Objective—To determine whether contrast harmonic ultrasonography (CHUS) can be used in dogs to distinguish splenic hemangiosarcoma from hematoma and to accurately detect and characterize liver nodules.
Animals—20 dogs with a splenic mass.
Procedures—Routine abdominal ultrasonography was followed by CHUS of hepatic and splenic lesions. Qualitative evaluation included location, enhancement pattern, and vascularity of lesions. Quantitative evaluation included peak mean pixel intensity, interval to peak intensity, area under the curve (spleen), and liver-to-lesion intensity ratio (liver). Histologic findings were compared with CHUS lesion characteristics.
Results—Histologic evaluation of the spleen was performed in 19 dogs, resulting in diagnoses of hemangiosarcoma (n = 11), hematoma (7), and undifferentiated sarcoma (1). Benign and malignant processes in the spleen were indistinguishable via CHUS. Histologic evaluation of the liver was performed in 18 dogs, resulting in a diagnosis of hemangiosarcoma in 5 dogs. None of the dogs with splenic hematomas had evidence of hepatic lesions by means of con-ventional or contrast ultrasonography, and none had histologic evidence of liver metastases. In 3 of 18 dogs, isoenhancing liver nodules were detected and all were histologically benign. Five dogs had liver nodules that remained hypoechoic after contrast agent was injected; all had histologic evidence of metastatic hemangiosarcoma. Results of CHUS were used to characterize hepatic metastases with 100% sensitivity and specificity.
Conclusions and Clinical Relevance—Contrast harmonic ultrasonography was a noninvasive and accurate means of differentiating metastatic versus benign hepatic disease in dogs with splenic hemangiosarcoma but was not useful in distinguishing splenic hemangiosarcoma from hematoma.
A 19-year-old male bottlenose dolphin (Tursiops truncatus) presented with inappetence and avoidant behavior.
Ultrasound revealed a large-volume left-sided pleural effusion, which was consistent with chronic nonchylous lymphatic effusion and mild chronic hemorrhage by cytology. Computed tomography identified ipsilateral rib fractures, atelectasis, nodular pleuritis, marginal lymph node enlargement, and suspected dilation of the thoracic duct and internal thoracic veins. Fifteen lipids were significantly higher in serum of the dolphin as compared with controls (n = 3) using nontargeted lipidomics.
TREATMENT AND OUTCOME
A series of thoracentesis procedures were performed. Follow-up CT demonstrated marked reduction in pleural effusion with persistence of thoracic duct dilation and mass-like areas of pleural thickening. Ultrasonographic resolution of pleural effusion occurred 14 months after presentation; however, recrudescence was noted 5 months later. Over a total of 24 months, 21.52 L of pleural effusion was removed. Despite the presence of pleural effusion, the patient was clinically stable during this time and quality of life was considered good on the basis of continuous animal welfare evaluations. Humane euthanasia was elected following acute clinical decline 27 months after initial diagnosis. Necropsy confirmed severe pleural effusion, chronic severe pleural fibrosis with chronic hemorrhage, and mediastinal fibrosis with entrapped lymph nodes and thymic tissue.
Pleuritis and effusion were suspected sequelae of previous rib fractures. To our knowledge, this is the first report of nonchylous lymphatic pleural effusion with repeated pleural drainage and diagnostic imaging for clinical management in a bottlenose dolphin.