Do hyperechoic mucosal striations = intestinal disease?

VRU 2007

JAMES SUTHERLAND-SMITH, DOMINIQUE G. PENNINCK, JOHN H. KEATING, CYNTHIA R. L. WEBSTER

Background
Ultrasonography is a valuable diagnostic tool for gastrointestinal disorders in dogs. This study identifies and investigates the clinical and histopathologic associations of a previously unreported sonographic finding: small intestinal hyperechoic mucosal striations. The authors hypothesize that these striations are linked to protein-losing enteropathy (PLE) and lymphangiectasia, aiding in the diagnosis of these conditions.

Methods
A retrospective review of 23 dogs with hyperechoic mucosal striations on abdominal ultrasonography and available intestinal biopsy data (endoscopic or surgical) was conducted. Data collected included clinical signs, laboratory results, sonographic features, and histopathological findings. Lacteal dilation and inflammation were assessed in tissue samples. Ultrasonographic features were evaluated for consistency and correlation with histological findings.

Results
Histopathology: Lacteal dilation was found in 96% of cases, with endoscopic biopsies showing mild-to-moderate villus dilation and surgical biopsies showing moderate-to-severe dilation.


Sonographic Findings:
-Mild jejunal wall thickening (96%) and duodenal wall thickening (78%) were common.
-Abdominal effusion was observed in 87% of cases, often associated with hypoalbuminemia.
-Mucosal striations were diffuse (70%) or multifocal (30%), primarily involving the duodenum and jejunum.


Clinical Findings: Most dogs presented with diarrhea (73%), vomiting (41%), and signs of protein-losing enteropathy, including hypoalbuminemia (87%) and panhypoproteinemia (78%).


Inflammation: Histological evidence of mild-to-moderate mucosal inflammation was present in 91% of dogs, with predominant cell types including eosinophils, lymphocytes, and plasma cells.


Specific Cases: One dog had villus histiocytic sarcoma associated with mucosal striations.


Limitations
The study was retrospective, introducing potential sampling and selection biases. Biopsy sites might not have corresponded precisely to the sonographic changes. The small sample size and lack of healthy control subjects limit generalizability. Additionally, interobserver variation in histopathologic interpretation was a potential confounder.

Conclusions
Hyperechoic mucosal striations in dogs are strongly associated with lacteal dilation and protein-losing enteropathy, suggesting their potential as a diagnostic marker for intestinal disease. However, the specific underlying pathology (e.g., lymphangiectasia vs. inflammation) cannot be reliably distinguished sonographically. Further studies with standardized biopsy protocols and prospective designs are recommended to confirm these findings.

Fig. 1. Longitudinal sonogram of a jejunal segment in a dog with hyperechoic mucosal striations extending from the lumen-mucosa interface towards the submucosal layer. The spleen is noted in the near field. The histopathologic diagnosis was marked diffuse villus lymphangiectasia with granulomatous lymphangitis. There were similar mild lymphatic lesions in the submucosa and serosa, as well as mild lymphocytic, eosinophilic, and
neutrophilic enteritis with mucosal edema.

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