Lung ultrasonography findings in dogs with various underlying causes of cough

In-hospital mortality in dogs with protein-losing enteropathy and associated risk factors

BACKGROUND

Risk factors associated with negative outcomes in dogs with protein-losing enteropathy (PLE) are well documented. However, mortality before hospital discharge and associated risk factors are not well described.

HYPOTHESIS/OBJECTIVES

Report the percentage of dogs with PLE that do not survive to hospital discharge and identify associated risk factors.

ANIMALS

One-hundred and seven dogs presented to a referral hospital and diagnosed with PLE caused by inflammatory enteritis, intestinal lymphangiectasia or both.

METHODS

Retrospective cross-sectional study assessing hospital records. Data on in-hospital mortality and cause were assessed, and presenting signs, treatments prescribed, neutrophil count, lymphocyte count, serum albumin, globulin, and C-reactive protein (CRP) concentrations, and histopathologic findings were compared between survivors and non-survivors.

RESULTS

In-hospital mortality was 21.5% with the most common causes including financial limitations, failure to improve and aspiration pneumonia. Factors associated with mortality during hospitalization included longer duration of hospitalization (P = .04), longer duration of clinical signs (P = .02) and an increase in serum CRP concentration after 1-3 days of in-hospital treatment (P = .02). Higher mortality was identified in Pugs (odds ratio [OR], 4.93; 95% confidence interval [CI], 1.41-17.2; P = .01) and was a result of presumptive aspiration pneumonia in 5/6 of these dogs.

CONCLUSIONS AND CLINICAL IMPORTANCE

Protein-losing enteropathy in dogs has substantial mortality during hospitalization. Monitoring for improvement in CRP concentration after treatment during hospitalization may help predict survival to discharge. Pugs have increased in-hospital mortality because of aspiration pneumonia; measures to prevent, recognize, and promptly treat this complication may improve outcomes in this breed.

Evaluation of B-lines with 2 point-of-care lung ultrasound protocols in cats with radiographically normal lungs

OBJECTIVE

To compare 2 point-of-care lung ultrasound (LUS) protocols for quantification of B-lines in cats without evidence of respiratory disease based on history, physical examination, and thoracic radiography.

DESIGN

Prospective observational study.

SETTING

Single center, veterinary teaching hospital.

ANIMALS

Fifty-seven cats without respiratory disease based on history, physical examination, and thoracic radiographs.

INTERVENTIONS

All cats had 2 point-of-care LUS protocols performed bilaterally: a regional protocol (veterinary bedside lung ultrasound evaluation [VetBLUE]) and a more comprehensive vertical sweeping (VS) protocol. The total number of B-lines per cat, number of sites with B-lines, and maximal number of B-lines at each site were recorded and compared.

MEASUREMENTS AND MAIN RESULTS

Ten cats (18%) had at least 1 B-line identified with VetBLUE, versus 29 (51%) with VS. Comparing protocols, VS had a statistically higher total number of B-lines per cat, higher number of sites with B-lines, and higher maximal number of B-lines per site. B-lines that were too numerous to count were identified at a single location in 1 cat with VetBLUE and 2 cats with VS. A maximum of 3 B-lines were identified at all other positive sites regardless of the protocol used. On average, it took 1.79 times longer to complete VS bilaterally compared to VetBLUE (median [interquartile range]: 140 [33] and 78 [14] s, respectively) (P = 0.001).

CONCLUSIONS

This study demonstrates it is not uncommon to identify a single or even multiple B-lines in 1 or several sites on LUS in cats deemed to be clinically free of respiratory pathology-essential knowledge when using LUS as a screening test and to monitor intrathoracic lesions. In cats asymptomatic for respiratory disease, VS generally identifies more B-lines than VetBLUE, likely because it assesses a larger lung surface area. The sonographic identification of B-lines should be interpreted considering the LUS protocol used, history, and other diagnostics to determine their clinical significance.

The Rat Thoracic Ultrasound protocol: scanning technique and normal findings

Respiratory diseases (especially pneumonia) are very common disorders in pet rats. The suspected diagnosis is mostly based on the clinical signs, thoracic auscultation, and thoracic radiography. However, auscultation is insensitive in determining the severity of the disease, and radiographs are often unremarkable. Non-cardiac thoracic ultrasonography is increasingly used in veterinary medicine; however, it has not been described in detail in rats. Thoracic ultrasonic examination was conducted on 400 client-owned conscious pet rats. The rats were examined in the period from June 2023 to August 2023 in two veterinary clinics. Due to the small size of the animal, different anatomical considerations, and different evaluation protocols, as well as to meet the optimal outcome of detailed thoracic ultrasound, a standard methodological protocol was developed, and the name RATTUS (Rat Thoracic Ultrasound) was proposed. Typical signs of normal RATTUS were described (bat sign, lung sliding, A-lines, abdominal curtain sign, ski jump sign, lung pulse, seashore sign in M-mode, and bamboo sign). The new evaluation of lung inflation symmetry by substernal access was also described. The methodical approach presented and the normal findings description are proposed to be used for a standard/routine thoracic ultrasound examination in pet rats.

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

Imaging and endoscopic diagnosis of lung diseases in small animals. A review

Diagnostic imaging plays a fundamental role in the diagnosis of pulmonary diseases. Radiography, ultrasound, computed tomography, and endoscopy are important tools for achieving a diagnosis. The choice of diagnostic procedure varies according to the patient, the suspected diagnosis and the risk/benefit ratio. Culture, cytology and histology are nearly always necessary to obtain a definitive diagnosis. Several biopsy sampling techniques are described. Surgical biopsies are the gold standard for the diagnosis of bronchiolitis or interstitial lung diseases but often not performed due to the high risk. In humans, the introduction of transbronchial cryobiopsies has led to excellent results in the study of interstitial lung diseases.

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

OBJECTIVE

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

CASE SERIES SUMMARY

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

NEW OR UNIQUE INFORMATION PROVIDED

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

Integrated Basic Heart and Lung Ultrasound Examination for the Differentiation between Bacterial Pneumonia and Lung Neoplasm in Dogs—A New Diagnostic Algorithm

Simple Summary

Dyspnea is a highly alarming sign both for dog owners and veterinarians. Although its recognition is usually easy due to prominent suffering of an animal, finding its cause is challenging because many diseases of the heart, lungs, and airways may manifest themselves this way. Echocardiography and lung ultrasound allow for relatively quick and accurate identification of heart diseases. Dyspneic dogs without a heart and upper airway disease are usually suspected of either bacterial pneumonia or lung neoplasm. Although prognosis in these two conditions is diametrically different, differentiation between them is challenging. Chest radiography is performed in a lateral position, which is barely tolerated by a dyspneic dog, and intensive chest movements often make X-ray scans inconclusive. Computed tomography, although much more accurate, requires general anesthesia, which is difficult and potentially life-threating in a dyspneic dog. Therefore, lung ultrasound, which can be performed quickly in a conscious dog, standing or in sternal position, seems to be the method of choice. We develop and evaluate a diagnostic algorithm based on detection of three well-defined abnormalities in the lung ultrasound. The algorithm allows one to distinguish between bacterial pneumonia and lung neoplasm in a dyspneic dog with high probability of a conclusive result (91%) and high accuracy (>95%).

Abstract

The diagnostics of two of the most prevalent lung diseases in dogs, bacterial pneumonia (BP) and lung neoplasm (LN), are challenging as their clinical signs are identical and may also occur in extrapulmonary diseases. This study aims to identify ultrasonographic criteria and develop a lung ultrasound (LUS)-based diagnostic algorithm which could help distinguish between these two conditions. The study is carried out in 66 dyspneic dogs in which a heart disease was excluded using echocardiography. Based on imaging and laboratory diagnostic tests, as well as follow-up, the dogs are classified into LN (35 dogs) and BP (31 dogs) groups. LUS is performed at admission and the presence of seven lung abnormalities (pleural thickening, B-lines, subpleural consolidations, hepatization with or without aeration, nodule sign and mass classified together as a tumor, and free pleural fluid) and classification and regression trees are used to develop an LUS-based diagnostic algorithm. Distribution of all LUS abnormalities except for aerations differs significantly between groups; however, their individual differentiating potential is rather low. Therefore, we combine them in an algorithm which allows for definitive classification of 60 dogs (91%) (32 with LN and 28 with BP) with correct diagnosis of LN and BP in 31 dogs and 27 dogs, respectively.

Influence of concurrent lower respiratory tract disease on point-of-care lung ultrasound in small-breed dogs with myxomatous mitral valve disease

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.

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

Background

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

Hypothesis

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

Animals

Seventeen dogs with AP.

Methods

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

Results

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

Conclusion and Clinical Importance

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

Lung Ultrasound for Imaging of B-Lines in Dogs and Cats-A Prospective Study Investigating Agreement between Three Types of Transducers and the Accuracy in Diagnosing Cardiogenic Pulmonary Edema, Pneumonia and Lung Neoplasia

Transthoracic heart and lung ultrasound (LUS) was performed in 200 dogs and cats with dyspnea to evaluate the agreement between the results obtained using three types of transducers (microconvex, linear, and phased array) and to determine the accuracy of LUS in discriminating between three conditions commonly causing dyspnea in companion animals: cardiogenic pulmonary edema (CPE), pneumonia, and lung neoplasm. The agreement beyond chance was assessed using the weighted Cohen's kappa coefficient (κw). The highest values of κw (>0.9) were observed for the pair of microconvex and linear transducers. To quantify B-lines the lung ultrasound score (LUSscore) was developed as a sum of points describing the occurrence of B-lines for each of 8 standardized thoracic locations. The accuracy of LUSscore was determined using the area under ROC curve (AUROC). In dogs AUROC of LUSscore was 75.9% (CI 95%: 65.0% to 86.8%) for distinguishing between lung neoplasms and the two other causes of dyspnea. In cats AUROC of LUSscore was 83.6% (CI 95%: 75.2% to 92.0%) for distinguishing between CPE and the two other causes of dyspnea. The study shows that results obtained with microconvex and linear transducers are highly consistent and these two transducers can be used interchangeably. Moreover, the LUSscore may help identify dogs with lung neoplasms and cats with CPE, however its diagnostic accuracy is only fair to moderate.

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

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

Global FAST for Patient Monitoring and Staging in Dogs and Cats

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

Successful management of aspiration pneumopathy without antimicrobial agents: 14 dogs (2014-2021)

OBJECTIVES

To describe clinical cases of aspiration pneumonitis and pneumonia in dogs, which were successfully managed without antimicrobials.

MATERIALS AND METHODS

Retrospective case review of dogs presenting to a referral teaching hospital between February 2014 and February 2021. Cases were included when a clinical diagnosis of aspiration pneumopathy was made (requiring one or more of the following: radiographic evidence of an aspiration pneumopathy, endotracheal airway sampling consistent with aspiration and/or a positive endotracheal airway sample culture) which was not treated with antimicrobial therapy.

RESULTS

Fourteen cases were identified of which nine had respiratory signs including increased respiratory rate or effort (n=8), arterial hypoxaemia (n=2), or a clinician-determined requirement for oxygen therapy (n=4). Where haematology was performed, five of nine displayed a normal neutrophil count with toxic changes, three displayed neutrophilia and one displayed neutropenia with toxic changes. Endotracheal airway sample cytology in four cases revealed neutrophilic inflammation with bacteria, plant material, yeasts and unidentified foreign material. Where respiratory signs were present, these resolved within 12 to 36 hours.

CLINICAL SIGNIFICANCE

In this case series, immunocompetent dogs sustaining aspiration events, even with classical evidence of pneumonitis or pneumonia, have been managed successfully without antimicrobials. Radiography alone cannot be used to determine the requirement for antimicrobials. Better characterisation of the pathogenesis and clinical trajectory of aspiration pneumopathy is required, which may enable a reduction in inappropriate antimicrobial prescriptions.

Lung ultrasound nodule sign for detection of pulmonary nodule lesions in dogs: Comparison to thoracic radiography using computed tomography as the criterion standard

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.

Comparison of curvilinear-array (microconvex) and phased-array transducers for ultrasonography of the lungs in dogs

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.

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

Background

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

Hypothesis/Objectives

Document GBWE associated with cardiac disease.

Animals

Fourteen client‐owned animals.

Methods

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

Results

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

Conclusions and Clinical Importance

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

Utility of thoracic ultrasonography in a rapid diagnosis of angiostrongylosis in young dogs presenting with respiratory distress

The nematode, Angiostrongylus vasorum is a nematode that lives in the pulmonary arteries of canids and has an obligate gastropod intermediate host. It can cause various clinical signs. with the two most common clinical scenarios consisting of acute respiratory distress and haemorrhagic diathesis, either separately or together. Younger dogs (< 2 years) are overrepresented, and dogs often show pulmonary granulomata (radiographically and pathologically). Thoracic ultrasonography offers a safe, rapid, commonly available, non-invasive means of assessing the lungs. We prospectively examined the utility of thoracic ultrasonography in the diagnosis of angiostrongylosis in 26 client-owned dogs <2 years old, presenting with respiratory distress. We identified small hypoechoic subpleural nodules in 15/26 dogs; 14 of these were subsequently confirmed to have angiostrongylosis by faecal Baermann concentration test, A. vasorum antigen testing or both. The remaining 11 dogs without subpleural nodules had negative faecal analysis and A. vasorum antigen testing and diagnosed with other respiratory diseases. This resulted in a sensitivity of 100% and a specificity of 92% for the detection of angiostrongylosis by thoracic ultrasonography in young dogs presenting with respiratory distress. Our results suggest that thoracic ultrasonography might offer a safe, rapid, relatively accurate diagnostic test for diagnosis of angiostrongylosis in young adult dogs with respiratory distress living in endemic areas.

Diagnostic accuracy of a lung ultrasound protocol (Vet BLUE) for detection of pleural fluid, pneumothorax and lung pathology in dogs and cats

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.

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

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

Utility of point-of-care lung ultrasound for monitoring cardiogenic pulmonary edema in dogs

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.

Cageside Ultrasonography in the Emergency Room and Intensive Care Unit

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

Respiratory Emergencies

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