MRI ischemic and hemorrhagic lesions in arterial and venous territories characterize central nervous system intravascular lymphoma in dogs.

Intravascular lymphoma (IVL) is characterized by the proliferation of large malignant lymphocytes within the lumen of blood vessels. This retrospective, multi-center, case series study aimed to describe the MRI features of confirmed central nervous system IVL in dogs and compare them with histopathological findings. Medical record databases from seven veterinary centers were searched for cases of histologically confirmed IVL. Dogs were included if an MRI was performed. The MRI studies and histopathology samples were reviewed to compare the MRI changes with the histopathological findings. Twelve dogs met the inclusion criteria (12 brains and three spinal cords). Imaging of the brains revealed multifocal T2-weighted/FLAIR hyperintense and T1-weighted iso-hypointense lesions, with variable contrast enhancement; areas of abnormal diffusion both in arterial and venous territories in diffusion-weighted imaging; and meningeal enhancement. On gradient echo images (GRE), the changes comprised tubular susceptibility artifacts, consistent with the "susceptibility vessel sign", and additional variably sized/shaped intraparenchymal susceptibility artifacts. Spinal cord lesions presented as fusiform T2-weighted hyperintensities with scattered susceptibility artifacts on GRE and variable parenchymal and meningeal contrast enhancement. On histopathology, subarachnoid hemorrhages and neuroparenchymal areas of edema and necrosis, with or without hemorrhage, indicating ischemic and hemorrhagic infarctions, were found. These lesions were concurrent with severely dilated meningeal and parenchymal arteries and veins plugged by neoplastic lymphocytes and fibrin. Due to the unique angiocentric distribution of IVL, ischemic and hemorrhagic infarcts of variable chronicity affecting both the arterial and venous territories associated with thrombi formation can be detected on MRI.

Bilateral thoracic radiographs increase lesion detection in horses with pneumonia or pulmonary neoplasia but do not bring any additional benefit for inflammatory or diffuse pulmonary disease.

Published studies describing the effects of bilateral radiographic projections on the detection of equine pulmonary lesions are currently lacking. The objectives of this retrospective, single center, observational study were to compare unilateral and bilateral thoracic radiographic projections for the detection of pulmonary lesions in a group of horses. Based on their clinical diagnosis, 167 adults and foals with bilateral thoracic radiographs were classified as having pneumonia (n = 88), inflammatory or diffuse pulmonary disease (n = 72), and pulmonary masses (n = 7). After an initial interrater repeatability test, right-to-left and left-to-right projections were anonymized and independently interpreted by a radiologist blinded to the clinical diagnosis. Scores were attributed for each pattern/lesion (alveolar, interstitial, bronchial, nodules/masses, cavitary lesions) and each quadrant. Agreement between scores from each projection was evaluated with Bland-Altman plots. Lesions identified on one side but not on the contralateral projection were considered discordant. There was no preferential lateralization of pulmonary lesions. The prevalence of discordance was 14.4%, 9.0%, and 4.2% for alveolar pattern, nodules/masses, and cavitary lesions, respectively. Up to nine horses (10.2%) with pneumonia could have been misdiagnosed. A pulmonary mass would have been missed in one case. For inflammatory or diffuse disease, discordance was slight, and the addition of contralateral projections had no impact on radiographic interpretation. In conclusion, in horses with pneumonia or neoplasia, bilateral projections, or adding at least one contralateral caudoventral view, increased the probability of identifying pulmonary lesions. In horses with inflammatory or diffuse disease, bilateral thoracic radiography provided no additional benefit.

Can MRI differentiate between ring-enhancing gliomas and intra-axial abscesses?

Gliomas of the brain may appear as expansile ring-enhancing masses in MRI studies, mimicking the appearance of intra-axial abscesses. The aims of this study were to compare the MRI features of ring-enhancing gliomas and intra-axial brain abscesses in dogs and cats and to identify the characteristics that might help differentiate them. For this multicenter, retrospective, and observational study, the inclusion criteria were as follows: (a) a definitive diagnosis of glioma or abscess based on cytological or histopathological examination following CSF collection or surgical biopsy/necropsy, respectively; (b) MRI study performed with a high- or low-field MRI scanner, including a same plane T1W pre- and postcontrast, a T2W and a T2 FLAIR sequence in at least one plane. If available, delayed T1W postcontrast, T2*W GE, DWI/ADC, and SWI sequences were also evaluated. Sixteen patients were diagnosed with ring-enhancing gliomas, and 15 were diagnosed with intra-axial abscesses. A homogenous signal on T1W (P = 0.049) and T2W (P = 0.042) sequences, a T2W (P = 0.005) or T2*W GE (P = 0.046) peripheral hypointense halo, and an even enhancing capsule (P = 0.002) were significantly associated with brain abscesses. A progressive central enhancement on delayed T1W postcontrast sequences was correlated with ring-enhancing gliomas (P = 0.009). The combination of the following features was suggestive of brain abscess: homogeneous T1W or T2W signal intensity, a T2W or T2*W GE peripheral hypointense halo and an evenly enhancing capsule. Central progression of enhancement on delayed T1W postcontrast sequences was suggestive of glioma.

Reversibility of clinical and computed tomographic lesions mimicking pulmonary fibrosis in a young cat.

BACKGROUND: In humans with idiopathic pulmonary fibrosis (IPF), specific thoracic computed tomographic (CT) features in the correct clinical context may be used in lieu of histologic examination. Cats develop an IPF-like condition with similar features to humans. As few cats have invasive lung biopsies, CT has appeal as a surrogate diagnostic, showing features consistent with architectural remodeling supporting "end-stage lung". CASE PRESENTATION: A 1-year-old female spayed Domestic Shorthair cat presenting with progressive respiratory clinical signs and thoracic CT changes (reticular pattern, parenchymal bands, subpleural interstitial thickening, pleural fissure thickening, subpleural lines and regions of increased attenuation with traction bronchiectasis and architectural distortion) consistent with reports of IPF was given a grave prognosis for long-term survival. The cat was treated with prednisolone, fenbendazole, pradofloxacin and clindamycin. Five months later, while still receiving an anti-inflammatory dose of prednisolone, the cat was re-evaluated with owner-reported absent respiratory clinical signs. Thoracic CT demonstrated resolution of lung patterns consistent with fibrosis. CONCLUSIONS: Fibrotic lung disease is irreversible. Despite this cat having compatible progressive respiratory signs and associated lung patterns on thoracic CT scan, these abnormalities resolved with non-specific therapy and time, negating the possibility of IPF. While the cause of the distinct CT lesions that ultimately resolved was not determined, infection was suspected. Experimental Toxocara cati infection shows overlapping CT features as this cat and is considered a treatable disease. Improvement of CT lesions months after experimental heartworm-associated respiratory disease in cats has been documented. Reversibility of lesions suggests inflammation rather than fibrosis was the cause of the thoracic CT lesions. This cat serves as a lesson that although thoracic CT has been advocated as a surrogate for histopathology in people with IPF, additional studies in cats are needed to integrate CT findings with signalment, other clinicopathologic features and therapeutic response before providing a diagnosis or prognosis of fibrotic lung disease.

Influence of abdominal elevation on radiographic measurements of the thoracolumbar interspinous spaces in asymptomatic horses.

The objective of this study was to determine if abdominal elevation could induce radiographically visible widening of the interspinous spaces in the thoracolumbar region of standing sedated horses and facilitate the surgical approach to the region. Radiographs centered on T13 and T18 were taken while applying different degrees of tension on a wide strap placed under the abdomen of 7 healthy horses. Then, the interspinous spaces between T11 and L2 were measured following a standardized method. The interspinous spaces widen radiographically between T11 to L2, except for T18-L1. Thus, the reported technique could potentially facilitate the surgical approach for horses with impinging and overriding dorsal spinous processes.

Influence de l'élévation abdominale sur les mesures radiographiques des espaces intervertébraux thoraco-lombaires chez des chevaux asymptomatiques. L'objectif de la présente étude était de déterminer si l'élévation abdominale pouvait causer un élargissement radiographique visible des espaces intervertébraux dans la région thoraco-lombaire de chevaux sous sédation en position debout et faciliter l'approche chirurgicale de la région. Des radiographies centrées sur T13 et T18 furent prises tout en appliquant différents degrés de tension sur une large courroie placée sous l'abdomen de sept chevaux en santé. Puis, les espaces intervertébraux entre T11 et L2 furent mesurés en suivant une méthode standardisée. Les espaces intervertébraux s'élargissaient radiographiquement entre T11 à L2, sauf pour T18­L1. Ainsi, la technique radiographique rapportée ici pourrait potentiellement faciliter l'approche chirurgicale chez des chevaux avec empiètement et chevauchement des apophyses épineuses.(Traduit par Dr Serge Messier).

Diffuse meningeal oligodendrogliomatosis characterized by spinal intra-parenchymal nodules on magnetic resonance imaging in a dog.

Meningeal oligodendrogliomatosis is a relatively rare neoplasm in dogs. Ante-mortem diagnosis is difficult due to nonspecific neurologic signs overlapping other conditions. The only reported consistent feature is a high level of protein in the cerebrospinal fluid. Veterinary literature offers only 1 case report with magnetic resonance imaging (MRI) of canine spinal meningeal oligodendrogliomatosis in a single dog. In contrast to the predominant diffuse meningeal enhancement shown in that report, we present the case of a young female cane corso dog with marked nodular invasion of the spinal cord on MRI, confirmed by histopathology to be consistent with diffuse meningeal oligodendrogliomatosis. Key clinical message: Meningeal oligodendrogliomatosis should be a differential diagnosis when marked nodular invasion of the spinal cord is seen on MRI, both with and without meningeal enhancement.

Oligodendrogliomatose méningée diffuse caractérisée par des nodules spinaux intraparenchymateux lors d'un examen d'imagerie par résonance magnétique chez un chien. L'oligodendrogliomatose méningée est un néoplasme relativement rare chez le chien. Son diagnostic ante-mortem est difficile en raison de signes neurologiques non spécifiques chevauchant d'autres conditions. La seule caractéristique fréquemment signalée est un niveau élevé de protéines dans le liquide céphalo-rachidien. La littérature vétérinaire ne propose qu'un seul rapport de cas illustrant des images obtenues suite à un examen d'imagerie par résonance magnétique (IRM) chez un seul chien diagnostiqué avec une oligodendrogliomatose méningée rachidienne. Contrairement au rehaussement méningé diffus prédominant montré chez ce chien, nous présentons le cas d'une jeune femelle Cane Corso avec une oligodendrogliomatose méningée diffuse confirmée à l'histopathologie, s'étant manifestée à l'IRM par une invasion nodulaire marquée de la moelle épinière.Message clinique clé:L'oligodendrogliomatose méningée doit être un diagnostic différentiel lorsqu'une invasion nodulaire marquée de la moelle épinière est observée à l'IRM, avec ou sans rehaussement méningé.(Traduit par Dre Isabelle Masseau).

Ultrasonographic anatomy of reproductive female leopard geckos (Eublepharis macularius).

Captive leopard geckos (Eublepharis macularius) often present to the exotic clinic for gastrointestinal impactions, follicular stasis, or dystocia. To our knowledge, normal ultrasonographic anatomy of these lizards has not been described. The objectives of this prospective, anatomic, analytical study were to develop ultrasound techniques for this species and to describe the normal sonographic anatomy of the head, coelomic cavity, and tail. Eleven, healthy, female leopard geckos were included. A linear array 13-18 MHz transducer was used. Geckos were sedated and restrained in dorsal recumbency for coelomic structure examination and in ventral recumbency for head and tail examinations. Sagittal and transverse images were acquired and authors recorded qualitative and quantitative ultrasonographic characteristics of anatomic structures. The ventral surface of the lungs, liver, gallbladder, caudal vena cava, portal vein, ventral abdominal vein, aorta, ovarian follicles, fat bodies, tail, and brain were visualized in 10 of 11 individuals. In one individual, molt precluded ultrasonographic examination. The heart, kidneys, urinary bladder, spleen, and pancreas were not visualized. The digestive tract was observed in 10 individuals but was too small to be measured. Findings from the current study could be used as a reference for future studies of leopard geckos.

The computed tomographic "tree-in-bud" pattern: Characterization and comparison with radiographic and clinical findings in 36 cats.

In humans, a CT "tree-in-bud" pattern has been described as a characteristic of centrilobular bronchiolar dilation, with bronchiolar plugging by mucus, pus, or fluid. Aims of this retrospective, descriptive, multi-center study were to characterize the CT appearance of a "tree-in-bud" pattern in a group of cats, and compare this pattern with radiographic and clinical findings. Databases from four hospitals were searched during the period of January 2012 to September 2015 and cats with thoracic radiographs, thoracic CT scans and CT reports describing findings consistent with a "tree-in-bud" pattern were included. Images were reviewed by two veterinary radiologists and characteristics were recorded based on consensus. Clinical findings were recorded by one observer from each center. Thirty-six cats met inclusion criteria. Six cats were asymptomatic, 12 were diagnosed with bronchial disease and 23 were suspected to have bronchial disease. Right cranial and right caudal lung lobes were most commonly affected on both imaging modalities. Localization of the "tree-in-bud" pattern was most often peripheral. On radiographs, the CT "tree-in-bud" pattern often appeared as soft-tissue opacity nodules; their number and affected pulmonary segments were often underestimated compared with CT. In conclusion, the "tree-in-bud" pattern should be considered as a differential diagnosis for radiographic soft tissue opaque nodules in feline lungs. Based on lesion localization and presence or suspicion of a concomitant bronchial disease for cats in this sample, authors propose that the CT "tree-in-bud" pattern described in humans is also a characteristic of bronchial or bronchiolar plugging and bronchial disease in cats.

COMPARISON OF LUNG ATTENUATION AND HETEROGENEITY BETWEEN CATS WITH EXPERIMENTALLY INDUCED ALLERGIC ASTHMA, NATURALLY OCCURRING ASTHMA AND NORMAL CATS.

Airway remodeling is a prominent feature of feline allergic asthma but requires biopsy for characterization. Computed tomography (CT) has appeal as a minimally invasive diagnostic test. The purpose of this prospective case-control study was to compare indices of airway remodeling between cats with experimentally induced, spontaneous asthma and healthy unaffected cats using CT. We hypothesized that experimental and spontaneous feline asthma would have similar CT airway remodeling characteristics and that these would be significantly different in healthy cats. Experimentally induced asthmatic research cats (n = 5), spontaneously asthmatic pet cats (n = 6), and healthy research cats (n = 5) were scanned unrestrained using a 64-detector row CT scanner. Inspiratory breath-hold CT scans were also performed in experimentally induced asthmatic and healthy cats. Mean ± extent variation of lung attenuation for each cat was determined using an airway inspector software program and CT images were scored for lung heterogeneity by a board-certified veterinary radiologist who was unaware of cat group status. Groups were compared using one-way ANOVA (unrestrained scans) and the Student's t-test (anesthetized scans) with significance defined as P < 0.10. Experimentally asthmatic and spontaneously asthmatic cats had significantly (P = 0.028 and P = 0.073, respectively) increased lung attenuation compared to healthy cats. Heterogeneity scores were higher in experimentally induced asthmatic cat than in healthy cats. Objective quantification of lung heterogeneity and lung volume did not differ among the three groups (P = 0.311, P = 0.181, respectively). Findings supported our hypothesis. Inspiratory breath-hold anesthetized CT scans facilitated discrimination between asthmatic and healthy cats in comparison to unrestrained CT scans.

Evaluation of B-lines with 2 point-of-care lung ultrasound protocols in cats with radiographically normal lungs.

OBJECTIVE: To compare 2 point-of-care lung ultrasound (LUS) protocols for quantification of B-lines in cats without evidence of respiratory disease based on history, physical examination, and thoracic radiography. DESIGN: Prospective observational study. SETTING: Single center, veterinary teaching hospital. ANIMALS: Fifty-seven cats without respiratory disease based on history, physical examination, and thoracic radiographs. INTERVENTIONS: All cats had 2 point-of-care LUS protocols performed bilaterally: a regional protocol (veterinary bedside lung ultrasound evaluation [VetBLUE]) and a more comprehensive vertical sweeping (VS) protocol. The total number of B-lines per cat, number of sites with B-lines, and maximal number of B-lines at each site were recorded and compared. MEASUREMENTS AND MAIN RESULTS: Ten cats (18%) had at least 1 B-line identified with VetBLUE, versus 29 (51%) with VS. Comparing protocols, VS had a statistically higher total number of B-lines per cat, higher number of sites with B-lines, and higher maximal number of B-lines per site. B-lines that were too numerous to count were identified at a single location in 1 cat with VetBLUE and 2 cats with VS. A maximum of 3 B-lines were identified at all other positive sites regardless of the protocol used. On average, it took 1.79 times longer to complete VS bilaterally compared to VetBLUE (median [interquartile range]: 140 [33] and 78 [14] s, respectively) (P = 0.001). CONCLUSIONS: This study demonstrates it is not uncommon to identify a single or even multiple B-lines in 1 or several sites on LUS in cats deemed to be clinically free of respiratory pathology-essential knowledge when using LUS as a screening test and to monitor intrathoracic lesions. In cats asymptomatic for respiratory disease, VS generally identifies more B-lines than VetBLUE, likely because it assesses a larger lung surface area. The sonographic identification of B-lines should be interpreted considering the LUS protocol used, history, and other diagnostics to determine their clinical significance.

Hyperthyroid cats have altered pulmonary arterial hemodynamics but rarely have intermediate or high probability of pulmonary hypertension.

OBJECTIVE: Apply the 3-site echocardiographic metrics utilized to assess pulmonary hypertension (PH) probability in dogs and humans to feline echocardiographic examinations to investigate the translatability of this scheme and subsequent enhancement of detection of PH in cats. ANIMALS: 27 client-owned cats (euthyroid [n = 11] and hyperthyroid [16]). METHODS: This was a single-center, prospective, observational case-control study. Demographic, physical examination, and echocardiographic data from hyperthyroid and euthyroid cats were compared via Fisher exact test and Kruskal-Wallis test. RESULTS: Hyperthyroid versus euthyroid cats had significantly greater right atrial area index values and were more likely to have late-peaking main pulmonary artery pulsed-wave flow profiles. Two hyperthyroid cats had measurable tricuspid regurgitation tracings (one with a high probability of PH and another with a low probability of PH). CLINICAL RELEVANCE: Hyperthyroid cats demonstrated altered pulmonary arterial hemodynamics and lacked consistent intermediate or high probability of PH. The 3-site echocardiographic metrics scheme is applicable for the evaluation of right-sided cardiac and pulmonary arterial hemodynamics in cats. Further research is needed to determine reference ranges in larger populations of healthy cats and those with high clinical suspicion for PH.

Muscular morphometric study of the canine shoulder for the design of 3D-printed endoprostheses in dogs with osteosarcoma of the proximal humerus: a pilot cadaveric study by MRI.

OBJECTIVE: Osteosarcoma frequently affects the proximal humerus in dogs. In veterinary medicine, no therapeutic option for the treatment of osteosarcoma satisfactorily preserves limb function. 3D-printed personalized endoprosthesis offers a promising treatment option. Morphometric data, necessary for the design of the endoprosthesis, are currently lacking in canine patients. Our objective was to acquire the morphometric data necessary to refine the design of the endoprosthesis. ANIMAL: A single canine cadaveric thoracic limb. PROCEDURES: Sagittal proton-density, and sagittal, dorsal, and transverse T1-weighted sequences of the thoracic limb were acquired with a 1.5 Tesla Magnetic Resonance Imaging (MRI) unit. Nineteen muscles of interest were subsequently identified using medical imaging software (Mimics©) and their volume was reconstructed in 3D using computer-aided design (CATIA©). Mormophetric data were recorded for each of the 19 muscles. The same canine cadaver was then dissected to measure the same parameters. RESULTS: All muscles were successfully identified with data consistent with the dissected cadaveric data. Certain muscles were more challenging to isolate on MRI, namely the heads of the triceps brachii, superficial pectoral, and latissimus dorsi. The relative distribution of muscle volumes was similar to historical data. Muscle tissue density was not significantly affected by freezing (1.059 g/cm3). CLINICAL RELEVANCE: MRI is a useful tool to collect morphometric data but imperfect if used alone. This approach was the first attempt to validate more general morphometric data that could be used to refine the design of custom 3D-printed prostheses for limb-sparing of the proximal humerus. Further imaging studies are warranted to refine our model.

Ventilator-Assisted Inspiratory and Expiratory Breath-Hold Thoracic Computed Tomographic Scans Can Detect Dynamic and Static Airway Collapse in Dogs with Limited Agreement with Tracheobronchoscopy.

Airway collapse (AC) in dogs includes a tracheal collapse, mainstem and lobar bronchial collapse, and bronchomalacia (i.e., segmental/subsegmental bronchial collapse). The clinical presentation of AC may overlap with non-collapsible airway disease (NCAD) or another non-lower airway respiratory disease (NLARD). This study determined whether paired inspiratory (I)/expiratory (E)-breath-hold computed tomography (I/E-BH CT) can detect a static and dynamic AC in dogs with spontaneous respiratory disease and it compared the CT-derived metrics of the AC to the tracheobronchoscopy metrics. The CT-acquired I and E diameter and cross-sectional area (CSA) for the trachea, mainstem and lobar bronchi in dogs with an AC (n = 16), NCAD (16), and NLARD (19) served for a dynamic percent of the airway narrowing (%AN) calculation. A scoring system assessed the bronchomalacia. The circularity was calculated for each airway. The results were compared to the tracheobronchoscopy collapse grading. In the dogs with an AC, the %AN was larger for the trachea, right mainstem bronchus and right middle lobar bronchus when they were compared to the dogs with NCAD and NLARD. Flattening was only identified for the trachea of the AC dogs. The agreement between the CT and tracheobronchoscopy scores was 20% from trachea to the lobar bronchi and 47% for the segmental/subsegmental bronchi. Paired I/E-BH CT can detect static and dynamic AC with limited agreement with the tracheobronchoscopy metrics. Independent scoring systems that are tailored to the clinical manifestations of functional impairments are needed.

No evidence of pulmonary hypertension revealed in an echographic evaluation of right-sided hemodynamics in hyperthyroid cats.

OBJECTIVES: Hyperthyroidism is a common endocrinopathy affecting middle-aged to elderly cats, with multisystemic repercussions. Hyperthyroid humans show decreased lung compliance and increased cardiac output with subsequent left heart failure leading to pulmonary capillary congestion. Prognosis worsens with the development of increased pulmonary vascular pressures (ie, pulmonary hypertension [PH]) in hyperthyroid humans. The effect of excess thyroid hormone concentration on pulmonary arterial hemodynamics is unknown in cats. Assessing pulmonary vascular pressures in veterinary medicine relies heavily on echocardiographic measurements performed at the level of the heart and pulmonary trunk. This study investigated right-sided cardiac and pulmonary arterial hemodynamics in hyperthyroid cats using echocardiography. METHODS: Echocardiographic examinations of hyperthyroid cats identified through a bi-institutional database search were reviewed for the determination of systolic pulmonary arterial pressure (PAP) and 20 other metrics. Values were compared with those of a healthy cat group using non-parametric statistical analyses. RESULTS: Systolic PAP could not be determined in 23/26 hyperthyroid and 13/14 healthy cats owing to unmeasurable tricuspid regurgitation flow velocity. Hyperthyroid cats were roughly twice as old (P <0.001) and had 2-4-fold higher respiratory rates (P <0.001) than healthy cats. Hyperthyroid cats showed an increase in acceleration time-to-ejection time ratio of pulmonary flow (1.4-fold, P = 0.001), pulmonary artery velocity time integral (1.2-1.6-fold, P = 0.001), maximal pulmonary velocity (1.3-1.7-fold, P = 0.002), stroke volume (1.5-fold, P = 0.001) and cardiac output (1.6-fold, P <0.001) vs healthy cats. None of the other echocardiographic metrics reached statistical significance. CONCLUSIONS AND RELEVANCE: Systolic PAP estimation proved unsuitable as a sole measurement for the assessment of PH in hyperthyroid cats owing to the frequent inability to interrogate tricuspid regurgitant flow velocity. Hyperthyroid cats have altered echocardiographic measures of pulmonary hemodynamics dissimilar to those reported in hyperthyroid humans. Differential effects of thyrotoxic cardiomyopathy on ventricular systolic function may underlie species differences.

Lower airway collapse: Revisiting the definition and clinicopathologic features of canine bronchomalacia.

Bronchomalacia (BM) is an inconsistently defined term in dogs, impairing understanding of clinical presentation, therapeutic response and prognosis. Herein the authors propose to clarify the definition of canine bronchomalacia (CBM) as regional to diffuse dynamic airway collapse of segmental and/or subsegmental bronchi with associated clinical signs due to airflow limitation. In contrast to tracheal collapse, mainstem bronchial collapse, and in some cases lobar collapse, CBM requires advanced imaging. Common co-morbid conditions (e.g., chronic bronchitis, mitral valve degenerative disease, etc.) should be identified during a comprehensive diagnostic evaluation. Current empiric treatments advocated in absence of clinical trials documenting efficacy in the dog warrant evaluation, as some (e.g., bronchodilators) may have detrimental effects in certain types of airway collapse in humans. There is no direct treatment for CBM, as defined above, but non-specific therapies and targeted treatment of co-morbid disease may improve clinical signs and quality of life. In this manuscript, the authors provide a review of the different types of airway collapse focusing on CBM, reviewing their definition and etiology, proposing a classification scheme, and discussing clinical signs, diagnostic testing, and treatment. Future studies should focus on both improving understanding of the etiology and natural disease progression of CBM and treatment trials.

Hirudotherapy (medicinal leeches) for treatment of upper airway obstruction in a dog.

OBJECTIVE: To describe upper airway obstruction (UAO) in a dog treated with medicinal leeches (hirudotherapy) as an ancillary therapy to hasten recovery. CASE SUMMARY: A 10-month-old neutered female Mastiff presented for acute respiratory distress. On admission, the dog was tachycardic, cyanotic, and orthopneic; stridor was audible. A 10-cm soft tissue swelling in the right ventral cervical region and bruising around the rostral mandible were noted. At the time of endotracheal intubation, the trachea was deviated to the right as a consequence of severe soft tissue swelling that was contiguous with the sublingual hematoma and cervical region, causing loss of visualization of the arytenoids. A computed tomography with contrast scan of the head, neck, and thorax was performed, showing severe soft tissue swelling of the tongue, obliteration of the common pharyngeal/laryngeal regions from suspected hemorrhage, and rightward displacement of pharynx, larynx, and proximal trachea. Marked diffuse bronchial/bronchiolar thickening associated with bronchiolectasis and diffuse opacification of the pulmonary parenchyma with regions of consolidation were noted. The dog was minimally hypercoagulable on thromboelastography. The imaging results together with results of bronchoalveolar lavage cytology supported a comorbidity of eosinophilic bronchopneumopathy. Intubation was maintained with infusions of propofol and fentanyl, with minimal changes in oropharyngeal swelling within the first 18 hours of treatment. Medicinal leeches were then applied to the sublingual and cervical regions. There was continued slow bleeding from the sites of leech detachment, and the dog was able to be extubated at 44 hours, followed by hospital discharge. NEW/UNIQUE INFORMATION PROVIDED: Leeches are utilized in human medicine for treatment of UAO. Although UAO from hemorrhage has been described in dogs, this is the first report of medicinal leeches (Hirudo verbana) as complementary treatment for sublingual hematoma that contributed to UAO.

Comparison of Short- versus Long-Course Antimicrobial Therapy of Uncomplicated Bacterial Pneumonia in Dogs: A Double-Blinded, Placebo-Controlled Pilot Study.

Current treatment for canine bacterial pneumonia relies on protracted courses of antimicrobials (3-6 weeks or more) with recommendations to continue for 1-2 weeks past resolution of all clinical and thoracic radiographic abnormalities. However, in humans, bacterial pneumonia is often treated with 5-10-day courses of antimicrobials, and thoracic radiographs are not considered useful to guide therapeutic duration. The primary study objective was to determine whether a short course of antimicrobials would be sufficient to treat canine bacterial pneumonia. Eight dogs with uncomplicated bacterial pneumonia were enrolled in this randomized, double-blinded, placebo-controlled study comparing clinical and radiographic resolution with differing durations of antimicrobial therapy. Dogs received a course of antimicrobials lasting 10 (A10) or 21 (A21) days. Dogs randomized to the A10 group received placebo for 11 days following antimicrobial therapy. Patients were evaluated at presentation and 10, 30 and 60 days after the initiation of antimicrobials. At 10 days, 6/8 dogs had resolution of both clinical signs and inflammatory leukogram, and 5/8 dogs had improved global radiographic scores. After 60 days, clinical and hematologic resolution of pneumonia was noted in all dogs regardless of antimicrobial therapy duration; however, 3/8 dogs had persistent radiographic lesions. Thoracic radiographs do not appear to be a reliable marker to guide antimicrobial therapy in canine bacterial pneumonia as radiographic lesions may lag or persist despite clinical cure. This pilot study suggests a 10-day course of antimicrobials may be sufficient to treat uncomplicated canine bacterial pneumonia.

Comparison of thoracic ultrasonography and thoracic radiography to detect active infectious bronchopneumonia in hospitalized dairy calves.

BACKGROUND: The best test between thoracic ultrasonography (TUS) and thoracic radiography (TR) or the best combination of tests (series or parallel) to detect active infectious bronchopneumonia (BP) in hospitalized dairy calves remains unknown. HYPOTHESIS/OBJECTIVES: To estimate performances of TUS and TR to detect active BP in hospitalized dairy calves and to determine the best strategy for using these tests based on a panel diagnosis method (PDM). Performances of TUS and TR were hypothesized to be equivalent. ANIMALS: Fifty hospitalized dairy calves (≥7 days old; ≤100 kg; standing; pCO2 ≥ 53 mm Hg; any reason of presentation). METHODS: Each calf prospectively and sequentially underwent physical examination, thoracic auscultation, blood analyses, and TUS and TR. Three blinded experts determined whether active BP was present/absent based on PDM. Krippendorff's alpha measured interexpert agreement. The sensitivities (Se) and specificities (Sp) of TUS and TR alone and in series or parallel were compared (McNemar's test; P < .05). RESULTS: Interexpert agreement was moderate at 0.58 (95%CI: 0.42; 0.73). The Se and Sp of TUS were 0.84 (95%CI: 0.60; 0.97) and 0.74 (95%CI: 0.57; 0.86), respectively. The Se and Sp of TR were 0.89 (95%CI: 0.67; 0.99) and 0.58 (95%CI: 0.39; 0.75), respectively. No significant difference was found in the Se and Sp of TUS and TR when analyzed alone, in series or in parallel. CONCLUSION: Thoracic ultrasonography or TR alone equally detected active BP in hospitalized dairy calves. Series or parallel analysis provided no additional benefit. Its ease of use and widespread accessibility support using TUS as a first-line test to detect active BP in hospitalized dairy calves.

X-linked CD40 ligand deficiency in a 1-year-old male Shih Tzu with secondary Pneumocystis pneumonia.

An approximately 1-year-old male intact Shih Tzu dog was referred to a tertiary facility with a history of progressive tachypnea, increased respiratory effort, and weight loss over a 3-month period that failed to improve with empirical antimicrobial treatment. Upon completion of a comprehensive respiratory evaluation, the dog was diagnosed with severe Pneumocystis pneumonia and secondary pulmonary hypertension. Clinical signs resolved and disease resolution was confirmed after completion of an 8-week course of trimethoprim-sulfonamide, 4-week tapering dose of prednisone to decrease an inflammatory response secondary to acute die-off of organisms, a 2-week course of clopidogrel to prevent clot formation, and a 2-week course of a phosphodiesterase-5 inhibitor to treat pulmonary hypertension. Immunodiagnostic testing and genetic sequencing were performed to evaluate for potential immunodeficiency as an underlying cause for the development Pneumocystis pneumonia, and identified an X-linked CD40 ligand deficiency.

Risk Factors and Outcomes in Dogs With Respiratory Disease Undergoing Diagnostic Airway Lavage.

Advanced diagnostic testing is becoming increasingly important to accurately assess pulmonary parenchymal, airway, and pulmonary vascular diseases in dogs. Due to respiratory system compromise, diagnostic procedures performed under general anesthesia, including thoracic computed tomography (CT) and bronchoalveolar lavage (BAL), are thought to carry significant risk to dogs with respiratory disease. In lieu of performing these diagnostics, empirical medical therapy is often administered, potentially delaying appropriate therapy or providing unnecessary treatment. This study prospectively evaluated risk factors and outcomes for dogs with respiratory disease undergoing general anesthesia for thoracic CT and BAL. Arterial blood gas samples were taken pre- and post-BAL to evaluate pulmonary gas exchange. Pre-BAL arterial partial pressure of oxygen-to-fractional inspired oxygen ratio was used to stratify dogs into groups of mild or moderate to severe disease severity. A novel thoracic CT disease severity scoring system was used to independently stratify dogs into mild or moderate to severe groups. Statistical comparisons between groups were made for signalment, body weight, temperature, pulse, respiratory rate, WBC count, ventilator-acquired pulmonary mechanics (specific compliance and resistance), change in arterial partial pressure of oxygen post-BAL, and outcomes. Seventeen dogs were prospectively enrolled. A comparatively lower heart rate at presentation was the only potential marker of increased disease severity identified when stratified by CT severity score. Arterial partial pressure of oxygen did not significantly decrease post-BAL regardless of disease severity or stratification method. The CT scoring system significantly correlated with the pre-BAL arterial partial pressure of oxygen-to-fractional inspired oxygen ratio. Incidence of post-procedural complications was 18%, with all complications being transient. Mortality as a direct complication of diagnostics was 0%. When considering euthanasia secondary to severity of the underlying disease and poor prognosis or death due to unrelated disease, mortality was 18%. In dogs with respiratory disease undergoing advanced diagnostic procedures, the overall incidence of post-procedural morbidity was low with no mortality directly attributed to the procedures. A novel CT disease severity scoring system was utilized and shows promise as a tool for evaluation of disease severity in this patient population when compared to arterial blood gas analysis.