Infrared thermography: a rapid and accurate technique to detect feline aortic thromboembolism

Feline Aortic Thromboembolism: Recent advances and future prospects

PRACTICAL RELEVANCE

Feline aortic thromboembolism (FATE) is commonly encountered in clinical medicine, especially in emergency situations. This often devastating syndrome usually develops secondarily to severe heart disease, and has short- and long-term consequences.

CLINICAL FEATURES

The clinical presentation of FATE is consistent with peripheral ischemic neuropathy, usually in both pelvic limbs. Diagnosis is relatively straightforward, but can be assisted with Doppler ultrasound, point-of-care ultrasound or infrared thermal imaging.

RECENT ADVANCES AND FUTURE PROSPECTS

Interpretation of survival rates in cats with FATE has been hampered by historically high admission euthanasia, but recent studies suggest a survival rate with supportive care of 30-40%. Moreover, with advances in post-FATE thromboprophylaxis, median survival times of over 1 year are being achieved. Future directions include use of thrombolytic agents and treatment of common FATE sequelae such as acute kidney injury and reperfusion injury.

OUTLINE

This article, aimed at small animal veterinarians, including emergency practitioners, reviews key aspects of the clinical presentation, diagnosis and treatment options for FATE, with a view to guiding client and veterinarian decision-making. Three case studies are included to illustrate the practical application of information presented in the review.

EVIDENCE BASE

There are limited prospective studies on FATE, although the recent literature reflects a resurgence in clinical research interest in the past few years. Advances in FATE treatment will benefit many cats and it is important that research efforts continue to identify appropriate treatment modalities.

Application of Infrared Thermography in the Rehabilitation of Patients in Veterinary Medicine

Infrared Thermography (IRT) has become an assistance tool in medicine and is used to noninvasively evaluate heat elimination during and after inflammatory processes or during the recovery period. However, its application in veterinary patients undergoing physiotherapy is a field that requires deep research. This review aims to analyze the application of IRT in the monitoring of animal physiotherapy, using the thermal changes that are present in patients undergoing gait or lameness issues (e.g., inflammation, pain, increased local temperature) as a neurobiological basis. Rehabilitation techniques such as acupuncture, physical therapies, thermotherapy, photo-biomodulation, and electrostimulation have been reported to have an anti-inflammatory effect that decreases the amount of local heat production, which is heat that can be recorded with IRT. Therefore, IRT could be used as a complementary tool to evaluate the effectiveness of the therapy, and it is suggested that further studies evaluate the accuracy, sensibility, and sensitivity of IRT.

Thermal Imaging as a Method to Indirectly Assess Peripheral Vascular Integrity and Tissue Viability in Veterinary Medicine: Animal Models and Clinical Applications

Infrared thermography (IRT) is a technique that indirectly assesses peripheral blood circulation and its resulting amount of radiated heat. Due to these properties, thermal imaging is currently applied in human medicine to noninvasively evaluate peripheral vascular disorders such as thrombosis, thromboembolisms, and other ischemic processes. Moreover, tissular damage (e.g., burn injuries) also causes microvasculature compromise. Therefore, thermography can be applied to determine the degree of damage according to the viability of tissues and blood vessels, and it can also be used as a technique to monitor skin transplant procedures such as grafting and free flaps. The present review aims to summarize and analyze the application of IRT in veterinary medicine as a method to indirectly assess peripheral vascular integrity and its relation to the amount of radiated heat and as a diagnostic technique for tissue viability, degree of damage, and wound care.

Applicability of thermography for cancer diagnosis in small animals

Medical thermography is an imaging test used to monitor skin surface temperature. Although it is not a recent technique, significant advances have been made since the 2000s with the equipment modernization, leading to its popularization. In cancer diagnosis, the application of thermography is supported by the difference in thermal distribution between neoplastic processes and adjacent healthy tissue. The mechanisms involved in heat production by cancer cells include neoangiogenesis, increased metabolic rate, vasodilation, and the release of nitric oxide and pro-inflammatory substances. Currently, thermography has been widely studied in humans as a screening tool for skin and breast cancer, with positive results. In veterinary medicine, the technique has shown promise and has been described for skin and soft tissue tumors in felines, mammary gland tumors, osteosarcoma, mast cell tumors, and perianal tumors in dogs. This review discusses the fundamentals of the technique, monitoring conditions, and the role of thermography as a complementary diagnostic tool for cancer in veterinary medicine, as well as future perspectives for improvement.

Ultrasonographic findings of feline aortic thromboembolism

OBJECTIVES

The aim of the study was to describe the ultrasonographic characteristics of feline aortic thromboembolism (ATE) and determine potential associations between ultrasonographic findings and prognosis.

METHODS

Data were retrospectively collected from the medical records (2013-2021) of cats that were diagnosed ultrasonographically with ATE based on the presence of a thromboembolus (TE) in the distal aorta beginning after the departure of the renal arteries.

RESULTS

Twenty-nine cats were included in this study. The most frequent location for an ATE was at the aortic trifurcation. The median length of TEs was 9 mm (range 3.5-42.9). TEs appeared homogeneous and isoechoic to surrounding tissues in all cases. No correlation was found between the appearance of the TE and the duration of clinical signs. The obstruction of blood flow in the distal aorta at the aortic trifurcation was complete in 66% of cases and incomplete in 34% of cases. The survival rate was significantly lower when the obstruction was complete (11%, 95% confidence interval [CI] 2-34) compared with incomplete (70%, 95% CI 35-92). The arterial wall characteristics were as follows: smooth and thin (62%), and hyperechoic (38%).

CONCLUSIONS AND RELEVANCE

Increased vascular obstruction of TEs was associated with a lower survival rate.

Bilateral lysis of aortic saddle thrombus with early tissue plasminogen activator (BLASTT): a prospective, randomized, placebo-controlled study in feline acute aortic thromboembolism

OBJECTIVES

The aim of this study was to investigate the impact of tissue plasminogen activator (TPA) on the treatment of feline aortic thromboembolism (FATE).

METHODS

Cats diagnosed with FATE involving ⩾2 limbs were enrolled in a prospective, multicenter, double-blinded, randomized, placebo-controlled study within 6 h of an event. Diagnosis was made by clinical findings and one confirmatory criterion. Cats received placebo or TPA (1 mg/kg/h with the first 10% by bolus). All cats received pain control and thromboprophylaxis. The primary outcome was a change from baseline in a published limb score at 48 h. Secondary outcomes included 48 h survival, survival to discharge and complication proportions. Statistical analyses included pattern-mixture models, logistic regression and Fisher's exact, Student's t- and Mann-Whitney-Wilcoxon tests.

RESULTS

Based on a power analysis, 40 cats were enrolled; however, only 20 survived to 48 h (TPA, n = 12; placebo, n = 8 [P = 0.34]). There was a statistically significant improvement in limb scores compared with baseline for both groups (P <0.001). Limb score at 48 h was 1 point lower (better) in the TPA group (P = 0.19). Thrombolysis had no statistically significant effect on 48 h survival (P = 0.22). Lower affected limb lactate was associated with better 48 h survival (odds ratio 1.53, 95% confidence interval 1.08-2.17; P = 0.02). The survival to discharge rates were 45% (TPA) and 30% (placebo; P = 0.51). Complications in the TPA and placebo groups included acute kidney injury (22% and 19%, respectively; P = 1.00) and/or reperfusion injuries (33% and 19%, respectively; P = 0.45).

CONCLUSIONS AND RELEVANCE

Survival and complication rates of acute FATE were not different with or without thrombolysis. High in-hospital mortality decreased the statistical power to detect a statistically significant difference between treatments with regard to our primary outcome.

Short Communication: Use of Infrared Thermometers for Cutaneous Temperature Recording: Agreement with the Rectal Temperature in Felis catus

Simple Summary

The recording of body temperature by rectal temperature assessments is a stressful procedure for cats. For this purpose, alternative methods for using rectal digital thermometers to monitor body temperature were investigated. Skin temperature was recorded in 20 cats, in 5 different body regions, and compared with the rectal temperature. The obtained data indicated that the cutaneous temperature recorded by the infrared thermometers was not in agreement with the data recorded by the digital thermometer in the rectum.

Abstract

In veterinary medicine, the gold standard for assessing body temperature is rectal temperature assessment. Considering that this procedure is stressful for many species, in particular for cats, it could be clinically important to consider an alternative approach for the monitoring of core body temperature. The aim of this study was to test if cutaneous temperature measurements by means of different infrared thermometers are in agreement with the most commonly used method for body temperature measurement in cats. The cutaneous temperature was recorded in the jugular, shoulder, rib, flank, and inner thigh, using three different non-contact infrared thermometers (IR1, IR2, and IR3) in 20 cats. The cutaneous temperature was then compared to the rectal temperature, recorded by means of a digital thermometer. The obtained data indicated that the cutaneous temperature recorded by the infrared thermometers was not in agreement with the data recorded by the digital thermometer in the rectum. In cats, the use of non-contact infrared thermometers gave no reproducible or constant data to justify their application for the recording of body temperature instead of rectal temperature recording. In addition, the infrared temperature measurement devices generated results that were not in good agreement among themselves, providing a novel result of clinical importance.

Thermal and Circulatory Changes in Diverse Body Regions in Dogs and Cats Evaluated by Infrared Thermography

Infrared thermography (IRT) has been proposed as a method for clinical research to detect local inflammatory processes, wounds, neoplasms, pain, and neuropathies. However, evidence of the effectiveness of the thermal windows used in dogs and cats is discrepant. This review aims to analyze and discuss the usefulness of IRT in diverse body regions in household animals (pets) related to recent scientific evidence on the use of the facial, body, and appendicular thermal windows. IRT is a diagnostic method that evaluates thermal and circulatory changes under different clinical conditions. For the face, structures such as the lacrimal caruncle, ocular area, and pinna are sensitive to assessments of stress degrees, but only the ocular window has been validated in felines. The usefulness of body and appendicular thermal windows has not been conclusively demonstrated because evidence indicates that biological and environmental factors may strongly influence thermal responses in those body regions. The above has led to proposals to evaluate specific muscles that receive high circulation, such as the bicepsfemoris and gracilis. The neck area, perivulvar, and perianal regions may also prove to be useful thermal windows, but their degree of statistical reliability must be established. In conclusion, IRT is a non-invasive technique that can be used to diagnose inflammatory and neoplastic conditions early. However, additional research is required to establish the sensitivity and specificity of these thermal windows and validate their clinical use in dogs and cats.

The Feline Cardiomyopathies: 1. General concepts

PRACTICAL RELEVANCE

The feline cardiomyopathies are the most prevalent type of heart disease in adult domestic cats. Several forms have been identified (see Parts 2 and 3), with hypertrophic cardiomyopathy (HCM) being the most common. Clinically the cardiomyopathies are often indistinguishable. Cats with subclinical cardiomyopathy may or may not have characteristic physical examination findings (eg, heart murmur, gallop sound), or radiographic cardiomegaly. Cats with severe disease may develop signs of heart failure (eg, dyspnea, tachypnea) or systemic arterial thromboembolism (ATE; eg, pain and paralysis). Sudden death is possible. Treatment usually does not alter the progression from subclinical to clinical disease and often the treatment approach, once clinical signs are apparent, is the same regardless of the type of cardiomyopathy. However, differentiating cardiomyopathy from normal variation may be important prognostically.

PATIENT GROUP

Domestic cats of any age from 3 months upward, of either sex and of any breed, can be affected. Mixed-breed cats are most commonly affected but certain breeds are disproportionately prone to developing HCM.

DIAGNOSTICS

Subclinical feline cardiomyopathies may be suspected based on physical examination findings, thoracic radiographs and cardiac biomarker results but often the disease is clinically silent. The definitive clinical confirmatory test is echocardiography. Left heart failure (pulmonary edema and/or pleural effusion) is most commonly diagnosed radiographically, but point-of-care ultrasound and amino terminal pro-B-type natriuretic peptide (NT-proBNP) biomarker testing can also be useful, especially when the stress of taking radiographs is best avoided.

KEY FINDINGS

Knowledge of pathophysiological mechanisms helps the practitioner identify the feline cardiomyopathies and understand how these diseases progress and how they manifest clinically (heart failure, ATE). Existing diagnostic tests have strengths and limitations, and being aware of these can help a practitioner deliver optimal recommendations regarding referral.

CONCLUSIONS

Several types of feline cardiomyopathies exist in both subclinical (mild to severe disease) and clinical (severe disease) phases. Heart failure and ATE are the most common clinical manifestations of severe cardiomyopathy and are therapeutic targets regardless of the type of cardiomyopathy. The long-term prognosis is often guarded or poor once overt clinical manifestations are present.

AREAS OF UNCERTAINTY

Some cats with presumed cardiomyopathy do not have echocardiographic features that fit the classic cardiomyopathies (cardiomyopathy - nonspecific phenotype). Although no definitive treatment is usually available, understanding how cardiomyopathies evolve remains worthy of investigation.

Thermographic assessment of skin and soft tissue tumors in cats

OBJECTIVES

This study set out to determine the average temperature of skin and soft tissue tumors in cats using infrared thermography and to investigate correlations between thermographic findings and tumor type. Correlations between thermographic findings, histologic subtype and tumor grade were also investigated in cases of feline injection site sarcoma (FISS).

METHODS

Thermographic images of normal skin and skin overlying neoplastic lesions were prospectively obtained. Following thermographic assessment, tumors were resected and submitted to histopathologic and immunohistochemical analysis. Mean temperatures detected in tumoral areas were compared between different tumor types and between FISSs of different histologic subtypes and grades.

RESULTS

Thermograms obtained from 11 healthy cats and 31 cats presenting with skin and soft tissue tumors (eight benign and 23 malignant tumors, including 21 FISSs) were evaluated in this study. Thermal behavior varied widely in normal skin, as well as in skin overlying neoplastic lesions. Mean temperatures were significantly higher in malignant compared with benign tumors (35.4 ± 1.8ºC and 34.5 ± 1.7ºC respectively; P = 0.01), with a temperature above 34.7ºC being associated with malignancy (sensitivity 76%, specificity 80%; P = 0.01). Temperatures detected in FISS did not differ significantly according to histologic subtype (P = 0.91) or tumor grade (P = 0.46), or between primary and recurring tumors (P = 0.25).

CONCLUSIONS AND RELEVANCE

Infrared thermography proved to be a sensitive and effective method for detection of temperature differences between malignant and benign skin and soft tissue tumors in cats. Thermographic assessment may contribute to diagnosis and prognostic estimation in feline oncologic patients.

Pulmonary Sarcomatoid Carcinoma Associated with Arterial Thromboembolism in a Cat

A 14-year-old, neutered male domestic shorthair cat presented for acute monoparesis with physical exam findings and biochemical data supportive of a distal arterial thromboembolism. Thoracic radiographs revealed an alveolar pattern in the right middle lung lobe and multifocal nodules in other lung lobes. A pulmonary mass was found on necropsy, which was composed of both carcinomatous and sarcomatous components, confirmed with cytokeratin and vimentin immunohistochemistry. Using the World Health Organization classification scheme for mixed pulmonary tumors, this tumor would be characterized as a pleomorphic squamous cell carcinoma under the umbrella term of pulmonary sarcomatoid carcinoma. The World Health Organization classification of mixed pulmonary tumors and its application to previously reported mixed pulmonary tumors in companion animals is discussed. This is the first reported case of this tumor type in a cat, as well as the first report of this tumor type associated with an arterial thromboembolism in any veterinary species.

Use of infrared thermography to detect early alterations of peripheral perfusion: evaluation in a porcine model

This study aimed to evaluate the variations of infrared thermography according to rapid hemodynamic changes, by measuring the peripheral skin temperature in a porcine model. Eight healthy piglets were anesthetized and exposed to different levels of arterial pressure. Thermography was performed on the left forelimb to measure carpus and elbow skin temperature and their associated gradient with the core temperature. Changes in skin temperature in response to variations of blood pressure were observed. A negative correlation between arterial pressure and temperature gradients between peripheral and core temperature and a negative correlation between cardiac index and these temperature gradients were observed. Thermography may serve as a tool to detect early changes in peripheral perfusion.

Evaluation of Thermographic Imaging in Canine Hindlimb Muscles After 6 Min of Walking-A Pilot Study

Objective: To evaluate changes in superficial temperature of hindlimb muscles before and after a 6-min walk in healthy dogs.

Methods: Two infrared thermographic images were captured of the proximal and distal hindlimbs of 11 healthy dogs before and after a 6-min walk. Orthopedic exam and objective gait analysis confirmed the healthy status of study subjects. Superficial temperatures of the gastrocnemius, biceps femoris, and gracilis were assessed. Analysis of images was performed using 2 different methods of region of interest (ROI) selection. ROI were selected first using one point (single pixel) in the muscle and then separately by selecting a line (LN) corresponding to many points of each muscle belly from which an average was taken. P < 0.05 was considered significant.

Results: There was no significant change in temperature using point ROI before and after 6 min of walking of the gastrocnemius, gracilis, and biceps femoris muscles (p = 0.273, p = 0.349, p = 0.351, respectively). Using linear ROI, both biceps femoris and gracilis muscles exhibited significant increases in temperature (p < 0.0001, p = 0.032, respectively). There was no significant increase in temperature of gastrocnemius muscle for both point and linear ROI selection (p = 0.273, p = 0.448, respectively). The right biceps femoris temperatures were higher compared to left biceps femoris using the linear ROI before and after walks (p < 0.0001). The overall (left and right limbs pooled) standard deviation of point selected values were greater than LN selected values of the biceps femoris (1.35 and 1.11) and gastrocnemius (1.51 and 1.23). In contrast, standard deviation for the gracilis measurements were decreased using point selection vs. LN selection (1.09 and 1.3).

Conclusions: The biceps femoris and gracilis muscles demonstrated significant increases in surface temperature after 6 min of walking using the linear method of ROI. Measurement of numerous points along the entire length of the biceps femoris and gastrocnemius muscles may provide a more accurate assessment of the increased vascularity within the tissues resulting from work compared to single point selection.

Clinical Significance: Prior activity and ROI selection method should be considered when interpreting thermography results.