Abdominal ultrasonographic findings of cats with feline infectious peritonitis: an update.

OBJECTIVES: The aim of this study was to describe the abdominal ultrasonographic findings in cats with confirmed or presumed feline infectious peritonitis (FIP). METHODS: This was a retrospective study performed in an academic veterinary hospital. The diagnosis of FIP was reached on review of history, signalment, clinical presentation, complete blood count, biochemistry panel, peritoneal fluid analysis, cytology and/or histopathology results from abnormal organs, and/or molecular testing (immunohistochemical or FIP coronavirus [FCoV] RT-PCR). Cats with confirmed FIP by molecular testing or with a highly suspicious diagnosis of FIP were included. Abdominal ultrasound examination findings were reviewed. RESULTS: In total, 25 cats were included. Common clinical signs/pathology findings included hyperglobulinemia (96%), anorexia/hyporexia (80%) and lethargy (56%). Abdominal ultrasound findings included effusion in 88% and lymphadenopathy in 80%. Hepatic changes were noted in 80%, the most common being hepatomegaly (58%) and a hypoechoic liver (48%). Intestinal changes were noted in 68% of cats, characterized by asymmetric wall thickening and/or loss of wall layering, with 52% being ileocecocolic junction and/or colonic in location. Splenic changes were present in 36% of cats, including splenomegaly, mottled parenchyma and hypoechoic nodules. Renal changes were present in 32%, encompassing a hypoechoic subcapsular rim and/or cortical nodules. Mesenteric and peritoneal abnormalities were seen in 28% and 16% of cats, respectively. Most cats (92%) had two or more locations of abdominal abnormalities on ultrasound. CONCLUSIONS AND RELEVANCE: The present study documents a wider range and distribution of ultrasonographic lesions in cats with FIP than previously reported. The presence of effusion and lymph node, hepatic and/or gastrointestinal tract changes were the most common findings, and most of the cats had a combination of two or more abdominal abnormalities.

Ultrasonographic prevalence and proposed morphologic classification of bilobed gallbladder in cats.

OBJECTIVES: Morphologic anomalies of the feline gallbladder (GB) have been previously reported in the literature. These morphologic variants are frequently encountered on routine abdominal ultrasound examination. The aim of this study was to provide an ultrasonographic classification system of these variants and document the overall incidence in the feline population. METHODS: A prospective, descriptive study was undertaken; cats that had an abdominal ultrasound examination that included at least one sagittal and transverse plane image of the GB were included. GB shape was evaluated and categorized based on a classification scheme of morphologic variants modified from the human literature. Septated (S), bilobed (B1, B2, B3), duplex (D) and complex (C) categories were described. RESULTS: Of 516 cats included in the study, 389 had normal GB morphology, while 127 had anomalous GB morphology. The overall incidence rate of anomalous GB morphology was 24.61%. When examined by morphologic type, the septated (S) morphology had an incidence of 9.69%. A bilobed (B) morphology was the most commonly observed classification; incidence was 14.35% within our population; incidence of B1, B2 and B3 subtypes were 2.91%, 6.98% and 4.46%, respectively. Duplex GBs only made up 0.39% of the total population. The incidence of complex (C) morphologies was 0.19%. CONCLUSIONS AND RELEVANCE: The incidence of GB morphologic anomalies was higher in our population than previously reported. Identification of these anomalies on routine ultrasound evaluation is common; numerous different morphologies can be identified and a standardized classification scheme is proposed. Complete evaluation of morphology can be challenging, particularly with regard to cystic duct anatomy. Clinical significance is uncertain and future studies are warranted to determine the relationship between morphologic variants and hepatobiliary disease.

Evaluation of coagulation parameters in dogs with gallbladder mucoceles.

BACKGROUND: Gallbladder mucocele (GBM) is a common biliary disorder in dogs. Limited information is available on the coagulation status of dogs with GBM. HYPOTHESIS/OBJECTIVES: To determine patterns of coagulation alterations in dogs with GBM and correlate them with clinicopathologic abnormalities and ultrasonographic findings of disease severity. ANIMALS: Twenty-three dogs with GBM identified on ultrasound examination were prospectively enrolled. METHODS: At the time of GBM identification, blood and urine were collected for CBC, serum biochemical panel, urinalysis, prothrombin time, activated partial thromboplastin time (aPTT), factor VIII, protein C (PC), von Willebrand's factor (vWF), antithrombin activity, fibrinogen, D-dimers, and thromboelastrography (TEG). Gallbladder mucoceles were classified into ultrasound types 1 to 5. Medical records were reviewed for clinical presentation, underlying conditions and to determine if systemic inflammatory response syndrome (SIRS) was present. RESULTS: Based on TEG parameters, maximal amplitude, and G, 19/23 (83%) of dogs with GBM had evaluations consistent with hypercoagulability. On plasma-based coagulation testing, dogs with GBM had increased total PC activity (20/23, 87%), fibrinogen (9/23, 39%), platelet count (9/23, 39%), and D-dimers (6/15, 40%) as well as prolongations in aPTT (9/22, 41%) and low vWF activity (5/21, 24%). No correlation was found between TEG G value and any coagulation or clinical pathology variables, ultrasound stage of GBM or disease severity as assessed by the presence of SIRS. CONCLUSIONS AND CLINICAL IMPORTANCE: Dogs with ultrasonographically identified GBM have changes in whole blood kaolin-activated TEG supporting a hypercoagulable state although traditional plasma-based coagulation testing suggests that a complex state of hemostasis exists.

Ultrasonographic evaluation of cholecystoduodenostomy sites in six cats.

CASE SERIES SUMMARY: This case series describes the postoperative ultrasonographic findings in six cats that underwent a cholecystoduodenostomy as treatment for extrahepatic biliary obstruction. The surgery site was identified in all six cats, most often within the right cranial abdomen as a thick-walled gall bladder, with a broad-based connection to the descending duodenum. Postoperatively, the biliary tree often remained distended, similar to its preoperative appearance. Recurrent extrahepatic biliary obstruction was suspected in three cats with worsening hyperbilirubinemia. Common bile duct distension was progressive in one of these cats and unchanged in another, but improved in the third. Intrahepatic bile duct distension resolved in one cat following surgery but reappeared with suspected recurrent biliary obstruction. In two cats, progressive echogenic biliary contents were associated with locally aggressive cholangiocarcinoma. Our findings suggest that in cats with cholecystoduodenostomy and progressive increases in hyperbilirubinemia following surgery, progressive or recurrent biliary distension and/or progressive echogenic biliary contents should prompt further investigation. RELEVANCE AND NOVEL INFORMATION: Biliary diversion surgery in cats is associated with high morbidity and mortality. The ultrasonographic appearance of a postoperative cholecystoduodenostomy site has not been described, making differentiation of the expected appearance from postoperative abnormalities difficult. The goal of this study was to determine the expected ultrasonographic appearance, in order to assist in managing cats with recurrent, persistent or worsening clinical signs and biochemical abnormalities following surgery.

Hemorrhage and complications associated with percutaneous ultrasound guided liver biopsy in dogs.

BACKGROUND: Liver biopsy is often necessary to obtain a diagnosis in dogs with hepatobiliary disease. Hemorrhage after biopsy is a concern. OBJECTIVE: To describe the extent of hemorrhage and incidence of complications after percutaneous ultrasound guided liver biopsy (PUGLB) in dogs and to examine risk factors for hemorrhage or complications. ANIMALS: One hundred two client owned dogs with suspected hepatobiliary disease that underwent PUGLB. METHODS: Medical records were retrospectively reviewed. Using human guidelines, major hemorrhage was defined as an absolute decrease in the PCV (ΔPCV) ≥ 6%. Complications were defined separately as clinically relevant physiologic compromise that necessitated intervention or death. The relationship between ΔPCV and the occurrence of complications and the initial PCV, coagulation variables, serum activity of liver-derived enzymes, serum bilirubin concentration, number of biopsies, biopsy needle gauge, radiologist experience, histological diagnosis, and ultrasound variables were compared. RESULTS: Before PUGLB, most aberrations in coagulation variables were mild. After biopsy a decrease in PCV occurred in 87/102 (85.3%) dogs. The mean ΔPCV was -7.2% ± 4.5%. Major hemorrhage occurred in 43/102 (42.2%) dogs and complications in 2/102 (1.9%). ΔPCV was significantly positively correlated with PCV before biopsy (r = .47, P = .004). There was no correlation between ΔPCV or complications with any of the variables examined. CONCLUSION AND CLINICAL IMPORTANCE: Percutaneous ultrasound guided liver biopsy in the population of dogs in the current study, with normal or mild abnormalities in coagulation, results in a high incidence of clinically silent, major hemorrhage (42.5%), but few complications (1.9%).

ACVIM consensus statement on the diagnosis and treatment of chronic hepatitis in dogs.

This consensus statement on chronic hepatitis (CH) in dogs is based on the expert opinion of 7 specialists with extensive experience in diagnosing, treating, and conducting clinical research in hepatology in dogs. It was generated from expert opinion and information gathered from searching of PubMed for manuscripts on CH, the Veterinary Information Network for abstracts and conference proceeding from annual meetings of the American College of Veterinary Medicine and the European College of Veterinary Medicine, and selected manuscripts from the human literature on CH. The panel recognizes that the diagnosis and treatment of CH in the dog is a complex process that requires integration of clinical presentation with clinical pathology, diagnostic imaging, and hepatic biopsy. Essential to this process is an index of suspicion for CH, knowledge of how to best collect tissue samples, access to a pathologist with experience in assessing hepatic histopathology, knowledge of reasonable medical interventions, and a strategy for monitoring treatment response and complications.

Bleeding risk and complications associated with percutaneous ultrasound-guided liver biopsy in cats.

OBJECTIVES: Liver biopsy is necessary for a diagnosis of liver disease; however, post-biopsy bleeding is a concern. The aim of this study was to describe the extent of bleeding and the occurrence of complications after percutaneous ultrasound-guided liver biopsy (PUGLB) in cats. METHODS: The medical records of 30 cats that had a PUGLB were retrospectively reviewed. Using human guidelines, bleeding was classified as minor or major when the absolute change in packed cell volume (ΔPCV) was <0 and >-6% or ≤-6%, respectively. Complications were defined as physiologic compromise necessitating an intervention, or death. The relationship between ΔPCV and the occurrence of complications and the signalment, initial PCV, coagulation parameters, serum liver enzymes and bilirubin, number of biopsies, histological diagnosis, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration were assessed using Fisher's exact test, ANOVA and Pearson's correlation coefficient, with a P value <0.05 considered significant. RESULTS: All cats had a decrease in PCV after biopsy. The mean ΔPCV was -6.9% ± 4.1%. Minor and major bleeding occurred in 13/30 (43.3%) and 17/30 (56.7%) cats, respectively, and non-lethal bleeding complications occurred in 5/30 (16.7%). Cats with complications had a lower pre-biopsy PCV ( P <0.003). Major bleeding was more likely with a diagnosis of hepatic lipidosis ( P = 0.03). There was no correlation between ΔPCV or complications and signalment, coagulation parameters, serum parameters, number of biopsies, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration. CONCLUSIONS AND RELEVANCE: PUGLB is a relatively safe procedure in cats, although many cats have a subclinical decrease in PCV. As conventional coagulation tests did not predict complications or the magnitude of ΔPCV, there is a need for more sensitive indicators of bleeding risk in cats undergoing PUGLB.

Ultrasonographic evaluation of the canine urinary bladder following cystotomy for treatment of urolithiasis.

OBJECTIVE To describe the ultrasonographic appearance of the urinary bladder incision site in dogs that underwent cystotomy for treatment of urolithiasis. DESIGN Prospective, longitudinal study. ANIMALS 18 client-owned dogs. PROCEDURES Dogs underwent urinary bladder ultrasonography at baseline (≤ 1 day before surgery) and at 1 day and approximately 2, 6, and 12 weeks after cystotomy for urocystolith removal. A baseline ratio between ventral (cystotomy site) and corresponding dorsal midline wall thickness was calculated and used to account for measurement variations attributable to bladder distension at subsequent visits. Patient signalment, weight, medications administered, urocystolith composition, and culture results were recorded. Clinical signs, reoccurrence of hyperechoic foci, and suture visualization were recorded at follow-up examinations. Variables were evaluated for association with cystotomy site thickening and resolution of thickening. RESULTS Median wall thickness at the ventral aspect of the bladder was significantly greater than that of the corresponding dorsal aspect at baseline. Cystotomy site thickening peaked 1 day after surgery and decreased at subsequent visits in a linear manner. Twelve weeks after surgery, 5 of 10 clinically normal dogs evaluated had persistent cystotomy site thickening. Eleven of 18 dogs had reoccurrence of hyperechoic foci within the bladder at some time during the study (median time to first detection, 17 days after surgery). CONCLUSIONS AND CLINICAL RELEVANCE Persistent cystotomy site thickening can be present up to 3 months after cystotomy for urolithiasis in dogs without lower urinary tract signs. Reoccurrence of hyperechoic foci in the bladder, although subclinical, was detected earlier and at a higher rate than anticipated.

Ultrasonographic and clinicopathologic features of segmental dilatations of the common bile duct in four cats.

CASE SERIES SUMMARY: This case series documents ultrasonographic and clinicopathologic features of four cats with marked segmental dilatations of the common bile duct (CBD). All cats had additional ultrasonographic changes to the hepatobiliary system, including hepatomegaly, tubular to saccular intra/extrahepatic biliary duct dilatation and biliary debris accumulation. Based on all available data the presence of extrahepatic biliary duct obstruction (EHBDO) was ruled out in 3/4 cases and was equivocal in one case. One cat underwent re-routing surgery to address the CBD dilatation after multiple recurrent infections, one cat was euthanized and had a post-mortem examination and two cats were medically managed with antibiotics, liver protectants, gastroprotectants and cholerectics. RELEVANCE AND NOVEL INFORMATION: The ultrasonographic features of the CBD in this population of cats were supportive of choledochal cysts (CCs). The maximal diameter of the CBD dilatations exceeded 5 mm in all cases, a sign that has been previously reported to be consistent with EHBDO. In our study, dilatations were segmental rather than diffuse. Given the high morbidity and mortality associated with hepatobiliary surgery in cats, segmental dilatation of the CBD should not prompt emergency surgery. Some cats may respond to medical management. Careful planning for cyst resection was beneficial in one cat. Evaluation of CC morphology (eg, size, location, concurrent intrahepatic anomalies) may assist in selecting cats that could benefit from surgical intervention.

Clinicopathological and ultrasonographic features of cats with eosinophilic enteritis.

Eosinophilic enteritis (EE) in cats is poorly characterized. The aim of the current study was to retrospectively evaluate the clinical and ultrasonographic findings in cats with histologic evidence of eosinophilic inflammation on gastrointestinal biopsy. Twenty-five cats with tissue eosinophilia on surgical (10) or endoscopic (15) biopsy of the gastrointestinal tract, having an abdominal ultrasound performed within 48 h of biopsy acquisition, were enrolled. History, clinical presentation, clinical pathology and abdominal ultrasound findings were reviewed. Intestinal biopsies were evaluated by a single pathologist and separated into two groups based on the degree of eosinophilic infiltrate: mild (<10 eosinophils/high-power field [HPF], 11/25 cats), or moderate/marked (>10 eosinophils/HPF, 14/25 cats). The former were considered primary lymphoplasmacytic or lymphocytic inflammatory bowel disease (LPE) with subtle eosinophilic infiltrates, and the latter to have EE. Signalment, history and clinical signs were similar in all cats. Only cats with EE (6/14) had palpably thickened intestines. The only distinguishing clinicopathological feature of cats with EE was the presence of peripheral eosinophilia (6/14). On ultrasound, when compared with cats with LPE, cats with EE had a greater mean jejunal wall thickness (3.34 mm ± 0.72 mm vs 4.07 mm ± 0.58 mm, respectively) and an increased incidence of thickening of the muscularis layer (1/11 and 11/14, respectively). In conclusion, ultrasonographic evidence of a prominent intestinal muscularis layer, palpably thickened intestines and peripheral eosinophilia can serve as biomarkers for the presence of EE in cats with chronic intestinal signs.

Comparison between clinical, ultrasound, CT, MRI, and pathology findings in dogs presented for suspected thyroid carcinoma.

This study compares clinical, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and pathology findings in 16 prospectively, and seven retrospectively recruited dogs presented for suspected thyroid carcinoma. Of these, 17 were confirmed thyroid carcinoma, while six were initially misdiagnosed. These included four carotid body tumors, one para-esophageal abscess, and one undifferentiated squamous cell carcinoma. Thyroid carcinomas occurred in older dogs without evidence of sex predilection, and were more often unilateral. All were large, heterogeneous, moderately to strongly vascularized, and most commonly contained areas of dystrophic mineralization and/or fluid accumulations. On MRI, thyroid carcinomas appeared hyperintense compared to surrounding musculature in all imaging sequences used, while on CT they had a lower attenuation value than normal thyroid gland tissue. Histologically confirmed tumor capsule disruption with invasion of the surrounding structures was most commonly detected with MRI. Palpation was not an accurate predictor of locally invasive vs. well-encapsulated masses. Computed tomography had the highest specificity (100%) and MRI had the highest sensitivity (93%) in diagnosing thyroid carcinoma, while ultrasound had considerably lower results. We conclude that ultrasound is adequate for use as a screening tool for dogs with suspected thyroid carcinoma, but recommend either CT or MRI for preoperative diagnosis and staging.

Gastropexy with an automatic stapling instrument for the treatment of gastric dilatation and volvulus in 20 dogs.

Surgical stapling equipment was used to create a gastropexy in 20 dogs undergoing emergency surgery for gastric dilatation and volvulus (GDV). The technique involved creation of a tunnel between the seromuscular layer and the submucosa of the pyloric antrum, and a matching tunnel beneath the right m. transversus abdominis. The arms of a gastrointestinal anastomosis stapling device were introduced into the tunnels, and the device was fired to create the gastropexy. One dog died of systemic sequelae of GDV during the early postoperative period. None of the remaining 19 dogs developed a recurrence of GDV during follow-up periods ranging from 5 to 43 months. In 11 dogs, the integrity of the gastropexy was evaluated by abdominal ultrasonography and either negative contrast gastrography or double contrast gastrography; in these dogs, the radiographic and/or the ultrasonographic findings were suggestive of an intact gastropexy. There were no complications involving the gastropexy staple line. The results of this study indicate that an effective and consistent permanent gastropexy can be created, using surgical stapling equipment.

Ultrasonographic appearance of canine gastric polyps.

Benign gastric polyps are uncommon in dogs and most are discovered incidentally. Polyps protruding into the pyloric antrum can cause gastric outflow obstruction. Clinical and ultrasonographic findings in seven dogs with histologically confirmed benign mucosal gastric polyps were reviewed. Sonographic findings such as shape, size, echogenicity, location, evidence of gastric wall thickening, wall layering, and size of regional lymph nodes were recorded. Five sessile and two pedunculated masses of different sizes (range 7-60 mm) and echogenicities were found. They primarily arose from the mucosal layer and protruded into the gastric lumen. Only one dog had a large inhomogeneous mass with a poorly visualized gastric wall layering. The polyps were all single, and were located in the pyloric antrum in six out of seven dogs. Although the ultrasonographic appearance allowed a presumptive diagnosis of mucosal gastric polyp, the final diagnosis was determined from histopathologic examination.

Ultrasonographic features of extrahepatic biliary obstruction in 30 cats.

The goals of our study were to review the ultrasonographic features of spontaneous extrahepatic biliary obstruction in cats and to determine whether these features can assist in differentiating tumor, inflammation, and choleliths as the cause of obstruction. Thirty cats with a presurgical ultrasound examination an dconfirmed extrahepatic biliary obstruction were studied. A common bile duct diameter over 5 mm was present in 97% of the cats with extrahepatic biliary obstruction. Gallbladder dilation was seen in < 50% of the cats. Ultrasound identified all obstructive choleliths (calculus or plugs) in the common bile duct. However, neither common bile duct diameter nor appearance or any other ultrasonographic feature allowed differentiation between tumor and inflammation as the cause of obstruction. A short duration of clinical signs (10 days or less) seemed to be associated with obstructive cholelithiasis.

Imaging findings in pancreatic neoplasia and nodular hyperplasia in 19 cats.

Pancreatic neoplasia in cats is rare and associated with a poor prognosis, but pancreatic nodular hyperplasia is a common incidental finding. The purpose of this study was to describe radiographic and ultrasonographic findings in cats with pancreatic neoplasia or nodular hyperplasia. Fourteen cats (age 3-18 years) were diagnosed with malignant pancreatic tumors: carcinoma/adenocarcinoma (n = 11), lymphoma (n = 1), squamous cell carcinoma (n = 1), and lymphangiosarcoma (n = 1). The most common radiographic findings were an abdominal mass or mass effect (6/6) and lack of serosal margin detail (4/6). On ultrasound, the most common finding was a focal pancreatic mass or nodule, with a size range from 0.4 cm to more than 7.0 cm (8/14). Lymphadenopathy (7/14) and abdominal effusion (7/14) were frequently seen. Five cats (age 10-16 years) with adenomatous/nodular hyperplasia had an abdominal mass or mass effect as the most common radiographic finding (3/3). On ultrasound, all cats had multiple hypoechoic nodules between 0.3 and 1.0 cm associated with the pancreas. Other common findings were pancreatic thickening (2/5), lymphadenopathy (2/5), and abdominal effusion (2/5). The only imaging finding unique to malignant pancreatic tumors was the presence of a single pancreatic nodule or mass exceeding 2cm in at least one dimension (4/14). Although there was a tendency for neoplastic lesions to manifest as single larger lesions and for nodular hyperplasia to manifest as multiple smaller lesions, there was overlap of the imaging findings in both entities. Radiographs and ultrasound can complement but not replace cytology and histopathology in the diagnosis of feline pancreatic neoplasia.

Ultrasonographic intestinal hyperechoic mucosal striations in dogs are associated with lacteal dilation.

In this retrospective study, the medical records of 23 dogs with the sonographic feature of small intestinal hyperechoic mucosal striations and an endoscopic or surgical intestinal biopsy were reviewed. Histopathologic lacteal dilation was present in 96% of dogs with mucosal striations. Sonographic findings associated with mucosal striations included: mild jejunal wall thickening (96%), mild duodenal wall thickening (78%), mucosal speckles (70%), and abdominal effusion (87%). The mucosal striations were diffuse (70%) or multifocal (30%) and did not cause loss of wall layering, except in one dog with a severe mural lipogranuloma. Mesenteric lymphadenopathy was identified in 9% of dogs. Thirteen dogs with endoscopic biopsies had mild to moderate villus lacteal dilation and the nine dogs with surgical biopsies had moderate to severe dilation. Inflammatory infiltrates were mild (61%) or moderate (30%) with variable numbers and combinations of cells, including eosinophils (65%), plasma cells (61%), lymphocytes (57%), and neutrophils (30%); one dog had disseminated villus histiocytic sarcoma. The biochemistry changes and clinical signs were consistent with protein-losing enteropathy in 78% of dogs. Hyperechoic mucosal striations in dogs are associated with lacteal dilation and are frequently associated with mucosal inflammation and protein losing enteropathy.

Imaging diagnosis--urinary obstruction secondary to prostaticlymphoma in a young dog.

A 3-year old, intact male Doberman pinscher was examined at the Foster Hospital for Small Animals at Tufts University for a 2-week history of stranguria, dyschezia, and weight loss. Ultrasonographically, there was bilateral hydronephrosis, right-sided hydroureter, hepatosplenomegaly, symmetric mild prostatomegaly, and a distended urinary bladder. Fine needle aspirates and biopsies of the prostate yielded a diagnosis of lymphoma. Lymphoma is a rare cause of prostatomegaly in the dog. Sonographic findings are nonspecific; fine needle aspirates or biopsies are needed to ascertain the diagnosis.

Presumptive primary cardiac lymphoma in a cat causing pericardial effusion.

We report a case of primary cardiac lymphoma in a cat, causing pericardial effusion. A 13-year-old castrated male Himalayan cat was evaluated for chronic weight loss and radiographic finding of cardiomegaly. Pericardial effusion and a heart mass were detected via echocardiography. Pericardiocentesis and ultrasound-guided fine needle aspirate of the heart mass were performed under sedation. Antemortem diagnosis of cardiac lymphoma was made based on cytology of pericardial fluid. Based on physical examination, laboratory tests and abdominal radiographs, primary cardiac lymphoma was established as the presumptive clinical diagnosis. Treatment with chemotherapeutic agents was initiated.

Gallbladder mucocele in dogs: 30 cases (2000-2002).

OBJECTIVE: To determine long-term outcome of dogs with gallbladder mucocele. DESIGN: Retrospective study. ANIMALS: 30 dogs with gallbladder mucocele, including 23 that underwent cholecystectomy. PROCEDURE: Medical records were reviewed for signalment, history, and clinical, ultrasonographic, and surgical findings. Follow-up information was obtained for all dogs that survived the perioperative hospitalization period. RESULTS: 23 dogs had signs of systemic illness; 7 had no clinical signs. Median values for serum activities of alanine aminotransferase and alkaline phosphatase, serum total bilirubin concentration, and total WBC count were significantly higher among dogs with gallbladder rupture than among dogs without rupture. Sensitivity of sonography for detection of rupture was 85.7%. Overall perioperative mortality rate for dogs that underwent cholecystectomy was 21.7%; mortality rate was not significantly greater for dogs with rupture. Aerobic bacteria were isolated from the bile or gallbladder wall in 8.7% of dogs. All 18 dogs discharged from the hospital had complete resolution of clinical signs. In dogs that underwent in-hospital reexamination, serum liver enzyme activities were significantly decreased, compared with preoperative activities. Persistent increases in serum activities of 1 or more liver enzymes were detected in 9 of 12 dogs; 6 of 12 dogs had persistent abnormalities in hepatic echogenicity. Mean follow-up period was 13.9 months. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that cholecystectomy is an effective treatment for gallbladder mucocele. Although perioperative mortality rate is high, prognosis after discharge from the hospital is excellent. Rupture of the gallbladder warrants emergency surgical intervention but does not preclude a positive outcome.

Ultrasonographic findings in dogs and cats with gastrointestinal perforation.

A retrospective study was performed to evaluate the sonographic features of gastrointestinal (GI) perforation in dogs and cats. Sonographic findings in 19 animals (14 dogs and 5 cats) included regional bright mesenteric fat (19), peritoneal effusion (16), fluid-filled stomach or intestines (12), GI wall thickening (11), presence of free air (9), loss of GI wall layering (9), regional lymphadenopathy (8), reduced GI motility (7), pancreatic changes (4), corrugated intestines (4), presence of a mass (3), presence of a foreign body (3), and mineralization of the gastric wall (1). In 14 patients, "perforation" was listed as a differential diagnosis by the sonographer. Abdominal radiographs and radiographic reports were available for 14 patients. Radiographic findings were decreased serosal detail (12), free air (8), peritoneal contrast medium (1), and suspected foreign body (1). GI perforation was listed as radiographic diagnosis in eight patients, seven of which had evidence of pneumoperitoneum, and one had leakage of contrast material on an upper GI study. In 9/14 patients with radiography, "GI perforation" was listed as a sonographic diagnosis. In three patients in which free air was diagnosed sonographically, radiographs were either not available (2) or the presence of free air was not detected at presentation (1). Peritoneal fluid analysis was performed in nine patients, five of which were identified as septic inflammation, and the remaining four were classified as neutrophilic inflammation with no etiologic agent identified. The histologic or surgical diagnoses were as follows: three intestinal surgical dehiscence; one percutaneous endoscopic gastrostomy tube site leakage; one duodenal adenocarcinoma; one ileocolic lymphoma; one trichobezoar; one ascarid impaction; and one bobby pin foreign body. In the remaining 10 patients, a focal area of gastric/intestinal ulceration or transmural necrosis with perforation was identified without evidence of an underlying cause.