Extruded gallbladder mucoceles have characteristic ultrasonographic features and extensive migratory capacity in dogs.

Limited information is available on the ultrasonographic characteristics of extruded gallbladder mucoceles. The objective of this retrospective case series study was to describe the ultrasonographic features of extruded gallbladder mucoceles in a group of dogs. Medical records of four veterinary centers were searched between June 2010 and January 2018 for all dogs with a suspected extruded gallbladder mucocele based on abdominal ultrasound. Seven client-owned dogs met the inclusion criteria. All seven dogs had a discrete, heteroechoic, multilayered, stellate, or striated mass within the peritoneal cavity. Blood flow was not present in these structures. Four of these structures were identified in the caudal abdomen. In five cases, the gallbladder lumen was filled with material similar in appearance to the free-floating peritoneal mass. Four cases were confirmed surgically and one case was confirmed at necropsy. Histopathology of the gallbladder wall was evaluated in all surgical cases and analysis of the free-floating material was performed in one of the four cases. Extruded gallbladder mucoceles have common imaging characteristics that may be helpful in establishing a presumptive diagnosis. Additionally, these structures may have extensive migratory capacity. The results of the study justify the recommendation for exploration of the entire abdomen during cholecystectomy for gallbladder mucocele removal.

[Subcutaneous ureteral bypass devices as a treatment option for bilateral ureteral obstruction in a cat with ureterolithiasis]. / Beidseitiger Einsatz eines subkutanen Ureter-Bypass bei einer Katze mit bilateraler Harnleiterobstruktion.

A 6-year-old female spayed Domestic Shorthair cat was presented with acute lethargy, dehydration, marked azotemia, metabolic acidosis, left-sided renomegaly, and bilateral hydronephrosis. Ureterolithiasis and ureteral obstruction were suspected based on further diagnostics including abdominal sonography. Medical treatment was not successful. Fluoroscopically guided antegrade pyelography confirmed the diagnosis of bilateral ureteral obstruction due to ureterolithiasis. Subcutaneous ureteral bypass (SUB) devices were placed bilaterally, followed by close patient monitoring. Frequent reassessment of patient parameters and blood work served to adjust the fluid needs of the patient and to ensure proper hydration, correction of azotemia at an appropriate rate, and cardiovascular stability. After significant improvement of all patient parameters within 5 days, the patient was discharged from the hospital. Treatment included a dietary change to reduce the risk of stone formation as well as a phosphorus binder. Clinical and clinicopathologic parameters were unchanged at the 1- and 4- and 7-month rechecks (consistent with IRIS CKD stage II-NP-AP0), and both SUB devices continued to provide unobstructed urine flow. Bilateral placement of subcutaneous ureteral bypass devices may be a safe and potentially effective treatment option for acute bilateral ureteral obstruction in cats with ureterolithiasis. Strict patient monitoring and patient-centered postoperative treatment decisions are crucial to successful treatment outcomes.

Imaging diagnosis--disseminated peritoneal leiomyomatosis in a dog.

A 17-month-old male Labrador retriever presented for evaluation of an abdominal mass felt during abdominal palpation. Multiple variably sized cystic masses were identified on sonographic and radiographic images. Exploratory laparotomy revealed multiple peritoneal masses that exhibited atypical contractions and lacked an identifiable organ of origin. Histology and immunohistochemistry of multiple surgically excised masses was consistent with benign tumors of smooth muscle origin (leiomyomas). The presence of multiple peritoneal leiomyomas in this dog is consistent with disseminated peritoneal leiomyomatosis. Two years after diagnosis and multiple surgical interventions, continual insidious enlargement of leiomyomas was identified on ultrasound and CT.

Clinical findings in dogs with incidental adrenal gland lesions determined by ultrasonography: 151 cases (2007-2010).

OBJECTIVE: To determine the prevalence of and clinical features associated with incidental adrenal gland lesions (IAGLs) discovered during abdominal ultrasonography in dogs. DESIGN: Retrospective case series. ANIMALS: 151 dogs with an IAGL and 400 control dogs. PROCEDURES: Reports of ultrasonographic examinations of the abdomen of dogs performed during a 3.5-year period were reviewed. Adrenal glands were classified as having an IAGL if a nodule or mass was described or the width of either gland was ≥ 10 mm. For dogs with an IAGL, information regarding signalment, concurrent disorders, and outcome was obtained from the medical record. Findings were compared with those in a control population of 400 dogs examined during the same period. RESULTS: An IAGL was detected in 151 of 3,748 (4%) dogs. Dogs with an IAGL were significantly older (median age, 11.25 years) and heavier (median body weight, 21 kg [46.2 lb]) than the control population (median age, 9.5 years; median body weight, 14 kg [30.8 lb]). Malignant tumors were reported in 6 of 20 (30%) dogs that underwent adrenal glandectomy or necropsy and had a maximum IAGL dimension that ranged from 20 to 46 mm; benign lesions all had a maximum dimension < 20 mm. Various coincidental conditions were reported in dogs with an IAGL, including nonadrenal gland malignant neoplasia in 43 (28.5%) dogs. CONCLUSIONS AND CLINICAL RELEVANCE: IAGLs were more likely in dogs ≥ 9 years of age. On the basis of this small data set, malignancy should be suspected for IAGLs ≥ 20 mm in maximum dimension.

Ultrasonographic characteristics of lipiduria in clinically normal cats.

Echoes are frequently seen in the urinary bladder of cats during abdominal ultrasound. These have been attributed to hematuria, pyuria, crystalluria, and lipid. However, sonographic findings have not been previously correlated with urinalysis. We prospectively evaluated 40 clinically normal cats via ultrasound, serum chemistry, and urinalysis. Thin layer chromatography was performed on the urine to determine the amount (mg) of lipid subfractions including diacylglycerol, triglyceride, phospholipid, free fatty acid, cholesterol, and cholesterol ester. Ninety percent (36/40) of the cats in our population had sonographic echoes suspended in the urinary bladder, with most having a subjective score of mild echoes (n = 20). None of the sonographic echoes were gravity dependent or caused distal acoustic shadowing, reverberation, or twinkle artifact. Of the cats with sonographic echoes in the urine, 66% (24/36) had no significant findings on urinalysis other than the presence of lipid. The total amount of subjective sonographic echoes was not significantly related to the total amount of fat measured on thin layer chromatography or the number of lipid droplets seen on urinalysis. An increased amount of urine diacylglycerol was significantly associated with clumping of echoes (P = 0.02) and the amount of lipid droplets seen on urinalysis (P = 0.04). An association between increased amounts of urine diacylglycerol and the amount of echoes seen on ultrasound approached significance (P = 0.05). Findings from this study support previously published theories that sonographic echoes within the urinary bladder of clinically normal cats may be due to urine lipid.

Formulation of a standardized protocol and determination of the size and appearance of the spleen in healthy cats.

Standard protocol for splenic measurement is warranted to aid in interpretation when sonographically imaging the spleen of cats. The purpose of this study was to describe the appearance and size of healthy cat spleens, and to develop a standard method of evaluation. Data were obtained from 31 clinically healthy non-sedated cats with no sonographic abnormalities. The sonographic appearance of the spleen's relative echogenicity compared to the left renal cortex and the hepatic parenchyma was recorded. Splenic height was measured at three sites. Three measurements were determined at each site, and the mean value of these three measurements was determined and used for data analysis. A significance level of P <0.05 was used for analysis, which was performed using S-PLUS software (version 8.1). The mean proximal height of the spleen was 7.1 mm. The mean body sagittal height was 9.3 mm. The mean height of the tail of the spleen was 8.7 mm (95% confidence interval). The splenic parenchymal echogenicity was less than the left renal cortex echogenicity and greater than the liver in 17/31cats; less than the left kidney cortex and equal to the liver in 5/31cats; equal to the cortex of the left kidney and greater than the liver in 5/31 cats; equal to the liver and renal cortex in 2/31 cats; and less than the liver and kidney with the renal cortex less than the liver in 2/31 cats. The protocol recommended for consistent evaluation of the spleen in the cat includes three specific measurements.

Imaging diagnosis--pulmonary alveolar proteinosis in a dog.

A young dog was presented for cyanosis and right heart failure. Radiographic and CT characteristics included right heart/pulmonary artery enlargement, hepatomegaly, abdominal effusion, and severe, generalized air-space filling. Focal increased opacities were present in the peripheral lung, as were multiple pulmonary blebs and bullae. Echocardiographic findings were consistent with cor pulmonale and pulmonary hypertension. Bronchoscopic findings were consistent with chronic inflammation. Pulmonary alveolar proteinosis (PAP) was confirmed at necropsy. Pulmonary alveolar proteinosis is an interstitial lung disease that results in accumulation of phospholipoproteinaceous material and should be included as a differential diagnosis for dogs with these clinical and imaging characteristics.

Multi-organ involvement of Heterobilharzia americana infection in a dog presented for systemic mineralization.

Canine schistosomiasis due to Heterobilharzia americana is a clinically underdiagnosed disease in dogs, which is found primarily in the Gulf Coast and south Atlantic region of the United States. A 3-year-old dog from Texas with a clinical diagnosis of systemic mineralization of unknown origin in the absence of evidence of hypercalcemia was found at necropsy to have severe disseminated H. americana infection involving the liver, pancreas, small and large intestine, lungs, and kidneys. Calcification of many of the large number of H. americana eggs gave the false impression of soft-tissue mineralization on radiographic and ultrasonographic images. Polymerase chain reaction amplification and sequencing of DNA derived from formalin-fixed sections of small intestine and liver, using primers specific for a 487-base pair segment of the H. americana small subunit ribosomal RNA gene, confirmed the presence of H. americana.

Imaging diagnosis--gastric pneumatosis in a cat.

Gastrointestinal foreign bodies were removed surgically from a 9-year-old Siamese cat. Two days later the cat became lethargic and started regurgitating. A degenerative leukocytosis and drop in packed cell volume were present. Gastric wall thickening with intramural gastric air was detected radiographically and sonographically. Gastric ulceration with a focal necrotic area was seen endoscopically. At surgery, the stomach wall was emphysematous. Clinical signs resolved following partial gastrectomy and medical management. Intramural gastric air with declining clinical course was a significant impetus to return to surgery.

Imaging diagnosis-heterobilharzia americana infection in a dog.

An approximately three-year-old mixed breed female dog was evaluated for peritoneal effusion, anorexia, intermittent vomiting, and diarrhea. Radiographically, there was mineralization of the wall of small intestinal segments. Sonographic findings were consistent with multisystemic mineralization of liver, small intestinal wall, and pancreas. Multifocal granulomas containing schistosome eggs (Heterobilharzia americana) were identified histologically. The mineralization pattern described herein is an uncommon presentation of severe diffuse heterobilharziasis in a dog.

Imaging diagnosis-synovial myxoma of lumbar vertebrae articular process joint.

Magnetic resonance (MR) imaging and histopathology were used to diagnose an articular process synovial myxoma in a dog. On MR images, the tumor was characterized by distortion of the left L1-L2 articular process, widening of the articular process joint, and the presence of a mass contiguous with the synovium of the articular process that displaced the spinal cord. The tumor was T2-hyperintense, T1-hypointense, relative to muscle, and had mild contrast enhancement. The MR features of articular process synovial myxoma may be distinct from other diseases of the articular process joint.

Bilateral renal agenesis in an alpaca cria.

A 3-day-old male alpaca cria was presented for lack of vigor and failure to urinate since birth. Based on the history, laboratory data, ultrasonographs, surgical findings, and postmortem examination, the cria was diagnosed with bilateral renal agenesis and hypoplastic bladder, a congenital condition rarely seen in veterinary medicine.

Doppler ultrasonographic evaluation of gastrointestinal hemodynamics in food hypersensitivities: a canine model.

Chronic enteropathy due to food hypersensitivity is a common complaint in dogs and humans, and definitive diagnosis and identification of offending allergens remains challenging. Doppler waveform analysis of the celiac artery (CA) and the cranial mesenteric artery (CMA) of 8 dogs with proven food hypersensitivity was performed in the fasting state and at 20, 40, 60, and 90 minutes after feeding their regular daily diet, and at 2 and 4 days after feeding 4 different allergens. Resistive index (RI), pulsatility index (PI), and the percentage differences between these measurements were calculated and compared statistically. The maximal decrease in RI and PI after feeding the regular diet was reached at 40 minutes after ingestion in both vessels (CA: RI = -6%, PI = -23%; CMA: RI = -9%, PI = -30%). After this trough, the resistance in both vessels rose nearly to baseline after 90 minutes (CA: RI = -1%, PI = -13%; CMA: RI = -3%, PI = -14%). When fed an allergen-containing meal the percentage changes at the trough were significantly greater (CA: RI = -10%, PI = -32%; CMA: RI = - 14%, PI = -40 %; p < 0.05) compared to those seen after feeding the maintenance diet. Also, RI and PI values were significantly (P < .05) lower at 90 minutes on days 2 and 4 of the challenge period. During the challenge period, dogs did not show overt signs of gastrointestinal disease. Significant postprandial hemodynamic alterations in response to food allergens in dogs with food hypersensitivities can be shown noninvasively with Doppler ultrasound.

Urinary bladder incarceration and infarction by an intra-abdominal fat pad in a Virginia opossum (Didelphis virginiana).

A 2.5-year-old, female opossum had acute stranguria. Based on radiography and ultrasonographic examination a cystic structure was identified in the caudal abdomen associated with bilateral hydroureter and hydronephrosis. This structure contained a neutrophilic fluid, determined to be urine. There was a neutrophilic leukocytosis. Serum chemistry values were within normal limits. The opossum was euthanized. An intra-abdominal fat pad incarceration of the urinary bladder above the trigone was present, resulting in complete obstruction of the urinary bladder and partial obstruction of the ureters. Vessels to the bladder were involved in the incarceration which resulted in vascular compromise and infarction of the bladder. Mild to moderate hydroureter and hydronephrosis were present.

Imaging diagnosis: biliopleural fistula in a dog.

A 3-year-old intact male Brittany Spaniel was admitted for thoracic gunshot wounds. Despite continued supportive care, the dog's condition deteriorated. Thoracic/abdominal ultrasound revealed a biliopleural fistula. Following fistula repair, the dog made a complete recovery. This case represented a diagnostic challenge because of the uncommon clinical presentation of a severe bile pleuritis in the absence of significant bile peritonitis. Biliopleural fistula is a rare condition but should be considered as a differential diagnosis in trauma patients with pleural effusion, especially those with penetrating thoracic injuries. Ultrasonography can be used to diagnose this disorder preoperatively.

Percutaneous ultrasound-guided cholecystocentesis in healthy cats.

Percutaneous ultrasound-guided cholecystocentesis (PUC) is a minimally invasive technique for bile collection that is used successfully in human patients with cholecystitis. Its use in veterinary medicine for evaluation of hepatobiliary disorders has been limited because of the perceived unacceptable risk of bile peritonitis. An experimental study was conducted to evaluate the safety and efficacy of PUC, to collect data on bile cytology and bacteriologic culture, and to attempt to isolate Helicobacter spp. from the bile of healthy cats. In fasted and sedated cats, PUC was performed with a 22-gauge 1.5-in. (3.81 cm) needle with an attached 12-mL syringe via a right-sided transhepatic approach (n = 1) or into the fundus of the gallbladder (n = 11) via a right ventral abdominal approach. An attempt was made to completely empty the gallbladder. A small amount of abdominal effusion, consistent with bile or blood, was seen ultrasonographically immediately after aspiration in the 1st cat. Ultrasonographic complications with the 2nd technique were not observed in the remaining 11 cats. Decreased appetite and evidence of mild abdominal pain were detected in 4 cats within 2 days after PUC. The mean neutrophil count increased 2 days after PUC (P < .01) but remained within the reference range. The bile was acellular in 11 of 12 cats, and aerobic, anaerobic, and Helicobacter spp. cultures yielded no growth in 12 of 12 cats. There were no remarkable gross or histologic lesions of abdominal organs at the postmortem examination (8 cats) performed 7-8 days after the procedure. PUC appears to be a safe and technically simple procedure. Further studies are warranted to determine the use and safety of PUC in cats with hepatobiliary diseases.

Radiographic features of aortic bulb/valve mineralization in 20 dogs.

The radiographic features of aortic bulb/valve mineralization in 20 dogs were reviewed. Extent, shape, number, and location of mineralization were recorded. Five of the dogs had additional alternate imaging examinations, including bone scintigraphy, echocardiography, and thoracic computed tomography. A necropsy was done on one dog, and the area of mineralization was evaluated using routine histology. The median age was 10 (mean 9.7; SD +/- 2.7) years. There were five males, seven neutered males, one female, and seven neutered females. The breeds were: Irish setter (6); rottweiler (7); chow-chow (1); miniature dachshund (1); borzoi (1); English setter (1); English springer spaniel (1); great Dane (1); and greyhound (1). Dogs with both right and left lateral radiographs (n = 17) had mineralization visible on both views, more conspicuously on the right lateral radiograph (n = 12). Aortic bulb mineralization was identified on the ventrodorsal radiograph of only one dog. On lateral radiographs, the aortic bulb mineralization was localized within the 4th intercostal space and in the craniodorsal quadrant of the cardiac silhouette. In nine of the dogs, there were complex or multiple mineralizations and in 11 dogs, there was a single curvilinear mineral opacity oriented in a caudoventral to craniodorsal direction. In all radiographs, the mineralization was in the expected position of the aortic bulb, and echocardiography (n = 4), spiral computed tomography (n = 2), and necropsy (n = 1) confirmed that the mineralization was within the aortic bulb. Clinical pathologic data of the dogs suggested no reason for metastatic mineralization. Exact etiopathogenesis of the lesions were not determined in this study. Based on the histologic findings in one dog, the mineralization seen in the aortic root is similar to a form of dystrophic mineralization called Monckeberg's calcific arteriosclerosis in humans. No clinical signs attributable to the mineralization were observed.

Acute nontraumatic hemoabdomen in the dog: a retrospective analysis of 39 cases (1987-2001).

The medical records of 39 dogs with acute nontraumatic hemoabdomen were identified and reviewed. Anemia and hypoalbuminemia were identified in 36/37 (97%) and 25/33 (76%) dogs, respectively. Coagulopathies were identified in 26/31 (84%) dogs. When a definitive diagnosis was obtained, malignant neoplasia was diagnosed most frequently and occurred in 24/30 (80%) dogs. Hemangiosarcoma accounted for 21/30 (70%) diagnoses. Sixteen dogs underwent exploratory laparotomy, of which seven (44%) survived the perioperative period. Of the dogs that did not undergo surgery, 9/23 (39%) survived to be discharged from the hospital.