1
|
Łobaczewski A, Czopowicz M, Moroz A, Mickiewicz M, Sapierzyński R, Tarka S, Frymus T, Mądry W, Buczyński M, Szaluś-Jordanow O. Integrated Basic Heart and Lung Ultrasound Examination for the Differentiation between Bacterial Pneumonia and Lung Neoplasm in Dogs—A New Diagnostic Algorithm. Animals (Basel) 2022; 12:ani12091154. [PMID: 35565580 PMCID: PMC9101849 DOI: 10.3390/ani12091154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 02/01/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Andrzej Łobaczewski
- Veterinary Clinic Auxilium, Arkadiusz Olkowski, Królewska Str. 64, 05-822 Milanówek, Poland;
| | - Michał Czopowicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska Str. 159c, 02-776 Warsaw, Poland; (M.C.); (A.M.); (M.M.)
| | - Agata Moroz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska Str. 159c, 02-776 Warsaw, Poland; (M.C.); (A.M.); (M.M.)
| | - Marcin Mickiewicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska Str. 159c, 02-776 Warsaw, Poland; (M.C.); (A.M.); (M.M.)
| | - Rafał Sapierzyński
- Department of Pathology and Veterinary Diagnostic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska Str. 159, 02-776 Warsaw, Poland;
| | - Sylwia Tarka
- Department of Forensic Medicine, Medical University of Warsaw, Oczki 1 Str., 02-007 Warsaw, Poland;
| | - Tadeusz Frymus
- Department of Small Animal Diseases with Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska Str. 159c, 02-776 Warsaw, Poland;
| | - Wojciech Mądry
- Department of Cardiac and General Pediatric Surgery, Medical University of Warsaw, Żwirki i Wigury 63A Street, 02-091 Warsaw, Poland; (W.M.); (M.B.)
| | - Michał Buczyński
- Department of Cardiac and General Pediatric Surgery, Medical University of Warsaw, Żwirki i Wigury 63A Street, 02-091 Warsaw, Poland; (W.M.); (M.B.)
| | - Olga Szaluś-Jordanow
- Department of Small Animal Diseases with Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska Str. 159c, 02-776 Warsaw, Poland;
- Correspondence: ; Tel.: +48-22-5936-111
| |
Collapse
|
2
|
Łobaczewski A, Czopowicz M, Moroz A, Mickiewicz M, Stabińska M, Petelicka H, Frymus T, Szaluś-Jordanow O. 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. Animals (Basel) 2021; 11:3279. [PMID: 34828010 PMCID: PMC8614539 DOI: 10.3390/ani11113279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/07/2021] [Accepted: 11/15/2021] [Indexed: 12/12/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Andrzej Łobaczewski
- Veterinary Clinic Auxilium, Arkadiusz Olkowski, Królewska Street 64, 05-822 Milanówek, Poland;
| | - Michał Czopowicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska Street 159, 02-776 Warsaw, Poland; (M.C.); (A.M.); (M.M.)
| | - Agata Moroz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska Street 159, 02-776 Warsaw, Poland; (M.C.); (A.M.); (M.M.)
| | - Marcin Mickiewicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska Street 159, 02-776 Warsaw, Poland; (M.C.); (A.M.); (M.M.)
| | - Marta Stabińska
- Private Veterinary Clinic, Wyszyńskiego Street 12/11, 41-200 Sosnowiec, Poland;
| | - Hanna Petelicka
- Veterinary Clinic Peteliccy, 1 Maja 27, 96-300 Żyrardów, Poland;
| | - Tadeusz Frymus
- Department of Small Animal Diseases with Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska Street 159, 02-776 Warsaw, Poland;
| | - Olga Szaluś-Jordanow
- Department of Small Animal Diseases with Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska Street 159, 02-776 Warsaw, Poland;
| |
Collapse
|