Diagnostic utility of abdominal ultrasonography in dogs with chronic diarrhea

Use of Contrast-Enhanced Ultrasonography and Shear-Wave Elastography in the Diagnosis of Granulomatous Colitis in a French Bulldog

An 11-month-old male intact French Bulldog was referred for chronic intermittent diarrhea lasting three months. Ultrasonographic (US) examination revealed severe thickening of the wall of the colon and caecum; contrast-enhanced US (CEUS) and elastography showed increased, heterogeneous vascularization and non-uniform stiffness of the colonic wall. The mucosa was thickened, fragile, and ulcerated as revealed by endoscopy, and histological examination confirmed the suspicion of granulomatous colitis.

Diagnostic features, treatment, and outcome of dogs with inflammatory protein-losing enteropathy

Background

Protein‐losing enteropathy (PLE) because of chronic inflammatory enteropathy (CIE) in dogs is often treated with a combination of glucocorticoids and second‐line immunosuppressant (SLI). This combined approach might not be necessary in all dogs.

Hypothesis/objectives

To describe diagnostic features and outcomes of dogs with PLE treated with glucocorticoids alone (group P) or with glucocorticoids and SLI (group S).

Animals

Thirty‐one dogs with PLE.

Material and methods

Retrospective analysis of signalment data from diagnostic procedures, treatment, and outcome of dogs with CIE/PLE (from 2015 to 2017), using the hospital's digital case database. Dogs with hypoalbuminemia and CIE were included. Because of a stepwise treatment algorithm, dogs were allocated to group P or S. Time to serum albumin concentrations ≥20 g/L and survival data were collected. Dogs were additionally categorized by their albumin and cobalamin serum concentrations. Multivariate and univariate analysis as well as Pearson's correlation and Kaplan‐Maier survival analysis were performed.

Results

Seventeen dogs were included in group P and 14 in group S. World Small Animal Veterinary Association score of the duodenum was different between groups (P = .05), but none of the other examined data. Median time until serum albumin reached >20 g/L was 13 days. Median survival time after start of treatment was 85 days (range, 13‐463 days) in group P and 166 days (range, 8‐390 days) in group S.

Conclusion and Clinical Importance

No routine diagnostic test was predictive of clinical response, treatment group, or outcome. Glucocorticoid treatment alone can be appropriate in dogs with PLE.

Ability of ultrasonography to predict the presence and location of histologic lesions in the small intestine of cats

BACKGROUND

Diagnosis of infiltrative small intestinal (SI) disease in cats is challenging, and debate continues regarding optimal biopsy techniques. Ultrasonography may facilitate selection of biopsy type and location.

HYPOTHESIS/OBJECTIVES

Assess ability of ultrasonography to predict histologic lesions by SI segment and tissue layer.

ANIMALS

One-hundred sixty-nine cats that had abdominal ultrasonography and full-thickness SI biopsies performed.

METHODS

Ultrasonographic images and full-thickness biopsy samples were retrospectively reviewed, and each SI wall layer evaluated for lesions according to published standards.

RESULTS

Ultrasonographic SI lesions were present in 132 cats (63 duodenum; 115 jejunum; 71 ileum). Samples were obtained at laparotomy (60) or necropsy (109). Ultrasonographic abnormalities had high positive predictive value (PPV) for histologic lesions (duodenum, 82.0%; 95% confidence interval [CI], 68.6-91.4; jejunum, 91.0%; 95% CI, 81.5-96.6; ileum, 88.1%; 95% CI, 74.4-96.0), but poor negative predictive value (duodenum, 27.1%; 95% CI, 17.2-39.1; jejunum, 27.3%; 95% CI, 10.7-50.2; ileum, 40.4%; 95% CI, 26.4-55.7). The ability of ultrasonography to predict histologic lesions in this population, which had high disease prevalence (SI histologic lesions in 78.1% of cats) was high for mucosal lesions (PPV, 72.7%-100%) but low for submucosal or muscularis lesions (PPV, 18.9%-57.1%).

CONCLUSIONS AND CLINICAL IMPORTANCE

In a population with high disease prevalence, most cats with SI mucosal ultrasonographic lesions will have mucosal histologic lesions. Small intestinal submucosal and muscularis ultrasonographic lesions are not predictive of histologic disease in those layers, suggesting that full-thickness biopsy may not be essential in these cats. Ultrasonography may help guide decisions about biopsy type in individual cats.

How useful is abdominal ultrasonography in dogs with diarrhoea?

OBJECTIVE

To assess the utility of abdominal ultrasonography in the diagnostic work-up of dogs with diarrhoea.

METHODS

Retrospective cross-sectional study based on a referral population of dogs with diarrhoea. Associations between the clinical signs, use of abdominal ultrasonography, results of abdominal ultrasonography and subsequent work-up were examined. The utility of abdominal ultrasonography was scored as high, moderate, none or counterproductive based on review of medical records.

RESULTS

Medical records of 269 dogs were reviewed, of which 149 (55%) had abdominal ultrasonography. The most frequent result was no ultrasonographic abnormalities affecting the intestine in 65 (44%) dogs. Ultrasonography results were associated with subsequent work-up as follows: (1) no detected abnormalities and dietary trial; (2) focal thickening of the intestinal wall, loss of intestinal wall layers or enlarged abdominal lymph nodes and ultrasound-guided fine-needle aspirates; (3) diffuse thickening of the intestinal wall or hyperechoic striations in the small intestinal mucosa and endoscopy; and (4) small intestinal foreign body and coeliotomy. Abdominal ultrasonography was considered to be diagnostic without further testing in only four (3%) dogs: two had a portosystemic shunt identified ultrasonographically, one had a linear foreign body and one had a perforated pyloric ulcer. Abdominal ultrasonography had moderate utility in 56 (38%) dogs and no utility in 79 (53%) dogs. Abdominal ultrasonography was considered counterproductive in 10 (7%) dogs because results were either falsely negative or falsely positive.

CLINICAL SIGNIFICANCE

These results should prompt clinicians to reconsider routine use of abdominal ultrasonography in dogs with diarrhoea.