EVALUATION OF CONTRAST‐ENHANCED ULTRASONOGRAPHY AS A METHOD FOR DETECTING GALLBLADDER NECROSIS OR RUPTURE IN DOGS

Gall bladder necrosis and rupture are life‐threatening conditions in dogs requiring surgical intervention and early diagnosis is essential. Human patients with suspected gall bladder necrosis/rupture are commonly evaluated with contrast‐enhanced ultrasonography (CEUS), however this procedure has not been described in dogs with suspected gall bladder necrosis/rupture. In a prospective diagnostic cohort study, CEUS (using SonoVue contrast medium) was performed in 93 dogs with gallbladder lesions identified by abdominal conventional ultrasonography. Necrosis/rupture was identified by CEUS as a focal lack of enhancement of the gallbladder wall. Dogs with positive CEUS finding for necrosis/rupture (complete lack of regional wall enhancement) underwent immediate surgery as did dogs with other biliary disorders requiring surgery. Dogs with negative CEUS findings or those not requiring surgery were managed medically. In cases undergoing surgery, necrosis/rupture was confirmed intraoperatively (and via histopathology). Absence of necrosis/rupture was confirmed either intraoperatively (via histopathology) or was assumed to be absent by complete recovery with medical management. Forty‐nine dogs underwent surgery and cholecystectomy: 24 had necrosis/rupture. CEUS was more accurate (100% sensitive and specific) in diagnosing gallbladder wall necrosis/rupture than conventional ultrasonography (75% sensitive and 81% specific) (P < 0.03). In conclusion, CEUS provides accurate characterization of gallbladder wall integrity that can impact decisions regarding clinical management, either surgical or medical.     

The clinical practice of CPCR in small animals: an internet‐based survey

Objective – To characterize the provision of CPCR by small animal veterinarians in clinical practice and to assess how this practice varies among different levels of expertise. Design – Internet‐based survey. Setting – Academia, referral practice, and general practice. Subjects – Six hundred and two small animal veterinarians in clinical practice. Respondents were grouped a priori according to level of expertise: board‐certified (ACVECC, ACVA, ECVAA) specialists; general practitioners in emergency clinics; general practitioners in general practice (GPG). Interventions – Email invitations to the online questionnaire were disseminated via a veterinary internet platform and mailing list server discussion groups. Questions explored respondent characteristics, CPCR preparedness, infrastructural and personnel resources, and techniques of basic and advanced life support. Main Results – In this group of practitioners, the majority (65%) were in general practice. GPG were more likely to perform CPCR <5 times per year and to have 3 or fewer members on their resuscitation team. Most practitioners have a crash cart and drug‐dosing chart available. GPG were less likely to obtain resuscitation codes on their patients, and less likely to use end‐tidal carbon dioxide monitoring or defibrillation. Intubation, oxygen supplementation, vascular access, and external thoracic compressions were widely used, however, GPG were more likely to use lower chest compression rates. Drugs used for CPCR differed among the groups with GPG more likely to use doxapram and glucocorticoids. Conclusions – CPCR is heterogeneously performed in small animal veterinary medicine; differences exist, both among and within different types of veterinarians with varying levels of expertise, in respect to available infrastructure, personnel and CPCR techniques used.     

Comparison of 4 Giardia Diagnostic Tests in Diagnosis of Naturally Acquired Canine Chronic Subclinical Giardiasis

Background: The performance of Giardia diagnostic tests that detect either cysts or fecal antigens has not been thoroughly examined. Hypothesis/Objectives: We examined the concordance and agreement among 4 Giardia diagnostic tests (2 cyst and 2 coproantigen detection methods) in a colony of dogs chronically and subclinically infected with Giardia. Animals: Twenty dogs with chronic, subclinical Giardia infection. Methods: Giardia diagnostic tests were performed repeatedly on each dog over 120 days. Fecal cyst detection methods (ZnSO₄ flotation and fluorescent antibody [FAB] coproscopy) were performed 3 times per week. Coproantigen methods (Giardia SNAP test and quantitative ELISA) were performed weekly. Results were analyzed and compared among methods. Results: When compared with FAB coproscopy, all of the in‐house diagnostic tests had excellent positive predictive values (PPVs, 95–99%) at the study prevalence (89%). At lower prevalence rates, ZnSO₄, SNAP, and ELISA tests all had good negative predictive values (NPVs), but poor PPVs. There was poor to good agreement among tests by κ analysis. Conclusion and Clinical Relevance: Our findings show that most commonly used in‐house Giardia diagnostic tests have poor agreement with the gold standard method (FAB coproscopy). The in‐house tests have good NPVs, but poor PPVs, at prevalence rates common in most clinical settings.     

Contrast‐enhanced ultrasound complements two‐dimensional ultrasonography in diagnosing gallbladder diseases in dogs

Gall‐bladder diseases are common in dogs and two‐dimensional ultrasonography is a current standard method for diagnosis and treatment planning. However, findings from this modality can be nonspecific. The aim of this retrospective, case series study was to describe conventional and contrast‐enhanced ultrasound (using SonoVue^®) findings in a group of dogs with histologically confirmed gall bladder disease. A total of 65 dogs were included. Branchlike, heterogeneous, and homogeneous contrast enhancement of echogenic intraluminal mass‐forming lesions was a contrast‐enhanced ultrasound characteristic of polypoid lesions due to cystic mucosal hyperplasia of the gallbladder and/or tumor, which had different wash‐in and washout characteristics. In dogs with mobile or immobile biliary sludge or mucocele, the echogenic intraluminal masses remained unenhanced. A double rim mark or enhancement defect in the gallbladder wall was a characteristic of edema or necrosis/rupture of the wall, respectively. Conventional ultrasonography correctly identified biliary sludge or mucocele in 36/37 dogs, cholecystitis/edema in 44/47 dogs, necrosis/rupture in 19/25 dogs, and gallbladder neoplasia in three of three dogs with these pathologies. It falsely identified biliary sludge or mucocele in eight of 28 dogs, cholecystitis/edema in three of 15 dogs, necrosis/rupture in 13/37 dogs, and gall‐bladder neoplasia in 20/59 dogs that did not have these pathologies. Contrast‐enhanced ultrasound correctly identified cholecystitis/edema in 42/47 dogs, but falsely identified cholecystitis/edema in three of 18 dogs. It correctly identified necrosis/rupture, benign polypoid lesions, and gallbladder neoplasia in all dogs with no false‐positive results. Findings supported contrast‐enhanced ultrasound as a complement to conventional ultrasonography for dogs with suspected gallbladder pathologies such as edema, necrosis, and rupture.     

SYSTOLIC AORTIC VALVE FLUTTER IN 6 DOGS

Systolic aortic valve flutter was identified by M-mode echocardiography in 6 large-breed dogs without evidence of structural cardiac disease. It ranged in amplitude, timing, and frequency. Systolic aortic valve flutter is considered an incidental and normal finding in some dogs, similar to the situation in humans.