ULTRASONOGRAPHIC INVESTIGATION OF THE ABDOMINAL CAVITY INCLUDING LYMPH NODES SURGICAL AFFECTIONS IN DOGS AND CATS

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1 Egypt. J. Basic Appl. Physiol., 12(1): (2013) ULTRASONOGRAPHIC INVESTIGATION OF THE ABDOMINAL CAVITY INCLUDING LYMPH NODES SURGICAL AFFECTIONS IN DOGS AND CATS GOMAA, M.**, SAMY, M. T. **, OMAR, M. S. **, NEFISSA H. MEKKAWY,** AND KRAMER, M.* * Department of Veterinary Clinical Sciences, Small Animal Clinic (Justus- Liebig University) Giessen, Germany. **Department of Surgery, Faculty of Veterinary Medicine, Zagazig University, Egypt. ABSTRACT In the present study, a total number of 39 dogs and 18 cats were ultrasonographically examined for abdominal cavity and lymph nodes surgical affections. These animals were admitted to the Department of Veterinary Clinical Sciences, Small Animal Clinic (Justus- Liebig University) Giessen, Germany during the period of Lymphadenopathy was found in dogs in 13 cases and constituted 33.3% of the ultrasonographically diagnosed cases. While in cats, there were 8 cases with elevated incidence reached 44.4%. Intraabdominal masses (6 dogs) and the free fluid in the abdominal cavity (6 dogs) were found with a ratio of 15.4%. Abdominal wall abscesses (4 dogs), intraabdominal cryptorchidism (2 dogs), peritonitis (2dogs) and (6 cats), wound seroma (2 dogs), abdominal and diaphragmatic hernias (4 dogs and 4 cats). The sonographic picture, blood analysis, cytological, bacteriological and histopathological findings as well as surgical treatment of these cases were carried out. Keywords: Ultrasonography, abdominal cavity, lymph nodes, surgical affections, dogs, cats. INTRODUCTION Ultrasound scanning has been used for diagnosis of many abdominal cavity diseases in large and small animals. It offers a safe, non invasive, non painful method for the diagnosis and staging of many diseases. It is the best modality to evaluate fluid filled and parenchymal organs. However, as ultrasound does not penetrate through air and gas, it cannot be used for evaluation of normal organs or abnormalities surrounded by gas (Nyland et al., 1995). They have negative influence on the diagnostic value of abdominal ultrasonography. In certain cases, however, gas may facilitate the diagnosis or under certain circumstances, even make a diagnosis possible (Kiefer et al., 2008). ISSN: ISBN: 12154/2002

2 Gomaa et al. (2013) Consistent findings in animals with diaphragmatic rupture were irregular or asymmetric cranial aspect of the liver and abdominal viscera in the thorax (Spattini et al., 2003). On the other hand, transabdominal ultrasound is complementary to clinical examination, abdominal radiography and laboratory data (Gaschen et al., 2007). Peritoneal effusion can be detected with ultrasonography if the volume of free fluid exceed 2 ml / kg BW (Henley et al., 1989). The echogenicity of the peritoneal fluid is usually proportional to its content of cells and other debris which act as ultrasound reflectors (Hanbidge et al., 2003). However, the detection of small amounts of free peritoneal fluid in the canine patient can be diagnostic dilemma (Henley et al., 1989) who found that ultrasonography is more sensitive than radiography and is the method of choice for detection of small amounts of free peritoneal fluid. On the other hand, peritoneal abscesses often present as fluid pockets with particles, surrounded by an ill defined hyperechoic wall and sometimes internal septa or gas foci (Konde et al., 1986 and Hanbidge et al., 2003). Moreover, massively infiltrated lymph nodes can become markedly enlarged, more rounded and distorted. Hypoechoic or anechoic areas may also be seen as the result of liquefaction necrosis or cyst formation. Meanwhile, certain sonographic features can be used to suggest whether lymphadenopathy is more likely benign or malignant. Specific changes in size, shape, echogenicity, and Doppler flow patterns have an association with malignancy (Llabres- Diaz, 2004). Therefore, the aim of the present study is to survey the different surgical affections of the abdominal cavity including lymph nodes in dogs and cats as well as to evaluate the efficacy of ultrasound for diagnosis of such affections. MATERIAL AND METHODS In the course of this study, a total number of 39 dogs and 18 cats have been examined and diagnosed with different abdominal surgical affections. These animals were admitted to the small animal clinic, Justus - Liebig University, Giessen, Germany during the period from 2008 to Ultrasonography was performed using a real-time ultrasound machine (Powervision 8000, SSA-390A; Toshiba) with an 8 to 12 MHz linear transducer and 5-7 MHz convex transducer and (LOGIQ 9 General Electric (GE) - USA) equipped with M7C (4-7 MHz) convex transducer and M12 L ISSN: ISBN: 12154/2002

3 Ultrasonographic Investigation of the Abdominal Cavity Including... (9-12 MHz) linear array transducer. The ventral abdominal wall was clipped and acoustic gel (Sonogel; Bad Camberg) was applied. The entire abdomen was examined ultrasonographically while the animal was in dorsal recumbency. Percutaneous ultrasound-guided aspiration biopsies were performed using either a 22 gauge spinal needle or a 20 gauge needle. The microcore automated biopsy was performed using an 18 gauge Tru-Cut-like needle, assisted by an automated biopsy gun. Fine - needle aspiration biopsy (FNAB) were also performed. Specimens were preserved and were sent to Pathology Department for examination and diagnosis. RESULTS In the course of this study, there were 39 dogs and 18 cats suspected of having different abdominal cavity abnormalities or pathologies as illustrated in table (1). In dogs, the most commonly encountered abdominal cavity abnormalities were lymphadenopathy 13 out of 39 cases constituted 33.3% of the ultrasonographically diagnosed cases. In the second level were the intraabdominal masses and the free fluid in the abdominal cavity, 6 cases of each with the ratio of 15.4%. The rest cases were sporadic 4 abdominal wall abscesses, 2 intraabdominal cryptorchidism. peritonitis, wound seroma each only 2 cases, abdominal and diaphragmatic hernias 4 cases and only one case parapreputeal abscess. In cats 18 cases were ultrasonographically diagnosed. Cases with lymphadenopathy were the most 8 out of 18 with a percentage of 44.4%, 6 cases with peritonitis 33.3% and 4 cases with abdominal and diaphragmatic hernia. Tables (1, 2 and 3) illustrated the different abdominal surgical affections, numbers, percentage, ultrasonographic findings, cytological, histopathological, microbiological and surgical findings of the examined dogs and cats. ISSN: ISBN: 12154/2002

4 Gomaa et al. (2013) Table (1): Number of abdominal cavity abnormalities including abdominal lymph nodes affections in dogs and cats Affections Dog (number and percentage) Cat (number and percentage) Abdominal wall abscesses 4 (10.3%) - Wound seromas 2 (5.1%) - Intraabdominal masses 6 (15.4%) - Free fluid in abdominal cavity (Ascites) 6 (15.4%) - Ventral abdominal and diaphragmatic hernias 4 (10.3%) 4 (22.2%) Peritonitis 2 (5.1%) 6 (33.3%) Intraabdominal cryptorchidism 2 (5.1%) - Lymphadenopathy 13 (33.3%) 8 (44.4%) Total number Abdominal wall affections (abscesss and seroma): There were 4 dogs with abdominal wall abscesses, of which 1 case located parapreputeal and 2 dogs with seroma. The ultrasonographic image showed swelling of the abdominal wall with hyperechoic irregular structure. It contains hypoechoic corpuscular fluid with hyperechoic caseated area with acoustic enhancement (Fig. 1). The cytological and bacteriological examination revealed Streptococcus pyogenes, Actinomyces, staphylococcus aureus, Corynebacterium pyogenes, aerobic microorganisms and purulent materials. All cases were surgically successfully treated through opening and drainage. Fig. (1): Ultrasound longitudinal scan of abdominal wall abscess in dog showed hyperechoic irregular wall, hypoechoic fluid content with corpuscular fluid with hyperechoic caseated areas (arrow). ISSN: ISBN: 12154/2002

5 Ultrasonographic Investigation of the Abdominal Cavity Including... Table (2): Ultrasonographic, surgical, cytological, histopathological and microbiological findings in the abdominal cavity and lymph nodes in dogs. Dog (number) Ultrasonographic findings Surgical findings Abdominal abscesses (4 cases) Wound seromas (2 cases) Abdominal (abscess) (1 case) wall mass Intraabdominal masses (5 cases) Ascites (6 cases) The ultrasonographic image showed swelling of the abdominal wall with hyperechoic irregular structure. It contains hypoechoic corpuscular fluid with hyperechoic caseated area with acoustic enhancement. demonstrated an anechoic area with multiple hyperechoic septae represented fluid filled pockets Large round inhomogeneous mass (10x10cm) in the caudal part of the abdomen. It has distinct hyperechoic capsule with underlying small anechoic areas. Free fluid in the abdomen with corpuscle. An inhomogenous rounded hypoechoic mass in different places in the abdomen. In one case there was a hyperechoic band 3 cm in diameter with strong distal acoustic shadowing near the abdominal wall. It was surgically manifested as surgical sponge forgotten from previous operation inside the abdominal cavity. Other case was with granuloma with necrosed and infected omentum. 2 cases suffered traumatic hematoma in caudal abdomen manifested hypoechoic area with spotty hyperechoic structure visible in the area of abdominal wall. There was also hypoechoic areas in the caudal abdomen with moderate free fluid. One case with abdominal hemorrhage (hemabdomen) manifested hypoechoic areas with hyperechoic structures and moderate degree of free fluid with corpuscles. Severe degree of ascites with hyperechoic swollen mesentry All cases were surgically successfully treated through opening and drainage. No surgery Surgery: drainage abscess near the prostate gland Surgery: granuloma with infected necrosed omentum were removed and remove the surgical sponge in one case No surgery Cytology, histopathology and microbiology findings The cytological and bacteriological examination revealed Streptococcus pyogenes, Actinomyces, staphylococcus aureus, Corynebacterium pyogenes, aerobic microorganisms and purulent materials No further examinations 3 Cytology: necrotic process with predominant granulomatous inflammation and low-grade chronic purulent inflammation Microbiology: aerobic microorganisms Cytology: suggestive of a mesenchymal proliferation (capsular contracture, scar tissue) granulation tissue Microbiology: Staphylococcus aureus (+++) No further examinations Figures in text 1&2 4& 5A,B&C A-C ISSN: ISBN: 12154/2002

6 Table (2): Continue... Gomaa et al. (2013) Different hernias (4 cases) (1 incarcerated abdominal hernia, 2 umbilical hernia and I diaphragmatic hernia), Peritonitis (2 cases) Intraabdominal cryptorchidism) (2 cases) Lymphadenopathy (13 cases) (+++): severe degree of infection The 1st one manifested swollen region with different intestinal wall layers in several intestinal loops and contained hyperechoic ingesta, umbilical hernia manifested the same while the diaphragmatic hernia showed hyperechoic round intestinal loops in the thoracic cavity Demonstrated hyperechoic mesentery or omentum which mask the normal anatomic details in right cranial abdomen. Intestines appear corrugated with thick hyperechoic submucosa, free abdominal fluid with corpuscles Demonstrated the left testicle found in left caudal lateral abdomen at the level of the bladder neck as an oval hypoechoic structure with hyperechoic clear homogeneous boundary. Inhomogenous smoothly marginated and enlarged, the hypoechoic lymph nodes are rounded. Two cases with lymph node abscess demonstrated hypoechoic to anechoic structure that is surrounded by very reflective hyperechoic mesentery with free abdominal fluid Surgery: herniorraphy resection of necrotized and incarcerated intestinal loops and enterectomy and herniorraphy in other cases Surgery purulent peritonitis drainage and lavage were done Laparotomy and removal of the left testis were done Surgery of a mesenteric lymph node abscess with abdominal lavage was done in one case but the other case with no surgical interference. No further examinations The result of cytological examination was septic inflammation and microbiology showed staphylococcus, E-coli and Klebsiella. 16 &17 No further examinations 22 Generalized inflammatory reaction in 4 cases, lymphoma in 5 cases out of the 12, while malignancy was carcinoma in 2 cases out of 13. and the microbiological findings in these 2 cases were E-coli, Staph intermedius and Enterococcus and cytology also revealed Pyogranulomatous inflammation in abdominal and thoracic lymph nodes in one case of these 2 cases ISSN: ISBN: 12154/2002

7 Ultrasonographic Investigation of the Abdominal Cavity Including... Table (3): Ultrasonographic, surgical, cytological, histopathological and microbiological findings in the abdominal cavity and lymph nodes in cats. Cat (number) Ultrasonographic findings Surgical findings Diaphragmatic hernia (4 cases) Peritonitis (6 cases) Lymphadenopathy (8 cases) Sonographically there was hypoechoic structure in thorax with coarse echotexture (liver) in 3 cats and mild degree homogenic echogenicity spleen in thorax Severe degree of ascites with hyperechoic swollen mesentery Enlarged hypoechoic rounded lymph node (thickened muscular layer of intestinal tract) Surgically operated to correct the diaphragmatic defect via liver and spleen reposition and herniorraphy Three of these cases were surgically treated with lavage and drainage and in one cat there was a foreign body (awn) grain No surgical interference to these cases Cytology, histopathology and microbiology findings Figures in text No further examinations 14&15 Microbiology: E-coli, Acinetobacter, Citrobacter and Enterobacter infection. Cytological examination of (3) cats revealed exudates of low cellularity that were chronic pyogranulomatous inflammation (Feline infectious peritonitis) (F.I.P.). The cytology revealed 5 cases with lymphoma and 3 cats with reactive hyperplasia A-D F.I.P.: Feline infectious peritonitis. ISSN: ISBN: 12154/2002

8 Gomaa et al. (2013) In this study one dog suffered parapreputeal phlegmone was scanned, the ultrasound picture of the parapreputeal phlegmone showed a hyperechoic bands with infiltrative hypo- to anechoic areas (sandwich phenomena or marble appearance) (Figure, 2). Cytology revealed purulent materials. This dog was treated with application of systemic antibiotic. The 2 cases with wound seroma demonstrated an anechoic area with multiple hyperechoic septae represented fluid filled pockets (Fig. 3). No surgery was done. Fig. (2): Ultrasound longitudinal scan of parapreputeal phlegmone in dog showed hyperechoic bands with infiltrative hypo- to anechoic areas. Note the sandwich phenomena or marble appearance. Fig. (3): Ultrasound longitudinal scan of seroma in dog with multiple hyperechoic septae represented fluid filled pockets Abdominal cavity masses: Six cases suffered intraabdominal masses, sonographically there was free fluid in the abdomen with corpuscle. An inhomogenous rounded hypoechoic mass in different places in the abdomen. ISSN: ISBN: 12154/2002

9 Ultrasonographic Investigation of the Abdominal Cavity Including... In one case there was a hyperechoic structure 3 cm in diameter with strong distal acoustic shadowing near the abdominal wall. It was surgically manifested as surgical sponge forgotten from previous operation inside the abdominal cavity. Other case was with granuloma with necrosed and infected omentum which is removed surgically. Intraabdominal abscess: Ultrasound examination in a dog with paraprostatic abscess showed large round inhomogeneous mass (10x10cm) in the caudal part of the abdomen that has a distinct hyperechoic capsule with anechoic small rounded areas (abscess in caudal abdomen) (Fig. 4 and 5 A, B, C). Fig. (4): Ultrasound longitudinal scan in a dog with paraprostatic abscess showed large round inhomogeneous mass (10x10cm) in the caudal part of the abdomen that has a distinct hyperechoic capsule with anechoic small rounded areas (abscess in caudal abdomen). A B C Fig. (5 A, B, C): Surgery in the same dog showed a large round mass in the caudal abdomen. It was surgically removed (abscess). Abdominal granuloma: Ultrasound examination of the left caudal abdomen in a dog showed an area caudal to the kidney which measured 4.5 x 5.2 cm as a hypoechoic mass with hyperechoic capsule (Fig. 6 A, B, and Fig. 7). The cytological picture was suggestive of a mesenchymal proliferation (capsular contracture, scar tissue) granulation tissue. Surgery ISSN: ISBN: 12154/2002

10 Gomaa et al. (2013) was done to remove this mass and the diagnosis was granuloma with infected and necrosed omentum. F A Fig. (6 A, B): Ultrasound longitudinal scan in a dog with granuloma caudal to the kidney reveals a 4.5 x 5.2 cm hypoechoic mass with hyperechoic capsule, Fluid (F). B Fig. (7): Surgery in the same dog with abdominal mass that was diagnosed as a granuloma with infected and necrotic omentum. Surgical sponge (Tampon) in the abdomen: In one dog, there was a foreign body in the abdomen. It was forgotted since 1 year from a previous operation. It was seen by ultrasound as hyperechoic structure 3cm in length with strong distal acoustic shadowing directly adhesed to the abdominal wall. Surgery was done for removal of the surgical sponge (Fig. 8 & 9 A, B). ISSN: ISBN: 12154/2002

11 Ultrasonographic Investigation of the Abdominal Cavity Including... Fig. (8): Ultrasound longitudinal scan in dog with retained surgical sponge showed hyperechoic band 3cm in diameter with strong distal acoustic shadowing. A Fig. (9 A, B): Surgery in the same dog with foreign body (tampon) was directly adhesed to the abdominal wall. Hematomas in the abdomen: Two cases suffered traumatic hematoma in caudal abdomen manifested hypoechoic area with spotty hyperechoic structure visible in the area of abdominal wall. There were also hypoechoic areas in the caudal abdomen with moderate free fluid. One case with abdominal hemorrhage (hemabdomen) manifested hypoechoic areas with hyperechoic structures and moderate degree of free fluid with corpuscles. Free fluid in the abdominal cavity (Ascites): Six cases out of 39 ultrasonographically diagnosed surgical affections suffered ascites, sonographically free fluid (anechoic) between spleen and abdominal wall with hyperechoic swollen mesentery (Fig 10 A, B, C). ISSN: ISBN: 12154/2002 B

12 Gomaa et al. (2013) A B Fig. (10 A, B, C): Ultrasound longitudinal scan in dog showing free abdominal fluid. A) in the region of the apex of the urinary bladder. B) intraabdominal between mesentery. C) between spleen and abdominal wall. Ventral abdominal and diaphragmatic hernias: In this study there are 4 dogs and 4 cats with abdominal or diaphragmatic hernia. Four cases of different hernias (1 incarcerated abdominal hernia, 2 umbilical hernia and 1 diaphragmatic hernia), the 1 st one manifested a swollen region with different intestinal wall layers and contained hyperechoic ingesta (Fig. 11), umbilical hernia manifested the same, while the diaphragmatic hernia showed hyperechoic round intestinal loops in the thoracic cavity (Fig. 13). C Fig. (11): Ultrasound longitudinal scan of abdominal hernia in a dog showed different intestinal wall loops, seen containing hyperechoic ingesta. ISSN: ISBN: 12154/2002

13 Ultrasonographic Investigation of the Abdominal Cavity Including... A B Fig. (12 A, B, C): Surgery in the same dog showed intestinal loops subcutaneously embedded and were necrotized. They were resected. Artificial nylon net was sutured with the surrounding musculature (C). C Fig. (13): Ultrasound cross scan of diaphragmatic hernia in dog through intrathoracic 8-10 th intercostal space showed dilated intestinal loops with thickened wall, fluid inside. Four cats suffered diaphragmatic hernia; sonographically there was hypoechoic structure in thorax with coarse echotexture (liver) in 3 cats. There was mild degree homogenic echogenicity spleen in thorax. These were surgically operated to correct the diaphragmatic defect via liver and spleen reposition and herniorraphy (Fig 14 A, B and 15 A, B). ISSN: ISBN: 12154/2002

14 Gomaa et al. (2013) S L A B Fig. 14 A, B: Ultrasound cross scan in 2 cats with diaphragmatic hernia showed a hypoechoic fine echotexture structure inside the thorax diagnosed as spleen (S). A hypoechoic structure with coarse echotexture diagnosed as liver (L) (left lateral lobe) (B). A Fig. (15 A, B): Surgery in cat with diaphragmatic hernia showed liver lobe in the thorax. Closure of diaphragmatic rupture with application of drainage tube. Peritonitis: Two dogs with peritonitis demonstrated hyperechoic mesentery or omentum which mask the normal anatomic details in right cranial abdomen. Intestine appeared corrugated with thick hyperechoic submucosa and free abdominal fluid with corpuscles. In surgery purulent peritonitis drainage and lavage were done. Cytological examination revealed septic inflammation. Microbiological examination demonstrated staphylococcus, E-coli and Klebsiella. The 6 cats with systemic rise of body temperature and lethargy and abdominal pain suffered peritonitis, revealed sonographically severe degree of ascites with hyperechoic swollen mesentery. 3 of these cases were surgically lavaged and drainaged. In one cat there was a foreign body (awn) grain (Fig. 19 A, B, C) with presence of E-coli, Acinetobacter, Citrobacter and Enterobacter infection. Cytological B ISSN: ISBN: 12154/2002

15 Ultrasonographic Investigation of the Abdominal Cavity Including... examination of 3 cats revealed exudates of low cellularity that were chronic pyogranulomatous inflammation (Feline infectious peritonitis) (F.I.P.). Fig. (16): Ultrasound longitudinal scan in a dog with peritonitis showed hyperechoic mesentery and omentum which mask the normal anatomic details in the right cranial abdomen. Intestinenal loops appear corrugated with thick hyperechoic submucosa. Fig. (17): Surgery in the same dog with peritonitis appeared as thick inflammed peritoneum and omentum. ISSN: ISBN: 12154/2002

16 Gomaa et al. (2013) Fig. (18): Ultrasound longitudinal scan in a cat with ascites (hypoechoic fluid) with hyperechoic sediments. A B C Fig. (19 A, B, C): Surgery in the same cat showed purulent peritonitis and foreign body (awn). Fig. (20): Ultrasound longitudinal scan in a cat with severe purulent peritonitis showed hypoechoic fluid intraabdominal and hyperechoic mesentery and fatty tissues. ISSN: ISBN: 12154/2002

17 Ultrasonographic Investigation of the Abdominal Cavity Including... Fig. (21): Surgery in the same cat showed pus inside the abdomen and necrotized fat. Intraabdominal cryptorchidism: 2 dogs with intraabdominal cryptorchidism demonstrated the left testicle in the left caudal lateral abdomen at the level of the bladder neck as an oval hypoechoic structure with hyperechoic clear homogeneous boundary and a central hyperechoic elongated structure (mediastinum testes) (Fig. 22). Laparotomy for surgical removal of the left testis was undertaken. Fig. (22): Ultrasound longitudinal scan in a dog with (Cryprtorchid testis) showed oval hypoechoic structure with hyperechoic clear boundary and a central hyperechoic elongated structure (mediastinum testes) (arrow) Lymph nodes: 13 dogs out of the 39 manifested lymphadenopathy which is characterized by inhomogenous smoothly marginated rounded and enlarged hypoechoic lymph nodes. No surgery was undertaken. Other findings were generalized inflammatory reaction in 4 cases, lymphoma in 5 ISSN: ISBN: 12154/2002

18 Gomaa et al. (2013) cases out of the 13, while malignancy was carcinoma in 2 cases. The last two cases demonstrated lymph node abscesses revealed hypoechoic to anechoic structure that is surrounded by very reflective hyperechoic mesentery with free abdominal fluid (Fig. 23 A&B). Abdominal lavage was done in one case while the other case refused any interference. The microbiological findings in these 2 cases were E-coli, Staph intermedius and Enterococcus. Cytology revealed pyogranulomatous inflammation in both abdominal and thoracic lymph nodes. F A Fig. (23 A, B): Ultrasound longitudinal scan in a dog with mesenteric lymph node abscess showed U-shaped hypoechoic to anechoic structure that is surrounded by very reflective hyperechoic mesentery. Also free abdominal fluid that is hypoechoic with debris (F) was described. B Fig. (24 A, B, C): Surgery in the same dog with abscess in mesenteric lymph node (A) that is removed (B) and (C) Pus in the syringe. ISSN: ISBN: 12154/2002

19 Ultrasonographic Investigation of the Abdominal Cavity Including... Eight cats were diagnosed with lymphadenopathy through the sonographic examination. These showed enlarged hypoechoic lymph nodes (Fig 25 and 26 A-D). No surgical interference was undertaken. The histopathological examination revealed 5 cases with lymphoma and 3 cats with reactive hyperplasia. Fig. (25 A, B, C, D): Ultrasound longitudinal scans in dogs with lymphadenopathy. A: homogenous, hypoechoic rounded 2.4x3.7 cm enlarged lymph nodes (lymphoma). B: lymph nodes are inhomogenous and smoothly marginated 2.8x1.5 cm (carcinoma). C: inflammatory reaction in the lymph nodes. D: lymphoma in lymph nodes ISSN: ISBN: 12154/2002

20 Gomaa et al. (2013) Fig. ( 26 A, B, C, D): Ultrasound longitudinal scan in cats with lymphadenopathy. A: thickened hypoechoic muscular layer of the intestinal tract. B: thickened hypoechoic muscular layer of the intestinal tract. C: enlarged lymph nodes (3.8 cm). D: spleen enlarged with several hypoechoic foci. DISCUSSION Ultrasonography has been considered to be one of the most valuable imaging techniques for evaluation of the abdominal cavity and its organs. In most cases, abdominal ultrasonography helps obtain information that leads to a definitive diagnosis. Ultrasonography is also valuable to narrow the list of differential diagnosis obtained with other diagnostic techniques. This article discusses the role of ultrasound for the diagnosis of the most common diseases that could be encountered in the abdominal cavity. Abdominal organs that can be evaluated using ultrasound and as previously described include the liver, biliary system, pancreas, stomach and small intestine, spleen, kidney, urinary bladder, uterus and prostate. The study denoted also that breed, sex, and weight did not play any role in the incidence of the different diagnosed surgical affection. Considering the age, the animals were of different ages and varying from 1 year to 13 years old. The younger animals were cases suffered intraabdominal cryptorchidism 8 months and 1 year old. Considering the sex, age and weight of cats. The same was also noted, as they did not play any role in the incidence of such affections. In accordance to breed 14 cats out of 18 were European shorthair, the rest 3 were two Maine coon, one ISSN: ISBN: 12154/2002

21 Ultrasonographic Investigation of the Abdominal Cavity Including... Abyssinian and one British shorthair. Pathologies of the abdominal cavity and retroperitoneal space can also be diagnosed with ultrasonography as also confirmed by Cruz- Arambulo and Wrigley (2003). Moreover, ultrasonography allows the evaluation of organs size, shape, contour and texture. The animal s entire abdomen and the parenchyma of the abdominal organs can be assessed together. Moreover, the origin and extension of abdominal masses could be determined as supported also by Besso (1996). In the course of this study, lymphadenopathy is considered to be the most commonly encountered abdominal cavity abnormalities in both dogs and cats and constituted 33.3% and 44.4% of the examined cases respectively. This high incidence is of course attributed to their metastasis and secondary enlargement in association with other inflammatory hyperplastic or malignant diseases. Normally, they are often indistinct during routine abdominal ultrasonographic examination. In affected cases, they are characterized by inhomogenous smoothly marginated rounded, distorted and enlarged hypoechoic or anechoic areas which may be a result of liquefaction as supported by Pugh (1994) and Llabres- Diaz (2004). Certain sonographic features can be used to suggest whether lymphadenopathy is more likely benign or malignant. Specific changes in size, shape, echogenicity and Doppler flow patterns have an association with malignancy. Kinns and Mai (2007) evaluated the association between abdominal lymph node heterogenicity and malignancy. They demonstrated 91% of heterogenous canine lymph nodes were malignant and 63% of heterogenous feline lymph nodes were malignant without significant association between heterogenicity and malignancy. The sonographic patterns of abdominal wall abscesses revealed swellings of the abdominal wall with hyperechoic irregular structure or wall. It contains hypoechoic corpuscular fluid content with hyperechoic caseated area with acoustic enhancement. While the intraabdominal abscesses is defined as an irregular hypoechoic mass with minimal to no through transmission of echoes.however, definitive diagnosis of inrtaabdominal abscesses using only sonography is not possible as variations of this common sonographic pattern are imaged. Therefore, sonography can be used to assist in percutaneous aspiration, catheterization and intraoperative localization of abscessation. This is confirmed by Konde et al. (1986) and Boland et al. (2003). On the other hand, wound seroma demonstrated characteristic pathognomonic anechoic area with multiple hyperechoic septa referred to fluid filled pockets. Also, the sporadic single ISSN: ISBN: 12154/2002

22 Gomaa et al. (2013) diagnosed parapreputeal phlegmone in a dog demonstrated a pathognomonic hyperechoic bands with infiltrative hypo to anechoic areas with the characteristic sandwich phenomena or marble appearance. Cases suffered different hernias especially incarcerated umbilical or abdominal hernias manifested sonographically swollen region with different intestinal wall layers in intestinal loops and contained hyperechoic ingesta. These were characteristically demonstrated in the thoracic cavity in cases of diaphragmatic hernias. While cases with liver displacement in the thoracic cavity due to rupture of the diaphragm, revealed hypoechoic structure in the thorax with coarse echotexture (liver). While with spleen displacement demonstrated mild degree of homogenic and echogenic spleen in the thorax. These findings are in agreement with those described by Spattini et al. (2003) and Debiak et al. (2009) who recorded also an accuracy of ultrasonography with 93% for the diagnosis of diaphragmatic hernias. On the other hand, abdominal cavity masses were diagnosed in 6 dogs as inhomogenous rounded hypoechoic mass in different places of the abdomen. Also intraabdominal free fluids with corpuscle were detected. These included abscesses and granulomatous swellings due to necrosed and infected omentum. Also a hyperechoic structure 3 cm long with strong distal acoustic shadowing near the abdominal wall. Surgical exploration revealed surgical sponge forgotten from previous operation (Merlo and Lamb, 2000 and Mai et al., 2001). Traumatic hematoma in the caudal abdomen manifested itself as hypoechoic area with spotty hyperechoic structure. Also hypoechoic areas in the caudal abdomen with moderate free fluids (hemabdomen or peritoneal hemorrhage) varies in appearance according to the interval between the onset of bleeding and the time of ultrasonographic examination. Fresh blood appear anechoic or echogenic with swirling of particles within the fluid (Hanbidge et al., 2003 and Pintar et al., 2003). Cases suffered free abdominal fluid or ascites sonographically demonstrated anechoic areas between spleen and abdominal wall or between hepatic lobes or intestinal loops with hyperechoic swollen mesentery, as also described by Spaulding (1993). This can be manifested when scanning most dependent portion of animal is in lateral recumbency and when the fluid exceeded approximately 2 ml/ kg BW as recorded by Henley et al. (1989) and Boysen et al. (2004). Moreover, Hanbidge et al. (2003) confirmed that the echogenicity of the peritoneal fluid is usually ISSN: ISBN: 12154/2002

23 Ultrasonographic Investigation of the Abdominal Cavity Including... proportional to its content of cells and other debris, which act as ultrasound reflectors, low cellular fluids, such as pure or modified transudates are typically anechoic to hypoechoic, in comparison with exudates which are typically moderately echogenic as supported by d Anjou (2008). High cellular and homogenous exudates can actually appear isoechoic to soft tissue organs, such as the spleen, also exudates can be also septated as in cases of seromas because of fibrin strands that commonly developed with this type of effusion, particularly with purulent peritonitis as emphasized by Spaulding (1993). Cases suffered peritonitis demonstrated hyperechoic mesentery or omentum which mask the normal anatomic details in right cranial abdomen. Intestine appeared corrugated with thick hyperechoic submucosa and free abdominal fluid with corpuscles (Negrini et al., 2003). Ultrasonographic-guided retrieval of plant awns was successfully undertaken by Santa et al. (2008) which could be the cause of body granuloma or abscesses formation. This could be challenging due to the inability to localize the foreign body during surgical removal which often leads to abscess recurrence. Ultrasound- guided retrieval as an alternative to standard surgical retrieval was performed in animals where the plant awn can be identified sonographically. The two ultrasonograhically diagnosed cases with intraabdominal cryptorchidism demonstrated the left testicle in the left caudal abdomen at the level of the bladder neck as an oval hypoechoic structure with hyperechoic clear homogenous boundary (Hecht, 2008). The authors would like to thank all staff members of Pathology and Microbiology Departments of the Justus- Liebig University, Giessen- Germany for their help in examination and diagnosis of the different specimens of this work. REFERENCES Besso J. (1996): Abdominal ultrasonography: Principles and practical aspects. Recueil de Medicine Veterinaire, 172 (1-2): Boland L.E., Hardie R.J., Gregory S.P. and Lamb C.R. (2003): Ultrasoundguided percutaneous drainage as the primary treatment for prostatic abscesses and cysts in dogs. J Am Anim Hosp Assoc. 39(2): Boysen, S.R.; Rozanski, E.A.; Tidwell, A.S.; Holm, J.L.; Shaw, S.P. and Rush, J.E. (2004): Evaluation of a focused assessment with sonography ISSN: ISBN: 12154/2002

24 Gomaa et al. (2013) for trauma protocol to detect free abdominal fluid in dogs involved in motor vehicle accidents. J.Am.Vet.Med.Assoc., 225: Cruz- Arámbulo, R.C. and Wrigley, R. (2003): Ultrasonography of the acute abdomen Clinical Techniques in: J. Small Animal Practice, 18 (1): d Anjou, M.A. (2008): Abdominal cavity, lymph nodes, and great vessels, chapter 15 In: Atlas of small animal ultrasonography Penninck, D. and d Anjou,M.A. Blackwell Publishing, Iowa. USA, Debiak, P., Szczepaniak, A.L. and Komsta, R. (2009): Diagnostics of canine peritoneal-pericardial diaphragmatic hernia (PPDH). Medycyna Wet., 65 (3): Gaschen, L.; Kircher, P. and Wolfram, K. (2007): Endoscopic ultrasound of the canine abdomen. Vet Radiol Ultrasound, 48 (4): Hanbidge, A.E.; Lynch, D. and Wilson, S.R. (2003): Ultrasound of the peritoneum. Radiographics, 23: Hecht, S. (2008): Male reproductive tract, chapter 14 In: Atlas of small animal ultrasonography, Penninck, D. and d Anjou, M.A. Blackwell Publishing, Iowa. USA, Henley, R.K.; Hager, D.A. and Ackerman, N. (1989): A comparison of twodimensional ultrasonography and radiography for the detection of small amounts of free peritoneal fluid in the dog. Vet Radiol Ultrasound, 30: Kiefer, I.; Muller, F.; Himmelsbach, P.; Oechtering, G. and Alef, M. (2008): Sonographic detection of gas as aid in making a diagnosis. Tierärztl. Prax. Ausgabe Kleintiere Heimtiere, 36 (3): Kinns, J. and Mai, W. (2007): Association between malignancy and sonographic heterogenicity in canine and feline abdominal lymph nodes. Vet Radiol Ultrasound, 48 (6): Konde, L.J.; Lebel, J.L.; Park, R.D. and Wrigley, R.H. (1986): Sonographic application in the diagnosis of intraabdominal abscess in the dog. Vet Radiol Ultrasound, 27: Llabres- Diaz, F.J. (2004): Ultrasonography of the medial lymph nodes in the dog. Vet Radiol Ultrasound, 45: Mai, W.; Ledieu, D.; Venturini, L.; Fournel, C.; Fau. D.; Palazzi, X. and Magnol, J.P. (2001): Ultrasonographic appearance of intra-abdominal granuloma secondary to retained surgical sponge, Vet Radiol Ultrasound, 42: Merlo, M. and Lamb, C.R. (2000): Radiographic and ultrasonographic features of retained surgical sponge in eight dogs. Vet Radiol Ultrasound, 41: ISSN: ISBN: 12154/2002

25 Ultrasonographic Investigation of the Abdominal Cavity Including... Negrini, S; Valentini, S; Spinella G. and Fedrigo, M. (2003): Peritoneal Ultrasonography in Dogs and Cats. Veterinary Research Communications, 27 Suppl. 1, Nyland, T.G. ; Mattoon, J.S. and Wisner, E.R. (1995a): Physical principles, instrumentation. In Nyland TG, Mattoon JS veterinary diagnostic ultrasound by W.B. Saunders Company, Philadelphia London: Pintar, J.; Breitschwerdt, E.B.; Hardie, E.M. and Spaulding, K.A. (2003): Acute nontraumatic hemoabdomen in the dog: A retrospective analysis of 39 cases ( ). J. Am. Anim. Hosp. Assoc., 39: Pugh, C.R. (1994): Ultrasonographic examination of abdominal lymph nodes in the dog. Veterinary Radiology & Ultrasound, 35 (2): Santa, D.D.; Rossi, F.; Carlucci, F.; Vignoli, M. and Kircher, P. (2008): Ultrasound- guided retrieval of plant awns. Vet Radiol Ultrasound, 49 (5): Spattini, G.; Rossi, F.; Vignoli, M. and Lamb, C.R. (2003): Use of ultrasound to diagnose diaphragmatic rupture in dogs and cats. Vet Radiol Ultrasound, 44 (2): Spaulding, K.A. (1993): Sonographic evaluation of peritoneal effusion in small animals. Vet Radiol Ultrasound, 34: ISSN: ISBN: 12154/2002