ACVR and ECVDI consensus statement for the standardization of the abdominal ultrasound examination.

This consensus statement is designed to provide a standard of care document and describes the ACVR and ECVDI definition for performing a standard abdominal ultrasound examination in dogs and cats. The ACVR and ECVDI define a standard abdominal ultrasonographic examination as a complete exam of the abdominal organs which is appropriately documented. The consensus statement intends to provide guidance to veterinary sonographers and veterinarians for the performance and documentation of high-quality diagnostic ultrasound examination. The document may also serve as a teaching aid for veterinary students, veterinarians, and residents in diagnostic imaging who seek proficiency in diagnostic ultrasound. Finally, it may serve an additional role in educating the public as to what a high-quality abdominal ultrasound examination should entail.

Diagnostic imaging for the assessment of acquired abdominal vascular diseases in small animals: A pictorial review.

Advances in interventional radiology and surgical techniques now allow complex abdominal diseases to be more successfully treated in small animals. Abdominal vascular alterations, acquired as individual process or as complication of other lesions such as neoplasia, can be life-threatening or at least greatly limit curative interventions of underlying diseases. Computed tomography (CT) and high-definition ultrasonography are now readily available in veterinary referral centers. Yet, there is little information currently available on the use of these modalities for the diagnosis and characterization of these vascular alterations. The purpose of this article is to review the CT and ultrasonographic findings of acquired vascular diseases in the abdomen of dogs and cats, using both the veterinary and human medicine literature as references, and highlighting essential concepts through figures.

Computed tomographic characteristics of collateral venous pathways in dogs with caudal vena cava obstruction.

Collateral venous pathways develop in dogs with obstruction or increased blood flow resistance at any level of the caudal vena cava in order to maintain venous drainage to the right atrium. The purpose of this retrospective study was to describe the sites, causes of obstruction, and configurations of venous collateral pathways for a group of dogs with caudal vena cava obstruction. Computed tomography databases from two veterinary hospitals were searched for dogs with a diagnosis of caudal vena cava obstruction and multidetector row computed tomographic angiographic (CTA) scans that included the entire caudal vena cava. Images for each included dog were retrieved and collateral venous pathways were characterized using image postprocessing and a classification system previously reported for humans. A total of nine dogs met inclusion criteria and four major collateral venous pathways were identified: deep (n = 2), portal (n = 2), intermediate (n = 7), and superficial (n = 5). More than one collateral venous pathway was present in 5 dogs. An alternative pathway consisting of renal subcapsular collateral veins, arising mainly from the caudal pole of both kidneys, was found in three dogs. In conclusion, findings indicated that collateral venous pathway patterns similar to those described in humans are also present in dogs with caudal vena cava obstruction. These collateral pathways need to be distinguished from other vascular anomalies in dogs. Postprocessing of multidetector-row CTA images allowed delineation of the course of these complicated venous pathways and may be a helpful adjunct for treatment planning in future cases.

Radiographic diagnosis of mechanical obstruction in dogs based on relative small intestinal external diameters.

Mechanical obstruction is a frequent cause of acute vomiting in dogs requiring prompt diagnosis to improve patient management and prognosis. The purpose of this retrospective study was to compare small intestinal radiographic characteristics in dogs with versus without mechanical intestinal obstruction. Fifty dogs with gastrointestinal clinical signs and abdominal radiographs were recruited from hospital record archives and assigned to groups (group 1, obstructive, n = 25; group 2, nonobstructive n = 25). Abdominal radiographs were randomized and independently interpreted by three examiners who were unaware of group status. Intestinal dilation was subjectively scored based on distribution (segmental, regional or diffuse), and severity (absent, mild, moderate or severe). Small intestinal maximal diameter (SImax), L5 vertebral body height, small intestinal minimal diameter (SImin), and an estimated average of small intestinal diameters (SIave) were measured and three ratios were calculated: SImax/L5, SImax/SImin, and SImax/SIave. Segmental dilation was more prevalent in obstructed dogs for all examiners (P ≤ 0.03) and most nonobstructed dogs had no dilation (P ≤ 0.05). All ratios were higher in obstructed dogs (P < 0.002). Subjective dilation scores and ratio measurements had low interobserver agreement (absent to fair, with kappa values between -0.06 and 0.57) and reproducibility (coefficients of 0.35-0.61). Findings indicated that dogs with SImax/L5 ≤ 1.4, SImax/SImin ≤ 2, and SImax/SIave ≤ 1.3 values are very unlikely to be mechanically obstructed; dogs with SImax/L5 ≥ 2.4, SImax/SImin ≥ 3.4 and SImax/SIave ≥ 1.9 are very likely obstructed, particularly if segmental dilation (less than 25% of the small intestine) is present. Dogs with ratios falling between these thresholds may need further testing unless other signs justify surgical exploration or endoscopy.

Validation of a novel technique for creating simulated radiographs using computed tomography datasets.

Understanding radiographic anatomy and the effects of varying patient and radiographic tube positioning on image quality can be a challenge for students. The purposes of this study were to develop and validate a novel technique for creating simulated radiographs using computed tomography (CT) datasets. A DICOM viewer (ORS Visual) plug-in was developed with the ability to move and deform cuboidal volumetric CT datasets, and to produce images simulating the effects of tube-patient-detector distance and angulation. Computed tomographic datasets were acquired from two dogs, one cat, and one horse. Simulated radiographs of different body parts (n = 9) were produced using different angles to mimic conventional projections, before actual digital radiographs were obtained using the same projections. These studies (n = 18) were then submitted to 10 board-certified radiologists who were asked to score visualization of anatomical landmarks, depiction of patient positioning, realism of distortion/magnification, and image quality. No significant differences between simulated and actual radiographs were found for anatomic structure visualization and patient positioning in the majority of body parts. For the assessment of radiographic realism, no significant differences were found between simulated and digital radiographs for canine pelvis, equine tarsus, and feline abdomen body parts. Overall, image quality and contrast resolution of simulated radiographs were considered satisfactory. Findings from the current study indicated that radiographs simulated using this new technique are comparable to actual digital radiographs. Further studies are needed to apply this technique in developing interactive tools for teaching radiographic anatomy and the effects of varying patient and tube positioning.

Ileocecocolic volvulus in a German shepherd dog.

This report describes an ileocecocolic volvulus in a German shepherd dog with risk factors of previous abdominal surgeries and concurrent chronic enteropathy. Contrast-enhanced computed tomography (CT) with multiplanar reformatting was more sensitive than abdominal radiographs or ultrasound to obtain a diagnosis, because of the presence of a "whirl-sign" on CT. A combination of colopexy and cecopexy was succesfully used to treat the patient's condition.

Volvulus iléo-caeco-colique chez un Berger Allemand. Ce rapport de cas décrit un volvulus iléo-caeco-colique chez un Berger allemand ayant différents facteurs de risque incluant des chirurgies abdominales préalables à sa présentation et une entéropathie chronique. L'observation d'un 'whirl-sign' lors des reconstructions de l'examen tomodensitométrique a permis d'obtenir le diagnostic de volvulus et s'est révélé dans ce cas être plus sensible que les examens d'imagerie usuels, soit la radiographie ou l'échographie abdominale. Le traitement chirurgical a été effectué avec succès grâce à la combinaison d'une cecopexie et d'une colopexie.(Traduit par les auteurs).

Drug product attributes predict clinical efficacy in betibeglogene autotemcel gene therapy for ß-thalassemia.

Ex vivo autologous hematopoietic stem cell lentiviral-based gene therapy with betibeglogene autotemcel has been studied in patients with transfusion-dependent ß-thalassemia in Phase III clinical trials (HGB-207 and HGB-212), with 90% of patients reaching transfusion independence (TI). Here, we explore manufacturing parameters, drug product quality attributes, and limited patient characteristics that had an impact on clinical efficacy in HGB-207 and HGB-212. Retrospective analysis revealed that the peripheral blood vector copy number (VCN) was related to TI, with a strong correlation between peripheral blood VCN at 6 months and gene therapy-derived therapeutic protein (HbAT87Q) expression at 6 months (correlation coefficient, 0.8681; p < 0.0001; R2 = 0.7536). A peripheral blood VCN threshold of ≥0.75 copies per diploid genome at 6 months post betibeglogene autotemcel infusion provided a stringent surrogate biomarker for TI and was used as the outcome variable for multivariate analysis using a random forest classifier. The top predictive feature of clinical efficacy was found to be the percentage of lentiviral vector-positive cells in the drug product. This retrospective analysis is critical to understanding the key product quality attributes that can predict clinical efficacy in lentiviral vector gene therapy within this clinical trial population.

Improvement of N-glycan site occupancy of therapeutic glycoproteins produced in Pichia pastoris.

Yeast is capable of performing posttranslational modifications, such as N- or O-glycosylation. It has been demonstrated that N-glycans play critical biological roles in therapeutic glycoproteins by modulating pharmacokinetics and pharmacodynamics. However, N-glycan sites on recombinant glycoproteins produced in yeast can be underglycosylated, and hence, not completely occupied. Genomic homology analysis indicates that the Pichia pastoris oligosaccharyltransferase (OST) complex consists of multiple subunits, including OST1, OST2, OST3, OST4, OST5, OST6, STT3, SWP1, and WBP1. Monoclonal antibodies produced in P. pastoris show that N-glycan site occupancy ranges from 75-85 % and is affected mainly by the OST function, and in part, by process conditions. In this study, we demonstrate that N-glycan site occupancy of antibodies can be improved to greater than 99 %, comparable to that of antibodies produced in mammalian cells (CHO), by overexpressing Leishmania major STT3D (LmSTT3D) under the control of an inducible alcohol oxidase 1 (AOX1) promoter. N-glycan site occupancy of non-antibody glycoproteins such as recombinant human granulocyte macrophage colony-stimulating factor (rhGM-CSF) was also significantly improved, suggesting that LmSTT3D has broad substrate specificity. These results suggest that the glycosylation status of recombinant proteins can be improved by heterologous STT3 expression, which will allow for the customization of therapeutic protein profiles.

Palpation and dorsal acetabular rim radiographic projection for early detection of canine hip dysplasia: a prospective study.

OBJECTIVE: To determine the value of 2 diagnostic methods: (1) the reduction angle (RA) using the Ortolani maneuver and (2) the dorsal acetabular slope (DAS) from the dorsal acetabular rim (DAR) radiographic projection, to predict osteoarthritis (OA) in dogs with hip dysplasia. STUDY DESIGN: Prospective study. SAMPLE POPULATION: Dogs (n = 73). METHODS: Hip-extended ventrodorsal (VD) radiographic projections, RA, and DAS were evaluated when dogs were 6, 12, and 24 months of age. VD projections were qualitatively scored for OA. RA was determined using the Ortolani maneuver in dorsal recumbency and DAS using the DAR projection. Distraction index (DI) measurements from the compression-distraction radiographic projections (PennHIP method) were also performed at 6 months of age. Statistical analyses were used to establish the range of values of normal and abnormal RA and DAS, to document the temporal variation in RA and DAS, to compare the ability of the different methods to predict coxofemoral OA, to determine the influence of pure passive laxity and of the DAS on the occurrence of an Ortolani sign and on the magnitude of the RA, to establish the relationship between the DAS and subsequent development of passive laxity and coxofemoral OA, and to evaluate the influence of the DAS and RA on the occurrence of coxofemoral OA with severe, moderate, and minimal coxofemoral passive joint laxity, respectively. RESULTS: VD, RA, DAS, and DI methods of coxofemoral joint evaluation correlated significantly with the status of the coxofemoral joints at 2 years of age. The risk of occurrence of coxofemoral OA increased, as the RA, DAS, or DI increased. There was a significant positive linear relationship between RA and DI (P = .015, r(2) = 0.32), RA and DAS (P = .0078, r(2) = 0.38), and DAS and DI (P = .015, r(2) = 0.33). A negative Ortolani sign was at all times significantly predictive of absence of coxofemoral OA at 2 years of age. DAS best predicted coxofemoral OA for DI ≥ 0.7, whereas RA best predicted coxofemoral OA for 0.3 < DI < 0.7; however, RA proved to be the best overall predictor of coxofemoral OA. CONCLUSION: RA measured at 6 months of age in dorsal recumbency was the best predictor of coxofemoral OA at 2 years of age.

Evaluation of osteoarthritis in cats: novel information from a pilot study.

OBJECTIVE: To describe structural changes associated with osteoarthritis (OA) in cats and to quantify OA-associated disability using functional evaluations. STUDY DESIGN: Cross-sectional pilot study with longitudinal data. ANIMALS: Normal cats (n = 2) and coxofemoral joint OA cats (n = 4) were evaluated by physical examination, radiography, and magnetic resonance imaging (MRI). METHODS: Structural changes related to OA were scored using computed radiographs (CR) and MRI. Functional evaluation consisted of podobarometric gait analyses performed using a pressure-sensitive mattress and motor activity assessments using collar-attached, accelerometer-based activity sensors. RESULTS: Structural scores for the coxofemoral joint OA-related lesions were lower in normal cats than OA cats for MRI (P = .07). Use of MRI allowed for whole-organ assessment of the coxofemoral joint. Pelvic limb peak vertical ground reaction force (PVF) was higher in normal cats than OA cats (P = .10). During the night, motor activity was greater in normal cats than OA cats (P = .04). PVF was positively correlated with mean motor activity (Spearman coefficient [Rho] = 0.83, P = .04) and negatively correlated with age and MRI structural score (Rho = -0.93 and -0.79, P < .01 and .06, respectively). CONCLUSIONS: This study provides the first description of OA-related lesions in cats using MRI. Gait analysis and accelerometry should be considered as objective tools to characterize OA-associated disability, although these assessments were weakly correlated with structural changes.

Ultrasound-guided percutaneous antegrade pyelography with computed tomography for the diagnosis of spontaneous partial ureteral rupture in a dog.

A 10-year-old spayed female dalmatian dog developed acute vomiting and abdominal pain. Ultrasound examination of the abdomen showed right hydronephrosis and proximal ureter dilation with mild retroperitoneal free fluid. Computed tomography (CT) of the abdomen confirmed the ultrasonographic findings and revealed, additionally, a right ureteral stone. Spontaneus rupture of the right ureter was confirmed with CT post ultrasound-guided percutaneous antegrade pyelography. Pyeloureteral rupture and the presence of a ureteral stone were confirmed at surgery.

Pyélographie antégrade percutanée guidée par échographie avec tomodensitométrie pour le diagnostic d'une rupture urétrale partielle spontanée chez un chien. Une chienne Dalmatien stérilisée âgée de 10 ans a manifesté des vomissements et de la douleur abdominale aigus. Une échographie de l'abdomen a montré de l'hydronéphrose à droite et une dilatation proximale de l'urètre avec un peu de liquide rétropéritonéal libre. Une tomodensitométrie de l'abdomen a confirmé les résultats de l'échographie et a révélé, en plus, un calcul urétéral droit. Une rupture spontanée de l'urètre droit a été confirmée par tomodensitométrie après une pyélographie antégrade percutanée guidée par échographie. La rupture pyélo-urétérale et la présence de calcul urétéral ont été confirmées à la chirurgie.(Traduit par Isabelle Vallières).

Purification process development of a recombinant monoclonal antibody expressed in glycoengineered Pichia pastoris.

A robust and scalable purification process was developed to quickly generate antibody of high purity and sufficient quantity from glycoengineered Pichia pastoris fermentation. Protein A affinity chromatography was used to capture the antibody from fermentation supernatant. A pH gradient elution was applied to the Protein A column to prevent antibody precipitation at low pH. Antibody from Protein A chromatography contained some product related impurities, which were the misassembling of cleaved heavy chain, heavy chain and light chain. It also had some process related impurities, including Protein A residues, endotoxin, host cell DNA and proteins. Cation exchange chromatography with optimal NaCl gradient at pH 4.5-6.0 efficiently removed these product and process related impurities. The antibody from glycoengineered P. pastoris was comparable to its commercial counterpart in heterotetramer folding, physical stability and binding affinity.

Gallbladder sludge on ultrasound is predictive of increased liver enzymes and total bilirubin in cats.

The purposes of this retrospective study were to assess the prevalence of gallbladder sludge (GBS) in a population of cats presented for abdominal ultrasound in a teaching hospital and to determine its association with increased serum alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total bilirubin (TB). Gallbladder sludge was detected in 152 (14%) of the cats undergoing abdominal ultrasound between 2004 and 2008. This population was compared to a control group of 32 cats without GBS. Alanine aminotransferase, ALP, and TB mean values were significantly higher in cats with GBS than in controls (P ≤ 0.0005) and odds for increased values in cats with GBS were 4.2 [95% confidence interval (CI): 1.6 to 11.0], 9.5 (95% CI: 2.2 to 41.7), and 4.1 (95% CI: 1.5 to 11.5), respectively (P ≤ 0.007). In conclusion, GBS is an uncommon ultrasonographic finding in cats that is predictive of increased liver enzymes and TB. More studies are needed to establish potential links between GBS and hepatobiliary disease in cats.

Costochondral junction osteomyelitis in 3 septic foals.

The costochondral junction constitutes a potential site of infection in septic foals and it could be favored by thoracic trauma. Standard radiographs and ultrasonography are useful tools for diagnosis of this condition and ultrasound-guided needle aspiration could permit the definitive confirmation of infection.

Antibody expression kinetics in glycoengineered Pichia pastoris.

Growth of the antibody market has fueled the development of alternative expression systems such as glycoengineered yeast. Although intact antibody expression levels in excess of 1 g L(-1) have been demonstrated in glycoengineered yeast, this is still significantly below the titers reported for antibody fragments in fungal expression systems. This study presents a simplified approach to estimate antibody secretion kinetics and oxygen uptake rate requirements as a function of growth-rate controlled by a limiting methanol feed rate in glycoengineered Pichia pastoris. The yield of biomass from methanol and the specific oxygen requirements predicted in this study compare well with values reported in the literature for wild-type P. pastoris, indicating the intrinsic nature of these yields independent of glycoengineering or the heterologous protein expressed. Specific productivity was found to be a non-linear function of specific growth rate. Based on comparison with relationships between specific growth rate and specific productivity reported in the literature this correlation seems empirical in nature and cannot be established a priori. These correlations were then used in a simple mass balance based model to predict the cultivation performance of carbon limited cultivations under oxygen transfer limited conditions to indicate the usefulness of this approach to predict large scale performance and aid in process development.

Correlation of signal attenuation-based quantitative magnetic resonance imaging with quantitative computed tomographic measurements of subchondral bone mineral density in metacarpophalangeal joints of horses.

OBJECTIVE: To evaluate the ability of signal attenuation-based quantitative magnetic resonance imaging (QMRI) to estimate subchondral bone mineral density (BMD) as assessed via quantitative computed tomography (QCT) in osteoarthritic joints of horses. SAMPLE POPULATION: 20 metacarpophalangeal joints from 10 horse cadavers. PROCEDURES: Magnetic resonance (MR) images (dorsal and transverse T1-weighted gradient recalled echo [GRE] and dorsal T2*-weighted GRE fast imaging employing steady-state acquisition [T2*-FIESTA]) and transverse single-slice computed tomographic (CT) images of the joints were acquired. Magnetic resonance signal intensity (SI) and CT attenuation were quantified in 6 regions of interest (ROIs) in the subchondral bone of third metacarpal condyles. Separate ROIs were established in the air close to the joint and used to generate corrected ratios and SIs. Computed tomographic attenuation was corrected by use of a calibration phantom to obtain a K(2)HPO(4)-equivalent density of bone. Correlations between QMRI performed with different MR imaging sequences and QCT measurements were evaluated. The intraobserver repeatability of ROI measurements was tested for each modality. RESULTS: Measurement repeatability was excellent for QCT (R(2) = 98.3%) and QMRI (R(2) = 98.8%). Transverse (R(2) = 77%) or dorsal (R(2) = 77%) T1-weighted GRE and QCT BMD measurements were negatively correlated, as were dorsal T2*-FIESTA and QCT (R(2) = 80%) measurements. Decreased bone SI during MR imaging linearly reflected increased BMD. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this ex vivo study suggested that signal attenuation-based QMRI was a reliable, clinically applicable method for indirect estimation of subchondral BMD in osteoarthritic metacarpophalangeal joints of horses.

Degenerative disease of the distal interphalangeal joint and sesamoid bone in calves: 9 cases (1995-2004).

OBJECTIVE: To evaluate the clinical signs, diagnosis, treatment, and outcome associated with distal interphalangeal joint (DIJ) degenerative disease in calves. DESIGN: Retrospective case series. ANIMALS: 9 calves with degenerative disease of the DIJ. PROCEDURES: Medical records of calves with lameness for which the cause had been localized to the distal aspect of a limb but without evidence of trauma or sepsis were included. Signalment and results of physical, lameness, radiographic, and postmortem examinations were recorded. Outcomes of medical and surgical treatments were evaluated. RESULTS: All 9 calves had forelimb lameness (4 bilaterally). The medial digit was affected in 12 limbs and the lateral digit was affected in 9 limbs. Radiographic examination revealed bridging osteoproliferation along the abaxial and palmar aspects of affected DIJs (18/21), subchondral cyst-like lucencies (19/21), and sclerosis (16/21). The DIJ was resected in 3 calves (7 joints), resulting in resolution of lameness within 3 months. Medical management was attempted in 4 calves (6 joints), and 2 calves (6 joints) did not receive treatment; 5 calves had a normal stance within 5 months. Results of postmortem computed tomographic and histologic examination were in accordance with degenerative joint disease processes. CONCLUSIONS AND CLINICAL RELEVANCE: Degenerative disease of the DIJ should be considered in calves with insidious, progressive forelimb lameness. Although the etiology of this process remains undetermined, results of radiographic, computed tomographic, and histologic examinations suggested an underlying developmental anomaly, such as osteochondrosis. Surgical treatment appeared promising on the basis of postoperative resolution of lameness in all surgically treated calves.

Radiographic abnormalities in cats with feline bronchial disease and intra- and interobserver variability in radiographic interpretation: 40 cases (1999-2006).

OBJECTIVE: To determine prevalence of various radiographic signs in cats with feline bronchial disease (FBD) and evaluate intra- and interobserver variability in radiographic interpretation for examiners with variable degrees of experience in radiographic interpretation. DESIGN: Retrospective case series. ANIMALS: 40 cats with FBD and 40 control cats without thoracic disease. PROCEDURES: Radiographic abnormalities in cats with FBD were scored by consensus of 2 radiologists. Radiographs of control cats and cats with FBD were examined twice by 5 other individuals, and diagnostic accuracy and observer agreement were assessed. RESULTS: In cats with FBD, the most common radiographic signs were bronchial (n=37) and unstructured interstitial (30) lung patterns, lung hyperinflation (31) and hyperlucency (21), aerophagia (19), and lung soft tissue opacities (11). Ratios of lung inflation on ventrodorsal views were significantly higher in cats with FBD. For the 5 examiners, sensitivity ranged from 71% to 89% and specificity ranged from 43% to 74%. Intraobserver agreement was good (N=0.47 to 0.60), but the agreement between examiners was only poor to good (N=0.22 to 0.70). For most examiners, significant associations were found between examiner diagnosis (correct vs incorrect), level of examiner certainty, and bronchial pattern severity. CONCLUSIONS AND CLINICAL RELEVANCE: Findings suggested that several radiographic abnormalities can commonly be seen in cats with FBD but highlighted the limitations of thoracic radiography. Examiner diagnosis and level of confidence were significantly associated with severity of a bronchial pattern.

Magnetic resonance imaging and marsupialization of a hemorrhagic intramedullary vascular anomaly in the cervical portion of the spinal cord of a dog.

CASE DESCRIPTION: A 1-year-old female spayed Labrador Retriever was admitted for evaluation of a progressive gait disturbance characterized by tetraparesis and general proprioceptive ataxia in all limbs. CLINICAL FINDINGS: Neurologic examination suggested a dysfunction of the C6-T2 spinal cord segments, which was slightly worse on the right side. Discomfort was suspected upon lateral flexion of the neck. Two magnetic resonance imaging (MRI) examinations at a 3-week interval revealed an intramedullary fluid-filled cavitary lesion adjacent to C7, containing a blood clot. TREATMENT AND OUTCOME: Following unsuccessful initial conservative management, surgical marsupialization of the lesion was performed through a dorsal laminectomy, durotomy, and myelotomy at C6 and C7. Histologic evaluation including immunohistochemistry was diagnostic for a vascular anomaly. Initially, the dog was nonambulatory with tetraparesis and became tetraplegic after surgery; movement was regained 6 days later. Four weeks after the procedure, the dog was able to walk unassisted. One year after surgery, the dog was actively running and jumping, with mild residual ataxia in the pelvic limbs. CLINICAL RELEVANCE: The intramedullary vascular anomaly in this dog was successfully treated with a surgical marsupialization technique. The combination of MRI, histologic evaluation, and immunohistochemistry enabled lesion localization, evaluation of cavity content, and final diagnosis.

Nonsurgical resolution of gallbladder mucocele in two dogs.

CASE DESCRIPTION: A gallbladder mucocele was diagnosed in 2 dogs. In both dogs, the mucocele resolved with medical treatment but without the need for surgical intervention. CLINICAL FINDINGS: A 12-year-old spayed female Miniature Schnauzer had a history of signs of gastrointestinal tract disease and high serum liver enzyme activities. Gallbladder mucocele and hypothyroidism were diagnosed. A 6-year-old neutered mixed-breed dog had chronic intermittent diarrhea and recurrent otitis; gallbladder mucocele and hypothyroidism were diagnosed. TREATMENT AND OUTCOME: The first dog was treated with S-adenosyl-methionine, omega-3 fatty acids, famotidine, ursodiol, and levothyroxine. Substantial improvement in the gastrointestinal tract condition and complete resolution of the gallbladder mucocele within 3 months were evident, but the dog was not available for further follow-up monitoring. The second dog was treated with fenbendazole, ursodiol, and levothyroxine and fed a hypoallergenic diet. One month after evaluation, abdominal ultrasonography revealed that the gallbladder mucocele was resolving, and treatment was continued. Ultrasonographic evaluation 2 and 4 months later revealed complete resolution of the mucocele. CLINICAL RELEVANCE: Review of the clinical course of 2 dogs in which there was nonsurgical resolution of gallbladder mucocele revealed that surgery is not necessary in all dogs with gallbladder mucocele. Hypothyroidism may have resulted in delayed gallbladder emptying, and its role in the pathogenesis of gallbladder mucocele merits investigation. Despite this information, until further prospective trials with a control group and standardized treatments and follow-up monitoring can be performed, the authors recommend surgical intervention for treatment of dogs with gallbladder mucocele.