Ultrasonography of the Gastrointestinal Tract in 2004

1
Ultrasonography of the Gastrointestinal Tract in
2004

• Dominique Penninck, DVM, DVSc
• Tufts University, MA (USA)

2
Anatomy

• 12 hours fast preferred
• Use positioning to your advantage
• High resolution transducers
• Add fluid in stomach if needed

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Esophagus
Cat
Dog
4
Gastric Contents
Food
Gas
Fluid
5
Gastric Contents food versus mass?
Food
6
Intestinal contents
7
Gastric motility
3 to 5 contractions per minute (pylorus)
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Distention
9
Layering
Thickness difficult to assess Dogs 3 to 6
mm Cats 2 to 3 mm
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Intestinal Wall
Dog 2-4 mm (duodenum thicker) Cat 2-2.5 mm
(ileum 2.8 mm) In dogs, body weight relationship
is present
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Pyloroduodenal Junction
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Duodenum
Papilla
Peyers patches
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Normal Feline Ileum
Colon
Colon
Long
Trans
Thickness 2.8 mm (range from 2.5 to 3.2
mm) Prominent sub-mucosa
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Ileo-ceco-colic junction
Cat
Dog
15
Colon normal
Thickness 2 to 3 mm (dog) 1.4 to 1.7 mm (cat)

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Foreign Bodies

• Size, shape, composition
• Echogenicity
• Bright interface with STRONG shadowing
• Linear FB plication, accordion sign
• Fluid accumulation
• Acute obstruction decreased motility

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Foreign Bodies (stomach)
Ball
Rocks
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Teriyaki stick
Swelling on left cranial abdominal wall Possible
rib periosteal response Hyperechoic linear
interface (with shadowing?)
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Trichobezoar
Rabbit
TR
Long
Cat
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Intestinal Foreign Bodies
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Very unusual
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(No Transcript)
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Legendary indestructible kong !
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Intestinal Foreign Body
Peach pit
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Linear Foreign Body
Long
TR
S120782 Sheltie
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Linear Foreign Bodies Plication
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Worm Infestation
Duod
St
Cat
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Pylorogastric-duodenogastric intussusception
TR
Long
s125750
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(No Transcript)
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Pyloric mucosal hypertrophy mimicking
intussusception
s128404
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Intussusception

• Too many layers sign
• Bright crescentintussuscepted fat
• Fluid accumulation
• Decreased motility
• Regional lymphadenopathy
• FB or mass
• Assessment of bowel viability?

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It is not always that easy
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Intussusception and FB
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Intussusception and Mass
S109022 Colonic adenocarcinoma
S114242 Jejunal leiomyoma
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Colonic Intussusception and Lymphadenopathy
S124773 Cecal/colic LMA with edematous lymph nodes
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Intussusception
Complexe invagination Cystic component
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Lymphocytic plasmocytic gastritis
38
Gastric Ulcerative Diseases

• Local thickening
• crater
• Fluid accumulation
• Gas bubbles at crater site
• Decreased gastric motility

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Gastric Ulcerative Diseases

• Local thickening
• crater
• Fluid accumulation
• Gas bubbles at crater site
• Decreased gastric motility

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Pyloric ulcer
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Ulcerated Tumors
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Gastric Ulcer and wall edema
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Ulceration and Perforation
s61320
s126576
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Severe Ulcerative Gastritis
Edema Perivascular inflammation
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Muscular hypertrophy/hyperplasia Focal ulcerative
gastritis Subacute submucosal edema/inflammation
S91740
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Gastric wall edema
Marked wall thickening (gt1cm) spongy appearance
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Gastric wall edema
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Uremic gastropathy
Thickening of the wall (fundus, body) Ulceration,
edema, necrosis, hemorrhage Submucosal
arteriopathy Hyperechoic line at mucosa
(mineralization)
Rt kidney
Grooters A., et al 1994
49
Enteritis (61 dogs)

• Mild to moderate wall thickening (median 0.6
  cm)
• Normal to altered layering (88.6 )
• Diffuse lesion ( 72)
• Regional lymphadenopathy (median 1 cm, recorded
  in 24/61 dogs)
• Motility decreased in 61 (recorded in 18/61
  dogs)
• 87 cases had moderate or severe
  histopathological grading

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Lymphocytic plasmocytic enteritis
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Smooth Muscle Hypertrophy
Feline LPE
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Muscular Hypertrophy (IBD)

Cat S-102615
IAssociated with enteritis, foreign body,
neoplasia Wall thickness 3.5 to 8 mm
Diana A. et Al, 2003
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Unusual Features
Speckles
Striations
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Unusual Features
Speckles
Striations
IBD
Lymphangiectasia
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Granulomatous lymphangitis (lymphangiectasia)
S115665 Carn T
S117461
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Granulomatous lymphangitis (lymphangiectasia)
Lacteal dilation
s121899
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Intestinal Toxoplasmosis
S130825
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Intestinal Toxoplasmosis
Mild villous edema
Submucosal and muscular inflammation
S130825
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Colitis

• Boxer histiocytic ulcerative colitis

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Typhytis/colitis?
s124484
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Jejunal perforation secondary to FB
GI Perforation regional bright fat peritoneal
effusion fluid-filled GI segments GI wall
thickening free gas loss of wall
layering regional lymphadenopathy reduced GI
motility pancreatic changes corrugated
bowel mass presence of FB gastric wall
mineralization
Boysen S, et al 2003
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Anastomosis evaluation
s125086
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Corrugation
Non specific sign Can be encountered with
regional inflammation (pancreatitis, enteritis,
peritonitis), Abdominal neoplasia, bowel wall
ischemia
Moon ML, et al 2003
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Chronic Hypertrophic Gastropathy
Lhasa Apso, Shih Tsu, Miniature Poodles Muscular
hypertrophy, mucosal hyperplasia
Biller D, et al 1994
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HPS
s108167
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HPS
1.09 cm
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Polyp, hyperplastic nodule
68
Benign inflamed mucosal polyp
s114494
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Intestinal mucosal hyperplasia
Sharpei
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Colonic Polyp ?
S121984 Westie
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Intestinal Neoplasia (89 dogs)

• Moderate to severe thickening (Median 1.5 cm)
• Lost layering (98.9 )
• Localized lesion (98)
• Regional lymphadenopathy (Median 1.9 cm,
  recorded in 56/89 dogs)
• Decreased motility (87, recorded in 45/89 dogs)
• Tumor types lymphoma (50.7), carcinoma
  (31.6), leiomyoma/sarcoma (11), round cell
  tumor (2.2), anaplastic sarcoma (2.2),
  malignant histiocytoma (1.1), spindle cell tumor
  (1.1)

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GI Lymphoma
Thickening of wall (extensive or
multi-segmental) Loss of layering Regional
lymphadenopathy Rarely obstructive lesion
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Intestinal lymphoma (cat)
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Extensive bowel and mesentery involvement Regional
lymphadenopathy
s118078
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Canine Lymphoma
76
Obstructive Intestinal Lymphoma
s117246
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Infiltrative LMA
S111821
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Gastric carcinoma

• Diffuse transmural thickening
• Wall pseudo-layering
• Regional lymphadenopathy
• Fluid accumulation
• Decreased motility
• Ulceration

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Carcinoma
S127357 Kees 11y
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Gastric Carcinoma
81
Ulcerated Tumors
s124017
s103135
Gastric carcinoma
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Intestinal carcinoma
Focal thickening Short segment involved Loss of
layering Commonly obstructive
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Intestinal Carcinoma
94687
84
SB Adenocarcinoma and fistula
s115612
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Intestinal Carcinoma and metastasis
86
Intestinal Carcinoma
87
US of GI Smooth Muscle Tumors

• Eccentric mass
• Large at time of diagnosis
• Cavitation component (gt 3cm)
• No regional lymphadenopathy
• Rarely obstructive

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Gastric Leiomyoma
89
Gastric Leiomyoma
S-103138
90
Jejunal Leiomyosarcoma
S100616 GSD
91
Colonic Mass
S118993 Sheltie Grade 1 leoimyosarcoma
S109022 Gldn Adenocarcinoma
92
Uncommon Tumors
Malignant histiocytosis
Jejunal mast cell tumor
93
Lymphadenopathy
S114857 Parvo
S115524 LMA
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To be a tumor or not to be ?
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It would have been too simple

• Enteritis with wall thickness of 1cm or more
  (4/61)
• Severe, transmural inflammation with edema,
  fibrosis, hemorrhage, and/or necrosis
• 2/4 dogs had bowel perforation
• Enteritis with loss of wall layering (7/61)
• Severe, necrotizing, suppurative and/or
  granulomatous enteritis
• 3/7 dogs had bowel perforation
• Intestinal tumor with wall thickness lt 1cm
  (13/89)
• but 12/13 had loss of wall layering
• Intestinal tumor with intact/altered wall
  layering
• Lymphoma (1/89)

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Lymphocytic plasmocytic enteritis
97
Gastric wall edema
Marked wall thickening (gt1cm) spongy appearance
98
Granulomatous gastritis

• Local thickening, mass
• Loss of layering
• Regional lymphadenopathy

99
Granulomatous enteritis
100
Transmural necrosis (FB?)
101
US-guided Fine Needle Aspiration-Biopsy
102
Today and tomorrow ?
Doppler evaluation Endosonography Sono CT, tissue
harmonic Higher frequency probe Laparoscopic
US Contrast agent 3-D imaging Larger prospective
clinical studies
103
Questions ?