Lung ultrasound to differentiate types of lesions

Front Vet Sci 2023

Author

Obi Veterinary Education
January 04, 2024

Katarzyna Kraszewska, Michał Gajewski and Søren R. Boysen

Background: The authors describe the use of lung ultrasound (LUS) and color Doppler sonography (CD) to assess pulmonary consolidations in a dog with suspected pulmonary thromboembolism (PTE) and Angiostrongylus vasorum infection. They highlight the advantages of LUS and CD over other imaging modalities, such as thoracic radiographs and computed tomography, and review the literature on the sonographic features of PTE and inflammatory lung lesions in humans and dogs.

Methods: The authors present a case report of a 1.5-year-old male Maltipoo with dyspnea, weakness, cough, and anorexia. The dog underwent echocardiography, LUS, CD, blood tests, and fecal examination. The LUS examination followed the VetLus protocol, which involves scanning the lung surface at three different vertical locations on each side of the thorax. The characteristics of the lung consolidations, such as shape, margins, echogenicity, bronchograms, blood flow, and pleural criteria, were evaluated using B-mode and CD. The dog was treated with anticoagulants, anti-parasitics, and other supportive medications.

Results: The echocardiography revealed severe pulmonary hypertension and a McConnell sign, suggestive of PTE. The LUS and CD identified two types of lung consolidations: irregular-shaped consolidations with preserved blood flow and bronchograms, consistent with inflammatory lesions, and triangular or basket-shaped consolidations without blood flow and with a vascular sign, consistent with PTE. The D-dimer and C-reactive protein levels were elevated, indicating a hypercoagulable and inflammatory state. The fecal Baermann test confirmed Angiostrongylus vasorum infection. The dog showed clinical improvement and resolution of the echocardiographic and sonographic abnormalities after treatment.

Limitations: The authors acknowledge that they could not confirm the diagnosis of PTE due to the lack of a reference standard test, such as computed tomography pulmonary angiography. They also note that the dog received multimodal treatment, which made it difficult to determine the exact cause of the pulmonary hypertension and the lung lesions. They suggest that further studies are needed to validate the use of LUS and CD for the diagnosis of PTE in dogs.

Conclusions: The authors conclude that LUS and CD can be useful tools to characterize and differentiate lung consolidations in dogs, and that the vascular characteristics of the consolidations can provide supportive information for the diagnosis of PTE. They propose that LUS and CD can complement other diagnostic tests and guide patient management in cases of suspected PTE.

Color doppler still image of a triangular shaped consolidation within the lung referred to as a “wedge sign”. An absence of blood flow within the consolidated region is visible, giving the impression the blood flow is “amputated” (↑), which is referred to as the “vascular sign”. A comet-tail artifact (C-line) extends from the lower edge of the consolidation (←). Short artifacts originating at the pleural line (→) are also visible, referred to as I-lines. Finally, hyperechoic vertical artifacts, believed to be B-lines are also visible (*). To confirm these are B-lines the depth should be extended (10-15 cm) to ensure these vertical white artifacts continue to reach the far field. Performed at presentation. Thyroid presets.

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