ENDOSCOPIC ULTRASOUND OF THE CANINE ABDOMEN

The aim of this study was to develop a standardized procedure for examination of the canine abdomen using endoscopic ultrasound and to describe the organs and structures that could be identified transgastrically. The abdomen of four healthy dogs and two cadavers were examined with endoscopic ultrasound. Five anatomic landmarks were used for standardized imaging of the cranial abdomen. These were the portal vein, splenic head and body, duodenum, left kidney, and aorta. High-resolution images of the following organs and structures could be made: distal esophagus, gastric wall from the cardia to the pylorus, liver, caudal vena cava, hepatic lymph nodes, liver hilus, and associated vessels, trifurcation of the celiac artery as well as the path of its branches and the left pancreatic limb and body. Structures that were more difficult to image were the distal duodenum and right pancreatic limb, the entire jejunum, ileum, and cecum as well as the tail of the spleen. Endoscopic ultrasound allowed excellent visualization of the gastric wall and regional structures without interference with gas artefacts. Centrally located organs such as the pancreas could be well examined transgastrically with endoscopic ultrasound without interference by overlying intestinal segments as is common with transabdominal ultrasound.     

ENDOSCOPIC ULTRASOUND INSTRUMENTATION, APPLICATIONS IN HUMANS, AND POTENTIAL VETERINARY APPLICATIONS

Endoluminal scanning under endoscopic guidance, or endoscopic ultrasonography (EUS), has become the most significant advance for imaging the gastrointestinal (GI) tract wall and contiguous organs in the past 20 years. It was originally designed to overcome the limitations in humans to imaging the abdominal organs transabdominally, such as large penetration depths and GI air. This imaging modality provides detailed images of pathological processes both within and outside of the GI wall since a high-frequency transducer can be brought into close proximity with the target regions. It has found most success in humans for the staging of lung, gastric, and esophageal cancer, the detection of both lymphatic and hepatic metastases, and diagnosis of pancreatitis and pancreatic cancer, as well as achieving an important role in interventional and therapeutic procedures. The EUS examination can be performed to examine both the thorax and abdomen in animals when both conventional transthoracic or transabdominal ultrasound are inadequate due to intervening air, bone, large penetration depths, or obesity. The echoendoscope is similar to a conventional endoscope but has an ultrasound transducer at its tip. Both radial and linear multifrequency scanners are available. Linear scanners allow fine-needle aspiration (FNA) of the bowel wall or extraluminal structures. Transducer coupling is either by direct mucosal contact or by inflation of a water-filled balloon surrounding the transducer. Current thoracic applications for EUS in veterinary medicine include examination of the mediastinum, bronchial lymph nodes, esophagus, and pulmonary lesions as well as FNA of pulmonary masses. Abdominal applications include examination of both pancreatic limbs and the liver, including portosystemic shunts, detection of lymphadenomegaly, and examination of the gastric wall, duodenum, and jejunum. Other potential applications in dogs and cats include tumor staging and intrapelvic ultrasound.     

ULTRASONOGRAPHIC EXAMINATION OF CERVICAL MASSES IN THE DOG AND CAT

The ultrasonographic appearance of clinically undifferentiated neck masses for which a definitive diagnosis was eventually obtained in nineteen dogs and one cat is presented in this report. Multiple lesions were seen ultrasonographically in 4 dogs and no cervical abnormalities were seen in 2 dogs resulting in 22 lesions in 20 annuals. Of 7 benign lesions, there were 2 patients with reactive lymph nodes from a regional inflammatory process, and 1 patient each with primary pyogranulomatous lymphadenitis, arteriovenous malformation, foreign body granuloma, cellulitis, and hematoma. Of 15 malignant lesions, 7 were thyroid carcinomas, 3 were lymphomas with submandibular and cervical lymph node enlargement, 3 were lymph node enlargements associated with regional metastasis of malignant tumors, one was a leiomyosarcoma and one was a carotid body tumor. One dog with a diffuse soft tissue swelling of the ventral cervical region had only slight asymmetry of the thyroid lobes on ultrasound examination and no abnormalities of the neck at post mortem. A second dog examined with ultrasound 4 months after surgical removal of a carotid body tumor had no evidence of tumor recurrence. Ultrasonographic examination provided information regarding the character of the lesions, the tissue or organ of origin, and invasion into other anatomic structures. Ultrasound examination in conjunction with fine needle or tissue biopsy provided a definitive diagnosis in those animals in which biopsies were performed.     

IMPROVED DETECTION OF METASTATIC HEPATIC HEMANGIOSARCOMA NODULES WITH CONTRAST ULTRASOUND IN THREE DOGS

Three dogs with a splenic hemangiosarcoma were imaged with conventional gray-scale ultrasound and no lesions were identified in the liver. After administration of intravenous ultrasound contrast medium (Definity) small, poorly enhanced, hypoechoic nodules were identified in the liver in each dog. The spleen and liver lesions were identified at surgery and the dogs underwent splenectomy and nodule biopsy. All lesions were identified histologically as hemangiosarcoma. These preliminary results suggest that contrast ultrasound may result in improved detectability of metastatic hepatic hemangiosarcoma.     

Clinical safety of percutaneous ultrasound‐guided fine‐needle aspiration of adrenal gland lesions in 19 dogs

Objective

To evaluate the safety of fine‐needle aspiration of adrenal gland lesions in dogs and to characterise the risks in a subset of patients with cytologically or histopathologically diagnosed phaeochromocytoma.

Materials and Methods

Retrospective review of medical records of dogs that underwent percutaneous ultrasound‐guided fine‐needle aspiration of adrenal gland lesions between August 2014 and December 2016. Nineteen dogs were identified, with three undergoing bilateral adrenal gland aspiration and one dog undergoing aspiration twice, yielding 23 cytology samples in total. Data collected included signalment, concurrent medical conditions, current medications, blood pressure and heart rate before adrenal fine‐needle aspiration, imaging characteristics of the adrenal gland lesions and any clinically apparent procedure‐related complications.

Results

Phaeochromocytoma was diagnosed in nine of 19 dogs, including one dog with bilateral phaeochromocytoma. One dog developed ventricular tachycardia following aspiration of an adrenal gland lesion cytologically consistent with a phaeochromocytoma.

Clinical Significance

Percutaneous ultrasound‐guided fine‐needle aspiration of adrenal gland lesions appears to be relatively safe, even in phaeochromocytoma, but further data are required to lend more weight to this finding. Minimally invasive aspirates could be considered as part of the diagnostic algorithm in the investigation of an incidentally detected adrenal gland lesion of uncertain clinical significance.     

SONOGRAPHIC APPEARANCE OF RENAL NEOPLASIA IN THE DOG

Eight dogs with renal neoplasia were radiographically and sonographically examined. An enlarged, nonopacified kidney was seen on the excretory urogram in four dogs, but differentiation between a solid mass or severe hydronephrosis was not possible. The excretory urogram suggested an avascular lesion in one kidney, but differentiation between solid or cystic disease was not possible. Renal neoplasia was diagnosed in two dogs by excretory urography. Radiographic examination suggested splenic neoplasia in one dog. Solid masses were sonographically diagnosed in all dogs. A metastatic lesion was sonographically diagnosed in the opposite kidney of one dog that was missed on the radiographic examination. Ultrasonography com-plemented radiography as a diagnostic modality in eliciting additional information on renal disease. Sonograms did not allow determination of tumor cell type or whether the tumor was benign or malignant.     

Real‐time elastosonography of lipomatous vs. malignant subcutaneous neoplasms in dogs: Preliminary results

Real‐time elastography is a recently introduced ultrasound technique allowing the investigation of elastic properties of tissues. A diagnostic accuracy study was conducted to test the performance of this technique in the assessment of subcutaneous lesions in dogs. Fifty‐two dogs were prospectively included in the preliminary study (34 malignant and 18 benign lesions). B‐mode ultrasound was performed assessing the shape, margins, heterogeneity, and echotexture of the lesions. On elastosonography, assessment of the percentage of softness/hardness was recorded. A qualitative assessment was performed according to the Tsukuba elasticity score with a 1–5 score, representing the increased percentage of high stiffness areas. Results were compared with cytology/histopathology of the lesions. Receiver Operating Curves of the overall diagnostic sensitivity and specificity were obtained. Fisher's exact test and Pearsons's Chi‐squared test estimated the relationship between the B‐mode appearance of the lesions and final diagnosis. A hardness cutoff of 50.25% was identified between lesions, with malignant neoplasms having higher percentages. A 100% specificity and 89% sensitivity for correctly detecting the nature of the lesion on elastosonography was established. Qualitative assessment of the Tsukuba elasticity score established 1.5 as the cutoff between elastograms of lipomatous and malignant lesions, with 100% sensitivity and 61% specificity in differentiating them. Real‐time elastosonography is a novel, noninvasive, and accurate technique for differentiating malignant from benign lipomatous lesions in dogs. This method could be considered as a complementary tool with additional diagnostic value for routine invasive procedures, such as fine needle aspirates.     

Synovial Hemangioma in a Dog

Objective— To report arthroscopic diagnosis and treatment of synovial hemangioma in a dog.
Study Design— Case report.
Animal— Standard Poodle (8-year-old neutered male).
Methods— A soft tissue density mass observed radiographically in the left stifle joint of a dog with a 2-month history of recurrent lameness, hemarthrosis, and a slight cranial drawer sign, was located by diagnostic arthroscopy and surgically excised via arthrotomy.
Results— Histologic evaluation revealed tissue composed of variably sized cavernous vascular spaces filled with erythrocytes that were considered compatible with synovial hemangioma.
Conclusions— In this dog, synovial hemangioma evident as a soft tissue mass on radiographs was associated with chronic lameness and hemarthrosis, and resolved with surgical excision.
Clinical Relevance— Synovial hemangioma, although seemingly rare in dogs, should be considered in the differential diagnosis for nontraumatic, recurrent lameness, and unresponsive to anti-inflammatory therapy when there is a circumscribed intracapsular soft tissue mass evident radiographically together with hemarthrosis.     

NON-CARDIAC THORACIC ULTRASOUND IN 75 FELINE AND CANINE PATIENTS

The purpose of this study was to describe the ultrasonographic appearance of non-cardiac diseases of the small animal thorax. Ultrasound images from a total of 75 animals (26 cats and 49 dogs) were compared to cytologic, histopathologic, and necropsy findings. Clinical diagnoses included neoplasia of the mediastinum, pleura, or lungs (43); idiopathic mediastinal cyst (3); diaphragmatic or peritoneopericardial hernia (4); lung lobe torsion (1); pulmonary eosinophilic infiltrates (1); and idiopathic, chylous, congestive heart failure, or lymphangiectasia associated pleural effusion (14). In the remaining 9 patients, a definitive diagnosis was not obtained. Ultrasound-guided fine needle aspirate was performed in 56 patients; 1 of these also had an ultrasound-guided tissue core biopsy. Of the fine needle aspirates, 51 (91%) were diagnostic. Ultrasound examination, particularly when accompanied by guided tissue sampling, can be a valuable tool in the diagnosis of non-cardiac intrathoracic lesions.     

Effect of sample quality on the sensitivity of endoscopic biopsy for detecting gastric and duodenal lesions in dogs and cats

Background: The quality of histopathology slides of endoscopic biopsies from different laboratories varies, but the effect of biopsy quality on outcome is unknown.
Hypothesis: The ability to demonstrate a histologic lesion in the stomach or duodenum of a dog or cat is affected by the quality of endoscopic biopsy samples submitted. More endoscopic samples are needed to find a lesion in poor-quality tissue specimens.
Animals: Tissues from 99 dogs and 51 cats were examined as clinical cases at 8 veterinary institutions or practices in 5 countries.
Methods: Histopathology slides from sequential cases that underwent endoscopic biopsy were submitted by participating institutions. Quality of the histologic section of tissue (inadequate, marginal, adequate), type of lesion (lymphangiectasia, crypt lesion, villus blunting, cellular infiltrate), and severity of lesion (normal, mild, moderate, severe) were determined. Sensitivity of different quality tissue samples for finding different lesions was determined.
Results: Fewer samples were required from dogs for diagnosis as the quality of the sample improved from inadequate to marginal to adequate. Duodenal lesions in cats displayed the same trend except for moderate duodenal infiltrates for which quality of tissue sample made no difference. Gastric lesions in dogs and mild gastric lesions in cats had the same trend, whereas the number of tissue samples needed to diagnose moderately severe gastric lesions in cats was not affected by the quality of tissue sample.
Conclusions and Clinical Importance: The quality of endoscopically obtained tissue samples has a profound effect on their sensitivity for identifying certain lesions, and there are differences between biopsies of canine and feline tissues.     

Ultrasonographic evaluation of normal canine iliopsoas muscle

The aim of this study was to describe the normal ultrasonographic appearance of the iliopsoas muscle and related landmarks. Hind limbs of five dog cadavers with no history of lameness were evaluated. The origin and mid-body of the psoas major and the common insertion of the iliacus and psoas major on the lesser trochanter of the femur were identified and evaluated. New methylene blue was injected under ultrasonographic guidance at the three sites. Dissection was performed to confirm placement of the dye. The L3 origin, mid-body, and insertion of the muscle were identified in all dogs and were consistent in appearance and compatible with the general appearance of muscle and tendons. The L2 origin was consistently difficult to image. The same ultrasound technique was subsequently applied to four healthy dogs, and consistent images of the iliopsoas muscle and associated landmarks were obtained. In this study, the major structures of the iliopsoas could be identified and in all dogs had a similar appearance. Ultrasound is an important tool for the diagnosis of musculotendinous injury and may be useful for identification of ilipsoas injury as a cause of lameness in the dog.     

Contrast‐enhanced ultrasonography characteristics of intrathoracic mass lesions in 36 dogs and 24 cats

Contrast‐enhanced ultrasonography (CEUS) is increasingly available for veterinary patients, however limited studies describe the use of this method for characterizing intrathoracic mass lesions. The aim of this prospective, observational study was to describe CEUS enhancement patterns for intrathoracic mass lesions in a sample of cats and dogs. Sixty patients (36 dogs, 24 cats) were included. Standardized CEUS examinations were performed for 41 pulmonary masses (68%) and 19 mediastinal masses (32%). Final diagnosis was based on cytology and/or histopathology. Absolute time to enhancement (TTE) values were recorded for the intrathoracic mass lesions and spleen. The spleen was used as a reference parenchymal organ to calculate relative TTE (rTTE) values. Absolute TTE of the spleen and intrathoracic mass lesions differed for dogs and cats (P = 0.001). The rTTE values significantly differed between lesions of neoplastic versus non‐neoplastic origin (P = 0.004). The majority of neoplastic pulmonary masses were supplied by bronchial arteries (63%), while most nonneoplastic pulmonary masses were supplied by pulmonary arteries (78%). The sensitivity and specificity for detecting pulmonary neoplastic masses with rTTE were 63% and 78%, respectively. Enhancement patterns for mediastinal thymomas and lymphomas significantly differed (P = 0.002). Thymomas enhanced heterogeneously in a centripetal pattern (86%), whereas lymphomas typically enhanced uniformly in a centrifugal pattern (75%). Findings indicated that CEUS is a feasible method for characterizing intrathoracic mass lesions in dogs and cats, however, the diagnostic sensitivity for detecting neoplastic pulmonary masses was low.     

CONTRAST‐ENHANCED ULTRASONOGRAPHY OF THE PANCREAS IN HEALTHY DOGS AND IN DOGS WITH ACUTE PANCREATITIS

Pancreatitis is the most frequent disease affecting the exocrine pancreas in dogs and reliable diagnostic techniques for predicting fatal complications are lacking. Contrast‐enhanced ultrasound (CEUS) improves detection of tissue perfusion as well as organ lesion vascular pattern. Objectives of this prospective case control study were to compare perfusion characteristics and enhancement patterns of the pancreas in healthy dogs and dogs with pancreatitis using CEUS. Ten healthy dogs and eight dogs with pancreatitis were selected based on physical examination, abdominal ultrasound, and blood analysis findings. A CEUS study of the pancreas was performed for each dog and two observers who were aware of clinical status used advanced ultrasound quantification software to analyze time‐intensity curves. Perfusion patterns were compared between healthy and affected dogs. In dogs with acute pancreatitis, mean pixel and peak intensity of the pancreatic parenchyma was significantly higher than that of normal dogs (P = 0.05) in between 6 and 60 s (P = <0.0001–0.046). This corresponds to a 311% increase in mean pixel intensity in dogs with acute pancreatitis compared to healthy dogs. Wash‐in rates were greater and had a consistently steeper slope to peak in dogs with pancreatitis as opposed to healthy dogs. All dogs with pancreatitis showed a decrease in pixel intensity 10–15 days after the initial examination (P = 0.011) and their times to peak values were prolonged compared to the initial exam. Findings from the current study supported the use of CEUS for diagnosing pancreatitis, pancreatic necrosis, and disease monitoring following therapy in dogs.     

DEVELOPING A TECHNIQUE FOR ULTRASOUND‐GUIDED INJECTION OF THE ADULT CANINE HIP

An accurate method for guiding injections into the canine hip would facilitate diagnostic localization of lameness and targeted treatments. Ultrasound‐guided hip injections are commonly used in humans and large animals. Aims of this prospective study were to describe ultrasound (US) anatomy of the adult canine hip and determine the feasibility and accuracy of intra‐articular placement of injectate using US‐guidance. Seven adult dogs were used to describe US anatomy, five dog cadavers were used to assess the feasibility of the injection technique and 11 dog cadavers were used to assess accuracy of injections. For the accuracy test, 22 joints were injected with iodinated contrast medium by three operators with different experience. With dogs in lateral recumbency, the hyperechoic femoral head surface was identified by following the femoral neck from the greater trochanter or the acetabular rim was localized by following caudally the ilium from the iliac wing.  An anechoic gap between the femoral head and acetabular surface represented the joint. The capsule was visible as a triangular echoic structure and the femoral head articular cartilage appeared as an anechoic band. The needle was inserted axial to the greater trochanter and directed in a dorsolateral–ventromedial direction toward the joint space and then pushed through the capsule. Based on postinjection radiography, accuracy was 81.8% at first attempt and 100% at second attempt. This study indicated that US‐guided injection is a feasible and accurate technique for injecting the adult canine hip. Future studies in live dogs are needed to assess safety and efficacy.     

PREVALENCE OF INCIDENTAL THYROID NODULES IN ULTRASOUND STUDIES OF DOGS WITH HYPERCALCEMIA (2008–2013)

Ultrasound is commonly used to evaluate the cervical region in dogs with hypercalcemia due to suspected hyperparathyroidism. Incidental thyroid nodules may be detected during these studies, however little information has been published to guide clinical decision‐making when this occurs. The purpose of this cross‐sectional study was to determine the prevalence of incidental thyroid nodules in hypercalcemic dogs undergoing cervical ultrasound at our hospital during the period of 2008–2013. Dogs with a palpable neck mass were excluded. Cervical ultrasound images for each dog were retrieved and reviewed by a board certified veterinary radiologist who was unaware of patient outcome. Presence, number, and dimensions of thyroid nodules were recorded. Results of thyroid nodule aspirate, biopsy or necropsy were recorded from medical records when available. Ninety‐one dogs met inclusion criteria. Of these, 14/91 (15%) dogs had at least one thyroid nodule. Mean (± standard deviation) thyroid gland nodule length, width, and height were 1.51 ± 0.74, 0.96 ± 0.73, and 0.75 ± 0.36 cm, respectively. A histologic diagnosis was available for the incidental thyroid lesions in eight dogs, including one dog with two nodules. Confirmed diagnoses for these nodules were thyroid cyst (3/9, 33%), thyroid adenoma (3/9, 33%), thyroid adenocarcinoma (2/9, 22%) and nodular hyperplasia (1/9, 11%). Findings indicated that incidental thyroid nodules may be present in hypercalcemic dogs with no palpable neck mass and no clinical signs of thyroid disease. Some of these nodules may be malignant and therefore a recommendation for cytology or biopsy may be justified.     

FEASIBILITY OF PERCUTANEOUS CONTRAST ULTRASOUND‐GUIDED CHOLECYSTOGRAPHY IN DOGS

Differentiating hepatocellular disease versus biliary obstruction can be challenging in dogs presented for icterus. The purpose of this prospective study was to determine the feasibility of percutaneous contrast ultrasound‐guided cholecystography in dogs. Ten normal dogs weighing 7.6–13.0 kg (median 9.8 kg) were recruited. All dogs were considered normal based on complete blood count, serum chemistry profile, ultrasound examination, and percutaneous radiographic cholecystography. Percutaneous contrast ultrasound‐guided cholecystography was performed using 0.5 ml of commercially available contrast agent and two conventional ultrasound machines for simultaneous scanning at two different locations. Two observers independently evaluated the time to initial detection of contrast in the proximal duodenum and duration of contrast enhancement via visual monitoring. Dynamic contrast enhancement was calculated using time‐intensity curves. Mean (±SD) and median (range) of time to initial detection were 8.60 s (± 3.35) and 8.0 s (2.0–11.0), respectively, and mean and median duration were 50.45 s (±23.24) and 53.0 s (20.0 – 70.0), respectively. Mean, median, and range of peak intensity were 114.1 mean pixel value (MPV) (SD ± 30.7), 109.2 MPV, and 79.7–166.7, respectively, and mean, median, and range of time to peak intensity were 26.1 s (SD ± 7.1 s), 24.0 s, and 19.0–41.0 s, respectively. Findings indicated that percutaneous contrast ultrasound‐guided cholecystography is a feasible technique for detecting and quantifying patency of the bile duct in normal dogs. Future studies are needed to assess the diagnostic utility of this technique for dogs with biliary obstruction.     

ENDOSCOPIC ULTRASONOGRAPHY OF THE PANCREAS IN THE DOG

Endoscopic ultrasonography was done in 12 normal adult dogs to investigate its efficacy in visualization of the pancreas. The endoscopic ultrasonographic device used in the present study had a curved-array ultrasound transducer mounted in front of the objective lens. The tip of the ultrasonic endoscope was inserted into the stomach, and all examinations of the pancreas were performed from within the stomach. Endoscopic ultrasonography provided good images of most parts of the pancreas except for the ends of each lobe. Useful information about the pancreatic parenchyma, including pancreatic lobular structure, pancreatic duct, and vessels of the pancreas was obtained by endoscopic ultrasonography. Blood flow within vessels was detected using color Doppler and pulsed-wave Doppler examination. These results suggest that endoscopic ultrasonography is available as an effective diagnostic modality in small animal practice.     

Percutaneous endoscopic tube gastrostomy in dogs

Percutaneous endoscopic tube gastrostomy was performed in 10 dogs, using mushroom-tip catheters (16 to 24 F) maintained in place for 5 to 32 days. Dogs were observed daily. Although placement of the catheter was simple and quick, 3 dogs destroyed their catheters. Patency of the catheter was maintained with or without regular flushings with saline solution. Pyrexia (greater than or equal to 39.4 C) developed in 3 dogs, but the rectal temperature returned to base line within 24 hours after catheter removal. After catheter removal, all wounds healed without complication. All dogs were euthanatized. Five were examined radiographically before euthanasia to determine the fate of the mushroom tip after transection of the catheter at skin level between days 5 and 21, and 5 dogs were evaluated at postmortem examination between days 10 and 32. In all dogs, the tip was not present in the gastrointestinal tract by 96 hours after catheter transection. During postmortem examination of the 5 dogs, minimal inflammatory lesions were seen in the gastric tissue. A gastrocutaneous fistula had formed in each dog, resulting in an adhesion between the stomach and peritoneum.