ULTRASONOGRAPHIC EXAMINATION OF CERVICAL MASSES IN THE DOG AND CAT

Lymph Node Abscessation Secondary to Neoplasia in Two Dogs

A 5-year-old male neutered mixed breed dog and an 8-year-old female spayed golden retriever presented for cervical swelling which was later diagnosed as abscessation of the retropharyngeal lymph node with a malignant round cell tumor and carcinoma with multifocal squamous differentiation, respectively. In veterinary medicine, there is limited published information regarding abscessation of lymph nodes secondary to a neoplastic process. While more common in humans, there are only limited case reports available. Advanced imaging (computed tomography), cytology, surgical excision, and histopathology lead to the final diagnosis. Both dogs underwent surgical extirpation of the lymph nodes and adjuvant chemotherapy protocols. Six weeks postsurgical excision, dog one was euthanized due to quality-of-life concerns. The second dog successfully completed 18 treatments of radiation therapy and was still alive at 388 days postsurgical excision. At the time of manuscript submission, the second dog was doing well clinically.

Imaging features of retroperitoneal extra-adrenal paragangliomas in 10 dogs

Retroperitoneal paragangliomas are rare tumors of the neuroendocrine system. Only a few canine case reports are available with rare descriptions of their imaging features. The objectives of this multi‐center, retrospective case series study were to describe the diagnostic imaging features of confirmed retroperitoneal paragangliomas and specify their location. Medical records and imaging studies of 10 affected dogs with cytological or histopathologic results concordant with retroperitoneal paragangliomas were evaluated. Dogs had a median age of 9 years. Four of them had clinical signs and laboratory reports compatible with excessive production of catecholamines. Six ultrasound, four CT, four radiographic, and one MRI studies were included. The paragangliomas did not have a specific location along the aorta. They were of various sizes (median 33 mm, range: 9–85 mm of length). Masses had heterogeneous parenchyma in six of 10 dogs, regardless of the imaging modality. Strong contrast enhancement was found in all CT studies. Encircling of at least one vessel was detected in six of 10 masses, clear invasion of a vessel was identified in one of 10 masses. In five of 10 cases, the masses were initially misconstrued as lymph nodes by the on‐site radiologist. Retroperitoneal paragangliomas appear along the abdominal aorta, often presenting heterogeneous parenchyma, possibly affecting the local vasculature, and displaying strong contrast enhancement on CT. Clinical signs can be secondary to mass effects or excessive catecholamine production. Underdiagnosis and misdiagnosis of this tumor are suspected as they can be silent, of small size, or confused with other structures.

Ultrasonographic characterization of cervical lymph nodes in healthy dogs

Ultrasonography provides a minimally invasive method to evaluate the cervical lymph nodes in dogs as part of staging head and neck cancer; however, standardized cohesive reports of the normal lymph node size and appearance are lacking. The purpose of this prospective, descriptive, reference interval study was to characterize the ultrasonographic appearance of cervical lymph nodes in 27 clinically healthy dogs. The size, shape, echogenicity, and margination of the mandibular, medial retropharyngeal, and superficial cervical lymph nodes were evaluated and correlated with age, breed, sex, body weight, and stage of dental disease. The appearance of the lymph nodes was variable among the population. The majority were cigar or ovoid in shape with smooth margins. The echogenicity of the mandibular lymph nodes was predominantly hypoechoic whereas the medial retropharyngeal lymph nodes were predominantly isoechoic compared to the salivary glands. The superficial cervical lymph nodes were predominantly hyperechoic to the surrounding muscle bellies. Higher body weight and younger age were associated with increased size in the medial retropharyngeal and superficial cervical lymph nodes (P-values < .05). Sex and breed were not found to correlate with lymph node characteristics, and there was no trend noted in lymph node appearance associated with dental disease. These data establish normal parameters for the ultrasonographic size and appearance of cervical lymph nodes in dogs and can provide a reference of comparison for future canine cervical ultrasounds, which can be considered for routine staging procedures for head and neck cancer.

CLINICAL AND MAGNETIC RESONANCE IMAGING FEATURES OF INFLAMMATORY VERSUS NEOPLASTIC MEDIAL RETROPHARYNGEAL LYMPH NODE MASS LESIONS IN DOGS AND CATS

Medial retropharyngeal lymph node (MRLN) mass lesions are a common cause of cranial cervical masses in dogs and cats, and are predominantly due to metastatic neoplasia, primary neoplasia, or inflammatory lymphadenitis. The purpose of this retrospective cross-sectional study was to test the hypothesis that clinical and magnetic resonance imaging (MRI) characteristics for dogs and cats with MRLN mass lesions would differ for inflammatory vs. neoplastic etiologies. Dogs and cats with MRLN mass lesions that had undergone MRI and had a confirmed cytological or histopathological diagnosis were recruited from medical record archives. Clinical findings were recorded by one observer and MRI characteristics were recorded by two other observers who were unaware of clinical findings. A total of 31 patients were sampled, with 15 in the inflammatory lymphadenitis group and 16 in the neoplasia group. Patients with inflammatory lymphadenitis were more likely to be younger and present with lethargy (P = 0.001), pyrexia (P = 0.000), and neck pain (P = 0.006). Patients with inflammatory lymphadenitis were also more likely to have a leukocystosis (P = 0.02) and segmental neutrophilia (P = 0.001). Inflammatory masses were more likely to have moderate or marked MRI perinodal contrast enhancement (P = 0.021) and local muscle contrast enhancement (P = 0.03) whereas the neoplastic masses were more likely to have greater MRI width (P = 0.002) and height (P = 0.009). In conclusion, findings indicated that some clinical and MRI characteristics differed for dogs and cats with inflammatory vs. neoplastic medial retropharyngeal lymph node masses. Although histopathological or cytological diagnosis remains necessary for confirmation, these findings may help with the ranking of differential diagnoses of future cases.

Computed tomographic features of basihyoid ectopic thyroid carcinoma in dogs

Eight dogs with a firm, nonpainful swelling in the ventral laryngeal region and with a final diagnosis of ectopic thyroid carcinoma were investigated by Computed Tomography (CT) at six different institutions. Computed Tomography findings were reviewed, focusing on lesion volume, shape, margins, relationship with surrounding structures and adjacent vessels, attenuation characteristics, and presence of metastases. Ectopic thyroid carcinomas were seen as oval-to-bilobed masses centered on the basihyoid bone with associated bone lysis, highly vascularized capsules with central poorly contrast enhancing areas. In all cases there was laryngeal wall infiltration, in two dogs invasion of the laryngeal lumen and in one case invasion of the ventral muscular and subcutaneous plane. Metastases were found in retropharyngeal lymph nodes (three cases) and in the lung (two cases). Ectopic thyroid carcinoma should be considered in the differential diagnosis when a mass in the basihyoid region is present. Described CT features may be typical for ectopic thyroid neoplasia and could be used to help decide the therapeutic plan.

Sonographic characteristics of presumptively normal main axillary and superficial cervical lymph nodes in dogs

OBJECTIVE

To evaluate the B-mode and Doppler ultrasonographic appearance of presumptively normal main axillary and large superficial cervical lymph nodes (MALNs and SCLNs, respectively) in adult dogs.

ANIMALS

51 healthy adult dogs (data from 1 dog were not analyzed).

PROCEDURES

For each dog, weight, distance from the cranial aspect of the first sternebra to the caudal aspect of the left ischiatic tuberosity, and thoracic height and width at the level of the xiphoid process were recorded. Via B-mode and Doppler ultrasonography, echogenic characteristics, size in relation to body size and weight, and vascular supply of the MALNs and the SCLNs were evaluated (1 SCLN in 1 dog was not ultrasonographically visible).

RESULTS

Most MALNs were clearly margined, solitary, and ovoid; echopatterns were homogenous or cortical and hypo- to isoechoic, compared with surrounding soft tissues. Size measurements of MALNs correlated with dogs' body length, thoracic width and height, and body weight. Most SCLNs were clearly margined, fusiform, and hypoechoic (compared with surrounding soft tissues) with a cortical or homogenous echopattern. Size measurements of SCLNs correlated with dogs' body length, thoracic width and height, and body weight. In 50 of the 100 MALNs, an intranodal vascular supply was detected; in contrast, an intranodal vascular supply in SCLNs was detected infrequently.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that, in dogs, anatomically separate lymph nodes have different echogenic and vascular characteristics; body size (skeletal length, height, and width), along with body weight, were correlated with sizes of presumptively normal MALNs and SCLNs.

Sonographic assessment of vessel invasion by cervical masses in dogs

Tumor invasion of the vessels displays both therapeutic and prognostic implications and represents a challenge for head and neck surgeons. Although previous research has shown that ultrasound can detect such invasions, accurate sonographic parameters to do so have not yet been established. We sought to determine sonographic criteria which are able to characterize these invasions. A high-resolution transducer was used to perform ultrasound examinations of 15 patients selected from a group with inconclusive radiography and computed tomography diagnosis. We found that encasement of the vessel, tumor immobility or fixation in the vessel wall, and narrowing and/or deformity of the lumen were the best criteria. Indeed, when loss of hyperechoic interface of the vessel wall was used as a single criterion it generated false positive results. This study shows that a combination of parameters can be used to provide the best sensitivity and specificity values to produce conclusive diagnosis of vessel invasion by tumors in the cervical region.

Magnetic resonance and computed tomography imaging of a carotid body tumor in a dog

A 5-year-old castrated male Labrador Retriever was presented to a referring veterinarian for a swelling in the neck region. Based on the results of histopathology, a carotid body tumor, was diagnosed. The dog was referred to a medical imaging unit for further staging and follow up. This report describes the magnetic resonance (MR) and computed tomographic (CT) appearance of a carotid body tumor.

Nuclear Imaging and Radiation Therapy in Canine and Feline Thyroid Disease

The indications, techniques, and expectations for radionuclide diagnostic studies on canine and feline thyroid glands are presented. In addition, the considerations surrounding radioiodine or external beam radiotherapy for benign and malignant thyroid disease are reviewed. The intent of this article is to familiarize primary care veterinarians with the utility of and outcome of the ionizing radiation-based diagnostic and therapeutic techniques for assessing and treating canine and feline thyroid disease.

Pre- and post-treatment ultrasonography in hypothyroid dogs

Primary hypothyroidism is a frequent endocrine disorder in the adult dog. However, false-positive diagnoses are common because of the relatively low accuracy of most commonly used biochemical tests. The purpose of this study was to describe the ultrasonographic features of the thyroid gland in hypothyroid dogs, to calculate the diagnostic sensitivity of gray-scale ultrasound using a combination of clinical symptoms and biochemical thyroid tests as gold standard, and to investigate the evolution of the ultrasonographic features after treatment of hypothyroidism. Eighteen dogs were studied prospectively. All dogs underwent an ultrasound examination at first presentation and 13 underwent one or two additional ultrasound examinations over time. At first presentation, a sensitivity of 76.5% (95% CI [50.0-93.0% 1) for decreased echogenicity, 64.7% (95% CI [38.385.8% 1) for inhomogeneity, 70.6% (95% CI 144.0-89.7%]) for irregular capsule delineation, 64.7% (95% CI [38.3-85.8%]) for abnormal lobe shape and 47.1% (95% CI 123.0-72.2%]) for decreased relative thyroid volume was obtained. Combining these five parameters together resulted in an overall sensitivity of 94.1% (95% CI [71.3-99.9%]) for gray-scale ultrasound in the detection of acquired hypothyroidism at first presentation. A continuous decrease of thyroid volume was seen over time after treatment, while the other investigated parameters did not change significantly during the follow-up period. None of the thyroid glands were considered normal at the last presentation. Grayscale ultrasound is a sensitive and quick test for the diagnosis of primary hypothyroidism in dogs.

INTRA- AND INTEROBSERVER VARIABILITY OF ULTRASONOGRAPHIC MEASUREMENTS OF THE THYROID GLAND IN HEALTHY BEAGLES

The repeatability of ultrasonographic measurements of the canine thyroid gland was evaluated. The variability of three different parameters (the maximal length, width, and height) within observer, between observer and between dogs was assessed based on three different measurements made by each of three observers infive healthy beagle dogs. From the three parameters, the volume of the gland was estimated using a formula of a rotation ellipse. The height and the volume had the lowest intra- and interobserver variability, while measurements of the length had the biggest intra- and interobserver variability. The mean values, with their 90% confidence interval were: height = 0.53cm [0.33-0.73], length = 2.45cm [2.04-2.85], width = 0.62cm [0.46- 0.78], volume = 0.38 cm3 [0.20-0.55].

Ultrasonographic imaging of the vagosympathetic trunk in the dog

The purpose of this study was to evaluate the applicability of ultrasonographic imaging of the vagosympathetic trunk in the dog. Cervical ultrasound was performed in 30 healthy dogs. In all 30 dogs the vagosympathetic trunk was detected as a hypoechoic structure in the carotid sheath, adhering the dorsomedial surface of the common carotid artery. The echotexture of the nerve was heterogeneous with anechoic areas separated by hypoechoic bands. A scanner equipped with a 5 to 8 MHz linear array probe was used for imaging and measurements. The diameter of the vagosympathetic trunk ranged from 0.59 to 2.48 mm varying in correlation to the body weight. In summary, ultrasonography is a helpful noninvasive method to image and evaluate the cervical vagosympathetic trunk in the dog.

Cervical neoplasia originating from the vagus nerve in a dog

An eight-year-old intact male Bernese mountain dog was referred with a history of chronic vomiting, coughing and signs of respiratory distress. Other historical findings included lethargy, weight loss and choking. On presentation, clinical findings were Horner's syndrome, ipsilateral laryngeal hemiplegia, coughing, gagging, respiratory distress and vomiting. Lateral cervical radiographs showed ill-defined mineralisation in the soft tissue ventral to the third cervical vertebra, while ultrasonography of the neck revealed a well marginated heterogeneous mass with focal hyperechogenic lesions and acoustic shadowing. Results of an ultrasound-guided fine needle aspirate suggested neoplasia. At necropsy, a large tumour was detected in the ventral cervical region, originating from the right vagosympathetic trunk. In view of the infiltrating pattern, the cellular pleomorphism and the numerous mitoses on histopathological examination, the tumour was classified as a malignant peripheral nerve sheath tumour.

Ultrasonography of the thyroid and parathyroid glands

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

Ultrasonographic appearance of normal superficial cervical and subiliac lymph nodes in cattle

The superficial cervical and the subiliac lymph nodes of 18 healthy, non-pregnant Simmental cows with a mean (sd) age of 5-6 (1.6) years were examined ultrasonographically in transverse and longitudinal planes with a real-time B-mode unit equipped with a 7.5 MHz linear-transducer. The position, demarcation and echogenicity of the lymph nodes were examined, and the craniocaudal and lateromedial diameters of each lymph node were measured three times within a period of six weeks. The pole to pole length of the lymph nodes was determined with a tape measure on the surface of the skin because the whole length could not be imaged in a single scan field. The gross anatomical and histological results showed that the lymph nodes were normal. Ultrasonographically, they were well demarcated from the adjoining muscular and subcutaneous tissue. Their internal structure was characterised by an anechoic to hypoechoic cortical zone corresponding to the lymphoid tissue, and an echogenic medullary zone, where the lymphatic sinuses converge towards the hilus and produce numerous acoustic interfaces. In all the lymph nodes, the hilar area had an echoic to hyperechoic appearance. The mean (sd) pole to pole length of the superficial cervical lymph nodes was 15.5 (3.2) cm and of the subiliac lymph nodes 13.5 (2.4) cm. The mean craniocaudal and lateromedial diameters of the superficial cervical lymph nodes were 2.8 (0.3) cm and 1.6 (0.3) cm, and those of the subiliac lymph nodes were 2.4 (0.4) cm and 1.1 (0.3) cm. The ultrasonographic morphology of these normal lymph nodes was consistent and provides basic reference data for the investigation of lymphadenopathies in cattle.