classified as true negative. Parathyroid scintigraphy correctly identified the presence and location of hyperfunctioning parathyroid tissue in only 1 of 6 dogs with a parathyroid adenoma. False positive and false negative results occurred in dogs with parathyroid adenomas. Parathyroid scintigraphy failed to detect hyperfunctioning parathyroid tissue in 5 of 6 dogs with parathyroid hyperplasia and were classified as false negative. False positive results were obtained in the remaining dog with parathyroid hyperplasia. Sensitivity of parathyroid scintigraphy for detecting and localizing hyperfunctioning parathyroid tissue was 11%, specificity was 50%, and overall accuracy was 27%. Positive and negative predictive value were 25% and 27%, respectively. Sensitivity for detection of parathyroid adenomas was 25%, and sensitivity for detection of hyperplastic glands was 0 %. Results of this study indicate that double-phase parathyroid scintigraphy does not appear to have acceptable accuracy in detecting hyperfunctioning parathyroid glands in dogs. Due to the poor sensitivity and specificity of the technique in dogs, parathyroid scintigraphy is not recommended for definitive identification of abnormal parathyroid glands as the cause of hypercalcemia in dogs.     

SONOGRAPHY OF THE EQUINE PALMAR METACARPAL SOFT TISSUES

It was hypothesized that ultrasonography may be a sensitive method for identifying pathologic changes in the tendons and ligaments of the palmar metacarpus of the horse. The palmar meta-carpi of equine cadavers and live horses were examined sonographically. The advantages and disadvantages of various ultrasound scanning techniques and the normal appearance of longitudinal and transverse palmar metacarpal sonograms are described.     

Contrast-enhanced CT features of pyloric lesions in 17 dogs: Case series

Pyloric outflow obstructions can be caused by several types of lesions. When a thickened gastric wall and pyloric mass are detected, malignant neoplasia must be differentiated from chronic hypertrophic pyloric gastropathy. CT can characterize gastric tumors. However, based on the authors’ review of the literature, there is limited information about the CT findings of pyloric lesions. The purpose of this retrospective case series study was to assess the CT findings of canine pyloric lesions. The following CT parameters were recorded: anatomical area, involved area, lesion shape, growth patterns of wall thickening lesions, enhancement pattern of the lesion in the early and delayed phases, lymphomegaly, and pulmonary metastasis. Seventeen dogs were included in this study and had the following final diagnoses: hyperplasia (five dogs), adenoma (five dogs), adenocarcinoma (three dogs), gastrointestinal stromal tumor (GIST; two dogs), polyposis (one dog), and pyogenic granuloma (one dog). Hyperplasia, adenoma, and polyposis formed mass lesions that involved the mucosal layer. Lymphomegaly was detected in two Jack Russell terriers with hyperplasia; however, the causes were unknown because we did not perform biopsies. All adenocarcinomas formed wall-thickened lesion that involved the outer layer, with lymphomegaly. All GISTs formed mass lesion that involved the outer layer. The pyogenic granulomas formed symmetric wall-thickened lesion that involved the mucosal and outer layers. CT facilitated the characterization of canine pyloric lesions using contrast enhancement, based on the involved area and lesion shape. However, polyposis may require caution in diagnosis based on CT findings alone.     

A RETROSPECTIVE STUDY OF UMBILICAL SONOGRAPHY IN CALVES

The purpose of this study was to assess the usefulness of diagnostic ultrasound for the detection of umbilical defects in calves. The medical records of 25 calves having undergone an ultrasound examination and for which a final diagnosis was available were reviewed retrospectively. Ultrasound was accurate (p = 0.05) for the diagnosis of umbilical defects in calves. Overall sensitivity (0.89) and specificity (0.83) were similar. Ultrasound was a better predictor of abnormal (PV' = 0.94) than normal PV- = 0.71) structures. Ultrasound was a good predictor (p < 0.05) of disease and normalcy in all umbilical region subdivisions except the umbilical vein (p = 0.16). Specificity was greater than sensitivity in all areas except the umbilical stalk. Sensitivity was lowest (0.50) for detection of umbilical herniae and lesions in the umbilical vein. When multiple umbilical areas were affected, ultrasound identified all lesions in 4 of 7 calves. Criteria determined to be subjectively useful in the sonographic diagnosis of infection in umbilical remnants were gas andlor echogenic fluid in the lumen and a thickened, hypoechoic wall.     

SONOGRAPHY OF THE NORMAL FELINE GASTROINTESTINAL TRACT

The normal sonographic appearance of the stomach in various degrees of distension, the duodenum, the small intestine, and the large intestine was determined in awake and sedated cats. The mean stomach rugal fold thickness was 4.38 mm, and the interrugal thickness was 2.03 mm. No significant difference in stomach wall thickness was seen when the stomach was empty, half full, or full. The duodenal wall thickness was significantly greater than other parts of the small intestine, and this difference was accentuated by sedation (awake mean 2.4 mm; sedated mean 2.71 mm). The mean small intestinal wall thickness was 2.1 mm, and the mean colonic wall thickness was 1.67 mm. The five characteristic sonographic layers similar to that seen in the gastrointestinal tract of other species were routinely identified at all regions of the feline gastrointestinal tract.     

Primary hyperparathyroidism in a 17‐year‐old Arab × Welsh Cob pony mare with a functional parathyroid adenoma

Primary hyperparathyroidism was identified in a 17‐year‐old Arab × Welsh Pony mare that experienced weight loss for 6 months and was presented with mild facial asymmetry, right forelimb lameness and weight shifting amongst all limbs. Osteodystrophia fibrosa was demonstrated on radiographic examination of the head and there was radiographic evidence of osteopenia of the appendicular skeleton. The horse had persistent hypercalcaemia (4.0 mmol/l), hypophosphataemia (0.59 mmol/l) and an increased concentration of circulating parathyroid hormone (1401 pg/ml). On scintigraphic examination, a subjective focal increase in uptake of ^99mtechnetium‐sestamibi was identified in the right thyroid gland and at the thoracic inlet in delayed images. Surgical exploration of the thyroid region was unrewarding, whereas surgery at the thoracic inlet was not undertaken. One year later, the horse developed a pathological fracture of the third metacarpal bone and was subjected to euthanasia. At post mortem examination, a parathyroid adenoma was found at the level of the thoracic inlet adjacent to the trachea. Gross and histological examination also confirmed severe osteodystrophia fibrosa and osteopenia.     

ADRENAL ULTRASONOGRAPHY CORRELATED WITH HISTOPATHOLOGY IN FERRETS

The adrenal glands of twenty-six, 12-to 53-month-old, ferrets without clinical signs of adrenal disease were examined and measured by ultrasonography and the findings compared with those from gross examination and histopathology. Of 51 adrenal glands examined, 27 were normal, 23 had either nodular or diffuse cortical hyperplasia and 1 had an adenocarcinoma. There was no statistically significant difference between the sonographic nor gross size of normal adrenal glands and those with hyperplasia. Moderate correlation was found between gross and sonographic measurements of length for both right (r=0.783; p<0.0001) and left (r=0.609; p<0.001) adrenal glands; however, the sonographic measurements were less than the gross measurements. Correlation was found between the sex and weight of the ferret and adrenal gland length (p<0.01) and width (p<0.02). In female ferrets, the length, width, and depth of the right adrenal gland sonographically measured (mean±sd) 7.5±1.2 mm, 3.7±0.6 mm, 2.8±0.4 mm, respectively, and the left measured 7.4±1.0 mm, 3.7±0.4 mm, 2.8±0.4 mm; in males, the right adrenal measured 8.9±1.6 mm, 3.8±0.6 mm, 3.0±0.8 mm and the left measured 8.6±1.2 mm, 4.2±0.6 mm, 3.0±0.6 mm. Accessory adrenal tissue was not identified during the sonographic examination but was grossly found in 10 of the ferrets. It was associated with either the right, left or both adrenal glands.     

TWINKLING ARTIFACT IN SMALL ANIMAL COLOR-DOPPLER SONOGRAPHY

Twinkling artifact is a recently described color-Doppler phenomenon that has not been studied in the veterinary field. Our purpose was to assess the grade of the artifact in vitro with varying urolith compositions, and to evaluate its potential role in clinical practice. Five canine and feline uroliths types of 100% mineral composition were studied in vitro with color-Doppler sonography, and a prospective study was performed in 41 patients with renal, bladder, gallbladder, or digestive focal hyperechogenicities. The images were analyzed for the presence and the grade of the artifact. Phantom study demonstrated the constant occurrence of the artifact regardless of the mineral composition of uroliths. Mottled and rough surfaced stones produced higher grades of twinkling artifact. High-grade, color-twinkling artifact generated by stones occured frequently in vivo. Bladder crystalluria was more frequently detected by artifact visualization than sample urinalysis performed by cystocentesis. In veterinary medicine, twinkling artifact may thus be considered an additional sonographic feature of urinary stones, and can lead to a more appropriate management of patients presenting gray-scale sonographic focal hyperechogenicities.     

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.     

Spontaneous Harderian Gland Adenocarcinoma in a Female F344 Rat: A Case Report

Harderian gland tumors are extremely rare in female F344 rats. An expansive enlarging lesion of the Harderian gland with compression, distortion and invasion of the surrounding muscle was found in a 110-week-old female F344/DuCrj rat, which was diagnosed as a Harderian gland adenocarcinoma. Epithelial growth patterns such as glandular, lobular, papillary and duct forming patterns were exhibited in most areas of the tumor. The tumor cells were pleomorphic and atypical. In one part of the tumor, poorly differentiated areas were found. This case was observed in the middle dose group of a carcinogenicity study of diphenylamine, which was not carcinogenic, we determine to be this case was a spontaneous tumor.     

Identification and preservation of the parathyroid gland during total thyroidectomy in dogs with bilateral thyroid carcinoma: a report of six cases

Simultaneous removal of bilateral thyroid tumors was performed while preserving the parathyroid gland in six dogs. At least one external parathyroid gland was identified in all dogs. In five cases, the external parathyroid gland and its blood supply were preserved intact. In one dog, the vessels supplying the external parathyroid gland had been invaded by the tumor, and the gland was thus removed and reimplanted into the sternohyoid muscle. That dog required postoperative treatment with oral calcium gluconate and vitamin D₃. Local tumor recurrence was not observed in any of the cases. The mean survival time was 920 days. We found that the external parathyroid gland could be identified and preserved in most dogs undergoing total thyroidectomy.     

Intraoperative parathyroid hormone concentration to confirm removal of hypersecretory parathyroid tissue and time to postoperative normocalcaemia in nine dogs with primary hyperparathyroidism

Objective To determine (1) whether the intraoperative parathyroid hormone concentration ([PTH]) during parathyroidectomy (PTX) can be used to indicate cure in dogs with primary hyperparathyroidism and (2) the time taken for postoperative serum calcium concentration to normalise. Design Retrospective study (2005–10) from a private referral hospital in Sydney, New South Wales, Australia. Procedure Nine client‐owned dogs underwent surgical PTX for naturally occurring primary hyperparathyroidism. [PTH] was measured from serum samples taken immediately post‐induction (pre‐PTX]) and at least 20 min after adenoma removal (post‐PTX) for all dogs, and during parathyroid gland manipulation (intra‐PTX) for six dogs. The concentration of ionised calcium (iCa) was measured at various time points postoperatively until it normalised, then stabilised or decreased below reference ranges. Statistical analysis compared the mean pre‐, intra‐ and post‐PTX [PTH] and the average rate of decline of iCa concentration postoperatively. Results All dogs demonstrated a significant decrease from mean pre‐PTX [PTH] (168.51 pg/mL) to mean post‐PTX [PTH] (29.20 pg/mL). There was a significant increase in mean intra‐PTX [PTH] (279.78 pg/mL). The average rate of decline of iCa concentration postoperatively to within the reference range (1.12–1.40 mmol/L) occurred after 24 h. Conclusion Intraoperative measurements of [PTH] can be used clinically to determine cure of primary hyperparathyroidism. Parathyroid hormone increases significantly during parathyroid gland manipulation. Plasma iCa concentration returns to within the reference range on average 24 h after successful PTX. Not all dogs require vitamin D or calcium supplementation pre‐ or postoperatively.     

Salivary Gland Adenocarcinoma in a Domestic Rabbit (Oryctolagus cuniculus)

A 2.4 kg, 7-year-old, female Rex rabbit was presented with a 4-month history of a left-sided head tilt, difficulty in mastication, lethargy, and chronic wasting. Diagnostic testing of the patient revealed a severe heterophilic leukocytosis and radiographic images of the skull radiographs indicated irregularity of the left tympanic bulla. A computed tomographic scan highlighted a heterogeneously contrast-enhancing mass, ventral and rostral to the left tympanic bulla, with contrast enhancement of the meninges on the left, consistent with an aggressive neoplasm. The patient was euthanized and the mass was identified as a salivary gland adenocarcinoma. The gland of origin is suspected to be the left parotid, owing to its location and close association with normal parotid tissue. To the authors' knowledge, this is the first report of a salivary gland adenocarcinoma in a domestic rabbit. A computed tomography (CT) scan and histopathology examination were useful modalities for identifying the neoplasm in this case.