Pancreatic Torsion Resulting in Acute Pancreatic Necrosis in a Young Dog.

We report a case of 7 mo old French bulldog who was referred to North Carolina State University Small Animal Emergency and Triage Services because of acute abdomen, regurgitation, lethargy, and fever. The patient had a history of pulmonic stenosis, which was corrected by balloon valvuloplasty 3 wk before presenting for the current complaint. The patient had nonspecific changes noted on blood work at his referring veterinarian. An abdominal ultrasound examination showed pathological changes that were supportive of a left-limb pancreatic torsion that was confirmed postmortem.

ULTRASONOGRAPHIC EVALUATION OF COELOMIC FLUID IN HEALTHY CORN SNAKES (PANTHEROPHIS GUTTATUS).

Free coelomic fluid can be a physiologic or pathologic finding in snakes. In this study, ultrasonography was used to assess the presence, volume, and type of coelomic fluid in 18 (16 females, 2 males) clinically healthy corn snakes (Pantherophis guttatus) using a semiquantitative scoring system. Each snake was divided into five equal regions (R1-R5) by length (from rostrum to vent) and fluid volume was scored on a scale of 0 to 4. Coelomic fluid was sampled when possible and cytologic analysis was performed. The majority of snakes (16/18) were found to have some degree of free coelomic fluid. The coelomic fluid samples that were collected (n= 6) were classified as transudates, acellular or primarily lymphocytic. Fluid was most likely to be found in R3 compared with all other regions and least likely to be found in R1 compared with R2, R3, and R4. A higher score of volume was found in R3 compared with R1 and R5. This study describes the distribution and abundance of coelomic fluid in snakes, as well as a method for point of care ultrasound (POCUS) in this species.

Ultrasonographic Appearance of Gallbladder Neoplasia in 14 Dogs and 1 Cat.

Ultrasonography is the most commonly used diagnostic imaging tool for gallbladder disease in veterinary medicine. Primary gallbladder neoplasia is an uncommon finding with variable prognosis for which no studies have been published describing their ultrasonographic appearance and diagnosis. This retrospective, multicenter, case series study examines the ultrasonographic appearance of gallbladder neoplasia with histologically or cytologically confirmed diagnoses. A total of 14 dogs and 1 cat were analyzed. All discrete masses were sessile in shape and varied in size, echogenicity, location, and gallbladder wall thickening. All studies with images showing Doppler interrogation exhibited vascularity. Cholecystoliths were an uncommon finding, being present in only one case in this study, unlike in humans. The final diagnosis of the gallbladder neoplasia was neuroendocrine carcinoma (8), leiomyoma (3), lymphoma (1), gastrointestinal stromal tumor (1), extrahepatic cholangiocellular carcinoma (1), and adenoma (1). Findings from this study indicate that primary gallbladder neoplasms have variable sonographic appearances and cytologic and histologic diagnoses.

First, do no harm. Ethical and legal issues of artificial intelligence and machine learning in veterinary radiology and radiation oncology.

Artificial Intelligence and machine learning are novel technologies that will change the way veterinary medicine is practiced. Exactly how this change will occur is yet to be determined, and, as is the nature with disruptive technologies, will be difficult to predict. Ushering in this new tool in a conscientious way will require knowledge of the terminology and types of AI as well as forward thinking regarding the ethical and legal implications within the profession. Developers as well as end users will need to consider the ethical and legal components alongside functional creation of algorithms in order to foster acceptance and adoption, and most importantly to prevent patient harm. There are key differences in deployment of these technologies in veterinary medicine relative to human healthcare, namely our ability to perform euthanasia, and the lack of regulatory validation to bring these technologies to market. These differences along with others create a much different landscape than AI use in human medicine, and necessitate proactive planning in order to prevent catastrophic outcomes, encourage development and adoption, and protect the profession from unnecessary liability. The authors offer that deploying these technologies prior to considering the larger ethical and legal implications and without stringent validation is putting the AI cart before the horse, and risks putting patients and the profession in harm's way.

Imaging Diagnosis: Thoracic radiographic features of toxoplasmosis in a 14-month-old Red Kangaroo (Macropus rufus).

A privately owned 14-month-old intact female red kangaroo (Macropus rufus) was presented for acute onset respiratory distress and lethargy. On presentation, the kangaroo was laterally recumbent, tachypneic, dyspneic, lethargic, and obtunded. Thoracic radiographs revealed a severe diffuse mixed pulmonary pattern (alveolar pattern superimposed on a bronchial pattern) and subjective mild generalized cardiomegaly. Due to the severity of clinical signs and grave prognosis, euthanasia was elected. Postmortem examination was consistent with systemic toxoplasmosis. Histopathology and immunohistochemistry staining on infected tissues confirmed Toxoplasma gondii. This is the first published report of radiographic findings for confirmed toxoplasmosis in a red kangaroo or marsupial.

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

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

Hypofractionated radiation therapy of a thyroid tumor in a pet raccoon (Procyon lotor).

Thyroid neoplasia has been documented in raccoons; however, successful management and treatment has not been well-described. A 15-year-old, intact female pet raccoon (Procyon lotor) was examined for evaluation of a right-sided ventral cervical mass and a cough of 4 to 5 mo duration. Cytology and computed tomography (CT) findings of the mass were most consistent with a thyroid tumor. The raccoon was treated with a hypofractionated external beam radiation protocol (8 Gy/fraction for 4 once/wk fractions). Treatments were well-tolerated and no radiation-induced side effects were detected. This is the first report of radiation treatment of thyroid neoplasia in a raccoon, presenting the challenges of animals that are difficult to handle or medicate.

Radiothérapie hypofractionnée d'une tumeur thyroïdienne chez un raton-laveur ( Procyon lotor ). La néoplasie thyroïdienne a été documentée chez les ratons-laveurs; cependant, la gestion et le traitement réussis n'ont pas été bien décrits. Un raton-laveur femelle intact de 15 ans (Procyon lotor) a été examiné pour l'évaluation d'une masse cervicale ventrale droite et d'une toux d'une durée de 4 à 5 mois. Les résultats de la cytologie et de la tomodensitométrie (CT) de la masse étaient les plus compatibles avec une tumeur thyroïdienne. Le raton-laveur a été traité avec un protocole de rayonnement externe hypofractionné (8 Gy/fraction pour quatre fractions 1 fois/semaine). Les traitements ont été bien tolérés et aucun effet secondaire radio-induit n'a été détecté. Il s'agit du premier rapport de radiothérapie d'une néoplasie thyroïdienne chez un raton-laveur, présentant les défis des animaux difficiles à manipuler ou à soigner.(Traduit par Dr Serge Messier).

What Is Your Diagnosis?

In collaboration with the American College of Veterinary Radiology.

Intravenous dexmedetomidine, morphine, or a combination can result in gallbladder wall thickening; with no significant association with plasma histamine concentrations.

The gallbladder is routinely evaluated during ultrasonographic examinations in dogs. However, published studies describing the effects of sedative agents on gallbladder wall thickness are currently lacking. The aims of this prospective, blinded, randomized crossover pilot study were to test hypotheses that IV morphine would result in gallbladder wall thickening, that morphine administration would increase plasma histamine concentrations, and that combining IV morphine with dexmedetomidine would potentiate gallbladder wall thickening. Six healthy Beagle dogs were sedated with intravenous (IV) morphine 0.4 mg/kg (group M), dexmedetomidine 7 µg/kg (group D), or a combination of the two (group MD). Physiologic parameters were measured at baseline and at regular intervals until the last ultrasonographic scan. Ultrasonographic scans were performed at baseline, 90 s, and at 5, 15, 30, 45, 60, 90, and 120 min. Plasma histamine samples were taken at baseline, 90 s, and 5 and 60 min. Cochran's Q-test was used to compare gallbladder wall thickening between groups, while the association between histamine plasma concentration and gallbladder wall thickness was compared with a mixed-effects model. Baseline gallbladder wall thickness was not significantly different between groups. Six of 18 treatments/dogs (33%) developed gallbladder thickening, with no difference between groups. There was no significant difference in baseline plasma histamine concentrations between groups, and no association between plasma histamine concentration and gallbladder wall thickness. Gallbladder wall thickening was observed in at least one dog in each group, therefore caution is recommended for gallbladder wall thickness ultrasonographic interpretation in dogs when these drugs have been administered.

Esophageal varices in dogs: A retrospective case series.

BACKGROUND: Esophageal varices (EV) are abnormally dilated veins in the esophagus caused by alterations of blood flow or pressure. Esophageal variceal hemorrhage is a major complication of hepatic disease in humans, but a lack of information exists regarding associated adverse events in dogs. OBJECTIVE: To describe the clinical manifestations and associated etiologies and outcomes of dogs with EV. ANIMALS: Twenty-five client-owned dogs with EV diagnosed via computed tomography (CT), endoscopy, or fluoroscopy. METHODS: Retrospective case series. Cases were identified by review of the hospital imaging records database between 2010 and 2020. Signalment, clinical signs, and outcomes were documented. When present, additional collateral vasculature was also recorded. Cases were subcategorized into suspected etiology based upon the anatomic location or absence of an attributable underlying disease process, as well as the direction of blood flow. RESULTS: Twenty-four of 25 cases were identified via CT, with a prevalence of 0.012% (24/1950 total studies). Presenting clinical signs were nonspecific, and more likely because of the underlying cause as opposed to complications secondary to EV themselves. Etiologic anatomic locations were similar in occurrence between the abdomen (N = 14) and thorax (N = 11). All cases with an abdominal etiologic location had presumed or confirmed portal hypertension and 9/11 cases with a thoracic etiologic location had pulmonary, caval, or systemic hypertension. No cases died or were euthanized as a direct result of EV or associated hemorrhage. CONCLUSIONS AND CLINICAL IMPORTANCE: Esophageal varices are rarely reported in dogs and commonly identified concurrently with portal, pulmonary, and caval hypertension. Hemorrhage is not a common clinical manifestation of EV.

Computed Tomographic Assessment of Hooking-Related Injuries in Recreationally Angled Blue Marlin.

Acute morbidity and mortality of marlins (family Istiophoridae) in hook-and-line fisheries have been studied; however, there has been little or no investigation of the skeletal injuries incurred from terminal tackles that could lead to decreased rates of postrelease survival. The objective of this study was to evaluate skeletal injuries in recreationally angled Atlantic Blue Marlin Makaira nigricans from the 2019 Big Rock Blue Marlin Tournament in Morehead City, North Carolina. We examined heads of six Blue Marlin that were angled using artificial lures rigged with J-hooks and harvested for weigh-in. The head of each Blue Marlin was scanned using computed tomography (CT) and examined with gross dissection. The CT interpretation revealed that two Blue Marlin had minimally displaced fractures of the maxilla, one of which also had a fracture to the lachrymal bone. These radiographic lesions were associated with penetrating hook injuries. The CT images also revealed degenerative changes within the quadrate-articular joint in four Blue Marlin, which was associated with fish weight; the causes and consequences of these degenerative changes are unknown. Although the hooking-related jaw fractures likely result in acute pain, their impact on postrelease morbidity is unknown and the impact on postrelease mortality is suspected to be small.

Inter- and intraobserver agreement for CT measurement of mandibular and medial retropharyngeal lymph nodes is excellent in dogs with histologically confirmed oral melanoma.

Mandibular and medial retropharyngeal lymph nodes are routinely evaluated with CT when staging dogs with oral melanomas. While size alone is considered inadequate for detecting nodal metastasis, it is critical in evaluating treatment response, as clinical decisions are based on changes in size. It is common for different radiologists to measure the size of pre- and posttreatment lymph nodes in the same patient. The objective of this retrospective, observer agreement study was to evaluate the inter- and intraobserver agreement in measuring canine mandibular and medial retropharyngeal lymph nodes by a diverse population of veterinary radiologists and trainees. Fourteen dogs with documented oral melanoma and head CT studies identified from records of a single institution were included in this study. North American veterinary radiologists and trainees were recruited to measure the mandibular and medial retropharyngeal lymph nodes; in triplicate. Prior to performing the study measurements, participants completed a training tool demonstrating the lymph node measurements. Overall, interobserver intraclass correlation coefficient (ICC) was 0.961 (95% confidence interval [CI]: 0.946, 0.972) and intraobserver ICC was 0.977 (95% CI: 0.968, 0.983), indicating excellent agreement (ICC > 0.9 considered excellent). Similar findings were noted following sub-analysis for most variables (experience, size, laterality, axis of measurement). These results suggest that follow-up measurement of the long and short axis of the mandibular lymph nodes and short axis of the medial retropharyngeal lymph nodes in the transverse plane, performed by different veterinary radiologists using the same method of measure, should have minimal impact on clinical decision making.

Radiographic Assessment of the Feline Temporomandibular Joint with Oblique Projections: A Preliminary Ex Vivo Study.

Radiographic assessment of the temporomandibular joint in the domestic cat using conventional radiographic views can be challenging due to superimposition of overlying structures and the complex anatomy of the skull. The use of computed tomography, magnetic resonance imaging, and cone beam computed tomography to assess the temporomandibular joint in the cat has increased, but these modalities are not always available in general veterinary practices. Conventional radiography is still commonly used for first line assessment of the temporomandibular joint. The aim of this preliminary study was to determine optimal angle of obliquity of lateroventral-laterodorsal and laterorostral-laterocaudal (nose up lateral oblique) oblique radiographic views in the assessment of the temporomandibular joints in five feline mesaticephalic dry skulls. Visibility of the mandibular head, mandibular fossa, retroarticular process, and temporomandibular joint space were evaluated and scored by two veterinary radiologists. The results of this study identified that the dependent temporomandibular joint anatomy was best seen on the latero-10°-ventral-laterodorsal, latero-15°-ventral-laterodorsal, and latero-20°-ventral-laterodorsal, oblique views, and opposite lateral oblique views at these angulations may be helpful in characterization of this anatomy in clinical patients. The results also indicate that the laterorostral-laterocaudal (nose up lateral oblique) oblique view did not allow adequate discrimination of all TMJ anatomy at any angle, and is not recommended.

Optimization of ultrasonographic ureteral jet detection and normal ureteral jet morphology in dogs.

Ureteral jets are visualized with ultrasound as echogenic streams extending from the ureterovesicular junction into the urinary bladder. In clinical practice, diuretics are sometimes administered to increase visibility of ureteral jets, however this has not been well described in the veterinary literature. The purpose of this prospective, crossover study was to describe the normal morphology of canine ureteral jets, determine an optimal protocol for diuretic administration to increase visibility of ureteral jets, and confirm in vitro the effect that differences in specific gravity and velocity have on visibility. Ultrasound of 10 normal dogs was performed at baseline and following 1 mg/kg furosemide administered intravenously or subcutaneously. Increased numbers of ureteral jets were seen post-furosemide administration compared to baseline, with an overall increased number of ureteral jets identified following intravenous administration when compared to subcutaneous administration. Time to first ureteral jet was significantly shorter with intravenous compared to subcutaneous administration. Urine specific gravity significantly decreased following furosemide administration. For the in vitro study, saline solutions of varying specific gravities were infused into a bath of hypertonic saline with specific gravity of 1.037. There was good visibility in vitro with infusion of solutions of specific gravities of 1.010-1.025. Infusion of saline solution with a specific gravity of 1.030 had reduced visibility, while infusion of saline with equivalent specific gravity (1.037) was not visible with B-mode ultrasonography. Both intravenous and subcutaneous furosemide administration significantly increase ureteral jet detection with ultrasound secondary to differences in specific gravity, confirming results of prior studies.

Multimodal Imaging Characteristics of a Migrating Oropharyngeal-Spinal Foreign Body in a Cat.

A 2.5 yr old female spayed domestic shorthair presented for acute tetraparesis, dull mentation, and fever. MRI and computed tomography identified a thin linear foreign body extending from the caudal nasopharynx through the atlanto-occipital joint and cervicomedullary junction. Signal changes within the musculature were consistent with myositis, edema, and abscessation. Inflammation and edema surrounded the foreign body, and a dorsal cervical myelopathy extended caudally to the level of C6. Computed tomography attenuation values of the foreign body were most consistent with plant material. Euthanasia was performed; postmortem dissection of the soft palate confirmed a plant stem with abscess.

Radiographic anatomy and barium sulfate contrast study of the gastrointestinal tract of eastern box turtles (Terrapene carolina carolina).

Gastrointestinal disorders are an important cause of morbidity in box turtles (Terrapene carolina Carolina), however published information is currently lacking on the normal radiographic anatomy, transit, and emptying times of the gastrointestinal tract. A total of 15 healthy box turtles were recruited for this prospective, anatomic, reference interval study. Three-view radiographic series (vertical beam dorsoventral, horizontal beam latero-lateral, and horizontal beam rostrocaudal views) were acquired prior to contrast administration, and following contrast administration at 0, 20, 40, 60, and 90 min, 2, 4, 8, 12, and 24 h post administration, and every 24 h thereafter until all contrast was eliminated (15 mL/kg barium sulfate diluted to 30% weight per volume was administered via orogastric gavage). Vertical beam dorsoventral and horizontal beam latero-lateral views were of excellent quality to identify gastrointestinal structures. The horizontal beam rostrocaudal view immediately postcontrast administration provided gastric and pyloric identification but had lesser diagnostic use at later time points due to anatomical superimposition. The gastrointestinal tract was composed of a tubular stomach, a pyloric sphincter near midline, a duodenum with a cranial flexure in the right cranial coelomic cavity, small intestines within the right coelom, a small cecal bulb, and a transverse and descending colon. Contrast media entered the large intestine by 24 h in all turtles, and a pyloro-colic indentation was noted at the proximal descending colon. The large intestinal emptying was highly variable due to the interindividual variability of contrast sequestration within the cecal bulb. Findings from the current study serve as a reference on the gastrointestinal anatomy, transit, and emptying times in healthy eastern box turtles; and introduce a novel, horizontal beam, rostrocaudal view for gastrointestinal contrast studies in chelonians.

Radiographic features of congenital segmental dilation of the intestine in a german shepherd dog.

A 10-week-old spayed female German Shepherd Dog was presented for acute vomiting and diarrhea. There was no reported foreign body or toxin ingestion. Radiographs showed a severely (∼11 × 7 cm), focally distended right abdominal intestinal segment containing gas and soft tissue material. Other small intestinal segments were segmentally gas distended. Celiotomy identified a ∼9 cm focally dilated segment at the jejunoileal junction with no aborad luminal obstruction. Resection and anastomosis of the dilation was performed. Histopathology showed mild mucosal inflammation, but otherwise normal wall layering and autonomic ganglia. Radiographic and histopathologic findings were consistent with congenital segmental dilation of the intestine.

INHALANT ANESTHETIC RECOVERY FOLLOWING INTRAMUSCULAR EPINEPHRINE IN THE LOGGERHEAD SEA TURTLE ( CARETTA CARETTA).

Prolonged anesthetic recovery time is a common complication of chelonian inhalant anesthesia and may be exacerbated by right-to-left intracardiac shunting of blood. Epinephrine may decrease intracardiac shunting, which may shorten anesthetic recovery time. The study objective was to assess inhalant anesthetic recovery time following intramuscular epinephrine compared with saline in the loggerhead sea turtle ( Caretta caretta). With the use of a prospective, randomized, blinded, crossover design with a 1-wk washout period, six turtles were anesthetized with intravenous (IV) alfaxalone 3 mg/kg, orotracheally intubated, manually ventilated with 3.5% isoflurane inhalant in 100% oxygen for 90 min, and administered either intramuscular (IM) epinephrine 0.1 mg/kg or IM saline 0.1 ml/kg. Isoflurane administration was immediately discontinued and turtles were manually ventilated with room air until extubation. Physiologic variables, sedation scores, end-tidal carbon dioxide (ETCO2) and isoflurane (ETISO) concentrations, time to first movement, and time to extubation were recorded and two-time-point venous blood gas analyses performed. Data were compared with the use of paired t-tests and repeated-measures analyses of variance (ANOVA) ( P < 0.05). No morbidity, mortality, or adverse events occurred. ETCO2 and ETISO did not significantly change over time during the isoflurane delivery period ( P = 0.990). Mean time to first movement was significantly faster following epinephrine (69.24 ± 12.28 min) compared with saline (87.71 ± 27.05 min, P = 0.047). Although differences were not statistically significant ( P = 0.133), time to extubation was at least 30 min faster (31-123 min) in 4/6 turtles following epinephrine compared with saline. Intramuscular epinephrine significantly reduces time to first movement during isoflurane anesthetic recovery in loggerhead sea turtles.