ULTRASONOGRAPHIC MEASUREMENT OF PALMAR METACARPAL TENDON AND LIGAMENT STRUCTURES IN THE HORSE

An ultrasonographic study was made at several levels of the palmar metacarpal region of 23 horses (Anglo-Arabian-Andalusian) aged over three years. Lateromedial and palmodorsal measurements were made of tendons and ligaments, following clinical examination to confirm the absence of pathology in this region. Dissection was performed on 23 forelimbs, and these were measured at the same levels to establish a base of reference for the study. These measurements should prove useful in the evaluation of possible pathology in this region.     

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.     

EFFECTS OF FASTING AND INTRALUMINAL CONTRAST ENHANCEMENT ON ULTRASONOGRAPHIC APPEARANCE OF THE EQUINE SMALL INTESTINE

The equine small intestine is challenging to evaluate ultrasonographically. In humans, hydrosonography has been used to improve ultrasonographic images of the small intestine. We hypothesized that fasting horses for 24 h would enhance the ability to image the small intestine transabdominally by separating intestinal loops and reducing intraluminal gas, and that the administration of intragastric contrast agent would further improve that ability. Ten healthy horses were examined ultrasonographically under three treatment conditions: (a) regular diet, (b) after a 24‐h fast, and (c) fasted plus intragastric administration of water and mineral oil. During each phase of the study, 30‐s video clips were obtained from four predetermined abdominal windows, and were examined to determine diagnostic quality. Fasting improved the ability to obtain high‐quality images of the small intestine significantly. The addition of contrast agent resulted in qualitative improvement in image quality, but differences did not result in statistically significant improvement.     

THE EFFECT OF ANESTHESIA ON THE RADIOGRAPHIC APPEARANCE OF THE COXOFEMORAL JOINTS

The effect of anesthesia on the radiographic appearance of the coxofemoral joints was evaluated by taking pelvic radiographs of thirty dogs. Each dog was radiographed twice, once under general anesthesia and once without anesthesia. The radiographs were submitted to the Orthopedic Foundation for Animals independently of one another to be evaluated for signs of hip dysplasia. Results suggest there was no statistical difference between the two groups of dogs. Twenty five dogs received the same reading. Three dogs received readings that were worse by one grade while under anesthesia and two dogs received readings that were one grade better while under anesthesia. This study failed to demonstrate any changes due to anesthesia on the radiographic appearance of the coxofemoral joints. Anesthesia may, however, be beneficial for proper positioning and to decrease unnecessary patient, and personnel exposure to radiation.     

ULTRASONOGRAPHY OF THE EQUINE LARYNX

Nasopharyngeal and laryngeal evaluation is important when examining horses with upper airway signs for poor performance. Currently endoscopy is the most common method to evaluate the equine upper airway. Ultrasonography of the equine larynx has not previously been described. Using six cadaveric specimens and four standing horses, the ultrasonographic appearance of the equine larynx was established. A scanning technique, including useful acoustic windows and the normal ultrasonographic appearance at each site, is described. Ultrasound allowed visualization of portions of the hyoid apparatus, laryngeal cartilages, associated soft tissues, and intrinsic and extrinsic laryngeal musculature, that are not seen using endoscopy. Additionally, real-time ultrasound allowed observation of the movement of the vocal folds and the arytenoid cartilages during respiration. In three horses with arytenoid chondritis, ultrasonography aided in the diagnosis and localization of arytenoid abcessation and perilaryngeal inflammation. The establishment of this technique will serve as the basis for future investigations in the evaluation of clinical patients with upper airway abnormalities.     

ULTRASONOGRAPHIC EVALUATION OF IATROGENIC INJURIES OF THE EQUINE ACCESSORY (CARPAL CHECK) LIGAMENT AND SUPERFICIAL DIGITAL FLEXOR TENDON

Iatrogenic lesions to the accessory ligament (carpal check or inferior check) and to the superficial digital flexor tendon of five ponies were monitored utilizing diagnostic ultrasound for a period of 6–24 weeks post-injury. The opposite limb was used as a non-surgical control. Sonographic differences from control limbs were recorded and correlated with the gross and microscopic post-mortem lesions. Early post-surgical sonographic findings included thickening with discrete hypoechoic areas within the injured tissues which corresponded to regions of hemorrhage, edema, and tissue disruption at necropsy. The linear hyperechoic pattern seen in normal tendons was disorganized in the injured portion of the tendons or ligaments. Disruption of the margins of the incised tissues was observed. The initial hypoechoic areas disappeared or decreased in size and became more echoic as healing progressed. The increasing echoic pattern in these areas corresponded to regions of fibrous tissues invasion and collagen deposition. As post-injury time increased, the size of the tendon or ligament decreased, the margins became more distinct, and the internal structure again became more organized (linear). It was concluded that diagnostic ultrasound can be useful in evaluating injury and healing of the accessory ligament and the superficial digital flexor tendon of horses.     

EFFECT OF SEVOFLURANE ANESTHESIA AND BLOOD DONATION ON THE SONOGRAPHIC APPEARANCE OF THE SPLEEN IN 60 HEALTHY CATS

The aims of this prospective study were to describe the normal sonographic size and appearance of the feline spleen, and to test effects of sevoflurane anesthesia and blood collection on sonographic characteristics. Sonographic evaluations were performed in 60 healthy blood donor cats prior to anesthesia and blood collection (baseline), after anesthesia induction, after completion of blood collection while under anesthesia, and 7–10 days after blood collection. Transverse sonographic images of the splenic mid‐body were made. Splenic height, width, cross‐sectional area, echogenicity relative to the left renal cortex, and echotexture were recorded. Height, width, and cross‐sectional area were compared across time periods using linear‐mixed effects models. Holm's method was applied to adjust for multiplicity and control the overall Type 1 error rate at α = 0.05. Normal transverse sonographic splenic measurements (mean ± standard deviation) at baseline were: height 8.2 ± 1.4 mm; width 26.7 ± 4.4 mm; and CSA 1.6 ± 0.5 cm². While there were statistically significant differences in splenic height, width, and cross‐sectional area after sevoflurane anesthesia and/or blood collection, differences were of low magnitude. The spleen was diffusely homogenous and subjectively isoechoic or mildly hyperechoic relative to the left renal cortex. In 77% of castrated male cats, the spleen was isoechoic to the left renal cortex. We conclude that sevoflurane anesthesia and blood donation do not subjectively alter splenic dimensions, echogenicity and echotexture in normal cats.     

QUANTITATIVE PERTECHNETATE THYROID SCINTIGRAPHY AND THE ULTRASONOGRAPHIC APPEARANCE OF THE THYROID GLAND IN CLINICALLY NORMAL HORSES

We characterized the scintigraphic and sonographic appearance of the thyroid gland in clinically normal horses to establish the value of these modalities for assessment of the thyroid gland in this species. Horses were divided into two age groups. One group consisted of eight horses between 3 and 10 years of age and the other of seven horses between 11 and 20 years of age. Total T₄ concentrations were within the laboratory reference interval in all horses. Thyroid to salivary (T/S) ratio, percent dose uptake of pertechnetate (Na^99mTcO₄) and thyroid lobe volume were calculated. The echogenicity of thyroid lobes and presence of nodules was documented. The two groups were compared using appropriate parametric and nonparametric statistics. Mean total T₄ concentration was lower in older horses. Sixty minute mean±standard deviation (SD) T/S ratios for old vs. young horses were 5.8±3.0 and 5.3±2.2, respectively. Sixty‐minute median and interquartile ranges for percent dose uptake of pertechnetate for old vs. young horses were 3.64% (1.5–3.98%) and 2.55% (2.33–2.90%), respectively. Mean±SD thyroid lobe volume for old vs. young horses were 18.93±5.16 cm ³ and 13.55±3.56 cm³, respectively. Differences between groups were not significant. Most thyroid lobes were hyper or isoechoic to the sternocephalicus muscle. Prevalence of thyroid nodules did not differ between groups. Further study is needed to determine if thyroidal percent dose uptake is significantly different in horses with thyroid dysfunction and if it is clinically useful.     

RADIOGRAPHIC EVALUATION OF THE PALMAR ASPECT OF THE EQUINEMETACARPAL CONDYLES: A NEW PROJECTION*

A New radiographic projection of the equine thrid metacarpal bone condyles and developed to aid detection and evaluation of ulcerative cartilaginous and osseous lesions on the MC III Papmar aspect. The most sccessful projection tried was a nonweight-bearing one with the leg extended. Subsequent clinical evaluation proved this projection to be significant in confirming and further delineating palmar lesions seen on weight-bearing lateromedial and flexed lateromedial radiographs. The new projection has also proved valuable in the complete evaluation of vertical MC III condylar fractures. It makes possible detection of fracture comminution at the condylar articular surface, fractures which cannot be seen on other projections.     

THE EFFECTS OF REGIONAL PERINEURAL ANESTHESIA ON SOFT TISSUE AND BONE PHASE SCINTIGRAPHY IN THE HORSE

Soft tissue phase scintigrams were acquired from 7 normal horses before and over a 17-day period after palmar digital, abaxial sesamoid, low palmar and high palmar nerve blocks. Bone phase scintigrams were acquired from 4 additional horses prior to performing similar regional anesthesia and over a 14-day period postanesthesia. Images were evaluated subjectively and quantitatively for increased activity in nerve block regions. On soft tissue phase scintigrams, palmar digital and abaxial sesamoid blocks resulted in increases in activity which were relatively mild, of short duration, and subjectively had little or no effect on image interpretation. Low palmar and high palmar blocks resulted in obvious focal accumulation of activity during the soft tissue phase. Such increases in activity were usually greatest at 1 day postanesthesia and persisted up to 17 days postanesthesia. On bone phase scintigrams, abnormal accumulation of activity was not evident.     

SCINTIGRAPHIC EVALUATION OF THE PROXIMAL METACARPAL AND METATARSAL REGIONS IN CLINICALLY SOUND HORSES

In recent years, pain arising from the proximal metacarpal and metatarsal regions has become well recognized as a cause of lameness and various disease entities have been identified. However, our knowledge of normal patterns of radiopharmaceutical uptake is limited, making interpretation of images problematic. It is therefore important to characterize normal patterns of radiopharmaceutical uptake at specific sites to ensure valid interpretation of images in clinical cases with subtle lesions. The purpose of this study was to describe the pattern of radiopharmaceutical uptake in the proximal metacarpal and proximal metatarsal regions in clinically sound horses. Scintigraphic images from 64 clinically normal horses were evaluated. All the images were assessed subjectively. The lateral, dorsal, and plantar scintigraphic images were assessed qualitatively using horizontal line profiles through the proximal metacarpal and proximal metatarsal regions. Mean ratios of radiopharmaceutical uptake were calculated from three regions of interest sited over the proximal metacarpal and proximal metatarsal regions and a reference site. In 78% of forelimbs the peak of radiopharmaceutical activity was at the dorsal to central portion of the proximal metacarpal region. Seventy-five per cent of the dorsal plane profiles of activity were symmetrical, with the highest peak over the medial to central portion of the proximal metacarpal region. In 80% of hindlimb lateral images the peak radiopharmaceutical activity was at the central to plantar aspect of the proximal metatarsal region. All (100%) plantar image profiles of activity were symmetrical, with the highest peak being over the lateral portion of the proximal metatarsal region. There was no significant left and right variation between sites for mean ratios on the lateral and dorsal images of the proximal metacarpal region. However, using lateral images the mean ratios from all regions of the right proximal metatarsal were greater than left (dorsal P = 0.003, plantar P < 0.0001 and whole proximal metatarsal, P = 0.0006). There was no significant variation in mean ratios between left and right on plantar images. However, the mean ratio for the lateral proximal metatarsal region was significantly greater than for the medial proximal metatarsal regions (P < 0.0001). There was no significant effect of age. Left/right symmetry of radiopharmaceutical uptake was shown in the proximal metacarpal region. However, there was a significant difference between left and right proximal metatarsal regions. There was higher radiopharmaceutical uptake in the right proximal metatarsal region than the left, which agrees with previous studies of the tarsal and metatarsophalangeal joints. There were differences in the pattern of radiopharmaceutical uptake between the forelimbs and hindlimbs. In the forelimbs maximum radiopharmaceutical uptake was located at the dorsal to central portion of the proximal metacarpal region in the lateral image, with peak activity over the medial to central portion of the proximal metacarpal region on dorsal images. In the hindlimbs the maximum radiopharmaceutical uptake was at the central to plantar aspect of the proximal metatarsal region in the lateral image, with peak activity over the lateral portion of proximal metatarsal region on plantar images. The results of this study support the hypothesis that there would be a standard pattern of radiopharmaceutical uptake across the proximal metacarpal and l metatarsal regions, but the pattern of uptake observed would be different in the proximal metacarpal region compared with the proximal metatarsal region. There was left/right symmetry of radiopharmaceutical uptake in the proximal metacarpal region. However, there was a significant difference between left and right proximal metatarsal regions, with higher radiopharmaceutical uptake in the right. There was no variation of radiopharmaceutical uptake pattern with age.     

TRANSCUTANEOUS ULTRASONOGRAPHIC EVALUATION OF THE AIR-FILLED EQUINE STOMACH AND DUODENUM FOLLOWING GASTROSCOPY

Gastroscopy with air insufflation was performed in 10 ponies, after which a transcutaneous ultrasound examination of the stomach and duodenum was performed immediately and at 1, 2, and 4 h postgastroscopy, and 24 h after feeding. Stomach measurements included the dorsoventral and craniocaudal dimensions, as well as the stomach depth from the skin surface and stomach wall thickness at the different time periods. Gastric wall folding was observed in one pony, becoming most distinct 2–4 h postgastroscopy. An undulating stomach wall was noted in eight other ponies postgastroscopy. These observations appeared to be a response to the deflation of the stomach as the insufflated air was released gradually. Gas was detected in the duodenum after the gastroscopy. The parameters measured were noted to be useful to evaluate the extent of stomach distension due to air or feed. The ultrasonographic appearance of the stomach can, therefore, be altered by gastroscopy and this should be borne in mind when examining horses with suspected gastric disease.     

COMPUTED TOMOGRAPHIC APPEARANCE OF MELANOMAS IN THE EQUINE HEAD: 13 CASES

Melanomas are one of the most common neoplasms in the horse and are frequently found in the head region. There is a genetic predisposition in horses with a gray hair coat. Computed tomography (CT) is frequently used in referral practice to evaluate the equine head but there are few reports describing the CT appearance of melanomas in this location. The aim of this retrospective, case series study was to describe characteristics in a group of horses with confirmed disease. Case records from two referral hospitals were reviewed, and 13 horses were identified that had undergone CT of the head, with a diagnosis of melanoma based on cytology, histopathology, or visual assessment of black (melanotic) tissue. A median of 11 melanomas was identified per horse (range 3–60), with a total of 216 masses. Melanomas were found most frequently in the parotid salivary gland, guttural pouches, surrounding the larynx and pharynx and adjacent to the hyoid apparatus. In noncontrast CT images, all melanomas were hyperattenuating (median; 113.5 Hounsfield units (HU), IQR; 26 HU) compared to masseter musculature (median; 69 HU, IQR; 5.5 HU). Fifty‐six (25.9%) masses were partially mineralized and 41 (19.4%) included hypoattenuating areas. Histopathological assessment of these melanomas suggested that the hyperattenuation identified was most likely a result of abundant intracytoplasmic melanin pigment. Melanomas of the equine head appeared to have consistent CT features that aided detection of mass lesions and their distribution, although histopathological analysis or visual confirmation should still be obtained for definitive diagnosis .     

ULTRASONOGRAPHIC APPEARANCE OF CANINE GASTRIC POLYPS

Benign gastric polyps are uncommon in dogs and most are discovered incidentally. Polyps protruding into the pyloric antrum can cause gastric outflow obstruction. Clinical and ultrasonographic findings in seven dogs with histologically confirmed benign mucosal gastric polyps were reviewed. Sonographic findings such as shape, size, echogenicity, location, evidence of gastric wall thickening, wall layering, and size of regional lymph nodes were recorded. Five sessile and two pedunculated masses of different sizes (range 7–60 mm) and echogenicities were found. They primarily arose from the mucosal layer and protruded into the gastric lumen. Only one dog had a large inhomogeneous mass with a poorly visualized gastric wall layering. The polyps were all single, and were located in the pyloric antrum in six out of seven dogs. Although the ultrasonographic appearance allowed a presumptive diagnosis of mucosal gastric polyp, the final diagnosis was determined from histopathologic examination.     

ULTRASONOGRAPHIC APPEARANCE OF CHRONIC HYPERTROPHIC PYLORIC GASTROPATHY IN THE DOG

Chronic hypertrophic pyloric gastropathy was diagnosed using ultrasound in six dogs that were presented for chronic vomiting. An evenly thick hypoechoic layer surrounding the pyloric lumen was visualized ultrasonographically in dogs with grades 1 or 2 chronic hypertrophic pyloric gastropathy. This was histologically found to correspond with a thickened muscular layer. Gastric wall thickness was greater than or equal to 9 mm in all six dogs. In dogs with grade 1 or 2 chronic hypertrophic pyloric gastropathy, the hypoechoic muscular layer was greater than or equal to 4 mm.     

ELASTOGRAPHIC CHARACTERISTICS OF THE METACARPAL TENDONS IN HORSES WITHOUT CLINICAL EVIDENCE OF TENDON INJURY

Tendon and ligament injuries are common causes of impaired performance in equine athletes. Gray‐scale ultrasonography is the current standard method for diagnosing and monitoring these injuries, however this modality only provides morphologic information. Elastography is an ultrasound technique that allows detection and measurement of tissue strain, and may provide valuable mechanical information about equine tendon and ligament injuries. The purpose of this study was to determine the feasibility, reproducibility, and repeatability of elastography; and to describe elastographic characteristics of metacarpal tendons in sound horses. Nineteen legs for 17 clinically sound horses without evidence of musculoskeletal pathology were included. Elastographic images of the superficial and deep digital flexor tendons and the branches of the suspensory ligament (tendon of the interosseous muscle) were described quantitatively and qualitatively. There was no statistically significant difference between operators (P = 0.86) nor within operators (P = 0.93). For qualitative assessments, reproducibility (0.46) was moderate and repeatability (0.78) was good. Similar to human Achilles tendons, equine tendons were classified as predominantly hard using elastography. There was no statistically significant difference in stiffness of the flexor tendons (P = 0.96). No significant difference in stiffness was found with altered leg position during standing (P = 0.84) and while nonweight bearing (P = 0.61). The flexor tendons were softer when imaged in longitudinal versus transverse planes (P < 0.01) however, the suspensory branches were not (P = 0.67). Findings supported future clinical application of elastography as a noninvasive “stall‐side” imaging modality for evaluation of the tendons and ligaments of the distal forelimb in horses.     

ULTRASONOGRAPHY OF THE EQUINE STIFLE

Ten stifles from 5 clinically sound adult horses were scanned by high-resolution ultrasound. Normal anatomic structures seen consistently included the subcutaneous tissue, the medial, middle and lateral patellar ligaments, the medial and lateral collateral ligaments, the femoral trochlear ridges, and menisci. Cruciate ligaments could not be visualized in the standing horse. Four stifle specimens obtained from 2 of these normal horses at necropsy were scanned in a water bath to create optimal technical conditions. The sonographic appearance of stifle specimens was similar to that found in live horses. Results from ultrasonographic examination of 3 horses with stifle abnormalities were described to illustrate some applications of ultrasonography in the evaluation of the equine stifle. In these horses, ultrasound was a valuable diagnostic tool to study joint effusion, synovial thickening, articular cartilaginous and subchondral defects, and soft tissue/bony injuries.     

ULTRASONOGRAPHIC APPEARANCE OF HISTOPLASMOSIS IDENTIFIED IN THE SPLEEN IN 15 CATS

Histoplasmosis is the second most common fungal infection reported in the cat. The disseminated form involving lung, liver, lymph nodes, spleen, and bone marrow is a frequent manifestation of the disease. Limited information is available in the literature regarding the ultrasonographic appearance of the spleen in cats with disseminated or splenic histoplasmosis. A retrospective review of splenic ultrasound images from 15 cats confirmed to have histoplasmosis by splenic aspirates was performed. Size, echotexture, echogenicity, margin appearance, presence of nodules, and the overall shape of the spleen were reported in each case. Splenomegaly was documented in all cases (15/15) and a hypoechoic appearance of the spleen was documented in 14/15 of cases. The spleen was diffusely and uniformly affected in 14/15 (six homogenous and eight with a subtle mottled appearance) and had discrete nodules in 1/15 cats. Histoplasmosis should be included in the differential list for an enlarged and hypoechoic spleen in cats with consistent clinical findings. Additionally, ultrasound guided splenic aspirate may be a useful method to obtain a cytology sample for diagnosis.     

ULTRASOUND APPEARANCE OF AN EQUINE TESTICULAR SEMINOMA

A 16-year-old thoroughbred stallion developed sudden swelling of the left testicle. The stallion had previously been regarded as a unilateral cryptorchid. Ultrasound examination of the left testicle revealed a diffusely heterogeneous parenchyma. The testicle was diffusely hypoechoic with ill defined regions of hyperechogenicity giving the appearance of hypoechoic nodules throughout the testicular parenchyma. No normal testicular tissue was identifiable. An echogenic band, representing a pseudocapsule could be seen surrounding the testicle. Histopathologic diagnosis a seminoma.