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Prevalence of heartworm infection in cats with signs of cardiorespiratory abnormalities.

OBJECTIVE: To determine prevalence of heartworm infection in a population of pet cats with cardiorespiratory abnormalities and to determine relative usefulness of clinical signs and tests in diagnosis of heartworm disease. DESIGN: Prospective case series. ANIMALS: 100 client-owned cats with clinical signs of cardiorespiratory abnormalities. PROCEDURE: Cats were evaluated using CBC, modified Knott test, ELISA for serologic detection of heartworm antigen and antibodies to heartworms, thoracic radiography, and echocardiography. Cats were considered infected if they had circulating microfilaria, heartworm antigens in serum, or if heartworms were detected by echocardiography or on necropsy. Cats were considered suspicious for infection if they had 2 of the following: serum antibodies to heartworms, eosinophilia or basophilia, or indicative radiographic findings. RESULTS: 9 cats were infected with heartworms, resulting in a prevalence of 9%; 26 cats had evidence of heartworm exposure (i.e., serum antibodies to heartworms). Twenty cats were considered suspicious for heartworm infection. Some outdoor exposure was reported twice as often in heartworm-infected cats, compared with noninfected and suspicious cats. However, a third of infected cats were reportedly housed totally indoors. Cough and dyspnea were strong indicators of heartworm disease. Eight of 9 infected cats had serum antibodies to heartworms and heartworm antigen in serum. Thoracic radiography and echocardiography indicated heartworm infection in 6 and 7 of the 9 cats, respectively. CLINICAL IMPLICATIONS: Cough or dyspnea may indicate heartworm disease in cats; serologic tests, echocardiography, and radiography are most useful diagnostic procedures. Although living indoors is protective, it may not preclude heartworm infection in cats.

Animals↗

Atypical pectus excavatum in two Welsh terrier littermates.

Two six-week-old intact Welsh terrier littermates, a male and a female, were presented for congenital ventral thoracic wall deformities characterised by noticeable funnel-like depressions of the cranial sternum associated with inversion of the rib cage. No exercise intolerance or cardiac murmurs were noted. Thoracic radiographic examination revealed a significant dorsal deviation of the first to the fifth sternebrae. At 12 weeks of age, the thoracic depressions had improved markedly in both puppies. Thoracic radiography to reassess the sternal deviation was at this stage within normal limits, demonstrating complete radiographic resolution of the sternal deformity.

Abnormalities, Multiple↗

Phase II clinical trial of carboplatin in canine transitional cell carcinoma of the urinary bladder.

Fourteen dogs with histologically-confirmed transitional cell carcinoma (TCC) of the urinary bladder were treated with 300 mg/m2 carboplatin every 3 weeks. Response to therapy was assessed with abdominal radiography, double contrast cystography, urinary bladder ultrasonography and thoracic radiography before therapy and at 6-week intervals during therapy. Dogs were monitored for hematologic toxicity with a CBC and platelet count performed immediately before and 10 to 14 days after carboplatin treatment. Tumor responses included progressive disease in 11 dogs and stable disease in 1 dog. Two dogs were euthanized due to carboplatin toxicity before assessment of tumor response. Toxicity included thrombocytopenia with or without neutropenia in 7 dogs and gastrointestinal toxicity in 6 dogs. Carboplatin therapy was not beneficial in the treatment of TCC in the 14 dogs in this study.

Animals↗

Use of keyhole lung biopsy for diagnosis of interstitial lung diseases in dogs and cats: 13 cases (1998-2001).

OBJECTIVE: To characterize interstitial lung diseases (ILDs) and evaluate use of keyhole lung biopsy for diagnosis of ILDs in dogs and cats. DESIGN: Retrospective study. ANIMALS: 11 dogs and 2 cats. PROCEDURE: Medical records of dogs and cats undergoing keyhole lung biopsy to confirm ILDs were reviewed. Signalment, clinical signs, results of thoracic radiography and other respiratory diagnostic tests, postoperative complications, and patient outcome were analyzed. RESULTS: Clinical respiratory signs included cough, tachypnea, exercise intolerance, and hemoptysis. Thoracic radiographic abnormalities included interstitial, alveolar, and bronchointerstitial patterns and multiple discrete pulmonary nodules. Lung biopsy and histologic examination revealed interstitial pulmonary fibrosis, bronchiolitis obliterans with organizing pneumonia, or unclassified lesions. Outcome after biopsy included no response to treatment, euthanasia, partial or complete remission while receiving medication, and cure. CONCLUSIONS AND CLINICAL RELEVANCE: Recognition and classification of ILDs in dogs and cats are likely to be important in guiding appropriate treatment and providing accurate prognostic information. Ancillary respiratory diagnostic tests are beneficial in ruling out infectious and neoplastic disorders that may mimic ILDs; however, their present use in the diagnosis of ILDs is limited. Results suggest that keyhole lung biopsy is an effective means for obtaining a specimen for histologic diagnosis in dogs and cats with ILDs.

Animals↗

Pictorial review: imaging of traumatic aortic injury.

Traumatic aortic injury is a leading cause of death in patients with blunt trauma of the thorax. More than 120 patients with traumatic aortic injury have been admitted to our institution. This institutional experience is the source of the material that is presented in this pictorial review. The appearance of traumatic aortic injury on chest radiography, thoracic aortography and CT scan is demonstrated.

Aortic Rupture↗

Radiographic scoring lacks predictive value in inflammatory airway disease.

REASONS FOR PERFORMING STUDY: Diagnosis of inflammatory airway disease (IAD) currently rests upon the results of bronchoalveolar lavage (BAL) cytology, lung function testing and histamine bronchoprovocation (HBP), none of which provides direct information about structural change in the lung. HYPOTHESIS: That thoracic radiography might better portray structural change in the lungs and therefore offer a good clinical assessment of IAD. METHODS: A radiographic scoring system was developed to assess the extent of bronchial and interstitial pattern on thoracic radiographs in the dorsocaudal, dorsocranial and caudoventral regions in 16 control horses and 33 horses with IAD. Mean scores were compared to ascertain whether thoracic radiographs could distinguish between the 2 groups. In order to determine whether independent observers reliably scored radiographs similarly, an inter-rater reliability score was employed for each radiographic observation. Correlations between radiographic scores, BAL cytology, lung function testing using the forced oscillatory technique and HBP were examined. RESULTS: Inter-rater reliability was only moderate. Radiographic scoring demonstrated no differences between the 2 groups. There were no correlations among BAL cytology, lung function testing, HBP and radiographic scores. CONCLUSIONS AND POTENTIAL RELEVANCE: Thoracic radiographs are a low-yield diagnostic modality in horses with a clinical history compatible with IAD. In the absence of clinical evidence of more extensive, infectious disease, thoracic radiographs neither refine nor improve diagnosis of IAD, but increase diagnostic costs.

Animals↗

Lack of residual lung damage in horses in which Rhodococcus equi-induced pneumonia had been diagnosed.

The effect of prior Rhodococcus equi-induced pneumonia on pulmonary health was investigated in 5 horses (< 24 months old) using endoscopy, radiography, hematologic and bronchoalveolar lavage analyses, and pulmonary function testing. Rhodococcus equi-induced pneumonia had been diagnosed in principal horses when they were foals. Diagnosis was based on positive results of transtracheal aspiration and thoracic radiography at the time of initial clinical examination. Results of reevaluation of the respiratory system of these horses (R+) were compared with those of 5 age-matched healthy horses (R-) that lacked clinical or historical evidence of foalhood pneumonia. Significant differences in variables between the 2 groups of horses were not evident. In both groups, most horses had radiographic evidence of an accentuated bronchointerstitial pattern, although results of analysis of bronchoalveolar lavage specimens were normal and mononuclear cells predominated. Variability in results of the pulmonary function tests was observed within the between the 2 groups of horses. Only normalized dynamic lung compliance was slightly lower in the previously infected horses, but this difference was not significant. We concluded that horses previously infected with and successfully treated for R equi-induced pneumonia do not have detectable evidence of residual lung damage.

Actinomycetales Infections↗

Analysis of prognostic indicators for dogs with pericardial effusion: 46 cases (1985-1996).

OBJECTIVE: To determine factors associated with disease-free interval and survival time for dogs with pericardial effusion. DESIGN: Retrospective study. ANIMALS: 46 dogs. PROCEDURE: Signalment, history, results of physical examination, electrocardiography, echocardiography, and thoracic radiography; disease-free interval; and survival time were obtained from medical records or telephone conversations with owners and referring veterinarians. RESULTS: Dogs that had ascites at the time of the initial physical examination were significantly less likely, and dogs that had evidence of pulmonary metastases on thoracic radiographs or that had echocardiographic evidence of a right atrial mass were significantly more likely, to have died of pericardial effusion or the underlying cause of effusion than were dogs that did not. Median survival time was 15.3 months for dogs with idiopathic pericardial effusion, 16 days for dogs with hemangiosarcoma, and 13.6 months for dogs with mesothelioma. Dogs that had a nonspecific extracardiac mass and underwent pericardiectomy were significantly less likely to have had recurrence of signs than were dogs that did not. However, dogs with mesothelioma or hemangiosarcoma that underwent pericardiectomy did not have a significantly different risk of recurrence of signs or survival time, compared with dogs that did not. CLINICAL IMPLICATIONS: Results suggest that pericardiectomy will not affect risk of recurrence or survival time in dogs with pericardial effusion secondary to hemangiosarcoma or mesothelioma. However, pericardiectomy is still needed to differentiate dogs with neoplastic pericardial effusion from dogs with idiopathic pericardial effusion.

Animals↗

Idiopathic primary chylopericardium in a dog.

CASE DESCRIPTION: A 7-year-old spayed female Labrador Retriever was evaluated because of pericardial effusion. CLINICAL FINDINGS: The dog had a history of decreased appetite and exercise intolerance of 3 days' duration. Thoracic radiography performed by the referring veterinarian revealed a large cardiac silhouette. Heart sounds were muffled. Echocardiographic findings were indicative of severe pericardial effusion with cardiac tamponade; no pleural effusion was identified. Pericardiocentesis yielded a considerable amount of chylous fluid. A diagnosis of chylopericardium in the absence of pleural effusion was made. TREATMENT AND OUTCOME: Conservative management was not effective, and subtotal pericardectomy and thoracic duct ligation were recommended. Surgery was postponed by the owners for 25 days, at which time the dog had both chylopericardium and chylothorax. The dog underwent subtotal pericardectomy and thoracic duct ligation; to delineate the thoracic duct, intraoperative lymphangiography was performed by injection of a radiopaque contrast agent directly into a mesenteric lymph node and subsequent injection of methylene blue solution into another mesenteric lymph node. Surgical treatment resulted in complete resolution of the clinical signs and pleural effusion. CLINICAL RELEVANCE: To the authors' knowledge, this is the first report of the development of chylopericardium prior to development of chylothorax in a dog. Treatment with thoracic duct ligation and pericardectomy resulted in complete resolution of the effusion and clinical signs.

Animals↗

Thoracic and abdominal blastomycosis in a horse.

A 5-year-old Quarter Horse mare was examined because of lethargy, fever, and weight loss of 1 month's duration. Thoracic auscultation revealed decreased lung sounds cranioventrally. Thoracic ultrasonography revealed bilateral anechoic areas with hyperechoic strands, consistent with pleural effusion and fibrin tags. A large amount of free fluid was evident during abdominal ultrasonography. Abnormalities included anemia, hyperproteinemia, hyperglobulinemia, hyperfibrinogenemia, and hypoalbuminemia. Thoracic radiography revealed alveolar infiltrates in the cranial and caudoventral lung fields. A cavitary mass, consistent with an abscess, could be seen caudodorsal to the crura of the diaphragm. Ultrasonographic evaluation of this area revealed a hypoechoic mass with septations. Bilateral thoracocentesis was performed. Bacterial culture of the pleural fluid did not yield growth, but Blastomyces dermatitidis was isolated from pleural fluid, abdominal fluid, and an aspirate of the abscess. The mare was euthanatized, and a diagnosis of thoracic and abdominal blastomycosis was confirmed at necropsy.

Animals↗

Selenium-based digital radiography of the chest: radiologists' preference compared with film-screen radiographs.

OBJECTIVE: A new digital thoracic radiography system (Thoravision; Philips Medical Systems, Hamburg, Germany), which uses selenium as a detector material, was evaluated for observer preference. The system has been shown to have higher detection efficiency than conventional film-screen systems and thus could provide an image with reduced noise. The hypothesis tested in this study was that the selenium-based digital system would provide an image appearance for conventional thoracic imaging that would be equal or superior to that provided by a conventional film-screen system. MATERIALS AND METHODS: Fifty-three patient volunteers were imaged at 120 kV with both the selenium-based system and a thoracic film-screen combination system (InSight HC; Kodak, Rochester, NY). Posteroanterior and lateral images were acquired with both systems, for a total of 212 images. Both imaging systems included a stationary 12:1 antiscatter grid. Exposures were the same for both imaging systems, and the digital images were printed to film. Images for the same patient were compared by six observers--three specialized chest radiologists and three general radiologists. Images included both normal chest radiographs and radiographs with abnormal findings. Each pair of images was ranked on a scale from 1 to 5 for preference of technique, with a score of 3 indicating no preference. Eleven anatomic features were evaluated in the posteroanterior views, and six features were evaluated in the lateral views. Statistical significance of preference was evaluated with Student's t test. RESULTS: The chest radiologists had a statistically significant preference for the selenium-based system for all 17 features (p < .001). The general radiologists had a statistically significant preference for the selenium-based system for visualization of 10 of the 17 features (p < .05). Neither group had a statistically significant preference for the conventional images in any category. CONCLUSION: The selenium-based system provided an image appearance that was significantly preferred by all radiologists, more strongly by those specializing in chest radiography. This study demonstrates that a digital thoracic imaging system can routinely produce images that are perceived as equal or superior to conventional images.

Artifacts↗

Evaluation of biopsy specimens obtained during thoracoscopy from lungs of clinically normal dogs.

OBJECTIVE: To determine whether lung biopsy specimens obtained during thoracoscopy, using a commercially available ligature, can provide an adequate amount of tissue for histologic evaluation and to characterize changes in the lungs and thoracic cavity that result from the procedure. ANIMALS: 6 mixed-breed dogs. PROCEDURE: All dogs underwent 2 anesthetic episodes. The first anesthetic episode was a sham procedure. During the second anesthetic episode, each dog underwent a thoracoscopic procedure to obtain a lung biopsy specimen, using a commercially available ligature. Biopsy specimens were assessed subjectively by means of histologic evaluation. Samples for arterial blood gas analysis were obtained, and thoracic radiography was performed after surgery. Dogs were evaluated daily for 14 days after thoracoscopy and then were euthanatized. Tissues were evaluated grossly and histologically. RESULTS: Excellent intraoperative visibility and biopsy specimens adequate for histologic evaluation were obtained from all dogs. Significant differences were not found between arterial blood gas values of sham- and thoracoscopy-treated dogs for samples obtained 0.25, 2, and 24 hours after extubation. Examination of thoracic radiographs obtained 2 and 24 hours after thoracoscopy revealed minimal localized pathologic changes. All dogs were clinically normal 24 hours after thoracoscopy, and major postoperative complications were not detected. Gross and histologic findings of specimens obtained during necropsy revealed changes localized to biopsy and trocar sites. CONCLUSIONS: Thoracoscopic placement of ligatures allowed procurement of lung lobe biopsy specimens from clinically normal dogs without complications. CLINICAL RELEVANCE: This procedure may provide a safe and minimally invasive means of obtaining lung biopsy specimens from clinically affected dogs.

Animals↗

Pulmonary thromboembolism in cats: 29 cases (1987-1997).

OBJECTIVE: To determine clinical signs, clinicopathologic abnormalities, radiographic findings, histologic abnormalities, and predisposing factors or diseases in cats with pulmonary thromboembolism (PTE). DESIGN: Retrospective study. ANIMALS: 29 cats in which PTE was confirmed at necropsy. PROCEDURE: Information on signalment, body weight, history, results of physical examination, results of CBC and serum biochemical analyses, whether PTE was suspected prior to death, type of indwelling venous catheter and duration of venous catheterization, results of thoracic radiography, and whether cats had any concurrent diseases was obtained from medical records. RESULTS: PTE was identified in cats of various ages (median, 8.7 years), weights (median, 4.1 kg [9 lb]), and breeds. The most common owner-reported problems included lethargy (17 cats), anorexia (14), weight loss (10), and difficulty breathing (8); physical abnormalities included lethargy (21), tachypnea or dyspnea (16), and dehydration (13). Clinicopathologic abnormalities reflected concurrent or underlying diseases. Common radiographic abnormalities included pulmonary vessel abnormalities (11), pleural effusion (8), and peripheral noncircumscribed consolidations (6). Underlying or predisposing conditions, including cardiac disease (12), neoplasia (10), corticosteroid administration (8), disseminated intravascular coagulation (5), protein-losing nephropathy (4) or enteropathy (4), immune-mediated hemolytic anemia (2), and sepsis (2) were identified in all cats. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that PTE can develop in cats of any age, sex, or breed. Because PTE is a serious, potentially life-threatening disease, it should be suspected in cats with thoracic radiographic changes suggestive of uneven distribution of blood flow between lung lobes, especially in cats that have predisposing factors or diseases.

Age Factors↗