Hepatic Ultrasonography and Pathological Findings in Dogs With Hepatocutaneous Syndrome: New Concepts

In dogs, hepatocutaneous syndrome (superficial neurolytic dermatitis) belongs to a group of syndromes in which cutaneous signs signal the presence of systemic disease. It is characterized by parakeratosis, superficial necrolysis, and basilar hyperplasia of the epidermis, in association with an unusual hepatopathy accompanied by certain metabolic derangements. Hepatocutaneous syndrome was diagnosed in 3 dogs on the basis of typical dermatologic changes and clinicopathologic findings. Hepatic ultrasonography revealed a hyperechoic network surrounding hypoechoic areas of parenchyma, resulting in a Swiss cheese-like appearance. The ultrasonographic image corresponded to the pathological findings. The liver had a nodular appearance, both grossly and microscopically; this was attributed to collapse of the areas of parenchyma surrounding the nodules, rather than to the cirrhosis and/or nodular hyperplasia reported previously.     

Correlation of ultrasonographic and patho-morphological findings in canine hepatic diseases

Findings of hepatic ultrasonography were analysed in 22 dogs with liver disease and compared with the results of final morphological diagnoses. Ultrasonographic appearance of the liver demonstrated focal alterations in 11 dogs (50 per cent): multifocal lesions in hepatic neoplasia (six), hepatic cirrhosis (one), generalised mycosis (one) and unifocal lesions in haemangiosarcoma (one), nodular hyperplasia (one) and misdiagnosed intestinal invagination (one), Diffuse ultrasonographic alterations were found in 11 dogs (50 per cent): hyperechoic liver of normal/enlarged size in lymphosarcoma (four) and hepatic lipidosis (two); hyperechoic ‘bright’ but small liver in atrophic cirrhosis (two); hypoechoic to normal intensity liver of normal size in liver dystrophy (two) and hepatic venous distension (one). Gallbladder abnormalities were detected in 14 of 20 dogs (70 per cent). Correct ultrasonographic diagnoses were made in 11 dogs (50 per cent). The best results were achieved by combining the clinicolaboratory and ultrasonographic findings, providing a correct diagnosis in 17 dogs (77-3 per cent).     

Ultrasonographic differentiation between portal venous and parenchymal gas may be important for the prognosis of canine and feline hepatic emphysema: 37 cases

The aim of this retrospective, cross‐sectional, study was to evaluate clinical findings and outcomes for different ultrasonographic patterns of hepatic emphysema in dogs and cats. Dogs and cats with an ultrasonographic diagnosis of hepatic emphysema and a known outcome, from January 2010 to January 2018, were enrolled. The following data were recorded from medical and ultrasonographic records: ultrasonographic patterns of hepatic emphysema (parenchymal, portal venous, biliary), clinical signs, laboratory findings, and outcomes (favorable, poor). A total of 33 dogs and four cats met the inclusion criteria. Among these, 23 cases were classified as hepatic portal venous gas, 10 as parenchymal emphysema, and four as biliary emphysema. Clinical diagnosis categories were as follows: infection/sepsis (9), gastro‐intestinal disease (9), iatrogenic (9), trauma (5), and liver neoplasia (5). An increase in serum liver enzymes was significantly associated with parenchymal emphysema (P = .03). Other clinical and laboratory findings were not associated with the type of hepatic emphysema. Hepatic portal venous gas was mostly transient in patients with ultrasonographic follow‐up. The overall mortality was 40.5%. A significant difference was found between mortality by portal venous gas (21.7%) and mortality by parenchymal emphysema (90%) (P = .003). In conclusion, the ultrasonographic differentiation of hepatic emphysema between hepatic portal venous gas and parenchymal emphysema may be important for the prognosis of hepatic emphysema. The presence of parenchymal emphysema may be a poor prognostic indicator, while hepatic portal venous gas may be more benign. However, ultrasound findings should be carefully evaluated in the context of clinical findings.     

Nodular dermatofibrosis and cystic renal disease in three mixed-breed dogs and a Boxer dog

Three mixed-breed dogs and a Boxer dog with nodular dermatofibrosis are described. The three mixed breed dogs had concurrent renal epithelial cysts ( n  = 2) or renal cystadenomas ( n  = 1); these lesions were visualized antemortem on ultrasonographic examination. One of these dogs was a 7-year-old Labrador Retriever-Gordon Setter mixed breed which survived 5 years after diagnosis, and was euthanized for unrelated causes. The Boxer dog had renal cystic adenomatous hyperplasia and renal cystadenocarcinomas which were not visualized on ultrasonographic examination but were diagnosed at necropsy.     

CT characteristics of primary hepatic mass lesions in dogs

Little information is available on the relationship between computed tomography (CT) imaging findings and the pathologic diagnosis of canine hepatic tumors. Our purpose was to clarify the characteristic features of CT findings in liver tumors in dogs. Data from 33 dogs with either a hepatocellular carcinoma, n = 14, hepatocellular adenoma, n = 14, or nodular hyperplasia, n = 5 were summarized from medical records. CT features for each histologic diagnosis were characterized and analyzed statistically. Common findings in hepatocellular carcinoma included central (79%, P = 0.0030) and marginal enhancement (93%, P = 0.00043) in the arterial phase, cyst-like lesions (93%), capsule formation (93%), and hypoattenuation in the portal (86%), and equilibrium phases (93%). Hepatic adenoma was characterized by a characteristic diffuse enhancement pattern during the arterial phase (57%, P = 0.013), which was also found in nodular hyperplasia (60%), but never in hepatocellular carcinoma. Nodular hyperplasia was less likely to have a capsule structure (20%, P = 0.0087). Mass size was significantly smaller in nodular hyperplasia than in hepatocellular carcinoma and hepatic adenoma (P = 0.0033 and 0.038, respectively). Hyperattenuation in the arterial and the portal phase i.e. contrast retention, was more frequent in hepatic adenoma than in the other groups (P = 0.037 and 0.037, respectively). Nodular hyperplasia was more frequently isoattenuating in the equilibrium phase (P = 0.043).     

STARRY SKY HEPATIC ULTRASONOGRAPHIC PATTERN IN HORSES

The starry sky hepatic pattern is an unusual ultrasonographic appearance of equine liver characterized by numerous small, hyperechoic foci, some of which cast an acoustic shadow, distributed randomly throughout the hepatic parenchyma. Our objectives were to describe the signalment, clinical signs, clinicopathological findings, primary disease process, and ultrasonographic findings of horses with this ultrasonographic pattern, as well as determine the associated gross and histologic changes. The starry sky pattern was identified in 18 adult horses of mixed gender and breed. The horses had various clinical signs, with weight loss and anorexia reported most commonly. Liver size and parenchymal echogenicity were normal in most horses. The hyperechoic foci frequently caused acoustic shadowing. Biliary dilation was noted rarely. The ultrasonographic pattern was the result of numerous fibrosing hepatic granulomas in all horses evaluated histologically. γ‐Glutamyltransferase was the most commonly elevated hepatic enzyme, though it was increased in fewer than half the horses. Fifteen horses had an additional disease that was identified as the apparent cause of clinical signs. Three horses had primary hepatic disease while 12 had diseases of other body systems. Therefore, the starry sky ultrasonographic pattern is likely incidental in most horses and not clinically significant. Improved recognition of this pattern and further investigation of affected horses may help refine the etiology and clinical significance of the granulomas.     

Lack of associations between ultrasonographic appearance of parenchymal lesions of the canine liver and histological diagnosis

Objective: To assess if there are any ultrasonographic features that may enable tentative diagnosis of hepatic parenchymal disease. Methods: Records of 371 dogs that had abdominal ultrasonography and abnormal liver on biopsy or necropsy were reviewed. Results: Histological diagnoses were hepatitis (n=77), nodular hyperplasia (n=47), vacuolar change (n=45), fibrosis (n=32), primary hepatic carcinoma (n=30), lymphoma (n=28), metastatic neoplasia (n=27), necrosis (n=21), lipidosis (n=17), haemangiosarcoma (n=13), round cell tumour (n=9), hepatocellular adenoma (n=8), degenerative change (n=6), steroid hepatopathy (n=7) and extramedullary haematopoiesis (n=4). The most prevalent ultrasonographic features were multifocal lesions (63% livers with haemangiosarcoma and 43% livers with hepatocellular carcinoma), diffuse lesions (71% livers with steroid hepatopathy, 44% livers with fibrosis and 40% livers with vacuolar hepatopathy), hyperechoic lesions (71% livers with steroid hepatopathy, 41% livers with lipidosis and 38% livers with fibrosis), heterogeneous lesions (62% livers with haemangiosarcoma), hepatomegaly (43% livers with steroid hepatopathy) and peritoneal fluid (62% livers with haemangiosarcoma). Target lesions were associated with malignancy in 67% instances. Marked variability in ultrasonographic appearance of lesions was observed for all diagnoses, and no statistically significant associations between ultrasonographic appearance and diagnosis were found. Clinical Significance: Histological examination remains essential for diagnosis of canine hepatic disease.     

ULTRASONOGRAPHY OF CANINE GASTRIC EPITHELIAL NEOPLASIA

Signalment, clinical and ultrasonographic findings from 16 dogs with histologically confirmed gastric epithelial neoplasia were reviewed. The most common clinical findings were vomiting, anorexia and weight loss. Hematemesis and melena were uncommon findings. Ten (10/16) dogs were female and there were four Chows. The most common ultrasonographic findings were transmural thickening of the gastric wall associated with altered wall layering. A poorly echogenic lining often was noted on the innermost and/or the outermost portions of the gastric wall, separated by a more echogenic central zone. The distribution of these changes was variable. This ultrasonographic feature, called pseudolayering, was present in 14 dogs. It was believed to most likely correlate to the unevenly layered tumor distribution noted histopathologically. The maximum wall thickening ranged from 1 cm to 2.7 cm. Regional lymphadenopathy was identified ultrasonographically in 15 dogs. Ultrasound-guided fineneedle aspiration biopsy or automated microcore biopsy, endoscopic biopsy, surgical biopsy or necropsy resulted in the diagnosis of carcinoma in 15 dogs and of carcinoid tumor in one dog. The results of this study suggested that ultrasonography was a useful tool for the detection and diagnosis of canine gastric epithelial neoplasia. Furthermore, ultrasonography can assist in obtaining diagnostic samples and in clinical staging of the tumor.     

RELATIONSHIP BETWEEN PROSTATOMEGALY, PROSTATIC MINERALIZATION, AND CYTOLOGIC DIAGNOSIS

Canine prostatic disease is commonly evaluated with abdominal ultrasound and radiographs. Mineralization of the prostate is often reported, but the clinical relevance of this finding is currently not known. The purpose of this study was to characterize the relationship between ultrasonographic and radiographic prostate mineralization and the final diagnosis. Medical records of 55 dogs with evidence of prostatomegaly or prostatic mineralization and a cytologic diagnosis were evaluated. Radiographs and ultrasound images were assessed for caudal retroperitoneal lymphadenopathy, vertebral lesions, or other signs of metastasis, and mineralization was assessed semiquantitatively. Twenty-two of 55 (40%) dogs had prostatic neoplasia. Regarding neoplasia, mineralization in neutered dogs had a positive predictive value (PPV) of 100%, a negative predictive value (NPV) of 50%, and a sensitivity and specificity of 84% and 100%, respectively. Mineralization in intact dogs had a PPV of 22%, an NPV of 96%, and a sensitivity and specificity of 67% and 77%, respectively. All neutered dogs with prostatomegaly but not prostatic neoplasia had bacterial prostatitis and were castrated within the previous 3 months. Intact dogs with prostatomegaly and mineralization but not neoplasia had paraprostatic cysts ( n =3), benign prostatic hyperplasia ( n =2) or prostatitis ( n =2). Mineralization score was not indicative of neoplasia. In conclusion, neutered dogs with prostatic mineralization were very likely to have prostatic neoplasia. Intact dogs were unlikely to have prostatic neoplasia if no mineralization was found on radiographs or ultrasound.     

Familial po1ycystic kidnev disease in bull terriers

Polycystic kidney disease was observed in eight related bull terriers. Two dogs died suddenly, two were presented for haematuria, while the remainder were outwardly normal but detected during ultrasonographic screening programmes. A definitive diagnosis was made at either necropsy or using renal ultrasonography, although affected dogs also had abnormal urinalyses with haematuria, proteinuria, cast formation and sometimes bacterial infection. Valvular heart disease was detected clinically or at necropsy in all the affected dogs. The presence of polycystic kidney disease in several related dogs suggests that this condition is familial. The disease has clinical and pathological similarities with autosomal dominant polycystic kidney disease of humans.     

Hepatic encephalopathy in a pregnant mare: identification of histopathological changes in the brain of a mare and fetus

An 11-year-old Thoroughbred broodmare was evaluated for suspected hepatic dysfunction. Clinical signs of hepatic encephalopathy were evident at admission. Hepatic ultrasonographic evaluation revealed an increase in hepatic size, rounded borders and normal echogenicity. There was no evidence of cholelithiasis or bile duct distention. Increased activity of hepatic enzymes, increased bile acid and bilirubin concentration and an increased ammonia concentration were supportive of a diagnosis of hepatic disease and hepatic encephalopathy. Histopathological evaluation of a liver biopsy specimen was consistent with chronic active hepatitis. The mare was treated with intravenous fluids and antimicrobials, pentoxyfilline, branched-chain amino acids and dietary manipulation. Clinical improvement was observed initially; however, 3 weeks later, deterioration in the mare's condition necessitated euthanasia. Pathological lesions at necropsy were restricted to the liver and brain. The liver was diffusely firm with a prominent reticular pattern on the cut surface. A large choledocholith was present in the main bile duct of the left liver lobe. Histopathological examination of the liver revealed severe fibrosis, with hyperplastic bile ducts and mononuclear and neutrophilic inflammation. Pathological changes consistent with hepatic encephalopathy, (Alzheimer type II cells), were evident in the cerebrum of both the mare and the fetus.     

Radiographic,ultrasonographic, and computed tomographic characteristics of an accessory liver lobe in a cat

A 5‐year‐old male Norwegian Forest cat presented with increased hepatic serum biochemical parameters. Abdominal radiography showed an oval cranioventral mass and ultrasound revealed a mobile mass attached to one hepatic lobe. Computed tomography (CT) confirmed that the mass was attached to the right medial liver lobe. Differential diagnoses were an accessory liver lobe, benign neoplasia, and focal nodular hyperplasia. The mass was removed and histopathology confirmed the mass to be normal liver tissue. Accessory liver lobe should be included in the differential diagnosis of a mobile cranial abdominal mass with a similar ultrasonographic or CT appearance to the liver.     

Ultrasonographic findings in 50 dogs with retrobulbar disease.

Records of 50 dogs with signs of retrobulbar disease that had ultrasonography and diagnosis based on results of cytopathology or histopathology were reviewed retrospectively. Abnormalities were identified ultrasonographically in 43 (86%) dogs. Mass effect was identified in 42% of dogs with neoplasia and 30% of dogs with abscess. Ten of 11 (91%) orbital bone lesions were in dogs with retrobulbar neoplasia. A cavitary lesion was recognized ultrasonographically in 75% of dogs with salivary mucocele and 50% of dogs with retrobulbar abscess. Neoplasms occurred predominantly on the ventral or medial aspect of the orbit, or both, which reflects invasion by nasal or sinus neoplasms. Presence of orbital bone lesions or a mass on the medial aspect of the orbit suggests neoplasia; however, other ultrasonographic signs were nonspecific.     

Follow-up studies by large intestinal biopsies and necropsy in dogs with clinical signs of large bowel disease.

The results of follow-up studies in 77 dogs with clinical signs of large bowel disease are presented. In 32 dogs colonic and/or rectal biopsy follow-up studies were done, combined with necropsy in seven dogs. In 45 dogs a follow-up necropsy only was done. The time between the first and the last series of biopsies varied from three to 729 days and between the first series of biopsies and necropsy from one to 980 days. Colitis found in 45 dogs in the initial biopsies was still present in 29 cases in the follow-up biopsy studies and/or at necropsy. Eleven cases showed hystiocytic ulcerative colitis. In general, adenoma, carcinoma and lymphosarcoma were confirmed in the follow-up examination, except for one adenoma, which appeared to be a carcinoma at necropsy. In cases in which the differential diagnosis was adenoma or carcinoma, the necropsy diagnosis was always carcinoma and in cases of a differential diagnosis of lymphosarcoma and/or colitis, lymphosarcoma was always diagnosed at necropsy. Several dogs without colonic changes in the initial biopsies had other gastric or small intestinal lesions at necropsy such as gastritis and enteritis of the small intestine, or tumors, in these areas.     

Gait deficits in liver disease: Hepatic encephalopathy and hepatic myelopathy

In this issue, the unusual clinical presentation of a horse diagnosed is described with severe liver cirrhosis and hepatic encephalopathy. The horse initially presented for thoracic and pelvic limb ataxia and weakness, and signs of forebrain disease were not apparent until later in the disease process. The typical pathology of central nervous system disease associated with liver disease is related to encephalopathy and forebrain disease; however, the spinal cord is occasionally also involved. Hepatic myelopathy is a rare syndrome usually associated with surgical or acquired portosystemic shunts, liver cirrhosis and/or portal hypertension in man. Where a gliopathy is the most prominent pathological feature seen in hepatic encephalopathy, in hepatic myelopathy the most remarkable feature is demyelination of the corticospinal tracts of the distal cervical and thoracic spinal cord with occasional axon loss. The clinical signs of hepatic myelopathy are spastic paresis/paralysis with normal sensory findings and preserved sphincter function. The prognosis for hepatic myelopathy is generally poor. In summary, in severe liver disease, motor deficits can occur secondary to the encephalopathy, but motor deficits can also occur as a result of spinal cord pathology such as seen in hepatic myelopathy. In examination of horses with myelopathies, liver disease as a cause of myelopathy should be included in our list of differentials.     

TRIPLE‐PHASE HELICAL COMPUTED TOMOGRAPHY IN DOGS WITH HEPATIC MASSES

The purpose of this study was to determine the utility of triple‐phase helical computed tomography (CT) for differentiating canine hepatic masses. Seventy dogs with hepatic masses underwent triple‐phase CT followed by surgical removal of the hepatic masses. Triple‐phase helical CT scans for each dog included precontrast, arterial phase, portal venous phase, and delayed phase studies. The removed hepatic masses were histopathologically classified as hepatocellular carcinoma (n = 47), nodular hyperplasia (n = 14), and hepatic metastatic tumors (n = 9) in dogs. Of the 47 hepatocellular carcinomas, the most common CT findings included a heterogeneous pattern with hyper‐, iso‐, and hypoenhancement in both the arterial and portal venous phases (40/47, 85.1%). Of the 14 nodular hyperplasias, the most common CT findings were a homogeneous pattern with hyper‐ and isoenhancement in both the portal venous and delayed phases (13/14, 92.9%). Of nine hepatic metastatic tumors, the most common CT findings included a homogeneous hypoenhancement pattern in both the arterial and portal venous phases (8/9, 88.9%). In addition, 5 (55.6%) showed homogeneous hypoenhancement patterns in the delayed phase. Findings from our study indicated that triple‐phase CT is a useful tool for preoperative differentiation of hepatocellular carcinoma, nodular hyperplasia, and hepatic metastatic tumors in dogs.     

Ultrasonographic Characteristics of the Adrenal Glands in Dogs With Pituitary-Dependent Hyperadrenocorticism: Comparison With Normal Dogs

Ultrasonographic evaluation of the adrenal glands was performed in 10 dogs with pituitary-dependent hyperadrenocorticism (PDH) and in 10 age- and weight-matched healthy control dogs. Thickness, shape, and echogenicity were determined for each adrenal gland. Adrenal thickness in dogs with PDH (median, 10 mm-left; 8.5 mm-right) was significantly greater than thickness in control dogs (median, 6 mm-left; 6 mm-right). Other ultrasonographic characteristics associated with PDH included bilaterally symmetrical adrenomegaly and maintenance of normal adrenal shape. Adrenal echogenicity was homogeneous and less than that of the adjacent renal cortex in 8 of 10 dogs with PDH and in 10 of 10 control dogs. Heterogenous echogenicity was present in 2 of 10 dogs with PDH, and was associated with nodular cortical hyperplasia in one of those dogs. Results of this study confirm the difference in sonographic appearance between PDH-induced bilateral cortical hyperplasia and functional adrenocortical neoplasia, and show a difference in so-nographically determined adrenal size between healthy dogs and dogs with PDH. J Vet Intern Med 1996; 10:110–115. Copyright © 1996 by the American College of Veterinary Internal Medicine .     

Computed tomography in the diagnosis of canine hyperadrenocorticism not suppressible by dexamethasone

Computed tomography (CT) was performed in 10 dogs with hyperadrenocorticism not suppressible by dexamethasone. In 6 of these dogs, a unilateral adrenal mass was found on CT images. Specimens of the masses were obtained via retroperitoneal laparotomy; histologic examination revealed 4 carcinomas, 1 adenoma, and 1 nodular hyperplasia. In the 4 other dogs, CT revealed symmetric bilateral adrenal gland enlargement. In 2 of these dogs, contrast-enhanced CT revealed a mass in the pituitary fossa, which could be identified at necropsy as a pituitary tumor. The other 2 dogs were successfully treated with mitotane.     

METRIZAMIDE MYELOGRAPHY IN FIVE DOGS AND TWO CATS WITH SUSPECTED SPINAL CORD NEOPLASMS

Metrizamide myelography was used in five dogs and two cats with signs of spinal cord disease. The history, clinical signs, cerebrospinal fluid examination, and myelography supported a presumptive diagnosis of spinal cord neoplasia in all seven animals. Myelography demonstrated a deviation of the subarachnoid space in each of them. Five of the animals had an expansile intramedullary spinal cord lesion causing thinning and peripheral deviation of the subarachnoid space. Two had extramedullary lesions causing a central deviation of the subarachnoid space. Spinal cord tumors in six of the seven animals were confirmed by necropsy or surgical excision and histopathologic examination. In the seventh animal, a spinal cord fungal grapuloma was diagnosed by necropsy.