A repeatable CT protocol for quantifying caudal vena cava growth in medium and large breed dogs.

Developmental malformations can cause stunted or abnormal growth and clinical disease in dogs. In humans, measurements of the inferior vena cava are used as methods for detecting abnormal growth trajectories. The objectives of this retrospective, multicenter, analytical, cross-sectional study were to develop a repeatable protocol to measure the caudal vena cava (CVC) and generate growth curves in medium and large-breed dogs during development. Contrast-enhanced CT DICOM images from 438 normal dogs, aged from 1 to 18 months, from five specific breeds were included. A "best guess" measurement protocol was created. Dogs were stratified into medium or large breed groups based on growth rate trajectories. Linear regression models and logarithmic trend lines were used to evaluate the CVC growth over time. The CVC measurements were analyzed from four anatomical regions: thorax, diaphragm, intra-hepatic, and renal. The thoracic segment produced the most repeatable measurements with the highest explanatory power. The CVC thoracic circumference ranged from 2.5 to 4.9 cm from 1 to 18 months of age. Medium and large breeds had similar CVC growth trajectories, with comparable estimated marginal means, however medium dogs reached 80% of predicted final CVC size approximately 4 weeks earlier than large breed dogs. This new protocol provides a standardized technique for evaluation of the CVC circumference over time using contrast-enhanced CT and is most repeatable when taken at the thoracic level. This approach could be adapted for other vessels to predict their growth trajectories, generating healthy reference population data for comparison against patients with vascular anomalies.

Differentiating Strongylus vulgaris-associated, non-strangulating intestinal infarctions from idiopathic peritonitis and acute colitis in horses.

BACKGROUND: Horses with non-strangulating intestinal infarction (NSII) are often misdiagnosed with idiopathic peritonitis or acute colitis. Early diagnosis is essential to ensure early surgical intervention and improve survival. METHODS: Clinical and laboratory data from horses admitted to the University of Copenhagen Large Animal Teaching Hospital with NSII, idiopathic peritonitis or acute colitis between 2009 and 2018 were used for univariate comparisons and a multivariable logistic regression model for prediction of NSII. RESULTS: Two hundred and thirty-one horses were included. A multivariable model for the prediction of NSII included gastric reflux (more than 5 L) (odds ratio [OR] 8.7; 95% confidence interval [CI] 2.1-36.2), abnormal findings palpated per rectum (intestinal dilatations/impactions [OR 4.43; 95% CI 1.43-13.38], colon displacements [OR 23.16; 95% CI 5.26-101.97] or intestinal mass [OR 179.7; 95% CI 23.5-1375.5]), white blood cell count (OR 1.2; 95% CI 1.1-1.4), packed cell volume (OR 0.9; 95% CI 0.8-0.9), age (OR 0.9; 95% CI 0.8-1.0) and heart rate (OR 1.1; 95% CI 1.0-1.1). The model had a low false positive rate (5%), but a high false negative rate (50%). LIMITATIONS: Due to the retrospective nature of the study, sample collection was inconsistent, resulting in missing values. CONCLUSION: The model had some capability in predicting NSII. However, the high risk of false negatives means that exploratory laparotomy should be considered in horses with peritonitis of unknown aetiology in areas where Strongylus vulgaris is prevalent and occurrence of idiopathic peritonitis is low.

Helping practitioners to stop the rot.

Rare and often fatal, cutaneous and renal glomerular vasculopathy (CRGV) has attracted much interest since the first UK cases were identified a decade ago. At BVA Live, David Walker will be sharing his knowledge of the disease with the aim of helping practitioners understand when CRGV should be high on their list of differential diagnoses.

Clinical features and treatment response to differentiate idiopathic peritonitis from non-strangulating intestinal infarction of the pelvic flexure associated with Strongylus vulgaris infection in the horse.

BACKGROUND: Peritonitis in horses secondary to non-strangulating infarction (NSII) has a guarded prognosis, even after intestinal resection. In contrast, horses with idiopathic peritonitis respond well to medical treatment. Affected horses in both cases often show signs of both colic and systemic inflammation, but early diagnosis is crucial for optimal treatment and an accurate prognosis. One cause of NSII is thrombus formation secondary to Strongylus vulgaris larval migration. There has been a documented increase in S. vulgaris prevalence in Sweden since the implementation of selective anthelmintic treatment in 2007, which subsequently could result in a rise in NSII cases. In a retrospective clinical study, medical records from cases diagnosed with NSII of the pelvic flexure or idiopathic peritonitis from three equine referral hospitals in Sweden during 2017-2020 were reviewed. Information including demographic data, relevant medical history, and clinical- and laboratory parameters were obtained from patient records. To facilitate the differentiation between cases of idiopathic peritonitis and cases with confirmed NSII of the pelvic flexure, the aim of the study was to compare clinical and laboratory parameters, clinical progression and initial response to antimicrobial treatment. A secondary aim was to compare survival-rates. RESULTS: Horses with NSII (n = 20) were significantly more likely to present during the winter months with a poorer response to medical treatment within 48 h. Cases of idiopathic peritonitis (n = 107) had a 100% survival rate with medical treatment, although one case required surgical correction of a colon displacement. In comparison, all confirmed NSII cases were non-responsive to antimicrobial treatment, with a survival rate to discharge of 50% after colon resection. Specific rectal findings and peripheral blood neutropenia were strongly associated with NSII. CONCLUSIONS: In Sweden, idiopathic peritonitis cases still predominate over S. vulgaris associated NSII cases and have an excellent survival rate with antimicrobial treatment. However, horses presenting with septic peritonitis during the winter months with a palpable rectal mass and displaying fever and colic signs beyond 48 h of medical treatment are likely to suffer from NSII of the pelvic flexure and should be considered for abdominal surgery.

Histological and biomechanical properties of systemic arteries in young and old Warmblood horses.

Arterial rupture is a well-recognized cause of sudden death in horses, which mainly affects older horses. The arterial wall is known to stiffen with age, although the underlying age-related histological and biomechanical changes remain unclear. The purpose of this study was to investigate the effect of aging by histological analysis of the arterial wall and examination of the arterial wall biomechanical properties using an inflation-extension test. Entire circular samples of the proximal and distal aorta, cranial and caudal common carotid, external iliac, femoral and median artery were collected from 6 young (6 years) and 14 old horses (≥15 years). Samples of all arteries were histologically examined and intima media thickness as well as area % of elastin, smooth muscle actin and collagen type I and III were determined. Older horses had a significantly larger intima media thickness and a significantly higher area % of smooth muscle actin compared to young horses. Samples of the proximal and distal aorta, the caudal common carotid and the external iliac artery were mechanically assessed using an in-house developed inflation-extension device with ultrasound analysis. Rupture occurred in a minority of arteries (8/78) at high pressures (between 250-300 mmHg), and mostly occurred in older horses (7/8). Pressure-area, pressure-compliance and pressure-distensibility curves were constructed. A significant difference in the pressure-area curves of the distal aorta, common carotid artery and external iliac artery, the pressure-compliance curves of the proximal aorta and carotid artery and the pressure-distensibility curve of the proximal aorta was observed between young and old horses. Results demonstrate an effect of age on the histological and biomechanical properties of the arterial wall, which might explain why arterial rupture occurs more often in older horses.

Clinicopathological features of cutaneous and renal glomerular vasculopathy in 178 dogs.

BACKGROUND: One hundred seventy-eight dogs with cutaneous and renal glomerular vasculopathy (CRGV) were evaluated to further the understanding of the natural course of CRGV. CRGV, a form of thrombotic microangiopathy, can cause skin lesions and potentially acute kidney injury (AKI) with a high mortality rate. METHODS: Cases were submitted from multiple practices from 2012 until June 2019. Clinical histories and laboratory data were reviewed to describe the features of CRGV. RESULTS: Most cases (91%) occurred between November and May. Fifteen dogs (8.4%) with CRGV were in contact with another dog that developed skin lesions +/- AKI. Limb lesions were present on 144 dogs (80.9%) at presentation. Median time from appearance of a lesion to AKI was 3 days (range -4-45 days). Neurological signs occurred in 33 dogs (18.6%) including at presentation in 2 (1.1%). Systemic signs were present in 13 dogs prior to a skin lesion (7.3%). Non-steroidal anti-inflammatory drugs were prescribed prior to AKI identification in 92 of 170 dogs (54.1%). Thrombocytopenia was present in 115 of 137 (83.9%) of dogs. CONCLUSION: The timeframe over which AKI may develop is longer than previously reported, neurological signs can be identified at presentation or during hospitalisation, and thrombocytopenia is even more common than previously reported.

[Diagnostics in epilepsy - potential of magnetic resonance imaging]. / Diagnostik der Epilepsie ­ Möglichkeiten der Magnetresonanztomografie.

Epilepsy is a common neurologic disease frequently encountered by small animal practitioners. The disease comprises a multiplicity of clinical presentations and etiologies and often necessitates a comprehensive as well as cost-intensive diagnostic workup. This is mandatory in order to be able to diagnose or exclude a metabolic cause of the seizures and to distinguish between idiopathic and structural epilepsy. The examination by means of magnetic resonance imaging (MRI) represents a central component of the diagnostic workup, which in turn has essential effects on treatment and prognosis. In order to achieve standardized examination and comparable results, it is of utmost importance to use defined MRI protocols. Accordingly, communication and interaction between clinical institutions may be facilitated and as of yet undetected structural changes might be recorded in future MRI techniques. This review article sets particularly emphasis on the definition and classification of epilepsy as well as its diagnostic imaging procedures and refers to statistics and specialists' recommendations for the diagnostic workup in dogs.

Internal thoracic veins: Anatomy, plasticity and clinico-imaging relevance in small animal practice.

The internal thoracic veins (ITVs) are small paired vessels located on the ventral surface of the thoracic cavity that drain the ventro-cranial abdominal wall, the ventro-lateral thoracic wall, the diaphragm and part of the mediastinum, conveying blood from these regions into the cranial vena cava. These vessels demonstrate a high level of anatomic plasticity and haemodynamic adaptability in both humans and small animals with blood flow impairment of the main abdominal and thoracic venous trunks. The ITVs may act as a natural bypass between the cranial and caudal venous system and between the portal vein and the cranial vena cava, depending on the level of the obstruction, giving rise to a wide spectrum of collateral pathways: intrathoracic cavo-caval, thoraco-abdominal cavo-caval, abdomino-thoracic cavo-caval, porto-cranial caval and lateral thoracic-azygos ITV collaterals. This paper provides a brief overview of the normal and pathologic anatomy of the ITVs described in dogs with cranial and caudal vena cava obstruction and portal hypertension as shown by CT angiography. Collateral ITV pathways need to be distinguished from other vascular anomalies in dogs, and their identification during routine CT studies could help radiologists to reach a more accurate diagnosis of caval or portal flow disturbance.

Pathology and Epidemiology of Cutaneous and Renal Glomerular Vasculopathy in Dogs.

Cutaneous and renal glomerular vasculopathy (CRGV) has been recognized as a potentially life-threatening condition of dogs in the UK since 2012, although there was a single (non-azotaemic) case reported in the UK in 2000. Prior to that, CRGV was recognized in the 1980s in southern USA as a disease affecting solely racing greyhounds (which gave rise to the colloquial name of 'Alabama rot'). CRGV manifests as ulcerative skin lesions, generally sparing the dorsum. It is variably associated with systemic signs including anaemia, thrombocytopenia and acute kidney injury, which, when it develops, is often severe and fatal. CRGV is characterized histopathologically as a thrombotic microangiopathy. To date in the UK, more than 230 dogs of varying breed and age have been humanely destroyed and histopathologically confirmed to be suffering from CRGV. The aetiology remains unknown, but the seasonal distribution (highest case incidence November-May each year) suggests that environmental or climatic factors may play a role in disease development. Further research to determine the aetiology and improve ante-mortem diagnostic testing, therapeutic options and preventive strategies is urgently needed.

Outcome of non-surgical dietary treatment with or without lactulose in dogs with congenital portosystemic shunts.

Background: Congenital portosystemic shunts (CPSS) are vascular anomalies, allowing portal blood to bypass the hepatic parenchyma, thereby accumulating toxic substances such as ammonia in the systemic circulation resulting in hepatic encephalopathy.Aim: To evaluate the outcome of non-surgically treated dogs with a CPSS.Methods: Case records of 78 dogs with a single congenital CPSS confirmed by ultrasound and/or computed tomography between September 2003 and February 2015 were reviewed. Median age at diagnosis of CPSS in dogs was 10.8 months (range 2-133 months). Non-surgical treatment was started as an adjusted diet (a diet restricted in protein) with or without lactulose. Owners were contacted by telephone to determine survival time and presumed cause of death, if applicable. In addition, a questionnaire was used to retrospectively assess quality of life (QoL) and CPSS scores in 37 dogs before and during non-surgical treatment. Differences between Kaplan-Meier curves were tested by a Log rank test.Results: Overall estimated median survival time (EMST) was 38.5 months (range 1 day - 91 months; 78 dogs). No significant differences between EMSTs were found between dogs with extra- (n = 48) or intrahepatic (n = 29) shunts, nor between treatment with only an adjusted diet, or an adjusted diet combined with lactulose. During non-surgical treatment, significant improvement in perceived QoL and CPSS scores were found (P < 0.01).Conclusion: Our study demonstrated that an overall median EMST of 3.2 years was reached and that owners retrospectively perceived that non-surgical treatment resulted in an improved QoL and clinical performance, irrespective of intrahepatic or extrahepatic CPSS location.

CT variants of the caudal vena cava in 121 small breed dogs.

Computed tomography is increasingly used as a treatment planning method in canine patients with diseases of the retroperitoneum, however, published information on normal variations in the caudal vena cava (CVC) are currently lacking. The objectives of this retrospective descriptive study were to characterize CVC variants using CT angiography in a sample of small breed dogs and localize the CVC bifurcations for each variant. Inclusion criteria were small breed dogs (weight ≤ 15) that underwent contrast-enhanced CT scans of the CVC, abdominal aorta, and CVC tributaries. A total of 121 small breed dogs were sampled. Four right-sided and one left-sided CVC variations were identified: normal (88/121, 72.7%), caudal-partial split (17/121, 14.0%), partial duplication (8/121, 6.6%), complete duplication (7/121, 5.8%), and left-sidedness (1/121, 0.8%). The mean lumbar vertebral levels of the CVC bifurcation were L6.39 ± 0.41, L5.70 ± 0.35, L4.39 ± 0.42, L2.74 ± 0.38, and L6.4 in the normal, caudal-partial split, partial duplication, complete duplication, and left-sidedness types, respectively. The location of the CVC bifurcation, the relationship between the aortic trifurcation and the CVC bifurcation, and the location of the bilateral deep circumflex iliac veins with respect to the CVC bifurcation were significantly different among the right-sided types (P ≤ .001). Bilateral deep circumflex iliac veins joined to the ipsilateral common iliac veins and the CVC in the caudal-partial split and duplication types, respectively. The results of this study indicated that canine CVC variants may be frequent and should be considered during surgery or diagnostic imaging of the retroperitoneum.

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

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

Cutaneous and Renal Glomerular Vasculopathy: What Do We Know so Far?

Cutaneous renal glomerular vasculopathy (CRGV), colloquially named "Alabama rot," is an emerging condition in the United Kingdom, previously reported from the United States and Germany. The cause of CRGV is not yet determined; no definitive link to an infectious agent has been made. Dogs diagnosed with CRGV initially develop cutaneous lesions, and a proportion of these dogs go on to manifest acute kidney injury, which may result in oligoanuric acute renal failure. Antemortem diagnosis is challenging given the lack of a specific diagnostic test, and confirmation of CRGV is therefore currently dependent on identification of thrombotic microangiopathy on renal histopathology.

Spatiotemporal patterns and agroecological risk factors for cutaneous and renal glomerular vasculopathy (Alabama Rot) in dogs in the UK.

The annual outbreaks of cutaneous and renal glomerular vasculopathy (CRGV) reported in UK dogs display a distinct seasonal pattern (November to May) suggesting possible climatic drivers of the disease. The objectives of this study were to explore disease clustering and identify associations between agroecological factors and CRGV occurrence. Kernel-smoothed maps were generated to show the annual reporting distribution of CRGV, Kuldorff's space-time permutation statistic used to identify significant spatiotemporal case clusters and a boosted regression tree model developed to quantify associations between CRGV case locations and a range of agroecological factors. The majority of diagnoses (92 per cent) were reported between November and May while the number of regions reporting the disease increased between 2012 and 2017. Two significant spatiotemporal clusters were identified-one in the New Forest during February and March 2013, and one adjacent to it (April 2015 to May 2017)-showing significantly higher and lower proportions of cases than the rest of the UK, respectively, for the indicated time periods. A moderately significant high-risk cluster (P=0.087) was also identified in the Manchester area of northern England between February and April 2014. Habitat was the predictor with the highest relative contribution to CRGV distribution (20.3 per cent). Cases were generally associated with woodlands, increasing mean maximum temperatures in winter, spring and autumn, increasing mean rainfall in winter and spring and decreasing cattle and sheep density. Understanding of such factors may help develop causal models for CRGV occurrence.

Signalment risk factors for cutaneous and renal glomerular vasculopathy (Alabama rot) in dogs in the UK.

Seasonal outbreaks of cutaneous and renal glomerular vasculopathy (CRGV) have been reported annually in UK dogs since 2012, yet the aetiology of the disease remains unknown. The objectives of this study were to explore whether any breeds had an increased or decreased risk of being diagnosed with CRGV, and to report on age and sex distributions of CRGV cases occurring in the UK. Multivariable logistic regression was used to compare 101 dogs diagnosed with CRGV between November 2012 and May 2017 with a denominator population of 446,453 dogs from the VetCompass database. Two Kennel Club breed groups-hounds (odds ratio (OR) 10.68) and gun dogs (OR 9.69)-had the highest risk of being diagnosed with CRGV compared with terriers, while toy dogs were absent from among CRGV cases. Females were more likely to be diagnosed with CRGV (OR 1.51) as were neutered dogs (OR 3.36). As well as helping veterinarians develop an index of suspicion for the disease, better understanding of the signalment risk factors may assist in the development of causal models for CRGV and help identify the aetiology of the disease.

Interventional Radiology Management of Vascular Obstruction.

Vascular obstructions in small animals have numerous etiologies and variable signs depending on location and chronicity. The decision to treat and by which method (medical, interventional, surgical) can be challenging. A combined approach of catheter-directed thrombolysis, angioplasty, or vascular stenting may be most appropriate for acute thrombosis, though optimal therapeutic strategies are undefined in this population. The role of embolic trapping devices in animals is uncertain. Chronic cases of vascular obstruction, with collateral flow and neither ischemia nor venous congestion manifest, may be conservatively managed. Prospective clinical studies are needed to better guide management of vascular obstructions in veterinary medicine.

IMAGING DIAGNOSIS-COMPUTED TOMOGRAPHIC ANGIOGRAPHY CHARACTERISTICS OF MULTIPLE VASCULAR ANOMALIES IN A SENIOR DOG WITH LATE-ONSET REGURGITATION.

A 10-year-old dog weighing 3.4 kg presented with intermittent regurgitation. Esophagography revealed that the thoracic esophagus was compressed dorsally at the region of the fourth intercostal space and segmentally dilated from the second to third intercostal region. Three-dimensional computed tomographic (CT) angiography confirmed a suspected vascular ring anomaly and also revealed multiple other vascular anomalies. These included aberrant right subclavian artery, absence of bilateral external jugular veins, right-gastric caval shunt, and a completely duplicated caudal vena cava. Findings supported the use of thoracic CT angiography to rule out additional vascular malformations in dogs with suspected vascular ring anomaly.

Longitudinal study of Senecavirus a shedding in sows and piglets on a single United States farm during an outbreak of vesicular disease.

BACKGROUND: The study highlights the shedding pattern of Senecavirus A (SVA) during an outbreak of vesicular disease in a sow farm from the South-central Minnesota, USA. In this study, 34 individual, mixed parity sows with clinical signs of vesicular lesions and 30 individual piglets from 15 individual litters from sows with vesicular lesions were conveniently selected for individual, longitudinal sampling. Serum, tonsil, rectal, and vesicular swabs were collected on day1 post outbreak, and then again at 1, 2, 3, 4, 6, and 9 weeks post outbreak. Samples were tested at the University of Minnesota Veterinary Diagnostic Laboratory for SVA via Real Time Polymerase Chain Reaction (RT-PCR) RESULTS: In sows, vesicular lesions had the highest concentration of SVA, but had the shortest duration of detection lasting only 2 weeks. Viremia was detected for 1 week post outbreak, and quickly declined thereafter. SVA was detected at approximately the same frequency for both tonsil and rectal swabs with the highest percentage of SVA positive samples detected in the first 6 weeks post outbreak. In suckling piglets, viremia quickly declined 1 week post outbreak and was prevalent in low levels during the first week after weaning (4 weeks post outbreak) and was also detected in piglets that were co-mingled from a SVA negative sow farm. Similar to sows, SVA detection on rectal and tonsil swabs in piglets lasted approximately 6 weeks post outbreak. CONCLUSION: The study illustrates the variation of SVA shedding patterns in different sample types over a 9 week period in sows and piglets, and suggests the potential for viral spread between piglets at weaning.

Vasa Vasorum Arteriopathy: Relationship With Systemic Arterial Hypertension and Other Vascular Lesions in Cats.

The vasa vasorum is a delicate network of small arterioles that supplies nutrients to the adventitia and outer media of large arteries. In humans, dysfunction of the vasa vasorum contributes to the pathogenesis of aortic dissection and atherosclerosis. Twenty-four cats from 1 to 18 years of age were prospectively evaluated. Cases were divided into 3 cohorts-with systemic hypertension, without systemic hypertension, and uncertain. Histologic sections of the aorta and main pulmonary artery, as well as sections of kidney and lung, were blindly examined by 2 pathologists. The severity of vasa vasorum arteriopathy was compared to the presence of renal arteriosclerosis, aortic medial degeneration, subintimal fibroplasia of the main pulmonary artery, and blood pressure. We found that vasa vasorum arteriopathy correlated strongly with hypertensive status, degree of renal arteriosclerosis, and lesions in the great vessels. The positive predictive value of a severe vasa vasorum score for systemic hypertension was 84.6%. Lesions of vasa vasorum arteriopathy were predictive of renal arteriosclerosis with 100% sensitivity and 64.7% specificity. The positive predictive value of a severe vasa vasorum score for the presence of aortic lesions was 69.2% vs 91.6% for lesions in the main pulmonary artery. The vasa vasorum appears to be an important responder to systemic hypertension in cats, and arteriopathy of this vascular bed has significant implications for the integrity of the great vessels.