DOPPLER ULTRASONOGRAPHIC DIAGNOSIS AND ANATOMY OF CONGENITAL INTRAHEPATIC ARTERIOPORTAL FISTULA IN A PUPPY

A dilated, tortuous blood vessel was identified sonographically in the right medial liver lobe in a puppy with severe ascites. This vessel was thought to represent the dilated right medial portal vein branch. Using pulsed wave Doppler ultrasonography, retrograde, abnormally pulsatile flow was detected in both the dilated right medial portal vein branch and the main portal vein. The right medial liver lobe was surgically resected then fixed in formalin. Silicon rubber was injected and outlined the connection between the portal vein and hepatic artery.     

ULTRASONOGRAPHIC FINDINGS IN 13 HORSES WITH LYMPHOMA

Ultrasonography and radiography are commonly used for staging of lymphoma in horses, however there is little published information on imaging characteristics for horses with confirmed disease. The purpose of this retrospective, case series study was to describe ultrasonographic and radiographic findings for a group of horses with a confirmed diagnosis of lymphoma. A total of 13 horses were sampled. Lymphadenopathy (8/13), peritoneal effusion (6/13), splenic (6/13), and hepatic (5/13) lesions were the most frequently identified. The predominant splenic and hepatic ultrasonographic lesions were hypoechoic nodules, organomegaly, and changes in echogenicity. Digestive tract lesions were detected in three horses and these included focal thickening and decreased echogenicity of the small (2/13) and large intestinal (2/13) wall. Thoracic lesions were predominantly pleural effusion (4/13), lymphadenopathy (4/13), and lung parenchymal changes (3/13). Enlarged lymph nodes were detected radiographically (4/13) and/or ultrasonographically (2/13) in the thorax and ultrasonographically in the abdomen (7/13) and in the caudal cervical region (4/13). Findings supported the use of abdominal and thoracic ultrasonography for lymphoma staging in horses. Ultrasound landmarks for localizing cecal and caudal deep cervical lymph nodes were also provided.     

DOPPLER MEASUREMENT OF HEPATIC ARTERIAL FLOW IN DOGS: TECHNIQUE AND PRELIMINARY FINDINGS

The common hepatic artery in 10 healthy adult beagles, 20 healthy pups (13 Deerhounds and seven Irish Wolfhounds), and seven dogs with either a congenital or acquired hepatic disorder was examined by duplex-Doppler ultrasonography. Peak systolic velocity (Vs), resistive index (RI), pulse rate, angle of insonation, and sample volume depth were recorded. Measurements in Beagles were made after a 24 h fast and repeated 2 h after feeding. The mean Vs and RI in fasted Beagles were 1.5 m/s (range 1.1-2.3 m/s) and 0.68 (range 0.62-0.74), respectively. Postprandially, there were no significant differences in any of these variables. Mean Vs and RI were lower in pups: 1.0 m/s (range 0.8-1.3 m/s) and 0.59 (range 0.46-0.65), respectively (P < .001). Two dogs with congenital arterioportal fistula had higher mean Vs (P < .001) and lower mean RI (P < .05) than normal pups. No significant differences were detected between normal Beagles, three dogs with portal vein thrombosis, and two dogs with acquired hepatic insufficiency. Differences in measured hepatic blood flow in dogs of different age or breed will complicate diagnostic use of hepatic arterial Doppler measurements.     

ULTRASONOGRAPHIC FINDINGS IN 14 DOGS WITH ECTOPIC URETER

To evaluate ultrasonography as an alternative to contrast radiography for diagnosis of ectopic ureter in dogs, ultrasonography of the urinary tract was performed prospectively in a series of urinary incontinent dogs anesthetized for contrast radiography. Fourteen dogs had ectopic ureter based on surgical, necropsy or unequivocal contrast radiographic findings. There were eight females and six males of a variety of breeds; five were Labrador retrievers. Mean (range) age at the time of diagnosis was 1.2 (0.2–4) years for females and 3.5 (0.3–5) for males (p < 0.05). Ectopic ureters were unilateral in five dogs (2 left; 3 right) and bilateral in nine dogs. Both ultrasound images and contrast radiographs were positive for 21 (91%) ectopic ureters; the same two ectopic ureters were not detected using either modality. The termination of each of the five normal ureters was visible on ultrasound images; two (40%) were visible on radiographs. Other ultrasonographic findings included dilatation of the ectopic ureter and/or ipsilateral renal pelvis in ten (43%) instances, evidence of pyelonephritis in two dogs (with enlargement of the contralateral kidney in one dog), and urethral diverticuli in one dog. Ultrasonography is a practical diagnostic test for ectopic ureter in dogs. In this series there was close correlation between the ultrasonographic and contrast radiographic findings for each ectopic ureter, but ultrasonography enabled more accurate determination of normal ureteral anatomy.     

ULTRASONGRAPHIC FINDINGS IN HEPATIC AND SPLENIC LYMPHOSARCOMA IN DOGS AND CATS

In a survey of patients with histologically-confirmed hepatic lymphosarcoma at Tufts University, abnormal ultrasound findings were detected in 3 of 14; two had diffuse hepatic hypoechogenicity, one had a focal hypoechoic lesion. In contrast, 5 of 6 patients with spleic lymphosarcoma had an abnormality on ultrasongraphy; two had diffuse hypoechogenicity, one had multiple hypoechoic foci, one had a large, cavitated-appearing mass, and one had an irregular border. In our experience, ultrasonography is an insensitive means of detecting hepatic lymphosarcoma but appears more sensitive for detection of splenic lymphosarcoma.     

ECHOCARDIOGRAPHIC DIAGNOSIS OF TRANSPOSITION OF THE GREAT ARTERIES IN A NEONATAL FOAL

The clinical and echocardiographic findings in a 19-h-old female foal with a ventricular septal defect, patent foramen ovale, patent ductus arteriosus, and complete transpositon of the great vessels are described. Clinical signs were suggestive of complex congenital heart disease and echocardiography of the foal allowed definitive diagnosis prior to postmortem.     

ULTRASONOGRAPHIC DIAGNOSIS OF A DEEP MUSCLE ABSCESS IN A HORSE

A deep muscle abscess was diagnosed in a horse with a clinical history of a painful swelling in the left gluteal region. The thick walled hypoechoic structure seen on presentation and the multiloculated hyperechoic mass seen on reevaluation are common Ultrasonographic appearances of abscesses. Ultrasonographic evaluation allowed characterization of a chronic mass with subsequent successful surgery and treatment.     

DOPPLER ECHOCARDIOGRAPHY IN THE NORMAL DOG: PART I VELOCITY FINDINGS AND FLOW PATTERNS

This study examined the blood flow velocities and flow patterns in the normal dog using pulsed wave spectral Doppler echocardiography in eight areas of the heart. Two breeds of dogs, aged between 8 and 112 weeks and of both sexes, were used. The dogs were fully conscious and no drugs were used. The areas examined were the mitral valve, left atrium, tricuspid valve, right atrium, aorta, left ventricular outflow tract, pulmonary valve and the right ventricular outflow tract. The peak and mean velocities, direction of flow and whether flow was systolic or diastolic was determined for each of these flow areas. Additionally each of these waveforms were described. Aortic flow was also measured from the thoracic inlet by continuous wave Doppler.     

ECHOCARDIOGRAPHIC EVIDENCE OF AN AORTICO-PULMONARY SEPTAL DEFECT IN A 4-DAY-OLD THOROUGHBRED FOAL

We describe the echocardiographic findings in a 4-day-old thoroughbred foal with an aortico-pulmonary septal defect. The foal had labored breathing, cyanotic mucous membranes and a continuous grade 5/6 heart murmur with point of maximal intensity over the base of the heart on the right side. Echocardiographically, there was a large communication between the aorta and the pulmonary artery just dorsal to the base of the heart. The cardiac anomaly seen during the echocardiographic exam was confirmed at necropsy where a large communication between the two great vessels was observed. These findings correlate with previous studies in humans, dogs, and cats. The possible failure in the embryologic development that led to this unusual cardiac anomaly is discussed.     

ULTRASONOGRAPHIC FINDINGS IN HORSES WITH FOOT PAIN BUT WITHOUT RADIOGRAPHICALLY DETECTABLE OSSEOUS ABNORMALITIES

Foot pain is an important cause of lameness in horses. When horses with foot pain have no detectable radiographic abnormalities, soft‐tissue assessment remains a diagnostic challenge without magnetic resonance (MR) imaging. Ultrasonography can provide an alternative to MR imaging when that modality is not available but the extent of changes that might be seen has not been characterized. We reviewed the ultrasonographic findings in 39 horses with lameness responding positively to anesthesia of the palmar digital nerves and without radiographically detectable osseous abnormalities. Thirty of the 39 horses had lesions affecting the deep digital flexor tendon (DDFT), 27 had abnormalities in the distal interphalangeal joint of which six had a visible abnormality in the collateral ligament. Ultrasonographic abnormalities were seen in the podotrochlear bursa in 22 horses and in the ligaments of the navicular bone in two horses. Abnormalities of the navicular bone flexor surface were detected in eight horses. In three of the 39 horses, only the DDFT was affected. The other 36 horses had ultrasonographic abnormalities in more than one anatomical structure. Based on our results, ultrasonographic examination provides useful diagnostic information in horses without radiographic changes.     

ECHOCARDIOGRAPHIC DETECTION OF A DISSECTING AORTIC ROOT ANEURYSM IN A THOROUGHBRED STALLION

A 12-year-old Thoroughbred stallion was referred with a history of acute pain and tachycardia immediately after breeding a mare. On presentation, the horse showed no evidence of pain and routine examination of the abdomen failed to yield any abnormalities, however, a persistent tachycardia remained. A base-apex ECG examination revealed sustained ventricular tachycardia which resolved spontaneously within 12 hours of hospitalization. During this period, the stallion developed a grade 4/6 heart murmur. An aortic root aneurysm in the right sinus of Valsalva was diagnosed using two-dimensional echocardiography. Pulsed-wave Doppler evaluation revealed turbulent flow within the aneurysm. Repeat echocardiographic examination 10 months after the onset of signs revealed no change and the horse continues to perform as a breeding stallion.     

M-MODE AND DOPPLER ECHOCARDIOGRAPHIC FINDINGS IN NORMAL FERRETS SEDATED WITH KETAMINE HYDROCHLORIDE AND MIDAZOLAM

M-mode and Doppler echocardiographic values were obtained from 30 normal adult ferrets (14 neutered females, 13 neutered males, 3 intact males) sedated with an intramuscular combination of ketamine hydrochloride and midazolam. Routine M-mode measurements of the left and right ventricle, left atrium (LA) and aorta (AO) and Doppler measurements of aortic and pulmonic outflow, and mitral inflow were recorded. The following values were calculated: LA:AO diameter, ratio of peak E: peak A wave velocity (E:A ratio) for mitral inflow, and stroke volume (SV), cardiac output (CO) and cardiac index (CI) for both pulmonary and aortic outflow tracts. Maximal aortic velocities (AOmax) and velocity-time integral values (AO VTI) were significantly less than corresponding pulmonary outflow tract values (PAmax, PA VTI) but there was no difference in calculated values for SV, CO or CI. Calculated CO values were in the range expected based on the size of the species. Difficulties in aligning the aortic outflow tract for Doppler imaging may make pulmonary outflow Doppler values more consistent for use in estimating volume flow in ferrets.     

ULTRASONOGRAPHIC FINDINGS IN CHOLECYSTOKININ-INDUCED PANCREATITIS IN DOGS

Pancreatitis can be induced in dogs by intravenous infusion of supraphysiologic doses of synthetic cholecystokinin octapeptide (CCK-8). Eight anesthetized female beagles were given either CCK-8 or saline in a randomized, blinded fashion and had abdominal ultrasonography to study the development of pancreatic lesions. Pancreatic lesions were apparent 2 hours after the start of CCK-8 infusion and included swelling, interlobular and subcapsular fluid accumulation and patchy hypoechogenicity of the gland parenchyma. CCK-8 had a variable effect on gallbladder emptying. No signs of biliary obstruction or duodenal lesions were identified. Dogs given CCK-8 had severe edematous pancreatitis at necropsy six hours after the start of the infusion. Compared to the oleic acid model of pancreatitis, CCK-8 infusion induces a rapid onset of pancreatitis and an ultrasonographic appearance that reflects diffuse edema of the gland. The short time-scale of the experiment may account for the relative absence of secondary lesions affecting the biliary tract or duodenum compared to the naturally-occurring disease.     

TRANSRECTAL ULTRASONOGRAPHY OF THE LEFT ADRENAL GLAND IN HEALTHY HORSES

Little information is available on medical imaging of the adrenal glands in horses. We investigated the feasibility of transrectal ultrasonography to characterize the normal equine adrenal gland. Transrectal ultrasonography was performed in 25 healthy horses using a 7.5 MHz linear array probe at a displayed depth of 8 cm. Transrectal ultrasonography of the right adrenal gland was not feasible. For the left adrenal gland, the left kidney, the abdominal aorta, the left renal artery, the left renal vein, and the cranial mesenteric artery were used as landmarks. The size of the left adrenal gland was variable, but it generally appeared as a long, flat structure with a hyperechoic medulla surrounded by a hypoechoic cortex. The most cranial part of the gland could not be delineated appropriately in 11 horses (44%). The mean (±SD) thickness of the gland and medulla was 0.66±0.15 cm (n=25) and 0.28±0.09 cm (n=25) near the caudal pole, 0.87±0.25 cm (n=14) and 0.40±0.18 cm (n=12) near the cranial pole, and 0.89±0.18 cm (n=25) and 0.36±0.13 cm (n=25) in the middle of the gland, respectively. The mean (±SD) length of the entire adrenal gland and of the medulla was 6.22±0.77 cm (n=14) and 5.45±0.71 cm (n=6), respectively. Transrectal ultrasonography allowed adequate visualization of the left adrenal gland in horses.     

COMPUTED TOMOGRAPHIC EVALUATION OF HEAD TRAUMA IN A FOAL

This case report describes computed tomographic findings of a three-month-old, 180 kg female Arabian foal that had suffered head trauma. Computed tomography proved valuable in antemortem diagnosis of skull base fracture and extradural hematoma, which were confirmed by postmortem examination.     

SOURCES AND MAGNITUDE OF VARIATION OF ECHOCARDIOGRAPHIC MEASUREMENTS IN NORMAL STANDARDBRED HORSES

The purpose of this study was to assess the intraobserver variation of various echocardiographic measures in standardbred trotters. Serial echocardiographic examinations were carried out on eight standardbred mares by one ultrasonographer for 5 separate days. During each examination, five nonconsecutive cardiac cycles (frames) were recorded and an average obtained for each individual measure. Various echocardiographic measures were obtained by use of two-dimensional (2-D), M-mode, color flow Doppler and pulsed wave Doppler echocardiography. The total variation in the echocardiographic measurements was split into three levels: the variation between horses, the day-to-day variation within individual horses, and finally the variation within horse on the same day of examination (intercardiac cycle variation). The intraclass correlation coefficient (ICC) was calculated for each measure. The ICC represents the variability of the measurements because of differences between the horses. In general the 2-D, M-mode and color flow Doppler measures had higher ICC values (ICC from 0.63 to 0.95) than the pulsed wave Doppler measures (ICC from 0.24 to 0.46), and the former measures were more repeatable than the pulsed wave measures. Exceptions to that were left ventricular free wall in diastole, the pulmonary artery in systole and the left ventricular mass, which all had low repeatability (ICC from 0.22 to 0.49). The results were used to calculate the relative differences that must be detected to diagnose a statistically significant change between two measurements in an individual horse. Differences from 4.2% to 21.8% must be achieved to document significant changes between serial measurements. A general tendency is that the color flow and pulsed wave Doppler measures require a larger relative difference (11.4-21.8%) between the measures to point out statistically significant cardiac changes than the 2-D and M-mode measures (4.2-13.9%).     

ULTRASONOGRAPHIC DIAGNOSIS OF CONGENITAL PORTOSYSTEMIC SHUNTS IN DOGS: RESULTS OF A PROSPECTIVE STUDY

The aims of this study were to determine if accurate diagnosis of congenital portosystemic shunt was possible using two dimensional, grey-scale ultrasonography, duplex-Doppler, and color-flow Doppler ultrasonography in combination, and to determine if dogs with congenital portosystemic shunts have increased or variable mean portal blood flow velocity. Eighty-two dogs with clinical and/or clinicopathologic signs compatible with portosystemic shunting were examined prospectively. Diagnosis of congenital portosystemic shunt was subsequently confirmed in 38 of these dogs using operative mesenteric portography: 14(37%) dogs had an intrahepatic shunt and 24(63%) had an extrahepatic shunt. Ultrasonography had a sensitivity of 95%, specificity of 98%, and accuracy of 94%. Ultrasonographic signs in dogs with congenital portosystemic shunts included small liver, reduced visibility of intrahepatic portal vessels, and anomalous blood vessel draining into the caudal vena cava. Correct determination of intra - versus extrahepatic shunt was made ultrasonographically in 35/38 (92%) dogs. Increased and/or variable portal blood flow velocity was present in 21/30 (70%) dogs with congenital portosystemic shunts. In one dog with an intrahepatic shunt the ultrasonographic diagnosis was based partly on finding increased mean portal blood flow velocity because the shunting vessel was not visible. Detection of the shunting vessel and placement of duplex-Doppler sample volumes were facilitated by use of color-flow Doppler. Two-dimensional, grey-scale ultrasonography alone is sufficient to detect most intrahepatic and extrahepatic shunts; sensitivity is increased by additional use of duplex-Doppler and color-flow Doppler. Increased and/or variable portal blood flow velocity occurs in the majority of dogs with congenital portosystemic shunts.     

COMPARISON OF RADIOGRAPHIC AND SCINTIGRAPHIC FINDINGS OF THE SPINOUS PROCESSES IN THE EQUINE THORACOLUMBAR REGION

Back pain is common in horses, but there has been no large‐scale in‐depth study describing radiographic changes of the spinous processes, the relationship between radiographic and scintigraphic findings, and the effect of size, age, breed, or discipline. The objectives were to investigate the frequency of occurrence in horses with perceived back pain of: (1) radiographic alteration of the spinous process structure; (2) increased radiopharmaceutical uptake (IRU) in the spinous processes; and (3) to compare radiographic and scintigraphic findings; and to determine if there was breed, gender, age, bodyweight, height, or work discipline predisposition for close, impinging, or overriding spinous processes. Radiographic and scintigraphic images of the thoracolumbar spine of 604 horses were graded. A radiographic grade for each spinous process (T8–L6) was assigned (0–7). The maximum radiographic grade for each horse was defined as the highest grade assigned to any spinous process; the total radiographic grade was the sum of all grades for each horse. A scintigraphic grade for each spinous process was determined (0–3). The maximum scintigraphic grade for each horse was defined as the highest grade assigned to any spinous process; the total scintigraphic grade was the sum of all grades for each horse. Associations between radiology and scintigraphy and age, gender, breed, height, weight, and discipline were analyzed statistically. The severity of radiographic lesions of the spinous processes was associated with the severity of scintigraphic abnormalities. The caudal thoracic spine (T14–T17) was most frequently affected. There was a significant breed and age effect, with Thoroughbreds and older horses having higher total and maximum radiographic grades. The severity of the lesions of the spinous processes was significantly associated with the presence of osteoarthritis of the articular process joints. It was concluded that there is a wide range of radiographic abnormalities of the spinous processes seen in horses with or without back pain. There is an association between radiographic and scintigraphic grades of the spinous processes.