Abdominal and thoracic focused assessment with sonography for trauma, triage, and monitoring in small animals

Retrospective evaluation of the agreement between thoracic point-of-care ultrasound and thoracic radiographs in cats with recent trauma: 111 cats

Introduction

Motor vehicular trauma, bite wounds, high-rise syndrome, and trauma of unknown origin are common reasons cats present to the emergency service. In small animals, thoracic injuries are often associated with trauma. The objective of this retrospective study was to evaluate limits of agreement (LOA) between thoracic point-of-care ultrasound (thoracic POCUS) and thoracic radiography (TXR), and to correlate thoracic POCUS findings to animal trauma triage (ATT) scores and subscores in a population of cats suffering from recent trauma.

Methods

Cats that had thoracic POCUS and TXR performed within 24 h of admission for suspected/witnessed trauma were retrospectively included. Thoracic POCUS and TXR findings were assessed as "positive" or "negative" based on the presence or absence of injuries. Cats positive on thoracic POCUS and TXR were assigned 1 to 5 tentative diagnoses: pulmonary contusions/hemorrhage, pneumothorax, pleural effusion, pericardial effusion, and diaphragmatic hernia. When available ATT scores were calculated. To express LOA between the two imaging modalities a kappa coefficient and 95% CI were calculated. Interpretation of kappa was based on Cohen values.

Results

One hundred and eleven cats were included. 83/111 (74.4%) cats were assessed as positive based on thoracic POCUS and/or TXR. Pulmonary contusion was the most frequent diagnosis. The LOA between thoracic POCUS and TXR were moderate for all combined injuries, moderate for pulmonary contusions/hemorrhage, pneumothorax, diaphragmatic hernia, and fair for pleural effusion. Cats with positive thoracic POCUS had significantly higher median ATT scores and respiratory subscores compared to negative thoracic POCUS cats.

Discussion

The frequency of detecting intrathoracic lesions in cats was similar between thoracic POCUS and TXR with fair to moderate LOA, suggesting thoracic POCUS is useful in cats suffering from trauma. Thoracic POCUS may be more beneficial in cats with higher ATT scores, particularly the respiratory score.

Development and Implementation of a Basic Veterinary Ultrasound Curriculum

Diagnostic ultrasound is an important imaging modality in veterinary medicine. Surveys of veterinarians suggest that ultrasound is a desired clinical competence and that new graduates are expected to practice basic ultrasound skills. This report describes the development and implementation of a basic ultrasound training program in the core curriculum at Iowa State University College of Veterinary Medicine (ISU-CVM). A multidisciplinary team of ISU-CVM faculty created and delivered a basic ultrasound training program consisting of two lectures and two hands-on laboratories incorporated into a second-year core course, utilizing ballistic gel and silicone phantoms as well as live-dog scanning. The focus of training was on basic image acquisition, image optimization, and regional sonographic anatomy of the canine abdomen. Students were surveyed at 6-month intervals during program implementation. Survey data from graduating students, alumni, and employers were also analyzed. The program was successfully implemented and was well-received by all key stakeholders. Alumni and employer surveys reinforced the importance of basic ultrasound skills as a competency for new graduates. Student survey data revealed that satisfaction with ultrasound training increased after implementation of the program, as did students' perception of their skill level in individual ultrasound competencies. Student surveys also identified ways to enrich the program by providing additional opportunities for ultrasound practice in subsequent laboratory courses and clinical rotations. This report summarizes lessons learned during development of basic ultrasound training in the core curriculum at ISU-CVM and can serve as a reference for other institutions considering similar programs.

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.

A case report: Null-cell cardiac lymphoma in an English bulldog

This case report describes a novel example of an extranodal null-type lymphoma in the myocardium of a middle-aged English bulldog who presented with signs of right heart failure. An echocardiogram found, in addition to the pericardial effusion, thickened right and left ventricular free walls and the interventricular septum. The right ventricular free wall myocardium had multinodular lesions, suspicious for infiltrative disease. The owner elected humane euthanasia, and permission for necropsy was obtained. Multifocal left and right ventricular nodules and an incidental aortic root mass were detected, the latter of which was later confirmed as a chemodectoma. Microscopically, the myocardial nodules were sheets of round cells consistent with a high-grade lymphoma. Neoplastic cells were not immunoreactive to CD3 (T-cell) or CD20 and CD79a (B-cell), Mum-1 (plasma cell), CD117 (mast cell), or CD18 (histiocyte). These findings are consistent with a high-grade, null-cell-type lymphoma.

Ultrasonographic measurement of caudal vena cava to aorta ratio during fluid resuscitation of dogs with spontaneous circulatory shock

OBJECTIVES

To describe the change in the caudal vena cava to aorta ratio (CVC:Ao) ratio during fluid resuscitation of circulatory shock in dogs and compare these results with those of the physical examination and blood lactate.

MATERIALS AND METHODS

Perfusion parameters and blood lactate were recorded at admission. An abdominal point-of-care ultrasound protocol was performed, during which the caudal vena cava to aorta ratio was measured on the spleno-renal view. Measurements were performed within 5 minutes before and after a 10 mL/kg crystalloid fluid bolus. Investigators were not blinded to therapeutic interventions.

RESULTS

Twenty-nine dogs with physical signs of circulatory shock were enrolled. Caudal vena cava to aorta ratios were below reference interval in 28 of 29 dogs. After bolus administration, median caudal vena cava diameter increased by 0.14 cm (0.69 to 0.83 cm) and median aorta diameter increased by 0.03 cm (0.87 to 0.90 cm) and caudal vena cava to aorta ratio returned to within reference range in 65% of dogs (13/29). Bolus administration was associated with an increase in median caudal vena cava to aorta ratio of 0.10 (95% CI:0.05 to 0.16, P=0.0005). Blood lactate did not change significantly. Heart rate and capillary refill time decreased significantly after fluid bolus (heart rate: estimate=-19 bpm, 95% CI:-30 to -8, P=0.002; capillary refill time: estimate=-1.0 s, 95% CI:-1.3 to -0.7, P < 0.0001).

CLINICAL SIGNIFICANCE

In this population of dogs with circulatory shock, the caudal vena cava to aorta ratio significantly increased after a fluid bolus. Future studies that implement blinding of the outcome assessors are warranted to confirm these findings.

The Role of Point-of-Care Ultrasound in Managing Cardiac Emergencies

Point-of-care ultrasound (POCUS) is a useful imaging tool for the diagnosis and monitoring of cardiac emergencies. Unlike complete echocardiography, POCUS is a time-sensitive examination involving a subset of targeted thoracic ultrasound views to identify abnormalities of the heart, lungs, pleural space, and caudal vena cava. When integrated with other clinical information, POCUS can be helpful in the diagnosis of left-sided and right-sided congestive heart failure, pericardial effusion and tamponade, and severe pulmonary hypertension and can help clinicians monitor resolution or recurrence of these conditions.

Assessing primary care veterinarians' use of and confidence in performing point-of-care ultrasound

BACKGROUND

Point-of-care ultrasound (POCUS) is gaining popularity in the veterinary field, but there is little information on operator confidence.

METHODS

A survey was distributed to primary care veterinarians (PCVs) via social media between May and July 2020. Details of participants' training in and use of POCUS were recorded. Participants' confidence in using thoracic and abdominal POCUS was also assessed using a five-point Likert scale.

RESULTS

Two hundred and one PCVs used POCUS, of which 32% reported using a non-standardised protocol. Fifty percent of PCVs were self-taught and 17.4% had attended a specific practical course. The median confidence score was 4 out of 5 (interquartile range [IQR] 2-5) for identifying abdominal abnormalities, irrespective of the training method. The median confidence score for thoracic abnormalities was 3 out of 5 (IQR 1-4) for those taught by a colleague or who were self-taught using journal articles or videos.

LIMITATIONS

The survey-based nature of the study relies on self-reporting and is therefore liable to recall bias.

CONCLUSIONS

PCVs' confidence in using POCUS is lacking, particularly with thoracic POCUS. Standardised practical training for PCVs, particularly in thoracic POCUS, would be beneficial. Future studies should explore how best to deliver this training.

DIAGNOSTIC IMAGING AND OROTRACHEAL INTUBATION IN CLINICALLY HEALTHY WILD SUNDA PANGOLINS (MANIS JAVANICA) IN SINGAPORE

Pangolins are amongst the most overexploited species in the world and all eight species of pangolins are threatened with extinction. These animals are rare in zoological collections and often suffer high mortality rates in captivity. Maintaining healthy populations in captivity has become more important with the declining populations in the wild, but knowledge of veterinary care of these animals is limited. Interpreting radiography and ultrasonography images in a patient can be challenging without knowledge of normal findings. The Wildlife Healthcare and Research Center (WHRC) at Mandai Wildlife Reserve (MWR) admits an average of 25 Sunda pangolins (Manis javanica) annually, which is a Critically Endangered species native to Singapore. All the pangolins are triaged on admission and anesthetized for a health assessment before release into the wild. Endotracheal intubation using an otoscope and stylet is a novel technique in the species that has been developed and is commonly performed with these pangolins. A retrospective study was done on 20 clinically healthy wild pangolins to determine normal ultrasonography and radiography findings in the species. Notable findings include the presence of radio-opaque particles in the stomachs of all pangolins, the presence of free fluid cranial to the left kidney (13/20), a spleen with multifocal hypoechoic regions (6/20), and open epiphyseal plates of long bones even in large individuals weighing as heavy as 6.8 kg. Ultrasonographic images and measurements of kidney, spleen, and adrenal gland sizes as well as intestinal, gallbladder, and urinary bladder wall thickness were also described. These diagnostic imaging findings can advance the veterinary care of captive and wild pangolins.

Establishment of Reference Intervals for Caudal Vena Cava-to-Aorta Ratio Measured Ultrasonographically in Healthy Nonsedated Dogs

The ultrasonographic assessment of the caudal vena cava-to-aorta ratio (CVC:Ao) appears to be a promising method for early recognition of alterations of intravascular volume status in veterinary medicine. The primary objective of this study was to establish the reference intervals of the CVC:Ao ratio with ultrasound in nonsedated healthy dogs. Secondary objectives were to determine the influence of the respiratory cycle and to evaluate correlations between ultrasonographic measurements, signalment and physical exam findings. Ultrasonographic measurements of Ao and CVC diameters were successfully obtained for all sixty dogs included. No evidence of a difference was observed between the measurements of Ao and CVC diameters, and CVC:Ao ratio between inspiration and expiration (P = .373, P = .318, and P = .537, respectively). The reference interval for CVC:Ao ratio (95% CI), generated from US measurements performed at any moment of the respiratory cycle was defined as 0.93 (0.91-0.95) -1.32 (1.30-1.34). The CVC:Ao ratio was significantly negatively correlated with age (r = -0.341, P = .008) and positively correlated with respiratory rate (r = 0.423, P < .001), but not with heart rate (P = .573) or arterial systolic blood pressure (P = .166). A low inter- and intraoperator variability in repeated measurements was observed for each operator and between operators. The ultrasonographic measurement of the CVC:Ao ratio appears as a simple method with low inter- and intraoperator variability using the ultrasonographic protocol described in the current study. With the reference interval established in the present study in healthy nonsedated dogs, further studies should evaluate the utility of this simple method in assessing and monitoring volume status in hypo- and hypervolemic dogs.

Assessment of a standing position during abdominal point-of-care ultrasound on abdominal fluid score in dogs

OBJECTIVE

To assess the use of a standing position during abdominal point-of-care ultrasound (POCUS) examination when evaluating dogs for peritoneal effusion.

DESIGN

Randomized prospective study over 17 months.

SETTING

Single-center, university veterinary teaching hospital.

ANIMALS

Thirty dogs presenting for acute abdominal disease. Eligibility included suspicion for free peritoneal effusion and the ability to stand.

INTERVENTIONS

Dogs underwent standing abdominal POCUS, right lateral abdominal POCUS, and a full abdominal ultrasound. We originally had nothing listed. It now includes all three ultrasound evaluations that were performed for each patient.

MEASUREMENTS AND MAIN RESULTS

Patients underwent both a right lateral and standing abdominal POCUS via a previously described abdominal focused assessment with sonography for trauma (A-FASTrl and A-FASTs, respectively) technique in a randomized and sequential order followed by a full abdominal ultrasound (AUS-full). The A-FASTs examination included a right flank location in addition to the following standard views: subxiphoid, left flank, urinary bladder, and umbilicus. Five-second cine loops were obtained at each location for each examination and reviewed in the order they were obtained. Locations for both A-FAST exams were interrogated in the same order every time. The cine loops were scored for the degree of peritoneal effusion based on a previously published abdominal fluid scoring system by a board-certified radiologist, radiology resident, and radiology intern. The overall abdominal fluid score (AFS) was compared to a subjective full abdominal ultrasound score given by a board-certified radiologist. Six dogs had no peritoneal effusion, 13 had a small volume (AFS 1 or 2), and 11 had a moderate to large volume (AFS 3 or 4). Excellent agreement (intraclass correlation coefficient) was found between the A-FASTs and A-FASTrl techniques (0.95, 0.93, 0.94), good agreement between A-FASTs and AUS-full (0.80, 0.77, 0.82), and good agreement between A-FASTrl and AUS-full (0.80, 0.82, 0.84). The interobserver agreement was good (0.87) for the A-FASTs technique and excellent (0.91) for the A-FASTrl technique. Mean observer agreement score was excellent (0.94) when evaluating A-FASTrl to A-FASTs, good (0.86) when evaluating A-FASTs to AUS-full, and good (0.87) when evaluating A-FASTrl to AUS-full.

CONCLUSION

Performing a standing abdominal POCUS examination may be a valid option for identifying and quantifying peritoneal effusion in situations when a more traditional right lateral approach cannot be performed.

The use of agitated saline as contrast agent in a contrast-enhanced cystosonography for detection of urinary bladder rupture in animal cadavers

OBJECTIVE

To determine the value of microbubble contrast cystosonography in the diagnosis of bladder rupture in animals.

DESIGN

Prospective, method comparison study from November 2019 to October 2020.

SETTING

University teaching hospital.

ANIMALS

Thirty-four ethically sourced cadavers of dogs, rats, and rabbits.

INTERVENTIONS

In a prospective and blinded study, the cadavers were divided into 2 randomized groups: with bladder rupture (CR), and without bladder rupture (SR). Urinary catheterization was performed in all cadavers. Through the urethral catheter, bladders in CR group were ruptured using a rigid stainless steel guide wire. Microbubble contrast was infused into the bladder through the urethral catheter, while a single, blinded observer sonographically assessed the bladder. The time to diagnosis and the number of attempts needed for diagnosis were recorded.

MEASUREMENTS AND MAIN RESULTS

The study included cadavers of 16 female Wistar rats, 6 female dogs, 11 male dogs, and 1 male rabbit. Time to diagnosis in dogs (2.25 ± 0.91 min) was statistically higher when compared to rats (1.15 ± 0.75 min; P = 0.03). Of the 34 cases, incorrect diagnosis of bladder rupture was made in only 2 dogs (6%), indicating a diagnostic sensitivity of 88.88%, specificity of 100%, and an accuracy of 94%. The positive predictive value was 1 and the negative predictive value was 0.9.

CONCLUSIONS

Our study showed that the described method is accurate, sensitive, and specific for the detection of bladder rupture in animal cadavers of different species, size, and sex.

Comparison of clinical outcomes in cases of blunt, penetrating, and combination trauma in dogs: A VetCOT registry study

OBJECTIVE

To evaluate outcome (survival to discharge) among trauma types (blunt, penetrating, both) in dogs. The secondary objective was to evaluate if other trauma registry parameters differ between trauma types and influence survival.

DESIGN

Retrospective evaluation of veterinary trauma registry data.

SETTING

Veterinary Committee on Trauma (VetCOT) identified Veterinary Trauma Centers (VTCs).

ANIMALS

A total of 20,289 canine trauma patients with data entered in the VetCOT trauma registry from April 1, 2017 to December 31, 2019 INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS

Data were obtained from the VetCOT database and included patient demographics, trauma type (blunt, penetrating, both), Animal Trauma Triage (ATT) score, modified Glasgow Coma Scale (mGCS), abdominal fluid score (AFS), loss of glide sign on thoracic focused assessment with sonography for trauma (TFAST), pleural effusion on TFAST, surgical procedure performed and in what location (emergency room vs operating room), and outcome. Data from 20,289 dogs were collected over a 30-month period. The most common type of trauma was penetrating (10,816, 53.3%), followed by blunt (8360, 41.2%) and then combined blunt and penetrating trauma (1113, 5.5%). Dogs suffering only penetrating trauma had a 96.5% survival rate, blunt trauma had an 89.5% survival rate, and combined trauma had an 86.3% survival rate. Dogs suffering from both types of trauma had higher ATT scores, lower mGCS scores, and were more likely to be admitted to the ICU. Trauma type, mGCS, and ATT score were found to be associated with survival.

CONCLUSIONS

The present study highlights that dogs suffering from a combination of blunt and penetrating trauma are more likely to suffer moderate to severe injuries, have lower survival rates, and are more likely to be admitted to the ICU compared to dogs suffering from only blunt or penetrating trauma. Trauma type, mGCS, and ATT scores were found to be associated with survival in all groups.

Pericardial effusion secondary to epicardial undifferentiated pleomorphic sarcoma in a young cat

Case summary

A 6.4 kg 3-year-old male neutered indoor-outdoor domestic shorthair cat was referred for further evaluation of non-resolving lethargy and hyporexia of 4 days' duration. Physical examination identified tachypnea with mild respiratory effort and muffled lung sounds bilaterally. Point-of-care ultrasound revealed a large volume of pleural and pericardial effusion (PCE), which was confirmed by thoracic radiography. Echocardiogram indicated normal cardiac function but revealed a mass-like structure along the left epicardium within the pericardial space. After 72 hours in hospital, re-evaluation via echocardiogram showed the epicardial mass lesion to have doubled in size and with apparent extension to involve the pericardium. The patient was hospitalized for 72 h of supportive care and intervention, including therapeutic pericardiocentesis, bilateral thoracocentesis, thoracic and cardiac imaging and infectious disease testing. On the third day of hospitalization, the patient developed cardiac tamponade. Further workup was discussed, including CT and subtotal pericardiectomy with biopsy, but the cat was euthanized due to clinical decline and rapid re-accumulation of effusion. Post-mortem histopathologic evaluation diagnosed an epicardial pleomorphic sarcoma, exclusive of mesothelioma or histiocytic sarcoma on immunohistochemistry (IHC).

Relevance and novel information

This report describes a case of epicardial undifferentiated pleomorphic sarcoma (UPS) in a young cat presenting with pleural and PCE. Pleomorphic sarcoma is a rarely reported mesenchymal neoplasia in the feline patient and has thus far primarily been identified in peripheral soft tissue structures. IHC is key to the correct histopathologic diagnosis. To our knowledge, epicardial UPS has not been previously reported in a cat.

Focused cardiac ultrasound examination in the emergency and critical care equine patient: Training for non-specialist veterinarians and evaluation of proficiency

Background

Focused cardiac ultrasound examination (FoCUS) is rapidly emerging for point‐of‐care cardiac assessment using hand‐carried ultrasound (HCU) devices. A specific FoCUS protocol for horses and adequate training guidelines currently are not available.

Hypothesis

To gain knowledge about the training necessary to become proficient in performing FoCUS using a HCU device.

Animals

Three healthy Warmblood horses were used for practical training of veterinarians and veterinary students in equine focused cardiac ultrasound (eFoCUS).

Methods

Prospective educational study. An eFoCUS protocol and 1‐day training course were developed. Pre‐ and post‐course written tests were administered to participants to evaluate proficiency in knowledge of echocardiography and echocardiographic pathology. A post‐course practical examination involved performing eFoCUS and storage of representative images. Images were evaluated using an image quality score and compared between participants with some practical experience and participants with no practical experience.

Results

Participants' knowledge of echocardiography increased significantly. Recognition of echocardiographic pathology pre‐course ranged from 40% to 90% (mean score, 65.7%) and post‐course from 85% to 100% (mean score, 92%). Eighteen of 21 participants were proficient in performing eFoCUS with a median image quality score of 79% (range, 42%‐95%). Image quality did not differ between participants with some practical experience compared to participants with no experience.

Conclusions and Clinical Importance

Veterinarians and veterinary students independent of previous experience can become proficient in performing eFoCUS after completion of a 1‐day training course.

High-rise syndrome in cats and dogs

OBJECTIVE

To review the current literature pertaining to the pathophysiology, diagnosis, and treatment of injuries sustained from high-rise syndrome in cats and dogs.

ETIOLOGY

High-rise syndrome is defined as a fall from a height of 2 or more stories that results in a constellation of injuries, including thoracic, abdominal, orthopedic, and orofacial trauma. Animals often fall after slipping from windowsills, engaging in mating behavior, or chasing prey. Cats suffer less severe injuries than dogs due to their "righting reflex" and smaller body mass. Affected animals are younger, and the frequency of falls is higher in warmer months.

DIAGNOSIS

Physical examination coupled with radiographs, ultrasound, and computed tomography can diagnose a myriad of injuries that include pneumothorax, pleural or abdominal effusion, orthopedic fractures, and orofacial injuries. Bloodwork may identify anemia, thrombocytopenia, or increases in hepatic, renal, or pancreatic values consistent with trauma to these organs. Serial venous or arterial blood gas can help determine the severity of respiratory compromise and influence resuscitative efforts. Traditional coagulation tests and thromboelastography can assess trauma-induced coagulopathy and guide transfusion therapy.

THERAPY

Animals presenting in shock require hemodynamic stabilization. Initial resuscitation may incorporate crystalloids, colloids, blood products, and analgesics. Thoracic injuries may require oxygen, thoracocentesis, chest tube placement, and mechanical ventilation. Fractures and wounds are decontaminated and splinted/bandaged, with definitive fixation pursued after stabilization. Abdominal injuries are managed medically unless there is severe ongoing bleeding, sepsis, or injury to the urinary tract.

PROGNOSIS

In feline high-rise syndrome, the prognosis is generally excellent following treatment, with survival exceeding 90%. Canine literature is sparse. The largest retrospective study reported a >90% survival to discharge and a greater need for surgical stabilization in this species. There are no prognostic factors identified that are associated with survival for either species.

Elective cricothyrotomy in a dog with transient laryngeal paralysis secondary to Australian paralysis tick (Ixodes holocyclus) envenomation

The tube cricothyrotomy (CTT) has recently been introduced to small animal medicine as a viable surgical airway access procedure; however, there are no reports documenting its clinical use. The author's objective is to describe the clinical application, complications, and management of an elective CTT in a dog. Furthermore, the characteristics of CTT that may be clinically advantageous over temporary tube tracheostomy (TT) will be discussed. A 2‐year‐old female spayed German shepherd dog required mechanical ventilation (MV) due to unsustainable work of breathing as a result of tick paralysis and aspiration pneumonia. After successful weaning from MV, the dog was diagnosed with laryngeal paralysis. A surgical airway was performed using CTT to allow extubation and patient management whilst conscious. Complications included frequent tube suctioning due to accumulation of airway secretions in the tube and a single dislodgement event. The dog made an uneventful recovery with complete stoma healing by the second intention within 15 days. To the authors' knowledge, this is the first clinical report of an elective CTT performed to successfully manage upper airway obstruction in the dog. Its efficacy, clinical management and patient outcome are described.

The wedge sign: A possible lung ultrasound sign for pulmonary thromboembolism

OBJECTIVE

To describe the finding of the lung ultrasound (LUS) "wedge sign" in dogs with presumptive pulmonary thromboembolism (PTE).

CASE SERIES SUMMARY

This case series describes 2 dogs with predisposing risk factors of (1) right transvenous pacemaker terminating in its right ventricle, severe protein-losing nephropathy, and glucocorticoid therapy, and (2) caval syndrome, each having the LUS "wedge sign" in upper lung regions, a sign consistent with pulmonary infarction and peripheral PTE.

NEW OR UNIQUE INFORMATION PROVIDED

Historically, the diagnosis of canine PTE has been made through supportive findings because the gold standard test, computed tomography pulmonary angiography (CTPA), poses limitations. The use of LUS has shown promise in people for detecting PTE, with the advantages of availability, being radiation- and contrast medium-sparing, rapid (<90 s), point-of-care, real-time information. Our cases suggest a possible new first-line approach for suspecting canine PTE by using LUS and the finding of the "wedge sign" in nongravity-dependent caudodorsal and perihilar lung regions.

Comparison of lung ultrasound, chest radiographs, C-reactive protein, and clinical findings in dogs treated for aspiration pneumonia

Background

Comparison of clinical findings, chest radiographs (CXR), lung ultrasound (LUS) findings, and C‐reactive protein (CRP) concentrations at admission and serial follow‐up in dogs with aspiration pneumonia (AP) is lacking.

Hypothesis

Lung ultrasound lesions in dogs with AP are similar to those described in humans with community‐acquired pneumonia (comAP); the severity of CXR and LUS lesions are similar; normalization of CRP concentration precedes resolution of imaging abnormalities and more closely reflects the clinical improvement of dogs.

Animals

Seventeen dogs with AP.

Methods

Prospective observational study. Clinical examination, CXR, LUS, and CRP measurements performed at admission (n = 17), 2 weeks (n = 13), and 1 month after diagnosis (n = 6). All dogs received antimicrobial therapy. Lung ultrasound and CXR canine aspiration scoring systems used to compare abnormalities.

Results

B‐lines and shred signs with or without bronchograms were identified on LUS in 14 of 17 and 16 of 17, at admission. Chest radiographs and LUS scores differed significantly using both canine AP scoring systems at each time point (18 regions per dog, P < .001). Clinical and CRP normalization occurred in all dogs during follow up. Shred signs disappeared on LUS in all but 1 of 6 dogs at 1 month follow‐up, while B‐lines and CXR abnormalities persisted in 4 of 6 and all dogs, respectively.

Conclusion and Clinical Importance

Lung ultrasound findings resemble those of humans with comAP and differ from CXR findings. Shred signs and high CRP concentrations better reflect clinical findings during serial evaluation of dogs.

Comparing diagnostic findings and cost of whole body computed tomography to traditional diagnostic imaging in polytrauma patients

OBJECTIVE

To compare the diagnostic utility of traditional diagnostic tests (ie, radiographs and focused assessment using sonography for trauma [FAST] scans) to whole-body computed tomography (WBCT) for characterizing injuries in polytrauma patients. A secondary objective was to compare costs of traditional diagnostic tests to WBCT.

DESIGN

Prospective, observational study.

SETTING

Private, level 1 veterinary trauma center.

ANIMALS

Convenience sample of 21 client-owned cats and dogs presenting with polytrauma.

INTERVENTIONS

Abdominal and thoracic FAST were performed by the primary clinician, if indicated. Radiographs were performed on areas concerning for trauma at the primary clinician's discretion. A WBCT was performed on each patient within 24 h of presentation and was blindly interpreted by a board-certified radiologist. Patients were only placed under anesthesia if further procedures were planned. IV contrast administration was employed at the discretion of the primary clinician and radiologist.

MEASUREMENTS AND MAIN RESULTS

Twenty-one patients (14 dogs and 7 cats) were enrolled. Sources of trauma included blunt force (80%), penetrating wounds (10%), and unknown sources (10%). Twelve injuries were missed on traditional diagnostics tests. Injuries missed on traditional diagnostic workup included pneumothorax, pneumomediastinum, pulmonary contusions, pleural effusion, traumatic bulla, peritoneal effusion, and an appendicular skeleton fracture. A distal metacarpal fracture was missed on WBCT. Traditional diagnostic tests misdiagnosed a diaphragmatic hernia and a ruptured urinary bladder, whereas WBCT was able to rule out these injuries. There were no adverse outcomes associated with missed injuries. The median cost of traditional diagnostic tests was significantly less than the cost of WBCT (P < 0.001).

CONCLUSIONS

Although cost is higher, WBCT is a single test that can provide more comprehensive information and may help decrease the risk of missed injuries compared to traditional diagnostic tests. WBCT may be considered as a first-line diagnostic in severely traumatized patients.

Deer Rescue in Tuscany: Retrospective Analysis and Assessment of Radiography Diagnoses

Simple Summary

Animal-vehicle collisions are the major cause of rescue and need for hospitalization in wildlife referral centers. Radiography is used to assess the traumatized animal and is a rapid means to evaluate various traumatic pathologies. Clinicians can exploit radiography when making rapid decisions about whether to euthanize or treat an animal. We evaluated data (reasons for rescue, diagnosed lesions, and outcome) from a population of hospitalized wildlife ungulates and we investigated the benefits of using radiography as a diagnostic tool.

Abstract

Animal-vehicle collisions are the major cause of rescue and need for hospitalization in wildlife referral centers. Clinicians need easy-to-use tools to make rapid decisions about whether to euthanize or treat injured animals. The aim of the study was to evaluate the data (reasons for rescue, diagnosed lesions, and outcome) from a hospitalized population of wildlife ungulates and investigate the benefits of using radiography as a diagnostic tool. Data were collected from three wildlife referral centers in Tuscany (Italy). The following information was collected for each animal: reason for hospitalization, clinical examination, radiographic examination, definitive diagnosis, and outcome. A chi-squared test was used to assess the benefits of radiography in detecting different traumatic lesions. Prevalence was reported according to the reason for hospitalization, definitive diagnosis, radiographic diagnosis, and outcome. The main reason for hospitalization was traumatic lesions due to vehicle collisions and 71.1% of the animals did not survive. Radiography was more useful in patients with traumatic axial skeletal lesions and/or multiple traumas with respect to traumatic appendicular skeleton lesions. Our results show that radiography is a useful diagnostic technique for assessing wildlife emergencies and it could help the clinician in making medical decisions.

Outcomes and Blood Product Use in 89 Surgically Managed and 79 Medically Managed Cases of Acute Spontaneous Hemoperitoneum in the Dog

Objective: To describe a population of dogs with acute spontaneous hemoperitoneum (ASH) that were treated with either surgical or medical management in the first 12 h after presentation, and to perform a preliminary investigation into whether there were differences in achieving cardiovascular stabilization or patterns of red blood cell (RBC) transfusion between patients treated with early (<12 h) surgery vs.medical management. Design: A retrospective multicenter preliminary study performed on 168 dogs presenting with ASH between January 2015 and May 2019. Patients were excluded if they were euthanized or discharged from hospital within the first 12 h, or if clinical records were incomplete. All patients received appropriate medical stabilization efforts. Statistical analysis was performed comparing patients that underwent early (<12 h) surgery and those that did not. Results: Eighty-nine patients were in the early surgical group and 79 patients in the medical group. A significantly higher proportion of medical cases were euthanized (p < 0.001). A significantly higher proportion of early surgical cases were discharged from hospital (p = 0.005). There was no statistically significant difference between groups in achieving cardiovascular stabilization (OR 1.07 p = 0.82). A higher proportion of patients with body-weight over 20 kg achieved stabilization within 12 h than those with body-weight of 20 kg or less (62.7 vs. 41.4%, p < 0.01). A higher proportion of patients with splenic conditions achieved stabilization than patients with non-splenic conditions (56.5 vs. 28.6%, p = 0.05). The odds of receiving an RBC transfusion were higher in the early surgical group than the medical group [OR 3.81 (p < 0.001)]. Conclusions: This preliminary study did not identify a significant difference in the ability to achieve cardiovascular stabilization in the first 12 h in dogs with ASH that underwent early surgical intervention vs. those managed medically. Patients in the early surgical group were more likely to receive a RBC transfusion than those in the medical group. At this time the decision on whether to pursue medical or early surgical management should be made on a case by case basis.

TFAST Accurate Diagnosis of Pleural and Pericardial Effusion, Caudal Vena Cava in Dogs and Cats

TFAST, a standardized and validated thoracic point-of-care ultrasound examination, includes 5 acoustic windows: bilaterally applied chest tube site and pericardial site views plus diaphragmatico-hepatic view, also part of AFAST/ Vet BLUE. TFAST is used for rapid detection of pneumothorax and pleural and pericardial effusion. By following a set of TFAST rules, image interpretation errors are avoided, including mistaking cardiac chambers for effusion. Moreover, TFAST echocardiography is used as a screening test for chamber size and soft tissue abnormalities, volume status and contractility, and intracardiac abnormalities.

AFAST Target-Organ Approach and Fluid Scoring System in Dogs and Cats

Point-of-care ultrasonography as part of the physical examination is becoming considered a core skill. AFAST includes 5 acoustic windows over the abdomen and serves as a rapid screening test for free fluid (ascites, retroperitoneal, pleural and pericardial effusion) and soft tissue abnormalities (target-organ approach), and has an abdominal fluid scoring system (semiquantitating volume). Moreover, add-on skills are possible without additional views that include characterizing the caudal vena cava and hepatic veins (volume status), measuring the urinary bladder (volume estimation and urine output), screening for free air (pneumoperitoneum, pneumoretroperitoneum), and assessing gastrointestinal motility.

Lung Ultrasound Fundamentals, "Wet Versus Dry" Lung, Signs of Consolidation in Dogs and Cats

Vet BLUE, a standardized and validated rapid lung ultrasound examination, includes 9 acoustic windows: 4 transthoracic bilaterally applied named Caudodorsal, Perihilar, Middle, and Cranial Lung Regions plus the Diaphragmatico-Hepatic view of AFAST/TFAST. Moreover, Vet BLUE has a B-line scoring system (weak positives-1, 2, and 3 and strong positives->3 and infinite) that semiquantitate degree of alveolar-interstitial syndrome and a visual lung language for signs of consolidation (Shred Sign [air bronchogram], Tissue Sign [hepatization], Nodule Sign, and Wedge Sign [pulmonary infarction]). Using its regional, pattern-based approach, a respiratory working diagnosis may be rapidly developed point-of-care and followed serially.

Global FAST for Patient Monitoring and Staging in Dogs and Cats

Please verify if FAST should be expanded at first use - "focused assessment with sonography for trauma"?: Global FAST consists of abdominal FAST, thoracic FAST, and Vet BLUE combined as a single point-of-care ultrasound examination used as an extension of the physical examination. By applying its unbiased set of 15 data imaging points, information is gained while avoiding image interpretation errors, such as satisfaction of search error and confirmation bias error, through selective POCUS imaging. Moreover, Global FAST is used for integrating information from both cavities, rapidly screening for the Hs and Ts of cardiopulmonary resuscitation, and staging localized versus disseminated disease, helpful diagnostically and prognostically for patient work-up. By seeing a problem list, patient care is improved.

Fluid Therapy in Pulmonary Disease: How Careful Do We Need to Be?

Intravenous fluid therapy is a vital and life-saving therapeutic in veterinary medicine. In the absence of heart or lung disease, trauma or sepsis there is limited evidence that fluid therapy will have a detrimental effect on lung function. In healthy dogs there is a reasonable level of experimental evidence that supraphysiologic rates of fluid are required before signs of fluid overload are made evident. In cats, however, this may not be the case. There are higher rates of asymptomatic myocardial disease, but even in the absence of that it seems that some cats may be susceptible to fluid overload. Where systemic inflammation already exists the careful homeostatic and protective mechanisms within the lung are deranged and increases in hydrostatic pressure are more likely to result in fluid movement into the lung tissues. Strategies including restricting the use of intravenous crystalloid fluid administration and using blood products for management of severe hemorrhage are of increasing importance in human trauma and seem to be associated with fewer pulmonary complications, and lower mortality. Managing dogs and cats with sepsis and acute respiratory distress syndrome is already challenging, but ensuring adequate vascular expansion needs to be balanced with avoiding excessive volume administration which may negatively impact pulmonary function. While fluids remain crucial to management of these conditions, there will be an ongoing requirement to balance need without providing excess. The use of point of care ultrasound may provide clinicians with a non-invasive and accessible way to do this.

Pocket-Sized Ultrasound Versus Traditional Ultrasound Images in Equine Imaging: A Pictorial Essay

This pictorial essay aims to display the image quality of pocket-sized ultrasound devices and hospital-based equipment to provide clinicians visual information about the potential uses of point-of-care ultrasonography (POCUS) in equine practice. Twenty-two paired images were obtained using traditional ultrasound equipment and pocket-sized ultrasound devices from patients evaluated at veterinary teaching hospitals. Images of many common ultrasound windows and miscellaneous sonographic abnormalities were obtained using pocket-sized ultrasound equipment.

Spontaneous Pneumothorax: Pathophysiology, Clinical Presentation and Diagnosis

Spontaneous pneumothorax, which may have an acute or insidious onset in dogs and cats, results in respiratory difficulty and has the potential to be life threatening.^1-3 Dogs commonly develop spontaneous pneumothorax due to bullae or blebs, while cats typically have underlying inflammatory disease, like feline allergic airway disease. Urgent therapeutic intervention is essential in animals with respiratory distress. The recommended therapeutic strategies are typically different in each of these species due to underlying etiology. The first part of this review article will focus on physiology, clinical presentation, and diagnosis of spontaneous pneumothorax in dogs and cats. Advances in diagnostics, especially the recent utility of point of care ultrasound, will be discussed. The second part of the series will provide an overview of therapeutic options and management of patients with spontaneous pneumothorax, as well as information on prognosis.

Focused ultrasound of the caudal vena cava in dogs with cavitary effusions or congestive heart failure: A prospective, observational study

INTRODUCTION

Ultrasonographic indices of the inferior vena cava are useful for predicting right heart filling pressures in people.

OBJECTIVES

To determine whether ultrasonographic indices of caudal vena cava (CVC) differ between dogs with right-sided CHF (R-CHF), left-sided CHF (L-CHF), and noncardiac causes of cavitary effusion (NC).

MATERIALS AND METHODS

113 dogs diagnosed with R-CHF (n = 51), L-CHF (30), or NC effusion (32) were enrolled. Seventeen of the R-CHF dogs had pericardial effusion and tamponade. Focused ultrasound was performed prospectively to obtain 2-dimensional and M-mode subxiphoid measures of CVC maximal and minimal size (CVCmax and CVCmin), CVCmax indexed to aortic dimension (CVC:Ao), and CVC collapsibility index (CVC-CI). Variables were compared between study groups using Kruskal-Wallis and Dunn's-Bonferroni testing, and receiver operating characteristics curves were used to assess sensitivity and specificity.

RESULTS

All sonographic CVC indices were significantly different between R-CHF and NC dogs (P < 0.001). Variables demonstrating the highest diagnostic accuracy for discriminating R-CHF versus NC were CVC-CI <33% in 2D (91% sensitive and 96% specific) and presence of hepatic venous distension (84% sensitive and 90% specific). L-CHF dogs had higher CVC:Ao and lower CVC-CI compared to NC dogs (P = 0.016 and P = 0.043 in 2D, respectively) but increased CVC-CI compared to the R-CHF group (P < 0.001).

CONCLUSIONS

Ultrasonographic indices of CVC size and collapsibility differed between dogs with R-CHF compared to NC causes of cavitary effusions. Dogs with L-CHF have CVC measurements intermediate between R-CHF and NC dogs.

Transabdominal ultrasonographic measurement of caudal vena cava to aorta derived ratios in clinically healthy neonatal foals

Background

Ultrasonographic measurement of the vena cava and aorta (Ao) diameters and their ratios have been suggested to be a reliable way of quantifying hypovolemia.

Objective

To evaluate the feasibility and reliability of an ultrasonographic technique for measurement of Ao and caudal vena cava (CVC) and derived ratios using three different acoustic windows in a population of healthy neonatal foals. Correlation between Ao and CVC measurements and ratios and foals' age or bodyweight were also investigated.

Methods

In 14 healthy foals aged less than 7 days, the diameters of the Ao and of the CVC in long and short axis were measured by two observers from images obtained using three different ultrasonographic imaging planes (left dorsal, left ventral and right views). The Ao and CVC cross‐sectional area and the CVC/Ao diameter and area ratios were calculated. Image quality was subjectively assessed. Intraobserver and interobserver reliabilities for image quality scores and measurements were evaluated between the two observers. Simple linear regression models were used to identify correlations between the CVC/Ao measurements and ratios and the age and bodyweight of the foals.

Results

The left ventral view showed the highest reliability. A correlation between bodyweight and the short axis measurement of the CVC was found (R² = 0.385; p = 0.018). Age was positively correlated with the long axis of measurement of the CVC (R² = 0.426; p = 0.011) and CVC/Ao diameter ratio (R² = 0.625; p = 0.001).

Conclusions

The left ventral view allows the Ao and CVC cross sections to be easily visualized and measured in neonatal foals in right lateral recumbency.

Thirteen dogs and a cat with ultrasonographically detected gallbladder wall edema associated with cardiac disease

Background

Ultrasonographically detected gallbladder wall edema (GBWE) is a marker for anaphylaxis in dogs. Cardiac disease can cause GBWE with similar signs and should be included as a differential diagnosis to prevent interpretation errors.

Hypothesis/Objectives

Document GBWE associated with cardiac disease.

Animals

Fourteen client‐owned animals.

Methods

Prospective case series with abdominal focused assessment with abdominal sonography in trauma, triage and tracking (AFAST), and thoracic focused assessment with abdominal sonography in trauma, triage, and tracking (TFAST) performed at triage. Animals with GBWE and cardiac disease were enrolled. A board‐certified radiologist reviewed images to confirm cardiac disease, GBWE, and characterize the caudal vena cava (CVC) and hepatic veins.

Results

Thirteen dogs and 1 cat had GBWE associated with cardiac disease. Gallbladder findings included mural thickness ranging from 3 to 5 mm, mild to moderate sludge (n = 3), and mild to moderate luminal distension (n = 6). CVC and hepatic venous distension were found in 5/6. Cardiac diagnoses in dogs included 11 with pericardial effusion (PCE) and 1 each with dilated cardiomyopathy and right‐sided myocardial failure. Severity of PCE was rated as mild (n = 1), moderate (n = 6), or severe (n = 4). Seven of 11 had pericardiocentesis performed. Nine of 13 had ascites with 4 having abdominal fluid scores of 1 (n = 2), 2 (n = 2), 3 (n = 1), and 4 (n = 0). Lung ultrasound findings were as follows: dry lung (n = 6), B‐lines (n = 4), and nodules (n = 1). The cat had moderate PCE, ascites scored as 1, and severe right‐sided ventricular enlargement associated with a ventricular septal defect. Primary presenting complaints included acute weakness (n = 9), acute collapse (n = 5), gastrointestinal signs (n = 3), respiratory distress (n = 2), and need for cardiopulmonary resuscitation (n = 1).

Conclusions and Clinical Importance

Ultrasonographically detected GBWE was associated with PCE in this small cohort of cases.

Traumatic abdominal wall rupture in cats: Decision-making and recommended repair techniques

PRACTICAL RELEVANCE

Traumatic abdominal wall rupture is a potentially serious injury in cats. Feline and general practitioners should be up to date with the significance of these injuries and the procedures required to correct them.

CLINICAL CHALLENGES

It is essential that the surgeon understands the local anatomy and adheres to Halsted's principles in order that postoperative morbidity and mortality are kept to a minimum.

EQUIPMENT

Standard general surgical equipment is required together with the facilities to provide adequate pre-, intra- and postoperative patient care.

EVIDENCE BASE

The authors have drawn on evidence from the published literature, as well as their own clinical experience, in developing this review aimed all veterinarians who want to update their skills in managing feline abdominal wall trauma.

Usefulness of Chest Ultrasonography in Predicting Diagnosis in Non-emergency Small Animal Patients With Lung Parenchymal and Pleural Disease

Chest ultrasonography has become an indispensable tool for pulmonary specialists in human medicine, but its current use in dogs and cats is primarily for emergency. The diagnostic performances of various ultrasonographic features other than comet-tail artifacts are of limited information in veterinary literatures. Therefore, the aims of this retrospective study were to investigate ultrasonographic findings in feline and canine respiratory patients with lung parenchymal and pleural space diseases, and to assess how ultrasonographic features correspond to specific diagnoses. Sixty-five non-emergency cases with radiographically identified lung parenchymal and pleural space abnormalities were included. Medical records and ultrasound video clips were reviewed, and additional follow-up information was subsequently collected. Common findings such as comet-tail artifacts (87.7% of cases), consolidation (84.6%), and thickened/irregular pleura (69.2%) were not distinguishable for a specific diagnosis. The presence of nodular/mass-like lesion (OR = 212, p < 0.001) and consolidated lesion with heteroechogenicity (OR = 240, p < 0.001) was significantly associated with and strongly predictive of neoplasia after age, body weight and other sonographic findings were adjusted. The finding of nodular/mass-like lesion has the best diagnostic performance (AUC = 0.93) for neoplasia, with sensitivity of 91.7% and specificity of 93.6%. For predicting a diagnosis of pneumonia, although several sonographic features were found to be statistically associated with pneumonia, only a negative finding of nodular/mass-like lesion showed good diagnostic performance (AUC = 0.83, sensitivity 95.7%, specificity 71%). These findings demonstrate the value of chest ultrasonography in predicting diagnosis in non-emergency cases. The application of thoracic ultrasound in small animal respiratory patients as part of non-invasive assessment warrants further investigation.

The expected frequency and amount of free peritoneal fluid estimated using the abdominal FAST-applied abdominal fluid scores in healthy adult and juvenile dogs

OBJECTIVE

To estimate the frequency and amount of free peritoneal fluid in juvenile and adult dogs using the abdominal focused assessment with sonography for trauma (AFAST) abdominal fluid scoring system.

DESIGN

Prospective case series.

ANIMALS

Healthy, privately owned juvenile and adult dogs.

PROCEDURES

Dogs undergoing routine surgical sterilization were evaluated at induction with AFAST and assigned measurements and fluid scores. A surgeon scored the degree of peritoneal fluid found during ovariohysterectomy.

RESULTS

Ninety-two dogs were enrolled (46 juveniles and 46 adults). Ninety-three percent and 52% were AFAST positive for peritoneal fluid, respectively. The AFAST-positive view frequency for right lateral recumbency in juveniles was diaphragmatico-hepatic (DH) 100%, spleno-renal (SR) 20%, cysto-colic (CC) 40%, and hepato-renal (HR) 20% versus adults, DH 60%, SR 20%, CC 0%, and HR 0%, respectively. The AFAST-positive view frequency for left lateral recumbency was DH 93%, SR 44%, CC 24%, and HR 12% in juveniles, and DH 50%, SR 3%, CC 3%, and HR 10% in adults. Overall abdominal fluid scores (AFS) in juvenilles were 0 (n = 3), 1 (n = 14), 2 (n = 22), 3 (n = 6), and 4 (n = 1); and in adults, scores were 0 (n = 22), 1 (n = 18), 2 (n = 6), and 3 and 4 (n = 0). The AFS differed between adults and juveniles (P < 0.001). Most dogs had maximum fluid dimensions ≤3 × 3 mm and width of fluid stripes ≤3 mm. The AFS was positively correlated to fluid amount observed during ovariohysterectomy with fair agreement (kappa = 0.233, P = 0.012).

CONCLUSIONS AND CLINICAL RELEVANCE

This study establishes the frequency and amount of free peritoneal fluid in healthy juvenile and adult dogs during AFAST. Maximum fluid pocket dimensions of ≤3 × 3 mm and fluid stripe widths of ≤3 mm in dogs with AFS 1 and 2 may be normal. The DH view was most frequently positive.

Anaphylaxis-related hemoperitoneum in 11 dogs

OBJECTIVE

To describe the unique complication of hemoperitoneum associated with anaphylaxis.

DESIGN

Retrospective case series from September 2012 to August 2017.

SETTING

Two private emergency and specialty referral hospitals.

ANIMALS

Eleven client-owned dogs diagnosed with anaphylaxis and hemoperitoneum upon presentation or referral.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Inclusion criteria included clinical signs consistent with anaphylaxis (hypotension, tachycardia, vomiting, diarrhea, weakness, collapse, with or without the presence of dermal signs) due to witnessed or unwitnessed presumed bee sting, an elevated alanine aminotransferase (ALT), performance of abdominal FAST (AFAST) examination with an abdominal fluid score, the sonographic presence of gallbladder wall edema, and hemoperitoneum. All dogs (n=11) were managed medically without surgical intervention. 91% (n=10) of dogs survived to discharge.

CONCLUSIONS

Hemoperitoneum development can be seen with anaphylactic reactions, though the exact mechanism remains to be fully understood. Medical therapy is warranted and can be successful in these patients; surgery is not indicated to address hemoperitoneum.

Diagnosis of pulmonary contusions with point-of-care lung ultrasonography and thoracic radiography compared to thoracic computed tomography in dogs with motor vehicle trauma: 29 cases (2017-2018)

OBJECTIVE

To determine the accuracy of lung ultrasound (LUS) using the Veterinary Bedside Lung Ultrasound Examination (VetBLUE) protocol and 3-view thoracic radiographs (TXR) compared to thoracic computed tomography (TCT) for diagnosing the presence and quantification of pulmonary contusions (PC).

DESIGN

Prospective cohort study conducted from February 2017 to June 2018.

SETTING

Private emergency and referral center.

ANIMALS

Thirty-two dogs having sustained motor vehicle trauma were consecutively enrolled. Three dogs were excluded from statistical analysis. All dogs survived to hospital discharge.

INTERVENTIONS

Within 24 hours of sustaining trauma, dogs had LUS, TXR, and TCT performed. Using the VetBLUE protocol, LUS PC were scored according to the presence and number of B-lines and C-lines, indicating extravascular lung water. Thoracic radiographs and TCT were scored for PC in a similar topographical pattern to the VetBLUE protocol. Lung ultrasound and TXR were compared to "gold standard" TCT for the presence and quantification of PC.

MEASUREMENTS AND MAIN RESULTS

On TCT, 21 of 29 (72.4%) dogs were positive and 8 of 29 (27.6%) dogs were negative for PC. When LUS was compared to TCT, 19 of 21 dogs were positive for PC (90.5% sensitivity) and 7 of 8 dogs were negative (87.5% specificity) for PC. LUS PC score correlated strongly with TCT PC score (R = 0.8, P < 0.001). When TXR was compared to TCT, 14 of 21 dogs were positive for PC (66.7% sensitivity) and 7 of 8 dogs were negative (87.5% specificity) for PC. TXR PC score correlated strongly with TCT PC score (R = 0.74, P < 0.001).

CONCLUSIONS

In this population of dogs with motor vehicle trauma, LUS had high sensitivity for diagnosis of PC when compared to "gold standard" TCT. LUS provides reliable diagnosis of PC after trauma. More patients with PC were identified with LUS than with TXR, and additional studies are warranted to determine whether this increased sensitivity is statistically significant.

Cageside Ultrasonography in the Emergency Room and Intensive Care Unit

Global Focused Assessment with Sonography for Trauma (FAST) and point-of-care ultrasonography carry the potential to screen for and monitor conditions rather than traditional means without ultrasonography. Advantages include being point of care, cageside, low impact, rapid, safe, and radiation sparing, and requiring no shaving and/or minimal patient restraint. Moreover, information is real time for free fluid and soft tissue abnormalities of the abdomen, heart, and lung, which are missed or only suspected by physical examination, basic blood and urine testing, and radiography. A standardized approach with recording of patient data is integral to a successful Global FAST program.

Respiratory Emergencies

Respiratory distress is commonly seen in dogs and cats presenting to the emergency room. Rapid identification of respiratory difficulty with strategic stabilization and diagnostic efforts are warranted to maximize patient outcome. This article focuses on the relevant anatomy and physiology of the respiratory system and the clinical recognition, stabilization, and initial diagnostic planning for small animal patients that present for respiratory emergencies.

Simultaneous Torsion of a Uterine Horn and Spleen in a Pregnant Two-Year-Old Crossbreed Bitch: A Case Report

A pregnant 2-year-old mixed-breed dog was admitted with a 2-day history of lethargy, anorexia and painful abdominal distension. Clinical manifestations were unspecific and mainly suggested hypovolemic shock. Physical examination, ultrasonographic evaluation and radiographs confirmed mid-late pregnancy and evident signs of fetal death and peritoneal effusion. An exploratory laparotomy was immediately initiated which revealed torsion of the right gravid uterine horn over the left one and, simultaneously, the unexpected presence of splenic torsion and rupture, with a stretched omentum covering and exerting tension on the spleen's cranial pole. Histopathology revealed hemorrhagic infarction of the uterus and spleen. The animal recovered uneventfully and was later submitted to a preventive gastropexy.

Utilization of whole body computed tomography in polytrauma patients

OBJECTIVE

To determine the safety, feasibility, and utility of whole body computed tomography (WBCT) in polytrauma patients. A second objective was to describe the utilization of the VetMouse Trap for sedated WBCT in polytrauma patients.

METHODS

A prospective, observational study in a high-volume private practice. Any cat or dog weighing <20 kg that presented to the emergency department following a polytrauma was eligible. Patients were given analgesia and sedation prior to placement in the VetMouse Trap. A WBCT was then performed.

RESULTS

A total of 16 patients (8 dogs and 8 cats) met inclusion criteria. All patients presented with blunt trauma; 3 also had evidence of penetrating wounds. Five (31.25%) patients met inclusion criteria for WBCT based on their neurological evaluation. Five (31.5%) were non-ambulatory with suspicion of orthopedic injury, and 37.5% met additional criteria for WBCT. The most common areas of injury were head (43.7%), lungs (25%), and pelvis (25%). Four patients (25%) had evidence of cavitary effusion that was not seen on focused assessment using sonography for trauma (FAST) scan. No patient had any adverse events during the CT.

CONCLUSION

This study demonstrated successful WBCT imaging of the sedated small animal polytrauma patient with the VetMouse Trap.

The use of focused cardiac ultrasound to screen for occult heart disease in asymptomatic cats

Background

Focused cardiac ultrasound (FCU) helps detect occult heart disease in human patients.

Hypothesis

Focused cardiac ultrasound by a nonspecialist practitioner (NSP) will increase the detection of occult heart disease in asymptomatic cats compared with physical examination and ECG.

Animals

Three hundred forty‐three client‐owned cats: 54 excluded and 289 analyzed.

Methods

Multicenter prospective cohort study. Twenty‐two NSPs were trained to perform FCU. Cats without clinical signs of heart disease were recruited, and NSPs performed the following in sequential order: physical examination, ECG, FCU, and point‐of‐care N‐terminal pro‐B‐type natriuretic peptide assay (POC‐BNP). After each step, NSPs indicated yes, no, or equivocal as to whether they believed heart disease was present. The level of agreement between the NSP diagnosis and a blinded cardiologist's diagnosis after echocardiogram was evaluated using Cohen's kappa test.

Results

Cardiologist diagnoses included 148 normal cats, 102 with heart disease, and 39 equivocal ones. Agreement between NSP and cardiologist was slight after physical examination (kappa 0.253 [95% CI, 0.172‐0.340]), did not increase after ECG (0.256 [0.161‐0.345]; P = .96), increased after FCU (0.468 [0.376‐0.558]; P = .002), and the level of agreement was similar after POC‐BNP (0.498 [0.419‐0.580]; P = .67). In cats with mild, moderate, and marked occult heart disease, the proportion of cats having a NSP diagnosis of heart disease after FCU was 45.6%, 93.1%, and 100%, respectively.

Conclusions and Clinical Importance

Focused cardiac ultrasound performed by NSPs increased the detection of occult heart disease, especially in cats with moderate to marked disease. Focused cardiac ultrasound appears to be a feasible and useful tool to assist NSPs in the detection of heart disease in cats.

A feline orthologue of the human MYH7 c.5647G>A (p.(Glu1883Lys)) variant causes hypertrophic cardiomyopathy in a Domestic Shorthair cat

Hypertrophic cardiomyopathy (HCM) is the most common inherited human heart disease. The same disease has a high prevalence in cats, where it is also suspected to be inherited. More than 1500 variants in MYBPC3, MYH7 and other sarcomeric genes are associated with human HCM, while in cats, only two causative variants in MYBPC3 are currently known. Here, we describe an adult Domestic Shorthair cat with arterial thromboembolism and heart failure that was diagnosed with HCM on necropsy. Sequencing of the coding regions of MYBPC3 and MYH7 revealed 21 variants, of which the MYH7 c.5647G>A (p.(Glu1883Lys)) variant was further analysed, because its orthologous variant had already been reported in a human patient with HCM, but with limited causal evidence. This variant affects the highly conserved assembly competence domain, is predicted in silico to be damaging and was found only once in population databases. Recently, functional studies have confirmed its predicted damaging effect and a paralogous variant in MYH6 has been associated with cardiac disease in humans as well. This report of an orthologous variant in a cat with HCM and its absence in 200 additional cats provides further evidence for its disease-causing nature. As the first report of feline HCM caused by a variant in MYH7, this study also emphasises this gene as a candidate gene for future studies in cats and highlights the similarity between human and feline HCM.

Multiorgan dysfunction syndrome in feline sepsis: prevalence and prognostic implication

OBJECTIVES

The current study was designed to evaluate the prevalence and prognostic significance of multiorgan dysfunction syndrome (MODS) in cats with sepsis.

METHODS

Cats hospitalised in the intensive care unit of a veterinary university hospital with a diagnosis of sepsis were prospectively enrolled and divided according to disease severity and outcome (survivors; non-survivors). The feline acute patient physiological and laboratory evaluation (APPLE) scores were calculated upon admission, as previously described. Specific criteria to identify selected organ dysfunction (hepatic, renal, respiratory, cardiocirculatory, haemostatic) were adapted from the available human and veterinary literature, and evaluated at baseline and at the end of hospital stay. MODS was defined as the presence of at least two dysfunctional organs simultaneously. Non-parametric statistics were used for comparisons. Univariate and multivariate regression analyses to evaluate significant risk factors for death were carried out. Correlations between variables were assessed by the Spearman's rank correlation coefficient. Significance was set at P <0.05.

RESULTS

A total of 43 cats with heterogeneous sources of sepsis were included. MODS was identified in 25/43 cats upon admission and in 32/43 cats at the end of hospital stay. Regression analyses showed a significantly elevated odds ratio for mortality for the presence of MODS, renal and cardiovascular dysfunction upon admission, as well as for the number of dysfunctional organs. The latter was the only variable retained by the model from the multivariate binary logistic regression analysis. Significant correlations were documented between the number of dysfunctional organs and the APPLE scores.

CONCLUSIONS AND RELEVANCE

MODS is a frequent complication of feline sepsis, and is associated with worse outcomes. In particular, renal and cardiovascular dysfunction significantly increase the odds for death. Hence, systematic screening for organ dysfunction is advocated in cats with sepsis.

Pneumatosis Coli in a Dog

The objective of this report is to document a case of pneumatosis coli in an immunosuppressed dog successfully treated with supportive care that included hyperbaric oxygen. A 9 yr old, neutered male Maltese was presented for hematochezia of ∼36 h duration. The dog had a history of immune-mediated thrombocytopenia that was well managed with prednisone and azathioprine. Initial evaluation was unremarkable except for increased rectal temperature and hematochezia on digital rectal examination. Abdominal radiographs revealed diffuse gas within the colonic wall consistent with pneumatosis coli. Scant-free air was also appreciated in the peritoneal and retroperitoneal cavities. The dog was managed for 4 days in hospital with broad spectrum antibiotic, anthelminthic, and gastroprotectant therapy. He received one session of hyperbaric oxygen therapy while in hospital. Repeat abdominal radiographs after 72 hr of medical management showed improvement of the pneumatosis coli. After 4 days of hospitalization, he was discharged with resolution of clinical signs. Pneumatosis coli is rarely diagnosed in dogs but should be considered in cases with clinical signs of colorectal disease.

Management of severe stifle trauma: 1. Stifle luxation

PRACTICAL RELEVANCE

Traumatic stifle joint luxation is an uncommon but severe injury. There is usually rupture of several stabilising structures of the joint including the cruciate ligaments, collateral ligaments, joint capsule and menisci. Successful management of this condition requires good anatomical knowledge and repair or replacement of all damaged structures to achieve adequate joint reduction and stability. Better understanding of the treatment options available will aid clinical decision-making.

CLINICAL CHALLENGES

Due to the significant joint instability associated with these injuries, surgical repair is challenging. The use of a temporary transarticular pin to hold the stifle joint in anatomic reduction greatly aids ligament repair or replacement. Postoperative joint immobilisation has traditionally been recommended to protect the primary repair and aid periarticular fibrosis, but prolonged immobilisation can have deleterious long-term effects on the joint. Thus recommendations for the duration of postoperative immobilisation vary between 2 and 6 weeks. Also, due to their independent, outdoor lifestyle, affected cats may have been involved in a significant trauma with important concurrent injuries that need to be addressed prior to the orthopaedic repair.

EVIDENCE BASE

Published data is limited, with reports including only a small number of cats. The information and recommendations in this article have therefore been drawn from the available literature, the authors' experience and preliminary data from an ongoing multicentre retrospective study (unpublished).

AIMS

The aims of this article are to give the reader as thorough a summary as possible of the diagnosis, treatment, outcome and complications of traumatic stifle luxation.

Evaluation of tissue oxygen saturation in naturally occurring canine shock patients

OBJECTIVE

To measure tissue oxygen saturation (StO₂ ) in a population of dogs with naturally occurring shock and to evaluate the relationship of StO₂ with an established veterinary severity scoring system (Acute Patient Physiologic and Laboratory Evaluation) and patient survival.

DESIGN

Prospective observational study.

SETTING

University teaching hospital.

ANIMALS

Twenty-five adult dogs presenting in shock, as determined by the presence of hypotension, the calculated shock index, and hyperlactatemia.

INTERVENTIONS

StO₂ was measured prior to any therapeutic interventions. Blood samples were also collected for measurement of plasma lactate, complete blood count, and a serum biochemical profile. Abdominal and thoracic focused assessment with sonography was also performed.

MEASUREMENTS AND MAIN RESULTS

Dogs enrolled in this study had lower mean (±SD) StO₂ values (65.12 ± 17.7%) than previously reported in experimental models of canine hemorrhagic shock. There was a moderate correlation between lower StO₂ and increasing Acute Patient Physiologic and Laboratory Evaluation scores. A single StO₂ value, assessed prior to therapeutic intervention, was not a sensitive predictor of mortality in this population.

CONCLUSIONS

Dogs with naturally occurring shock have lower mean StO₂ values than those previously reported in dogs with experimentally induced shock. A lower initial StO₂ was associated with worse disease severity but was not a significant predictor of survival in this population.