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Matson H, Llewellyn EA. Retrospective evaluation of the utility of shock index to determine the presence of congestive heart failure in dogs with myxomatous mitral valve disease (2019-2021): 98 cases. J Vet Emerg Crit Care (San Antonio) 2024; 34:231-237. [PMID: 38809224 DOI: 10.1111/vec.13379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/22/2023] [Accepted: 02/07/2023] [Indexed: 05/30/2024]
Abstract
OBJECTIVES To calculate the shock index (SI) in dogs with myxomatous mitral valve disease (MMVD) and to evaluate its use to predict the presence of congestive heart failure (CHF). DESIGN Retrospective study. SETTING Small animal university veterinary teaching hospital. ANIMALS Ninety-eight dogs with MMVD and 20 healthy dogs as part of a control group. INTERVENTIONS Heart rate (HR) and systolic blood pressure (SBP) were recorded, and SI was calculated by dividing HR by SBP for each dog. MEASUREMENTS AND MAIN RESULTS The mean (SD) HR, SBP, and SI were 123/min (32.6), 147 mm Hg (21.5), and 0.86 (0.3), respectively, for dogs with MMVD and 98/min (20.9), 145 mm Hg (18.7), and 0.68 (0.13), respectively, for control dogs. Dogs with MMVD had a significantly higher HR compared with control dogs (P < 0.01), and an elevation in HR was seen as the severity of MMVD increased. Dogs in stage B2 and C/D MMVD had a significantly higher SI value compared with control dogs (P = 0.04 and P < 0.01, respectively). SI was significantly higher in dogs in stage C/D MMVD compared with dogs in stage B2 MMVD (P < 0.01). Ten of 98 (10%) dogs had an arrhythmia. HR, SBP, and SI were not significantly different between dogs with and without arrhythmias (P = 0.13, P = 0.57, and P = 0.07, respectively), but significantly more dogs with CHF had an arrhythmia (P = 0.01). SI (area under the curve [AUC]: 0.98) and HR (AUC: 0.95) were excellent indicators for the presence of CHF. An optimal SI cutoff value ≥1.1 had 92% sensitivity and 95% specificity for predicting the presence of CHF, and an optimal HR cutoff value of ≥157/min had 92% sensitivity and 93% specificity for the prediction of CHF. CONCLUSIONS When there are compatible clinical signs, SI values ≥1.1 may suggest the presence of CHF in dogs with MMVD.
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Affiliation(s)
- Hannah Matson
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, UK
| | - Efa A Llewellyn
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, UK
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Rigot M, Boysen SR, Masseau I, Letendre JA. Evaluation of B-lines with 2 point-of-care lung ultrasound protocols in cats with radiographically normal lungs. J Vet Emerg Crit Care (San Antonio) 2024; 34:143-152. [PMID: 38407524 DOI: 10.1111/vec.13360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 09/20/2022] [Accepted: 10/18/2022] [Indexed: 02/27/2024]
Abstract
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.
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Affiliation(s)
- Manon Rigot
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Søren R Boysen
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Isabelle Masseau
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
| | - Jo-Annie Letendre
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
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3
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Oricco S, Medico D, Tommasi I, Bini RM, Rabozzi R. Lung ultrasound score in dogs and cats: A reliability study. J Vet Intern Med 2024; 38:336-345. [PMID: 38009739 PMCID: PMC10800220 DOI: 10.1111/jvim.16956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Lung ultrasound (LUS) is a noninvasive tool for examining respiratory distress patients. The lung ultrasound score (LUSS) can be used to quantify and monitor lung aeration loss with good reliability. HYPOTHESIS/OBJECTIVES Assess the reliability of a new LUSS among raters with different levels of experience and determine how well the same raters agree on identifying patterns of LUS abnormalities. ANIMALS Forty LUS examinations of dogs and cats and 320 videos were reviewed from a digital database. METHODS Retrospective reliability study with post hoc analysis. Protocolized LUS were randomly selected; intrarater and interrater reliability of the LUSS and pattern recognition agreement among 4 raters with different levels of experience in LUS were tested. RESULTS The intrarater intraclass correlation coefficient (ICC) single measurement, absolute agreement, and 2-way mixed effects model was 0.967 for the high-experience rater (H-Exp), 0.963 and 0.952 for the medium-experience raters (M-Exp-1; M-Exp-2), and 0.950 for the low-experience rater (L-Exp). The interrater ICC average measurement, absolute agreement, and 2-way random effects model among the observers was 0.980. The Fleiss' kappa (k) values showed almost perfect agreement (k = 1) among raters in identifying pleural effusion and translobar tissue-like pattern, strong agreement for A-lines (k = 0.881) and B-lines (k = 0.806), moderate agreement (k = 0.693) for subpleural loss of aeration, and weak agreement (k = 0.474) for irregularities of the pleural line. CONCLUSIONS AND CLINICAL IMPORTANCE Our results indicate excellent intra- and interrater reliability for LUS scoring and pattern identification, providing a foundation for the use of the LUSS in emergency medicine and intensive care.
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Affiliation(s)
- Stefano Oricco
- Centro Veterinario ImperieseImperiaItaly
- Department of Veterinary SciencesUniversity of ParmaParmaItaly
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Ward JL, DeFrancesco TC. The Role of Point-of-Care Ultrasound in Managing Cardiac Emergencies. Vet Clin North Am Small Anim Pract 2023; 53:1429-1443. [PMID: 37423842 DOI: 10.1016/j.cvsm.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
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.
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Affiliation(s)
- Jessica L Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1809 South Riverside Drive, Ames, IA 50010, USA.
| | - Teresa C DeFrancesco
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1052 William Moore Drive, Raleigh, NC 27607, USA
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Koster L, Vogel J, Springer CM, Hecht S. Radiographic lung congestion scores in dogs with acute congestive heart failure caused by myxomatous mitral valve disease. J Vet Intern Med 2023; 37:1983-1991. [PMID: 37694988 PMCID: PMC10658542 DOI: 10.1111/jvim.16850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/23/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND In humans, lung congestion scores are predictive of recurrence of acute congestive heart failure (CHF) and are superior to cardiac biomarkers in predicting survival. OBJECTIVES The primary aim of this retrospective study was to determine if a modified lung congestion score (LCS) in dogs diagnosed with acute CHF because of myxomatous mitral valve disease was associated with time until recurrence or death. ANIMALS Complete medical records were available for a total of 94 dogs between 2010 and 2019, but only 35 dogs fulfilled the criteria for inclusion. METHODS This retrospective study used descriptive statistics to describe the cumulative and corrected LCS. Correlations were used to examine the association of the corrected LCS and time until recurrence or death, selected echocardiographic variables, and timing of furosemide administration. RESULTS The mean LCS was 8.4 (SD 3.3) and corrected LCS was 0.48 (SD 0.19). The pattern was predominantly symmetric (40% of dogs) and focal (caudal) but more commonly right-sided when asymmetric (40% vs 20%). The median number of days after initial diagnosis of acute CHF to readmission and death was 150 days (range 4-572), and 266 days (range 5-965), respectively. No significant association between the dog's corrected LCS and number of days until readmission (r = .173, P = .42) nor survival (r = .109, P = .56) was found. There was a negative significant correlation (r = -.71, P < .001) between the time interval of furosemide administration and corrected LCS.
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Affiliation(s)
- Liza Koster
- Department of Small Animal Clinical SciencesUniversity of Tennessee College of Veterinary MedicineKnoxvilleTennesseeUSA
| | - Jenna Vogel
- Department of Small Animal Clinical SciencesUniversity of Tennessee College of Veterinary MedicineKnoxvilleTennesseeUSA
| | - Cary M. Springer
- Office of Information TechnologyUniversity of TennesseeKnoxvilleTennesseeUSA
| | - Silke Hecht
- Department of Small Animal Clinical SciencesUniversity of Tennessee College of Veterinary MedicineKnoxvilleTennesseeUSA
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Barron LZ, DeFrancesco TC, Chou YY, Bonagura JD, Tropf MA, Murphy SD, McManamey AK, Yuan L, Mochel JP, Ward JL. Echocardiographic caudal vena cava measurements in healthy cats and in cats with congestive heart failure and non-cardiac causes of cavitary effusions. J Vet Cardiol 2023; 48:7-18. [PMID: 37276765 DOI: 10.1016/j.jvc.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 04/15/2023] [Accepted: 05/04/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Echocardiographic indices of the inferior vena cava have been associated with elevated right atrial pressures in humans. HYPOTHESIS/OBJECTIVES Describe caudal vena caval (CVC) sonographic dimensions in healthy cats compared to cats with cardiogenic cavitary effusion (CCE), cardiogenic pulmonary edema (CPE), or non-cardiac causes of cavitary effusion (NCE). ANIMALS 30 healthy control cats and 52 client-owned cats with CCE, CPE, or NCE examined at two university hospitals. METHODS Sagittal 2-dimensional (2D) and M-mode CVC dimensions were acquired from the subxiphoid view. Caudal vena cava collapsibility index (CVC-CI) was calculated. Variables were compared between study groups using Kruskal-Wallis and Dunn's Bonferroni testing. Receiver operating characteristic curves were used to assess sensitivity and specificity for diagnostic categories. RESULTS Healthy cats had sagittal 2D and M-mode (median, interquartile range) CVC maximal dimensions of 2.4 mm (1.3-4.0) and 3.4 mm (1.5-4.9) and CVC-CI of 52% (45.2-61.8) and 55% (47.8-61.3), respectively. The CVC maximal dimensions in healthy controls were smaller than in cats with cavitary effusions or pulmonary edema (all P<0.05). CVC-CI was different between CCE and NCE (P<0.0001) with cutoffs of CVC-CI ≤38% (2D) or ≤29% (M-mode) being 90.5% and 85.7% sensitive, and 94.4% and 100% specific for diagnosis of CCE, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE Caudal vena cava measurements are larger in cats with cavitary effusions and cats with CPE than healthy cats. In cats with cavitary effusion, decreased CVC-CI, ≤38% (2D) or ≤29% (M-mode), was helpful in distinguishing between cardiogenic and noncardiogenic etiology.
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Affiliation(s)
- L Z Barron
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hitchin SG5 3HR, United Kingdom
| | - T C DeFrancesco
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Dr., Raleigh, NC, 27607, USA.
| | - Y-Y Chou
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1800 Christensen Dr, Ames, IA 50011, USA
| | - J D Bonagura
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Dr., Raleigh, NC, 27607, USA
| | - M A Tropf
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1800 Christensen Dr, Ames, IA 50011, USA
| | - S D Murphy
- Mission Veterinary Emergency & Specialty, 5914 Johnson Dr, Mission, KS 66202, USA
| | - A K McManamey
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, 625 Harrison St, West Lafayette, IN 47907, USA
| | - L Yuan
- Department of Veterinary Biomedical Sciences, College of Veterinary Medicine, Iowa State University, 1800 Christensen Dr, Ames, IA 50011, USA
| | - J P Mochel
- Department of Veterinary Biomedical Sciences, College of Veterinary Medicine, Iowa State University, 1800 Christensen Dr, Ames, IA 50011, USA
| | - J L Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1800 Christensen Dr, Ames, IA 50011, USA
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7
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Tani A, Suzuki R, Matsukata S, Nakamura A, Nuruki T. The Prognostic Utility of Venous Blood Gas Analyses at Presentation in Cats with Cardiogenic Pulmonary Edema. Vet Sci 2023; 10:vetsci10030232. [PMID: 36977271 PMCID: PMC10051196 DOI: 10.3390/vetsci10030232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/05/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Cats urgently visit emergency hospitals due to respiratory distress, and the chief cause is cardiogenic pulmonary edema (CPE). Although cats with CPE were frequently encountered in clinics, the prognostic factors were poorly reported. The objective of this retrospective study was to investigate the association of physical examination and venous blood gas parameters with the survival of cats with CPE in an emergency hospital. Thirty-six cats with CPE were ultimately included in the present study, and eight of them died within 12 h after their presentation to our hospital. Statistical analyses of clinical parameters between cats that died within 12 h and those that survived for 12 h were conducted using Mann-Whitney U test with Bonferroni correction. Cats that died within 12 h had significantly lower rectal temperatures and higher PvCO2 than those that did not die within 12 h. Moreover, hypotension and vasoconstrictor use were related to death within 12 h of presentation and higher PvCO2. These findings indicated the prognostic utility of body temperature and PvCO2, and the association between hypercapnia and the severity of CPE or hypotension. A large number of prospective studies should be performed to validate these results.
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Affiliation(s)
- Akiyoshi Tani
- The TRVA Animal Medical Center, Tokyo Jonan Regional Veterinary Medicine Promotional Association, Tokyo 158-0081, Japan
| | - Ryohei Suzuki
- Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Tokyo 180-8602, Japan
| | - Satoshi Matsukata
- The TRVA Animal Medical Center, Tokyo Jonan Regional Veterinary Medicine Promotional Association, Tokyo 158-0081, Japan
| | - Atsushi Nakamura
- The TRVA Animal Medical Center, Tokyo Jonan Regional Veterinary Medicine Promotional Association, Tokyo 158-0081, Japan
| | - Takaomi Nuruki
- The TRVA Animal Medical Center, Tokyo Jonan Regional Veterinary Medicine Promotional Association, Tokyo 158-0081, Japan
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8
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Unger K, Martin LG. Noncardiogenic pulmonary edema in small animals. J Vet Emerg Crit Care (San Antonio) 2023; 33:156-172. [PMID: 36815753 DOI: 10.1111/vec.13278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To review various types of noncardiogenic pulmonary edema (NCPE) in cats and dogs. ETIOLOGY NCPE is an abnormal fluid accumulation in the lung interstitium or alveoli that is not caused by cardiogenic causes or fluid overload. It can be due to changes in vascular permeability, hydrostatic pressure in the pulmonary vasculature, or a combination thereof. Possible causes include inflammatory states within the lung or in remote tissues (acute respiratory distress syndrome [ARDS]), airway obstruction (post-obstructive pulmonary edema), neurologic disease such as head trauma or seizures (neurogenic pulmonary edema), electrocution, after re-expansion of a collapsed lung or after drowning. DIAGNOSIS Diagnosis of NCPE is generally based on history, physical examination, and diagnostic imaging. Radiographic findings suggestive of NCPE are interstitial to alveolar pulmonary opacities in the absence of signs of left-sided congestive heart failure or fluid overload such as cardiomegaly or congested pulmonary veins. Computed tomography and edema fluid analysis may aid in the diagnosis, while some forms of NCPE require additional findings to reach a diagnosis. THERAPY The goal of therapy for all types of NCPE is to preserve tissue oxygenation and reduce the work of breathing. This may be achieved by removing the inciting cause (eg, airway obstruction) and cage rest in mild cases and supplemental oxygen in moderate cases and may require mechanical ventilation in severe cases. PROGNOSIS Prognosis is generally good for most causes of veterinary NCPE except for ARDS, although data are scarce for some etiologies of NCPE.
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Affiliation(s)
- Karin Unger
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington, USA
| | - Linda G Martin
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington, USA
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9
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Role of echocardiographic views adapted for lung evaluation in diagnosis of cardiogenic pulmonary edema in Dogs. Vet Res Commun 2022; 47:675-682. [DOI: 10.1007/s11259-022-10026-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
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10
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Overview of TFAST and AFAST: point‐of‐care ultrasounds and how to perform them. IN PRACTICE 2022. [DOI: 10.1002/inpr.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Hepworth-Warren KL, Nelson N, Dembek KA, Young KAS. Comparison of thoracic ultrasonography and thoracic radiography between healthy adult horses and horses with bacterial pneumonia using a novel, objective ultrasonographic scoring system. Front Vet Sci 2022; 9:991634. [PMID: 36311667 PMCID: PMC9608548 DOI: 10.3389/fvets.2022.991634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/19/2022] [Indexed: 11/04/2022] Open
Abstract
Background Thoracic ultrasonography (TUS) is widely used in equine practice but comparison to radiography is limited in horses. Objectives To validate a novel, objective scoring system for TUS in adult horses and to compare ultrasonographic and radiographic findings. Animals 13 healthy horses and 9 with confirmed bacterial pneumonia Methods Prospective study in which TUS and radiography were performed on healthy horses and those with bacterial pneumonia confirmed by clinical signs and results of transtracheal wash analysis. Ultrasonography was scored utilizing a novel scoring system evaluating number of comet tail lesions, the presence or absence of pleural effusion and/or pulmonary consolidation in each intercostal space. Eighteen horses had thoracic radiographs taken that were scored by a board-certified radiologist utilizing a previously described system. Total scores were recorded and compared between control and diseased patients. Results/Findings Ultrasonographic scores were significantly higher in the diseased group (median= 126) than in the control group (median = 20, p = 0.01). Receiver operating characteristics (ROC) analysis identified a sensitivity of 66.7% (95% CI 0.417–1) and specificity of 92.3% (95% CI 0.462–1) for the ability of ultrasonography to identify bacterial pneumonia utilizing a TUS score cutoff of 37. Conclusions and clinical importance TUS had moderate sensitivity and high specificity for identification of bacterial pneumonia in adult horses. TUS appears to be an acceptable stand-alone imaging modality for diagnosis of bacterial pneumonia in horses when radiography is not practical.
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Affiliation(s)
- Kate L. Hepworth-Warren
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States,*Correspondence: Kate L. Hepworth-Warren
| | - Nathan Nelson
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Katarzyna A. Dembek
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Kimberly A. S. Young
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
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Eberhardt C, Schwarzwald CC. Focused cardiac ultrasound examination in the emergency and critical care equine patient: Training for non-specialist veterinarians and evaluation of proficiency. J Vet Intern Med 2022; 36:1471-1480. [PMID: 35657023 PMCID: PMC9308440 DOI: 10.1111/jvim.16446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 05/04/2022] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Christina Eberhardt
- Vetsuisse Faculty, Equine Department, University of Zurich, Zurich, Switzerland
| | - Colin C Schwarzwald
- Vetsuisse Faculty, Equine Department, University of Zurich, Zurich, Switzerland
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Lam MC, Lin CH, Lo PY, Wu HD. Influence of concurrent lower respiratory tract disease on point-of-care lung ultrasound in small-breed dogs with myxomatous mitral valve disease. J Vet Intern Med 2022; 36:1075-1081. [PMID: 35475522 PMCID: PMC9151468 DOI: 10.1111/jvim.16428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 04/04/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Small‐breed dogs commonly have concurrent myxomatous mitral valve disease (MMVD) and lower respiratory tract disease (LRTD). Hypothesis Small‐breed dogs with preclinical MMVD and concurrent LRTD have more B‐lines on point‐of‐care lung ultrasound (POC‐LUS) compared to dogs without concurrent LRTD and are prone to misdiagnose as cardiogenic pulmonary edema (CPE). Animals A total of 114 small‐breed dogs with preclinical MMVD. Methods A prospective study was conducted, in which POC‐LUS was obtained and the number of B‐lines was calculated by a single clinician using the Veterinary Bedside Lung Ultrasound Examination protocol. The presence/absence of LRTD was assessed by clinicians blinded to the POC‐LUS results. Results Fifty and 64 dogs were in ACVIM stage B1 and B2, respectively. The presence of LRTD was prevalent in 74.6% (85/114) of small‐breed dogs with preclinical MMVD. When a previously reported criterion for CPE diagnosis (≥2 sites with >3 B‐lines/site) was applied, false‐positive results were observed in 15.8% (18/114) of dogs with preclinical MMVD. The summated number of B‐lines (3 vs. 1, P = .003), as well as the false‐positive rate (20% vs 3%, P = .04), were significantly higher in dogs with LRTD compared with dogs without LRTD. Multivariable logistic regression showed the presence of abnormalities other than B‐line on POC‐LUS (eg, thickened pleura or consolidation) could predict false‐positive results (odds ratio = 3.75, 95% confidence intervals 1.12‐12.54; P = .03) after adjustment for other clinical and echocardiographic factors. Conclusions and Clinical Importance Concurrent LRTD and abnormalities other than B‐lines should be considered in the interpretation of POC‐LUS in MMVD dogs.
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Affiliation(s)
- Man-Cham Lam
- National Taiwan University Veterinary Hospital, National Taiwan University, Taipei, Taiwan.,Lab of Small Animal Respiratory and Cardiovascular Medicine, TACS-Alliance Research Center, Taipei, Taiwan
| | - Chung-Hui Lin
- National Taiwan University Veterinary Hospital, National Taiwan University, Taipei, Taiwan.,Lab of Small Animal Respiratory and Cardiovascular Medicine, TACS-Alliance Research Center, Taipei, Taiwan.,Graduate Institute of Veterinary Clinical Sciences, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-Ying Lo
- National Taiwan University Veterinary Hospital, National Taiwan University, Taipei, Taiwan.,Lab of Small Animal Respiratory and Cardiovascular Medicine, TACS-Alliance Research Center, Taipei, Taiwan
| | - Huey-Dong Wu
- Section of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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Fernandes Rodrigues N, Giraud L, Bolen G, Fastrès A, Clercx C, Boysen S, Billen F, Gommeren K. Comparison of lung ultrasound, chest radiographs, C-reactive protein, and clinical findings in dogs treated for aspiration pneumonia. J Vet Intern Med 2022; 36:743-752. [PMID: 35247005 PMCID: PMC8965265 DOI: 10.1111/jvim.16379] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 12/30/2022] Open
Abstract
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.
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Affiliation(s)
- Nina Fernandes Rodrigues
- Department of Clinical Sciences, University of Liège, Faculty of Veterinary Medicine, Liège, Belgium
| | - Léna Giraud
- Department of Clinical Sciences, University of Liège, Faculty of Veterinary Medicine, Liège, Belgium
| | - Géraldine Bolen
- Department of Clinical Sciences, University of Liège, Faculty of Veterinary Medicine, Liège, Belgium
| | - Aline Fastrès
- Department of Clinical Sciences, University of Liège, Faculty of Veterinary Medicine, Liège, Belgium
| | - Cécile Clercx
- Department of Clinical Sciences, University of Liège, Faculty of Veterinary Medicine, Liège, Belgium
| | - Søren Boysen
- Department of Veterinary Clinical and Diagnostic Sciences, University of Calgary, Calgary, Canada
| | - Frédéric Billen
- Department of Clinical Sciences, University of Liège, Faculty of Veterinary Medicine, Liège, Belgium
| | - Kris Gommeren
- Department of Clinical Sciences, University of Liège, Faculty of Veterinary Medicine, Liège, Belgium
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Kim E, Fischetti AJ, Sreetharan P, Weltman JG, Fox PR. Comparison of artificial intelligence to the veterinary radiologist's diagnosis of canine cardiogenic pulmonary edema. Vet Radiol Ultrasound 2022; 63:292-297. [PMID: 35048445 DOI: 10.1111/vru.13062] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022] Open
Abstract
Application of artificial intelligence (AI) to improve clinical diagnosis is a burgeoning field in human and veterinary medicine. The objective of this prospective, diagnostic accuracy study was to determine the accuracy, sensitivity, and specificity of an AI-based software for diagnosing canine cardiogenic pulmonary edema from thoracic radiographs, using an American College of Veterinary Radiology-certified veterinary radiologist's interpretation as the reference standard. Five hundred consecutive canine thoracic radiographs made after-hours by a veterinary Emergency Department were retrieved. A total of 481 of 500 cases were technically analyzable. Based on the radiologist's assessment, 46 (10.4%) of these 481 dogs were diagnosed with cardiogenic pulmonary edema (CPE+). Of these cases, the AI software designated 42 of 46 as CPE+ and four of 46 as cardiogenic pulmonary edema negative (CPE-). Accuracy, sensitivity, and specificity of the AI-based software compared to radiologist diagnosis were 92.3%, 91.3%, and 92.4%, respectively (positive predictive value, 56%; negative predictive value, 99%). Findings supported using AI software screening for thoracic radiographs of dogs with suspected cardiogenic pulmonary edema to assist with short-term decision-making when a radiologist is unavailable.
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Affiliation(s)
- Eunbee Kim
- Department of Diagnostic Imaging, The Animal Medical Center, New York, New York, USA
| | - Anthony J Fischetti
- Department of Diagnostic Imaging, The Animal Medical Center, New York, New York, USA
| | | | - Joel G Weltman
- Department of Emergency and Critical Care, The Animal Medical Center, New York, New York, USA
| | - Philip R Fox
- Department of Cardiology, The Animal Medical Center, New York, New York, USA
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Rodrigues NF, Giraud L, Bolen G, Fastrès A, Clercx C, Boysen S, Billen F, Gommeren K. Response to letter regarding "Comparison of lung ultrasound, chest radiographs, C-reactive protein, and clinical findings in dogs treated for aspiration pneumonia". J Vet Intern Med 2022; 36:1856-1857. [PMID: 36189851 PMCID: PMC9708441 DOI: 10.1111/jvim.16558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Nina F. Rodrigues
- Department of Clinical SciencesFaculty of Veterinary Medicine, University of LiègeLiègeBelgium
| | - Léna Giraud
- Department of Clinical SciencesFaculty of Veterinary Medicine, University of LiègeLiègeBelgium
| | - Géraldine Bolen
- Department of Clinical SciencesFaculty of Veterinary Medicine, University of LiègeLiègeBelgium
| | - Aline Fastrès
- Department of Clinical SciencesFaculty of Veterinary Medicine, University of LiègeLiègeBelgium
| | - Cécile Clercx
- Department of Clinical SciencesFaculty of Veterinary Medicine, University of LiègeLiègeBelgium
| | - Søren Boysen
- Department of Veterinary Clinical and Diagnostic SciencesUniversity of CalgaryCalgaryCanada
| | - Frédéric Billen
- Department of Clinical SciencesFaculty of Veterinary Medicine, University of LiègeLiègeBelgium
| | - Kris Gommeren
- Department of Clinical SciencesFaculty of Veterinary Medicine, University of LiègeLiègeBelgium
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Abstract
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.
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Affiliation(s)
- Mark D Kittleson
- School of Veterinary Medicine, Department of Medicine and Epidemiology, University of California, Davis, and Veterinary Information Network, 777 West Covell Boulevard, Davis, CA 95616, USA
| | - Etienne Côté
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
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18
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Lisciandro GR. TFAST Accurate Diagnosis of Pleural and Pericardial Effusion, Caudal Vena Cava in Dogs and Cats. Vet Clin North Am Small Anim Pract 2021; 51:1169-1182. [PMID: 34535337 DOI: 10.1016/j.cvsm.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
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19
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Lisciandro GR, Lisciandro SC. Lung Ultrasound Fundamentals, "Wet Versus Dry" Lung, Signs of Consolidation in Dogs and Cats. Vet Clin North Am Small Anim Pract 2021; 51:1125-1140. [PMID: 34535335 DOI: 10.1016/j.cvsm.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
| | - Stephanie C Lisciandro
- Hill Country Veterinary Specialists and FASTVet.com, Spicewood, TX, USA; Oncura Partners, Fort Worth, TX, USA
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20
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Lisciandro GR, Lisciandro SC. Global FAST for Patient Monitoring and Staging in Dogs and Cats. Vet Clin North Am Small Anim Pract 2021; 51:1315-1333. [PMID: 34535333 DOI: 10.1016/j.cvsm.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
| | - Stephanie C Lisciandro
- Hill Country Veterinary Specialists and FASTVet.com, Spicewood, TX, USA; Oncura Partners, Fort Worth, TX, USA.
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21
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Dicker SA. Lung Ultrasound for Pulmonary Contusions. Vet Clin North Am Small Anim Pract 2021; 51:1141-1151. [PMID: 34521570 DOI: 10.1016/j.cvsm.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Lung ultrasound (LUS) has high sensitivity for the rapid and reliable diagnosis of pulmonary contusions (PC) in patients who have sustained trauma. LUS diagnosis of PC exceeds that of thoracic radiographs in multiple animal and human studies. The sonographer should understand potential caveats and confounding variables for proper diagnosis of PC with LUS. LUS does not replace conventional radiography or computed tomography, especially in the polytrauma patient. LUS should be used concurrently with other point-of-care ultrasound trauma protocols to rapidly optimize patient assessment before movement to the radiology suite.
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Affiliation(s)
- Samuel A Dicker
- Veterinary Emergency & Referral Group, 196 4th Avenue, Brooklyn, NY 11217, USA.
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22
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DeFrancesco TC, Ward JL. Focused Canine Cardiac Ultrasound. Vet Clin North Am Small Anim Pract 2021; 51:1203-1216. [PMID: 34511294 DOI: 10.1016/j.cvsm.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Focused cardiac ultrasound (FCU) is a useful point-of-care imaging tool to assess cardiovascular status in symptomatic dogs in the acute care setting. Unlike complete echocardiography, FCU is a time-sensitive examination involving a subset of targeted ultrasound views to identify severe cardiac abnormalities and is performed as part of an integrated thoracic ultrasound including interrogation of the pleural space and lungs. When integrated with other clinical information, FCU 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 provide estimates of fluid responsiveness in hypotensive dogs.
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Affiliation(s)
- Teresa C DeFrancesco
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1052 William Moore Dr, Raleigh, NC 27607, USA.
| | - Jessica L Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1809 S. Riverside Dr, Ames, IA 50010, USA
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23
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Loughran K. Focused Cardiac Ultrasonography in Cats. Vet Clin North Am Small Anim Pract 2021; 51:1183-1202. [PMID: 34454727 DOI: 10.1016/j.cvsm.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Heart disease is a common cause of morbidity and mortality in cats. Focused cardiac ultrasonography (FCU) is a useful diagnostic tool for identifying heart disease in symptomatic and asymptomatic cats when performed by trained veterinarians. When used in conjunction with other diagnostics such as physical examination, blood biomarkers, electrocardiography, Global FAST, and other point-of-care ultrasonographic examinations, FCU may improve clinical decision making and help clinicians prioritize which cats would benefit from referral for complete echocardiography and cardiac consultation. This article reviews the definition, advantages, clinical indications, limitations, training recommendations, and a protocol for FCU in cats.
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Affiliation(s)
- Kerry Loughran
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104.
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24
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Adamantos S. Fluid Therapy in Pulmonary Disease: How Careful Do We Need to Be? Front Vet Sci 2021; 8:624833. [PMID: 34434982 PMCID: PMC8380830 DOI: 10.3389/fvets.2021.624833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 07/13/2021] [Indexed: 12/30/2022] Open
Abstract
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.
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25
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Pacholec C, Lisciandro GR, Masseau I, Donnelly L, DeClue A, Reinero CR. Lung ultrasound nodule sign for detection of pulmonary nodule lesions in dogs: Comparison to thoracic radiography using computed tomography as the criterion standard. Vet J 2021; 275:105727. [PMID: 34343710 DOI: 10.1016/j.tvjl.2021.105727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
Thoracic radiography (TR), the most common screening test for pulmonary metastases in dogs, can fail to detect small lesions <3 mm. Lung ultrasonography (LUS) is a widely available imaging modality capable of detecting peripheral nodules but is underutilized for this purpose. Thoracic computed tomography (CT) is the criterion standard for diagnosis of lung metastases and nodular disease but is less practical for a variety of reasons. We hypothesized that LUS would be more sensitive but less specific at detecting nodules consistent with metastatic pulmonary disease in dogs compared to TR, using CT as the criterion standard. This was a masked, single-center prospective study of 62 client-owned dogs evaluated for respiratory signs or pulmonary metastatic neoplasia screening using TR, LUS and CT. Dogs were included if metastatic pulmonary disease was a differential. All imaging modalities were scored as having nodules (yes/no) and other types of pathologic lesions were recorded. Sensitivity (Se), specificity (Sp) and positive (LR+) and negative likelihood ratios (LR-) were determined for TR and LUS. For TR, Se and Sp were 64% and 73%, and LR+ and LR- were 2.37 and 0.49, respectively. For LUS, Se and Sp were 60% and 65% and LR+ and LR- were 1.71 and 0.62, respectively. The results of the study indicate that LUS had a similar Se to TR, with both modalities missing nodules when used for screening. The low Sp and LR- suggests caution should be used when assuming TR and LUS rule out the presence of nodules.
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Affiliation(s)
- C Pacholec
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, 900 East Campus Dr., Columbia, MO 65211, USA
| | - G R Lisciandro
- Hill Country Veterinary Specialists, Spicewood, TX, 78669, USA
| | - I Masseau
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, 900 East Campus Dr., Columbia, MO 65211, USA; Department of Sciences Cliniques, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Canada
| | - L Donnelly
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, 900 East Campus Dr., Columbia, MO 65211, USA
| | - A DeClue
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, 900 East Campus Dr., Columbia, MO 65211, USA
| | - C R Reinero
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, 900 East Campus Dr., Columbia, MO 65211, USA.
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26
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Ward JL, Murphy SD, Lisciandro GR, Tropf MA, Viall AK, DeFrancesco TC. Comparison of curvilinear-array (microconvex) and phased-array transducers for ultrasonography of the lungs in dogs. Am J Vet Res 2021; 82:619-628. [PMID: 34296938 DOI: 10.2460/ajvr.82.8.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To compare the use of curvilinear-array (microconvex) and phased-array transducers for ultrasonographic examination of the lungs in dogs. ANIMALS 13 client-owned dogs with left-sided congestive heart failure. PROCEDURES In a prospective methods comparison study, 24 ultrasonographic examinations of the lungs (4 sites/hemithorax) were performed with both curvilinear-array and phased-array transducers at 3 clinical time points. Two observers independently assessed the number of B lines (scored per site and in total), number of sites strongly positive for B lines (ie, those with > 3 B lines/site), and image quality (scored on a 5-point scale). Analyses included assessment of interobserver agreement with κ analysis, comparison of quality scores between transducers with mixed-effects modeling, and investigation of agreement and bias for B-line data and quality scores between transducers with Passing-Bablok regression. RESULTS Interobserver agreement for total B-line scores and number of strong-positive sites was excellent (κ > 0.80) for both transducers. There was no evidence of analytic bias for the number of B lines or strong-positive sites between transducers. Interobserver agreement for image quality scores was moderate (κ, 0.498 and 0.517 for the curvilinear-array and phased-array transducers, respectively). Both observers consistently assigned higher-quality scores to curvilinear-array images than to phased-array images. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated both curvilinear-array (microconvex) and phased-array transducers can be used by experienced sonographers to obtain diagnostic ultrasonographic images of the lungs in dogs with acute or resolving left-sided congestive heart failure and suggested the former transducer may be preferred, particularly to aid identification of anatomic landmarks for orientation.
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Affiliation(s)
- Jessica L Ward
- From the Department of Veterinary Clinical Sciences and Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Shane D Murphy
- From the Department of Veterinary Clinical Sciences and Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | | | - Melissa A Tropf
- From the Department of Veterinary Clinical Sciences and Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Austin K Viall
- From the Department of Veterinary Clinical Sciences and Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, IA 50011
| | - Teresa C DeFrancesco
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27695
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Roche-Catholy M, Van Cappellen I, Locquet L, Broeckx BJG, Paepe D, Smets P. Clinical relevance of serum electrolytes in dogs and cats with acute heart failure: A retrospective study. J Vet Intern Med 2021; 35:1652-1662. [PMID: 34096660 PMCID: PMC8295692 DOI: 10.1111/jvim.16187] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022] Open
Abstract
Background Hypochloremia is a strong negative prognostic factor in humans with congestive heart failure (CHF), but the implications of electrolyte abnormalities in small animals with acute CHF are unclear. Objectives To document electrolyte abnormalities present upon admission of small animals with acute CHF, and to assess the relationship between electrolyte concentrations and diuretic dose, duration of hospitalization and survival time. Animals Forty‐six dogs and 34 cats with first onset of acute CHF. Methods Retrospective study. The associations between electrolyte concentrations and diuretic doses were evaluated with Spearman rank correlation coefficients. Relationship with duration of hospitalization and survival were assessed by simple linear regression and Cox proportional hazard regression, respectively. Results The most commonly encountered electrolyte anomaly was hypochloremia observed in 24% (9/46 dogs and 10/34 cats) of cases. In dogs only, a significant negative correlation was identified between serum chloride concentrations at admission (median 113 mmol/L [97‐125]) and furosemide doses both at discharge (median 5.2 mg/kg/day [1.72‐9.57]; r = −0.59; P < .001) and at end‐stage heart failure (median 4.7 mg/kg/day [2.02‐7.28]; r = −0.62; P = .005). No significant hazard ratios were found for duration of hospitalization nor survival time for any of the electrolyte concentrations. Conclusions and Clinical Importance The observed association between serum chloride concentrations and diuretic doses suggests that hypochloremia could serve as a marker of disease severity and therapeutic response in dogs with acute CHF.
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Affiliation(s)
- Marine Roche-Catholy
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Iris Van Cappellen
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Laurent Locquet
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Bart J G Broeckx
- Department of Nutrition, Genetics and Ethology, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Dominique Paepe
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Pascale Smets
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Belgium
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Lisciandro GR, Gambino JM, Lisciandro SC. Thirteen dogs and a cat with ultrasonographically detected gallbladder wall edema associated with cardiac disease. J Vet Intern Med 2021; 35:1342-1346. [PMID: 33826214 PMCID: PMC8163112 DOI: 10.1111/jvim.16117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 12/25/2022] Open
Abstract
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.
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Cole L, Pivetta M, Humm K. Diagnostic accuracy of a lung ultrasound protocol (Vet BLUE) for detection of pleural fluid, pneumothorax and lung pathology in dogs and cats. J Small Anim Pract 2021; 62:178-186. [PMID: 33496045 DOI: 10.1111/jsap.13271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To assess the accuracy of the lung ultrasound protocol Vet BLUE, using thoracic CT as the reference standard, for the detection of thoracic pathology in dogs and cats. MATERIALS AND METHODS Animals that had thoracic ultrasound and thoracic CT were prospectively recruited between May 2017 and September 2018. The Vet BLUE protocol was performed on animals at the time of admission by veterinarians with basic training in emergency ultrasound. A board-certified radiologist, blinded to the Vet BLUE findings, reviewed the CT images. RESULTS CT was abnormal in 64.5% (20/31) animals. The number of CT sites positive for alveolar-interstitial syndrome was 24.2% (60/248). When using CT as the reference standard, detection of ≥3 B lines with thoracic ultrasound had a sensitivity of 18.33% and specificity of 98.4% for detection of site specific alveolar-interstitial syndrome. The sensitivity of Vet BLUE to detect alveolar-interstitial syndrome increased to 56.9% when including the presence of any B line as abnormal. Overall accuracy for detection of alveolar-interstitial syndrome based on these two criteria was 79% and 73%, respectively. Vet BLUE correctly identified consolidation in 58.3% (14/24) sites, pleural effusion in 66.6% (2/3) cases, pneumothorax in 33.3% (1/3) cases and intrathoracic mass in 25% (1/4) cases. CLINICAL SIGNIFICANCE The Vet BLUE protocol is a useful technique to detect alveolar-interstitial syndrome and other thoracic pathology but should not be used as a sole imaging method. Detection of ≥3 B lines is highly suggestive of alveolar-interstitial syndrome and warrants further diagnostics.
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Affiliation(s)
- L Cole
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA, UK
| | - M Pivetta
- Antech Imaging Services, Irvine, CA, 92614, USA
| | - K Humm
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA, UK
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Lin CH, Lo PY, Lam MC, Wu HD. Usefulness of Chest Ultrasonography in Predicting Diagnosis in Non-emergency Small Animal Patients With Lung Parenchymal and Pleural Disease. Front Vet Sci 2020; 7:616882. [PMID: 33392301 PMCID: PMC7775533 DOI: 10.3389/fvets.2020.616882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Chung-Hui Lin
- National Taiwan University Veterinary Hospital, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Veterinary Clinical Sciences, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-Ying Lo
- National Taiwan University Veterinary Hospital, National Taiwan University, Taipei, Taiwan
| | - Man-Cham Lam
- National Taiwan University Veterinary Hospital, National Taiwan University, Taipei, Taiwan
| | - Huey-Dong Wu
- Section of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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Murphy SD, Ward JL, Viall AK, Tropf MA, Walton RL, Fowler JL, Ware WA, DeFrancesco TC. Utility of point-of-care lung ultrasound for monitoring cardiogenic pulmonary edema in dogs. J Vet Intern Med 2020; 35:68-77. [PMID: 33270302 PMCID: PMC7848339 DOI: 10.1111/jvim.15990] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 02/02/2023] Open
Abstract
Background Point‐of‐care lung ultrasound (LUS) is an effective tool to diagnose left‐sided congestive heart failure (L‐CHF) in dogs via detection of ultrasound artifacts (B‐lines) caused by increased lung water. Hypothesis/Objectives To determine whether LUS can be used to monitor resolution of cardiogenic pulmonary edema in dogs, and to compare LUS to other indicators of L‐CHF control. Animals Twenty‐five client‐owned dogs hospitalized for treatment of first‐onset L‐CHF. Methods Protocolized LUS, thoracic radiographs (TXR), and plasma N‐terminal pro‐B‐type natriuretic peptide were performed at hospital admission, hospital discharge, and recheck examinations. Lung ultrasound findings were compared between timepoints and to other clinical measures of L‐CHF. Results From time of hospital admission to discharge (mean 19.6 hours), median number of LUS sites strongly positive for B‐lines (>3 B‐lines per site) decreased from 5 (range, 1‐8) to 1 (range, 0‐5; P < .001), and median total B‐line score decreased from 37 (range, 6‐74) to 5 (range, 0‐32; P = .002). Lung ultrasound indices remained improved at first recheck (P < .001). Number of strong positive sites correlated positively with respiratory rate (r = 0.52, P = .008) and TXR edema score (r = 0.51, P = .009) at hospital admission. Patterns of edema resolution differed between LUS and TXR, with cranial quadrants showing more significant reduction in B‐lines compared to TXR edema score (80% vs 29% reduction, respectively; P = .003). Conclusions and Clinical Importance Lung ultrasound could be a useful tool for monitoring resolution of pulmonary edema in dogs with L‐CHF.
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Affiliation(s)
- Shane D Murphy
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Jessica L Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Austin K Viall
- Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Melissa A Tropf
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Rebecca L Walton
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Jennifer L Fowler
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA.,Present address: Jennifer L. Fowler, Idexx Laboratories, 1 Idexx Dr., Westbrook, ME, USA
| | - Wendy A Ware
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Teresa C DeFrancesco
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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Dicker SA, Lisciandro GR, Newell SM, Johnson JA. 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). J Vet Emerg Crit Care (San Antonio) 2020; 30:638-646. [PMID: 33085212 DOI: 10.1111/vec.13021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/29/2019] [Accepted: 05/10/2019] [Indexed: 01/05/2023]
Abstract
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.
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Lisciandro GR. Cageside Ultrasonography in the Emergency Room and Intensive Care Unit. Vet Clin North Am Small Anim Pract 2020; 50:1445-1467. [PMID: 32912606 DOI: 10.1016/j.cvsm.2020.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Gregory R Lisciandro
- Emergency and Critical Care, Hill Country Veterinary Specialists, Spicewood, TX, USA; FASTVet.com, Spicewood, TX, USA.
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Ward JL, Lisciandro GR, Ware WA, Miles KG, Viall AK, DeFrancesco TC. Lung ultrasonography findings in dogs with various underlying causes of cough. J Am Vet Med Assoc 2020; 255:574-583. [PMID: 31429645 DOI: 10.2460/javma.255.5.574] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize lung ultrasonography (LUS) findings in dogs with a primary clinical complaint of cough. ANIMALS 100 client-owned coughing dogs. PROCEDURES A standardized LUS examination was performed for all dogs to quantify the number of B lines and identify subpleural abnormalities at 4 sites on each hemithorax. The final clinical diagnosis (reference standard) was determined by medical record review, and sensitivity and specificity of LUS for the diagnosis of selected causes of cough was determined. RESULTS Common underlying causes of cough included dynamic airway collapse (n = 37), cardiogenic pulmonary edema (CPE; 12), and bronchitis (10). Compared with dogs with other causes of cough, dogs with bacterial pneumonia (n = 7) were more likely to have subpleural shred signs, whereas dogs with pulmonary neoplasia (4) were more likely to have subpleural nodule signs. Dogs with CPE had higher total B-line scores and higher numbers of LUS sites strongly positive for B lines (> 3 B lines/site) than other dogs. The LUS criteria of total B-line score ≥ 10 and presence of ≥ 2 sites strongly positive for B lines were each 92% sensitive and 94% specific for CPE diagnosis. Notably, 18% (16/88) of dogs with noncardiac causes of cough had been treated previously with diuretics because of prior CPE misdiagnosis. CONCLUSIONS AND CLINICAL RELEVANCE LUS profiles in dogs with cough differed by the underlying cause. In dogs with a clinical history of cough, this imaging modality could be diagnostically useful, particularly to help exclude the possibility of underlying CPE.
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Hori Y, Yamashita Y, Sakakibara K, Sano T, Hori A. Usefulness of pericardial lung ultrasonography for the diagnosis of cardiogenic pulmonary edema in dogs. Am J Vet Res 2020; 81:227-232. [PMID: 32101047 DOI: 10.2460/ajvr.81.3.227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate whether lung ultrasonography (LUS) performed around the heart, where the lungs are in contact with the pericardium (ie, pericardial LUS), could be used for the diagnosis of cardiogenic pulmonary edema (CPE) in dogs with degenerative mitral valve disease (DMVD). ANIMALS 15 control dogs with healthy hearts and 26 dogs with DMVD. PROCEDURES In a prospective multicenter study design, dogs with DMVD were assigned to 2 groups: those with CPE (n = 11) and those without CPE (15). Thoracic radiography, echocardiography, and pericardial LUS were performed for all dogs. For pericardial LUS, the left ventricular short-axis view was obtained with a sector probe (dog positioned in right parasternal recumbency) and the number of B lines was recorded. Accuracy of pericardial LUS for the diagnosis of CPE was calculated, with thoracic radiography used as the reference standard. RESULTS On thoracic radiography, all dogs with CPE had a diffuse distribution of interstitial to alveolar pulmonary infiltrates. On pericardial LUS, most control dogs (14/15) and dogs with DMVD but no CPE (13/15) had ≤ 2 B lines, whereas all dogs with DMVD and CPE had ≥ 3 B lines. The presence of ≥ 4 B lines had high sensitivity (91%; 95% confidence interval, 62% to 98%) and excellent specificity (100%; 95% confidence interval, 89% to 100%) for the diagnosis of CPE, and the area under the receiver operating characteristic curve was 0.99. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that identification of ≥ 4 B lines extending from the epicardium of the left ventricle into the lung field on pericardial LUS may be useful in the diagnosis of CPE in dogs with DMVD. Additional research is needed to determine whether pericardial LUS allows differentiation between CPE and pneumonia.
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Janson CO, Hezzell MJ, Oyama MA, Harries B, Drobatz KJ, Reineke EL. Focused cardiac ultrasound and point-of-care NT-proBNP assay in the emergency room for differentiation of cardiac and noncardiac causes of respiratory distress in cats. J Vet Emerg Crit Care (San Antonio) 2020; 30:376-383. [PMID: 32579274 DOI: 10.1111/vec.12957] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 10/14/2018] [Accepted: 10/31/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the accuracy of focused cardiac ultrasound (FOCUS) and point-of-care N-terminal proBNP assay in the emergency setting for differentiation of cardiac from noncardiac causes of respiratory distress in cats. DESIGN Prospective diagnostic accuracy study between 2014 and 2016. SETTING Emergency room at an urban university teaching hospital. ANIMALS Forty-one client-owned cats presenting for evaluation of respiratory distress. INTERVENTIONS Emergency clinicians made an initial diagnosis of noncardiac or cardiac cause of respiratory distress based on physical examination (PE) findings and history. The diagnoses were updated after performing FOCUS and point-of-care N-terminal B-type natriuretic peptide (POC-BNP). Reference standard diagnosis was determined by agreement of a board-certified cardiologist and critical care specialist with access to subsequent radiographs and echocardiograms. MEASUREMENTS AND MAIN RESULTS Forty-one cats were enrolled. Three cats with incomplete data and 1 cat with an uncertain reference standard diagnosis were excluded. The remaining 37 cats were used for analysis: 21 cardiac and 16 noncardiac cases. The ratio of left atrial to aortic root diameter (LA:Ao) measured by FOCUS was significantly correlated with LA:Ao measured by echocardiography (R = 0.646, P < 0.0001). Emergency clinicians correctly diagnosed 27 of 37 (73.0%), yielding a PE positive percent agreement = 76.2% (95% CI, 52.8-91.8%) and negative percent agreement = 68.8% (95% CI, 41.3-89.0%). Five noncardiac and 5 cardiac cats were misdiagnosed. Post FOCUS, overall percent agreement improved to 34 of 37 (91.9%), with positive percent agreement = 95.2% (95% CI, 76.2-99.9%) and negative percent agreement = 87.5% (95% CI, 61.7-98.5%). The POC-BNP yielded an overall percent agreement = 32/34 (94.1%), positive percent agreement = 100% (95% CI, 82.4-100.0%), and negative percent agreement = 86.7% (95% CI, 59.5-98.3%) in differentiating cardiac versus noncardiac cases. CONCLUSIONS FOCUS evaluation of basic cardiac structure and LA:Ao by trained emergency clinicians improved accuracy of diagnosis compared to PE in cats with respiratory distress. FOCUS and POC-BNP are useful diagnostics in the emergent setting.
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Affiliation(s)
- Cassandra Ostroski Janson
- Department of Clinical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Melanie J Hezzell
- Department of Clinical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark A Oyama
- Department of Clinical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin Harries
- Department of Clinical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth J Drobatz
- Department of Clinical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica L Reineke
- Department of Clinical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Ferreira J. Preanaesthetic screening in dogs and cats. IN PRACTICE 2020. [DOI: 10.1136/inp.m1448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Luis Fuentes V, Abbott J, Chetboul V, Côté E, Fox PR, Häggström J, Kittleson MD, Schober K, Stern JA. ACVIM consensus statement guidelines for the classification, diagnosis, and management of cardiomyopathies in cats. J Vet Intern Med 2020; 34:1062-1077. [PMID: 32243654 PMCID: PMC7255676 DOI: 10.1111/jvim.15745] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/14/2020] [Indexed: 12/24/2022] Open
Abstract
Cardiomyopathies are a heterogeneous group of myocardial disorders of mostly unknown etiology, and they occur commonly in cats. In some cats, they are well‐tolerated and are associated with normal life expectancy, but in other cats they can result in congestive heart failure, arterial thromboembolism or sudden death. Cardiomyopathy classification in cats can be challenging, and in this consensus statement we outline a classification system based on cardiac structure and function (phenotype). We also introduce a staging system for cardiomyopathy that includes subdivision of cats with subclinical cardiomyopathy into those at low risk of life‐threatening complications and those at higher risk. Based on the available literature, we offer recommendations for the approach to diagnosis and staging of cardiomyopathies, as well as for management at each stage.
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Affiliation(s)
- Virginia Luis Fuentes
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, United Kingdom
| | - Jonathan Abbott
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee, USA
| | - Valérie Chetboul
- Alfort Cardiology Unit (UCA), Université Paris-Est, École Nationale Vétérinaire d'Alfort, Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Maisons-Alfort cedex, France
| | - Etienne Côté
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | | | - Jens Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Mark D Kittleson
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California Davis, Davis, California, USA
| | - Karsten Schober
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Joshua A Stern
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California Davis, Davis, California, USA
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Hezzell MJ, Ostroski C, Oyama MA, Harries B, Drobatz KJ, Reineke EL. Investigation of focused cardiac ultrasound in the emergency room for differentiation of respiratory and cardiac causes of respiratory distress in dogs. J Vet Emerg Crit Care (San Antonio) 2020; 30:159-164. [PMID: 32067327 DOI: 10.1111/vec.12930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/28/2018] [Accepted: 06/03/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether focused cardiac ultrasound (FOCUS) performed by emergency and critical care (ECC) specialists or residents in training improves differentiation of cardiac (C) versus non-cardiac (NC) causes of respiratory distress in dogs compared to medical history and physical examination alone. DESIGN Prospective cohort study (May 2014 to February 2016). SETTING University hospital. ANIMALS Thirty-eight dogs presenting with respiratory distress. INTERVENTIONS FOCUS. MEASUREMENTS AND MAIN RESULTS Medical history, physical examination, and FOCUS were obtained at presentation. Emergency and critical care clinicians, blinded to any radiographic or echocardiographic data, categorized each patient (C vs NC) before and after FOCUS. Thoracic radiography (within 3 h) and echocardiography (within 24 h) were performed. Percent agreement was calculated against a reference diagnosis that relied on agreement of a board-certified cardiologist and ECC specialist with access to all diagnostic test results. Reference diagnosis included 22 dogs with cardiac and 13 dogs with noncardiac causes of respiratory distress. In 3 dogs a reference diagnosis was not established. Prior to FOCUS, positive and negative percent agreement to detect cardiac causes was 90.9% (95% CI, 70.8-98.9) and 53.9% (25.1-80.8), respectively. Overall agreement occurred in 27 of 35 dogs (77.1%). Two C and 6 NC cases were incorrectly categorized. Following FOCUS, positive and negative percent agreement to detect cardiac causes was 95.5% (77.2-99.9) and 69.2% (38.6-90.9), respectively. Overall agreement occurred in 30 of 35 dogs (85.7%). Three dogs with discrepant pre-FOCUS diagnoses were correctly re-categorized post-FOCUS. One C and 4 NC cases remained incorrectly categorized. No correctly categorized dogs were incorrectly re-categorized following FOCUS. The proportions of dogs correctly classified pre- versus post-FOCUS were not significantly different (P = 0.25). CONCLUSIONS FOCUS did not significantly improve differentiation of C vs NC causes of respiratory distress compared to medical history and physical examination alone.
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Affiliation(s)
- Melanie J Hezzell
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Cassandra Ostroski
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mark A Oyama
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Benjamin Harries
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kenneth J Drobatz
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Erica L Reineke
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
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Loughran KA, Rush JE, Rozanski EA, Oyama MA, Larouche-Lebel É, Kraus MS. The use of focused cardiac ultrasound to screen for occult heart disease in asymptomatic cats. J Vet Intern Med 2019; 33:1892-1901. [PMID: 31317580 PMCID: PMC6766524 DOI: 10.1111/jvim.15549] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 06/19/2019] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Kerry A Loughran
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts.,Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John E Rush
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - Elizabeth A Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - Mark A Oyama
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Éva Larouche-Lebel
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marc S Kraus
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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The utility of point-of-care ultrasound right-sided cardiac markers as a screening test for moderate to severe pulmonary hypertension in dogs. Vet J 2019; 250:6-13. [PMID: 31383421 DOI: 10.1016/j.tvjl.2019.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 12/11/2022]
Abstract
Dogs with respiratory disease can develop pulmonary hypertension (PH), a comorbid condition that can impact therapy and prognosis. Without confirmation using the criterion standard of echocardiography, this complication may be missed. Point-of-care ultrasound (POCUS) is a simple, non-invasive screening test that may suggest PH. It was hypothesized that in dogs POCUS right-sided cardiac markers (R-SCM) at the subxiphoid view would predict moderate to severe PH confirmed by echocardiography. Forty-three client-owned dogs that underwent respiratory evaluation with POCUS and echocardiography were included. POCUS R-SCM evaluated in the subxiphoid view included subjective caudal vena cava distention (CVCsx), CVCsx >1cm, gallbladder wall edema and ascites. PH was defined by tricuspid regurgitation pressure gradient (TRPG) as mild (30-49.9mmHg), moderate (50-74.9mmHg) or severe (>75mmHg). POCUS subxiphoid views were blindly evaluated post hoc and compared to echocardiography. Chi square test and one-way ANOVA were used to evaluate correlations between POCUS R-SCM and echocardiographic diagnosis of moderate to severe PH. Twenty-six dogs with PH, and 17 dogs without PH, were enrolled. There was no significant difference in the presence or absence of any R-SCM between dogs with and without PH. When dogs with no PH and mild PH were grouped and compared to dogs with moderate to severe PH (i.e., dogs for which treatment for PH would be recommended), no significant differences in R-SCM were noted. POCUS R-SCM using the CVCsx view was not a sensitive screening test to identify dogs with PH in this study population.
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Ferasin L, Linney C. Coughing in dogs: what is the evidence for and against a cardiac cough? J Small Anim Pract 2019; 60:139-145. [PMID: 30652329 DOI: 10.1111/jsap.12976] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 10/16/2018] [Accepted: 12/05/2018] [Indexed: 01/06/2023]
Abstract
Cough has been historically reported as a major clinical sign of cardiogenic pulmonary oedema in dogs. However, recent evidence appears to contradict the traditional dogmatic approach that linked cough to congestive heart failure in dogs. Here we use a question-based format to introduce and discuss the modern evidence regarding "cardiac cough" and the interpretation of this important but often misleading clinical sign.
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Affiliation(s)
- L Ferasin
- Lumbry Park Veterinary Specialists, Alton, Hampshire, GU34 3HL, UK
| | - C Linney
- Willows Veterinary Referral Service, Solihull, West Midlands B90 4NH, UK
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Armenise A, Boysen RS, Rudloff E, Neri L, Spattini G, Storti E. Veterinary-focused assessment with sonography for trauma-airway, breathing, circulation, disability and exposure: a prospective observational study in 64 canine trauma patients. J Small Anim Pract 2018; 60:173-182. [PMID: 30549049 DOI: 10.1111/jsap.12968] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To describe the technique and findings of the 'veterinary focused assessment with sonography for trauma-airway, breathing, circulation, disability and exposure' protocol in dogs suffering from trauma. MATERIALS AND METHODS Prospective observational study on a new point-of-care ultrasound protocol on 64 dogs suffering from trauma and comparison of findings with radiology. RESULTS Comparison of the results of this new ultrasound protocol for trauma patients with radiography findings for pneumothorax, pleural effusion, alveolar-interstitial syndrome and abdominal effusion revealed positive agreement of 89, 83, 100 and 87% and negative agreement of 76, 83, 76 and 92%, respectively. Novel findings of the 'veterinary focused assessment with sonography for trauma-airway, breathing, circulation, disability and exposure' exam, which were not previously reported for dogs undergoing focused assessment with sonography for trauma, included alveolar-interstitial syndrome (suggestive of pulmonary contusions), diaphragmatic hernia, retroperitoneal effusion and tracheal injury. Our new technique may also help identify increased intracranial pressure via changes in optic nerve sheath diameter and haemodynamic instability through the evaluation of the caudal vena cava and cardiac function. CLINICAL SIGNIFICANCE The described ultrasound examination protocol can be rapidly performed on dogs suffering from trauma during resuscitation and it may detect injuries previously undetectable using other veterinary point-of-care ultrasound protocols.
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Affiliation(s)
- A Armenise
- Ospedale Veterinario Santa Fara, Bari 70124, Italy
| | - R S Boysen
- Faculty of Veterinary Medicine, University of Calgary, Calgary T2N 1N4, Canada
| | - E Rudloff
- Lakeshore Veterinary Specialists, Glendale, Wisconsin 53209, USA
| | - L Neri
- AAT118 Milano, AREU, Niguarda Ca' Granda Hospital, Milan 20162, Italy
| | - G Spattini
- Castellarano Veterinary Clinic, Castellarano (RE) 42014, Italy
| | - E Storti
- Lodi's ICU and Sub ICU Head, ASST Lodi 26900, Italy
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Ward JL, Lisciandro GR, Ware WA, Viall AK, Aona BD, Kurtz KA, Reina‐Doreste Y, DeFrancesco TC. Evaluation of point-of-care thoracic ultrasound and NT-proBNP for the diagnosis of congestive heart failure in cats with respiratory distress. J Vet Intern Med 2018; 32:1530-1540. [PMID: 30216579 PMCID: PMC6189386 DOI: 10.1111/jvim.15246] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/03/2018] [Accepted: 05/22/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The diagnosis of congestive heart failure (CHF) in cats is challenging. Point-of-care (POC) thoracic ultrasound and NT-proBNP testing are emerging tools that may aid in diagnosis. HYPOTHESIS/OBJECTIVES To assess the diagnostic accuracy of POC lung ultrasound (LUS), focused cardiac ultrasound (FCU), and NT-proBNP in predicting a final diagnosis of CHF. ANIMALS Fifty-one cats in respiratory distress. METHODS Blood NT-proBNP, LUS, and FCU evaluating left atrial (LA) size and presence of pericardial effusion (PCEFF) were performed in all cats. Lung ultrasound findings including pleural effusion (PLEFF), number of B-lines, and sub-pleural abnormalities were noted. Medical records were evaluated for final diagnosis. RESULTS Thirty-three of 51 (65%) cats were diagnosed with CHF. Lung ultrasound and blood NT-proBNP were significant predictors of CHF in a multivariate model. The LUS criterion that maximized accuracy for CHF diagnosis was presence of >1 site strongly positive for B-lines (>3 B-lines per site), resulting in sensitivity of 78.8%, specificity of 83.3%, and area under the curve (AUC) of 0.833. Subjective LA enlargement was 97.0% sensitive and 100% specific for CHF (AUC 0.985). Presence of PCEFF also was 100% specific, but only 60.6% sensitive, for CHF (AUC 0.803). A positive blood NT-proBNP test was 93.9% sensitive and 72.2% specific for the diagnosis of CHF (AUC 0.831). CONCLUSIONS AND CLINICAL IMPORTANCE Point-of-care diagnostic techniques of LUS, FCU, and NT-proBNP are useful to diagnose CHF in cats with respiratory distress.
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Affiliation(s)
- Jessica L. Ward
- Department of Veterinary Clinical SciencesCollege of Veterinary Medicine, Iowa State UniversityAmesIowa
| | | | - Wendy A. Ware
- Department of Veterinary Clinical SciencesCollege of Veterinary Medicine, Iowa State UniversityAmesIowa
| | - Austin K. Viall
- Department of Veterinary PathologyCollege of Veterinary Medicine, Iowa State UniversityAmesIowa
| | - Brent D. Aona
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth Carolina
| | - Kari A. Kurtz
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth Carolina
| | - Yamir Reina‐Doreste
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth Carolina
| | - Teresa C. DeFrancesco
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth Carolina
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Ward JL, Lisciandro GR, DeFrancesco TC. Distribution of alveolar-interstitial syndrome in dogs and cats with respiratory distress as assessed by lung ultrasound versus thoracic radiographs. J Vet Emerg Crit Care (San Antonio) 2018; 28:415-428. [PMID: 30075063 DOI: 10.1111/vec.12750] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/01/2016] [Accepted: 12/05/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess distribution of alveolar-interstitial syndrome (AIS) detected by lung ultrasound (LUS) compared to thoracic radiographs (TXR). DESIGN Prospective study. SETTING University teaching hospital. ANIMALS Seventy-six dogs and 24 cats with acute respiratory distress or tachypnea. INTERVENTIONS Patients underwent LUS and TXR within 6 hours. Lung ultrasound images were scored for presence and quantity of B-lines in 4 lung quadrants (right cranial, right caudal, left cranial, left caudal). An individual LUS quadrant was scored positive if > 3 B-lines were observed within a single intercostal space. Dorsoventral TXR were scored for presence of AIS in the same 4 quadrants. An individual TXR quadrant was scored positive if infiltrate was present in ≥ 25% of the quadrant. Medical records were evaluated for final diagnosis. MEASUREMENTS AND MAIN RESULTS Quadrant-by-quadrant spatial agreement in assigning AIS using LUS versus TXR was fair (K = 0.24 - 0.56). Lung ultrasound scored a higher number of quadrants positive per patient (2.65 ± 1.59 vs. 2.13 ± 1.48; P = 0.012). Patterns of distribution of AIS differed significantly based on final diagnosis. Patients with left-sided congestive heart failure were more likely to have diffuse AIS on LUS (P < 0.001) or bilateral caudal AIS on TXR (P = 0.04) while patients with noncardiac disease were more likely to have absence of AIS in all quadrants using either modality (P < 0.001). Differences in spatial distribution of AIS were also noted among disease subcategories. CONCLUSIONS Lung ultrasound and TXR were both useful to detect and categorize distribution of alveolar or interstitial pulmonary pathology. Spatial agreement between modalities was only fair. Overall, LUS detected a higher incidence of AIS compared to TXR. Both modalities detected differences in distribution of AIS based on final diagnosis, suggesting that a regional pattern-based approach to thoracic imaging may prove diagnostically useful.
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Affiliation(s)
- Jessica L Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA
| | | | - Teresa C DeFrancesco
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
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Dickson D, Little CJL, Harris J, Rishniw M. Rapid assessment with physical examination in dyspnoeic cats: the RAPID CAT study. J Small Anim Pract 2017; 59:75-84. [PMID: 29120036 DOI: 10.1111/jsap.12732] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 07/14/2017] [Accepted: 07/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
- D. Dickson
- HeartVets, 7 Kingshill; Porthcawl CF36 5LD UK
| | - C. J. L. Little
- Barton Veterinary Hospital, 34 New Dover Road; Canterbury CT1 3AT UK
| | | | - M. Rishniw
- Veterinary Information Network, 777 West Covell Boulevard; Davis California 95616 USA
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Linta N, Baron Toaldo M, Bettini G, Cordella A, Quinci M, Pey P, Galli V, Cipone M, Diana A. The feasibility of contrast enhanced ultrasonography (CEUS) in the diagnosis of non-cardiac thoracic disorders of dogs and cats. BMC Vet Res 2017; 13:141. [PMID: 28545570 PMCID: PMC5445396 DOI: 10.1186/s12917-017-1061-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 05/17/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study describes the feasibility of Contrast Enhanced Ultrasonography (CEUS) in the diagnostic work-up of non-cardiac thoracic disorders of small animals. The second aim is to assess the usefulness of CEUS as a direct guide for sample procedures. RESULTS Forty animals, 28 dogs and 12 cats, were included in the study. Thoracic disorders included 23 pulmonary lesions [primary carcinoma (14), lymphoma (1), sarcoma (1), histiocytic sarcoma (1), abscess (1) and pneumonia (5)] and 17 mediastinal lesions [lymphoma (8), thymoma (3), mesothelioma (1), melanoma (1), carcinomatous lymphadenopathy (1), mixsosarcoma (1), lipoma (1), and abscess (1)]. The majority of neoplastic pulmonary lesions showed an inhomogeneous distribution of contrast medium, whereas inflammatory lesions had a homogenous distribution with typical pulmonary vessels ramification. The majority of mediastinal malignant lesions showed an inhomogeneous distribution pattern. The lung and mediastinal abscesses had peripheral enhancement of the wall with an avascular center. All cytological and biopsy samples obtained after CEUS were diagnostic. Quantitative analysis, performed in 19/23 pulmonary lesions, showed a statistically significant difference (P < 0.0001) between the arrival time of the malignant (7.27 s - range 4.46-13.52 s) and benign (4.52 s - range 2.87-6.06 s) pulmonary lesions. CONCLUSIONS CEUS may be a useful tool for the evaluation of non-cardiac thoracic lesions. The contrast medium allows for the precise definition of lesion edges, the presence of necrotic areas, and the distribution of pulmonary vessels. Based on our preliminary results, the use of ultrasonographic contrast medium can be recommended for improving the diagnostic usefulness of cytology and biopsy sampling, because CEUS may help to define necrotic areas from viable tissue.
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Affiliation(s)
- N. Linta
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - M. Baron Toaldo
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - G. Bettini
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - A. Cordella
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - M. Quinci
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - P. Pey
- ANTECH Imaging Services, 17672-B Cowan Avenue, Irvine, CA 92614 USA
| | - V. Galli
- Freelance sonographer, Rome, Italy
| | - M. Cipone
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
| | - A. Diana
- Department of Veterinary Medical Sciences, Alma Mater Studiorum – University of Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia, Bologna Italy
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