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- How do you prioritize HSA ddx in dogs?
Mirko Mattolini et al
Background
Hemangiosarcoma (HSA) is a highly malignant neoplasm commonly affecting dogs, particularly large breeds like German Shepherds and Golden Retrievers. It often metastasizes to organs like the lungs, liver, and peritoneum. Accurate detection of pulmonary and extrapulmonary metastases is vital for staging and management. While CT imaging is more sensitive than radiography for detecting such metastases, detailed descriptions of their CT features in dogs have been limited.
Methods
This retrospective, observational study analyzed CT scans of 33 dogs with histologically confirmed HSA and lung metastases. Inclusion required pulmonary or extrapulmonary metastases confirmed cytologically or histologically. CT imaging included pre- and postcontrast studies, assessing features such as nodule size, distribution, enhancement patterns, and associated thoracic changes. Statistical analyses examined correlations between findings and lesion distribution.
Results
Pulmonary Metastases:
-Found in all 33 dogs, predominantly with more than 10 nodules (79%).
-Nodules were generalized in distribution (73%), small (miliary to subcentimetric in 97%), and often well-defined (88%).
-Common CT features included a halo sign (73%) and feeding vessels (97%).
-Homogeneous contrast enhancement predominated (79%), though ring or heterogeneous enhancement appeared in larger lesions.
Extrapulmonary Metastases:
-Identified in 70% of dogs, involving the liver (42%), spleen (33%), muscles (30%), and peritoneum/retroperitoneum (18%).
-Exhibited heterogeneous enhancement with intralesional hyperdensity patterns, termed the SPLASH sign, in liver (86%), spleen (82%), and muscle (80%) metastases.
R-are findings included mineralization and intralesional gas.
Thoracic and Abdominal Changes:
-Thoracic lymphadenomegaly occurred in 33%, mostly involving sternal nodes.
-Peritoneal effusion was noted in 21%.
Limitations
The study's retrospective design and inclusion of dogs with advanced HSA may limit generalizability.
Sampling challenges in confirming smaller or inaccessible lesions.
Limited use of standardized triple-phase angio-CT protocols.
Conclusions
Pulmonary HSA metastases are typically numerous, small, and generalized, often with a halo sign and feeding vessels. Extrapulmonary lesions exhibit the SPLASH sign, which could aid in prioritizing HSA in differential diagnoses. This study emphasizes the utility of whole-body CT for staging and guiding management in canine HSA. Further studies are warranted to refine the diagnostic role of these imaging features across neoplastic types.
Figure 1—A and B—Transverse CT lung images showed 2 examples of hemangiosarcoma lung metastases with feeding vessels (white arrows) in 2 dogs. In both cases, these nodular lesions appeared well-marginated, peripherally located, and miliary to subcentimetric in size. High-resolution CT images acquired in the transverse plane with 1.25-mm slice thickness and maximum intensity projection reformatted (3 slabs thick) and shown with lung window (window length, −400; window width, +1,500).
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