Use of percutaneous ethanol injection for treatment of bilateral hyperplastic thyroid nodules in cats.

OBJECTIVE: To determine the efficacy and safety of percutaneous ethanol injection (PEI) for the treatment of hyperthyroidism caused by bilateral hyperplastic thyroid nodules in cats. DESIGN; Prospective study. ANIMALS: 7 cats. PROCEDURE: Hyperthyroidism was diagnosed on the basis of clinical signs and increased serum total thyroxine (TT4) concentrations. The presence of 2 cervical thyroid nodules was confirmed by use of ultrasonography and technetium Tc 99m albumin thyroid scans. After the death of 1 cat that received PEI in both thyroid nodules at the same time, the protocol was changed to injecting ethanol into 1 nodule at a time, with at least 1 month between injections. Clinical signs, serum TT4 concentrations, serum ionized calcium concentrations, laryngeal function, findings on ultrasonographic examinations of the ventral cervical region, and results of thyroid scans were monitored. RESULTS: Serum TT4 concentrations transiently decreased in all 6 cats (into the reference range in 5 of 6 cats) within 4 days of the first staged ethanol injection. Each subsequent injection resulted in a transient decrease in serum TT4 concentration. The longest period of euthyroidism was 27 weeks. Adverse effects included Horner's syndrome, dysphonia, and laryngeal paralysis. One cat died of unrelated causes. One cat underwent bilateral thyroidectomy, 2 cats were treated with methimazole, and 2 cats that had increased serum TT4 concentrations were not treated further, because they remained clinically normal. CONCLUSIONS AND CLINICAL RELEVANCE: Percutaneous ethanol ablation of bilateral thyroid nodules as a treatment for cats with hyperthyroidism is not recommended. This treatment is not as efficacious as the medical and surgical treatments presently used.

Ultrasonographic evaluation of biliary cystadenomas in cats.

The purpose of this study was to describe the ultrasonographic appearance of biliary cystadenomas in cats and compare the findings to a similar rare form of liver tumor in humans. Biliary cystadenomas are uncommon, benign liver tumors of older cats that may occur as focal or multifocal cystic lesions within the liver. The records of 10 cats which had abdominal ultrasonography and histologic diagnosis of biliary cystadenoma were reviewed. The average age of affected cats was 13.3 years (range 10-16 years). Eight cats were neutered males and two were neutered females. In three cats, the tumors were not seen ultrasonographically due to their small size or from being obscured by near-field reverberation echoes. The remaining seven cats had solitary (4 cats) or multifocal (3 cats) masses corresponding to variable ultrasonographic patterns: multilocular masses containing thin-walled cysts, hyperechoic masses with cystic components, or masses of mixed echogenicity with cystic components. The masses had variable ultrasonographic patterns when multifocal disease was present. Recognizable cysts were evident somewhere within the tumors seen ultrasonographically, although sometimes the cysts appeared very small. The biliary cystadenomas were thought to be clinically silent. Although liver enlargement or a cranial abdominal mass was palpable in 4 cats, no consistent trend of clinical signs, CBC or serum biochemical abnormalities could be directly attributed to biliary cystadenoma. The treatment of choice is surgical resection of the tumor, as continued growth may compress adjacent vital structures within the liver. The differential diagnosis of biliary cystadenomas from other cystic liver lesions such as hepatic cysts, hematomas, abscesses, parasitic cysts, or other liver tumors is discussed.

Ultrasonographic evaluation of the canine shoulder.

The aim of this study was to determine the normal ultrasonographic anatomy of the canine shoulder. Fourteen shoulders from 7 clinically normal mid-sized dogs were radiographed and imaged using high frequency ultrasound. Each shoulder was isolated postmortem, and the ultrasonographic and gross anatomy was studied during dissection. The ultrasonographic appearance of the shoulder specimens was similar to that found in the live dogs. Twenty-four shoulders isolated postmortem from 12 variably sized dogs were also used to characterize the normal ultrasound anatomy over a range of sizes. Important anatomic structures that could be consistently evaluated were the biceps tendon and bursa, the bicipital groove surface, the supraspinatous tendon, the infraspinatous tendon, the teres minor tendon, and the caudal aspect of the humeral head. Results of ultrasonographic examination of 4 dogs with shoulder lameness are described to illustrate some applications of canine shoulder ultrasonography in the evaluation of the canine shoulder. In these dogs, ultrasound was a valuable tool to evaluate effusion and synovial proliferation within the bicipital bursa, supraspinatous and biceps tendinitis, biceps tendon strain, and dystrophic calcification.

Ultrasonographic evaluation of renal autografts in normal cats.

The purpose of this study was to determine changes in resistive index (RI) and renal size that occur in normal feline kidney autografts in the immediate post-transplant period. Qualitative changes in renal parenchymal echogenicity and pelvic dilation were also noted, although this was not a major focus of the study. Fourteen domestic short-haired cats underwent bilateral nephrectomies followed by an autograft of the right kidney to either the aorta or external iliac artery. Due to post-operative complications, only nine of these cats completed the study. Ultrasonographic determination of the RI and renal size was made before transplantation and on days 1, 4, 7, 10, and 13 following transplantation. No significant changes in renal RI were identified during the study. Renal size increased significantly, peaking at 63% above baseline on day 7, and stayed elevated at 50% above baseline on day 13. There was no evidence of rejection or other abnormalities found on histologic evaluation of the transplanted kidneys. It was concluded that the RI of normal feline renal autografts does not significantly change in the immediate post-operative period. However, significant renal enlargement, likely due to a combination of post-operative edema and hypertrophy, does occur. This study provides baseline information for comparison with feline allografts in the immediate post-transplant period.

Percutaneous ultrasound-guided chemical parathyroid ablation for treatment of primary hyperparathyroidism in dogs.

OBJECTIVE: To evaluate the efficacy, feasibility, and safety of ultrasound-guided chemical ablation of parathyroid masses in dogs with primary hyperparathyroidism. DESIGN: Prospective clinical trial. ANIMALS: 8 dogs. PROCEDURE: In all dogs, a solitary parathyroid mass was evident ultrasonographically. Dogs were anesthetized with propofol, and a 27-gauge needle was directed into the parathyroid mass under ultrasound guidance. Ethanol (96%) was injected into the mass until there was evidence of diffusion of fluid throughout the mass. Serum total calcium, ionized calcium, phosphorus, and parathyroid hormone (PTH) concentrations were monitored daily for 5 to 7 days after the ablation procedure and again 1, 3, and 6 months after the procedure. Dogs were also monitored for adverse effects. Follow-up ultrasonography was performed 5 days and 1 month after the ablation procedure. RESULTS: One injection was required in 7 dogs, and 2 injections were required in 1. Serum total and ionized calcium concentrations were within reference ranges within 24 hours after treatment in 7 dogs and within 5 days in 1 dog. Serum PTH concentration decreased and serum phosphorus concentration increased within 24 hours after treatment in all 8 dogs. Transient hypocalcemia developed in 4 dogs during the first 5 days after treatment, but only 1 dog required treatment for hypocalcemic tetany. Hypercalcemia recurred in 1 dog 1 month after the procedure and surgical removal of the parathyroid mass was required. Other adverse effects were not reported. CONCLUSIONS AND CLINICAL RELEVANCE: Ultrasound-guided chemical ablation of parathyroid masses is a safe and effective alternative to surgery for dogs with primary hyperparathyroidism.

Development of an automated 12-8 bit conversion algorithm for displaying and archiving scanned radiographs.

The lossless capture of the entire range of optical densities encountered in a radiograph can require up to 4000 individual shades of gray. Most inexpensive computer displays, and most grayscale image formats contain only 256 gray shades. To use these systems, a look up table must be generated to display the scanned image, which maps the approximately 4000 gray shades in the digitized radiograph to the 256 gray shades on the monitor. However, if this conversion is inappropriately performed, much of the information contained in the original image could be lost. This study was undertaken to develop an histogram equalization algorithm that would automatically convert the 4000 gray shade digitized radiograph into a 256 gray shade image file, without perceptable loss of diagnostic information or image quality.

Ultrasound-guided fine-needle aspiration biopsy of bone lesions: a preliminary report.

The purpose of this preliminary study was to determine the feasibility of ultrasound-guided fine-needle aspiration biopsy of suspected neoplastic lesions of bone. Ultrasound-guided fine-needle aspiration biopsy samples were obtained in 23 patients (22 dogs and one cat) with radiographic evidence of a destructive or destructive/productive bone lesion. The lesions were located in the appendicular skeleton in 20 patients and in the axial skeleton in three. Histopathology from tissue core biopsies and/or necropsy was not deemed necessary in 11 patients where ultrasound-guided fine-needle aspiration biopsy results were conclusive for neoplasia. A cytologic diagnosis from ultrasound-guided fine-needle aspiration biopsy was confirmed by histologic samples obtained at surgery or necropsy in five patients. In one of these five, ultrasound-guided fine-needle aspiration biopsy samples were diagnostic for sarcoma when tissue-core biopsy was inconclusive. Both ultrasound-guided fine-needle aspiration biopsy and tissue core biopsy techniques were inconclusive in one patient. Ultrasound-guided fine-needle aspiration biopsy samples were nondiagnostic in five patients where a follow-up histopathologic diagnosis of neoplasia was made. It was concluded that ultrasound-guided fine-needle aspiration biopsy of bone, if diagnostic, may help avoid the need for a tissue-core biopsy in some instances. However, a negative ultrasound-guided fine-needle aspiration biopsy sample does not rule out neoplasia. A negative ultrasound-guided fine-needle aspiration biopsy should be followed by a tissue-core biopsy and histologic analysis in all patients. Ultrasound-guided fine-needle aspiration biopsy seems to be a promising technique for the diagnosis of bone lesions.

Ultrasonography of the adrenal glands in the dog, cat, and ferret.

Ultrasonography has become an important modality for imaging adrenal glands in small animals. Normal adrenal glands and structural abnormalities, such as changes in size, shape, and echogenicity, can be identified. In the case of adrenal tumors, ultrasonography is a valuable tool for identifying neoplastic masses with local and regional involvement, as well as potential abdominal metastases. When correlated with clinical findings and results of hematologic, serum biochemical and endocrine tests, ultrasonographic findings make a substantial contribution to the diagnosis of adrenal diseases in dogs, cats, and ferrets.

Ultrasonography of the thyroid and parathyroid glands.

High-resolution thyroid and parathyroid ultrasonography can play an integral part in the diagnosis and management of patients with clinically undifferentiated cervical masses, thyroid carcinomas or adenomas, and primary parathyroid hyperplasia or neoplasia. Because the study is inexpensive, noninvasive, and easily performed, ultrasonography can be performed as a screening test early in the evaluation of a patient, and ultrasound findings can corroborate the results of other diagnostic procedures, leading to a more accurate diagnosis.

Prevalence of prostatic cysts in adult, large-breed dogs.

The prevalence of prostatic cysts was evaluated in 85 adult, male dogs weighing more than 16 kg which were admitted for problems unrelated to the prostate gland. Urine culture and prostatic evaluation by ultrasonography were performed in all dogs. Prostatic cysts were identified in 12 (14%) of the 85 dogs. Cultures of prostatic cysts were positive in five (42%) of the 12 dogs. Nonclinical, aerobic bacteriuria was documented in 9% of the study population. Urine cultures correlated with prostatic cyst cultures in four of the five dogs that had positive prostatic cyst cultures. Results of this study indicate that the prevalence of prostatic cysts in adult, intact male dogs is approximately 14% and that approximately 42% are infected with bacteria.

High-resolution parathyroid sonography.

The purpose of this study was to assess the diagnostic utility of parathyroid ultrasonography to differentiate causes of hypercalcemia in dogs. We analyzed qualitative and quantitative ultrasound imaging findings and clinical pathology data from 33 dogs that underwent parathyroid ultrasound examination as part of the diagnostic evaluation for hypercalcemia. Diagnoses of the diseases causing hypercalcemia included parathyroid carcinoma (n = 5), parathyroid adenoma (n = 15), parathyroid adenomatous hyperplasia (n = 6), chronic renal insufficiency (n = 3), and hypercalcemia of malignancy (n = 4). All parathyroid lesions were round or oval and hypoechoic compared with surrounding thyroid parenchyma. Adenomatous and adenocarcinomatous glands were 4 mm or larger in longest linear measurement on US examination and were statistically significantly larger than hyperplastic glands. (p < 0.001) Linear measurements of parathyroid glands acquired at the time of ultrasound examination correlated well with direct size determination after surgical excision. (r2 = 0.9, p < 0.0001) Parathyroid lesions > or = 4 mm are highly suspicious for parathyroid adenoma or carcinoma, while US lesions < 4 mm most likely represent primary adenomatous hyperplasia or secondary parathyroid hyperplasia. Parathyroid size estimation from ultrasound examination is an accurate predictor of true size.

Ultrasonographic evaluation of renal size in dogs with acute allograft rejection.

The purpose of this study was to determine the best method to ultrasonographically monitor renal size changes associated with acute allograft rejection in dogs. Qualitative changes in renal cortical and medullary echogenicity were also evaluated, although this was not a major focus of the study. Four unrelated, mixed-breed dogs underwent bilateral nephrectomies and heterotopic renal allograft transplantation. Ultrasound examinations of transplanted kidneys were initiated at 3 days after surgery and continued at 2-3 day intervals until death (38 +/- 2 days). Ultrasound measurements of kidney length, width, height, cross-sectional area, and estimated volume were used to assess relative changes in renal size associated with transplantation and rejection. Transplanted kidneys had a rapid increase in volume and cross-sectional area that averaged 103% and 83% above baseline levels, respectively, by 17 days after transplantation. The increased size was attributed to a combination of hypertrophy and acute rejection, the latter of which was confirmed at postmortem. Kidney volume decreased to approximately 35% above baseline volume by day 34 as rejection became more advanced. Qualitative changes associated with rejection included medullary enlargement with decreased echogenicity early in the study, followed by increased cortical thickness and echogenicity with poor cortical medullary definition in the latter stages of the survival period. It was concluded that relative changes in renal allograft size can be easily monitored with ultrasound. In regard to linear measurements, changes in renal width were more pronounced than changes in height or length with acute rejection. Therefore measurements that incorporate the width, namely volume or cross-sectional area, appear to be the most sensitive for monitoring changes in allograft size. Renal cross-sectional area measurements are preferred because they are simple to perform using the automated calculation capability of most newer ultrasound units.

Ultrasonographic evaluation of the adrenal glands in dogs.

OBJECTIVE: To determine normal adrenal gland size by means of ultrasonography in dogs and to determine the value of ultrasonography in the diagnosis of pituitary-dependent hyperadrenocorticism (PDH) in dogs. DESIGN: Prospective observational study. ANIMALS: 62 dogs: 20 healthy dogs, 20 dogs with non-endocrine disease, and 22 dogs with untreated PDH. PROCEDURE: Length and maximum and minimum diameter of the adrenal glands were measured ultrasonographically. Multiple regression and correlation analyses were used to determine whether body weight, kidney length, aortic diameter, or age was related to adrenal gland size. Two-tailed t-tests and multiple linear regression analysis were used to compare values between groups. Sensitivity and specificity of using ultrasonographic measurement of adrenal gland size as a diagnostic test for PDH were determined. RESULTS: There was a significant linear relationship between adrenal gland length, but not maximum and minimum diameters, and body weight, aortic diameter, and kidney length in healthy dogs and in dogs with nonendocrine diseases. Length, maximum diameter, and minimum diameter of the right adrenal gland and maximum and minimum diameters of the left adrenal gland were significantly greater in dogs with PDH than in healthy dogs and dogs with nonendocrine diseases. As a diagnostic test for PDH, ultrasonographic measurement of maximum or minimum diameter of the left adrenal gland gave the best combination of sensitivity and specificity. For maximum diameter of the left adrenal gland, sensitivity was 77% and specificity was 80%. For minimum diameter of the left adrenal gland, sensitivity was 73% and specificity was 85%. CLINICAL IMPLICATION: Ultrasonography of the adrenal glands is a valuable diagnostic procedure in dogs suspected of having pituitary-dependent hyperadrenocorticism.

Experimental induction of hepatic lipidosis in cats.

The effect of long-term voluntary fasting on hematologic variables, biochemical profiles, and liver histologic findings was assessed in 15 obese cats (> 40% overweight). Clinical signs and laboratory results consistent with hepatic lipidosis were observed in 12 of 15 cats after 5 to 7 weeks of fasting, and were associated with 30 to 35% reduction of initial body weight. Histologic examination of successive liver biopsy specimens revealed that obesity was not associated with liver parenchymal lipid accumulation, but that fasting resulted in lipidosis in all 15 cats. The long-term fast was associated with an early (after 2 to 4 weeks of fasting) and significant (P < 0.05) reduction in serum urea, glucose, and albumin concentrations, and RBC mass. Fasting for 5 to 7 weeks was associated with a significant (P < 0.05) increase in hepatic-associated enzyme activities and in total and direct serum bilirubin concentrations. Significant (P < 0.05) changes in serum alkaline phosphatase developed as early as 3 weeks before the onset of hyperbilirubinemia. Except for development of hepatic lipidosis, cats appeared to tolerate the fast without other adverse effect. This study confirmed that long-term fasting may induce clinical hepatic lipidosis in obese cats. Fasting appears to induce a syndrome of hepatic lipidosis that is indistinguishable from feline idiopathic hepatic lipidosis and may be an appropriate model to study the pathophysiologic features and treatment of hepatic lipidosis.

Prostaglandin induction of abortion in pregnant bitches after misalliance.

Of 48 privately-owned bitches evaluated 30 to 35 days after a single, unplanned breeding, 30 (62%) dogs were determined not to be pregnant by abdominal ultrasonography and 18 dogs were confirmed to be pregnant. Each pregnant dog was hospitalized, allotted to a treatment group, and given prostaglandin F2 alpha, SC, at 1 of 3 dosages: group 1, 0.1 mg/kg of body weight, every 8 hours; group 2, 0.25 mg/kg, every 12 hours; and group 3, 0.1 mg/kg, every 8 hours for 2 days and then 0.2 mg/kg every 8 hours thereafter. Plasma from each dog was assayed for progesterone concentration before treatment and daily until abortion was completed. Physical examinations and abdominal ultrasonography were performed every 12 and 48 hours, respectively. Treatment was continued until abortion was complete as determined by results of abdominal ultrasonography. Ultrasonography was performed earlier than the scheduled 48 hours if abdominal contractions, fetuses, or bloody or dark colored vaginal discharge was observed. Dogs of 14 breeds were treated; body weight ranged from 5.4 to 37.7 kg. All dogs aborted all fetuses within 9 days of beginning treatment. Abdominal palpation was not satisfactory in confirming whether the abortion process had been completed; however, results of ultrasonography were a reliable indicator. Plasma progesterone concentrations prior to treatment were typical of the middle phase of gestation, with all concentrations > 6.0 ng/ml. The plasma progesterone concentration decreased significantly in each dog after the first 48 hours of therapy. None of the bitches aborted any fetal material until at least 24 hours after the plasma progesterone concentration was < 2.0 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of two sample collection methods for quantitative bacteriologic culture of canine prostatic fluid.

Ejaculate, urine, urethral swab specimens, and ultrasonography-guided small-needle prostatic cyst aspiration and/or tissue core biopsy specimens were collected for bacteriologic culture from 25 dogs in which prostatic disease was suspected on the basis of history, clinical signs of disease, or results of physical examination. The prostate gland in each dog was examined ultrasonographically, and the tissue core biopsy specimens were examined histologically and bacteriologically. Two methods were used to assess bacterial prostatitis. In 5 dogs (20%), bacteriologic culture results of paired urethral swab and ejaculate specimens differed from culture results of specimens obtained by needle aspiration of prostatic cyst fluid or tissue core biopsy. The prostate gland in 17 dogs had 1 or more cystic, fluid-filled structures (0.5 to 4.0 cm in diameter). Ultrasonographic appearance of the prostate gland did not have obvious correlation with culture results from dogs of the study. Histologic results of prostatic tissue core biopsy specimens correlated well with culture results.

Sonography of the liver, gallbladder, and spleen.

Focal hepatic and splenic lesions, vascular abnormalities, and disorders of the biliary system can readily be detected with ultrasonography. The sonographic diagnosis can be substantially narrowed when the presenting clinical signs are considered. Ultrasonography is less helpful when the liver or spleen is diffusely involved without parenchymal, abnormalities. However, certain diseases may also be eliminated from diagnostic consideration on the basis of this finding. Percutaneous ultrasound guided biopsy markedly improves the success and safety of obtaining a definitive diagnosis when either diffuse or focal lesions are present. Sonography has also been very beneficial for serially evaluating the response to therapy once focal lesions of the liver or spleen have been identified.

Thoracic, abdominal, and vertebral actinomycosis. Diagnosis and long-term therapy in three dogs.

The clinical, laboratory, radiographic, and histologic features and the response to therapy in three dogs with actinomycosis are reported. One dog (dog 1) had a 12-cm nonresectable mass extending from the ventrolateral chest wall into the left ventricular myocardium. Another dog (dog 2) had a diffuse peritonitis with "sulfur granules" and two large masses. One of these masses was nonresectable involving adjacent abdominal structures. A third dog (dog 3) had a subvertebral mass at T1-3 producing quadraplegia. Two dogs had periosteal reactions involving adjacent sternebrae (dog 1) or ribs and vertebral bodies (dog 3) that are characteristic of Actinomyces spp infections. In dogs 1 and 2 the diagnosis was based on the morphologic and tinctorial properties of free sulfur granules and/or tissue granules. Culture results were variable. Tissue from dog 1 yielded no growth, while polymicrobial infections, which included Actinomyces spp, were identified in dogs 2 and 3. Actinomyces odontolyticus was isolated from dog 3. Although the actinomycotic granulomas were either not excised or only partially excised from dogs 1 and 2, both animals were cured by the oral administration of high doses of penicillin G for 19 and 6 months, respectively. Dog 3 responded dramatically to the same antibiotic therapy given for 5 months. However, within 4 months of discontinuing treatment an abscess and draining fistulous tracts developed in the left axillary region. Two surgical fistulectomies and additional penicillin therapy were required to cure this animal. These cases and the current veterinary and human literature on actinomycosis are used to propose a rational approach to the treatment of actinomycosis in the dog.