Abstract
ObjectivesTo evaluate the feasibility of CT pulmonary angiography for identification of naturally occurring pulmonary thromboembolism in dogs using predefined diagnostic criteria and to assess the ability of echocardiography, cardiac troponins, D-dimers and kaolin-activated thromboelastography to predict the presence of pulmonary thromboembolism in dogs.MethodsTwelve dogs with immune-mediated haemolytic anaemia and evidence of respiratory distress were prospectively evaluated. Dogs were sedated immediately before CT pulmonary angiography using intravenous butorphanol. Spiral CT pulmonary angiography was performed with a 16 detector-row CT scanner using a pressure injector to infuse contrast media through peripheral intravenous catheters. Pulmonary thromboembolism was diagnosed using predefined criteria. Contemporaneous tests included echocardiography, arterial blood gas analysis, kaolin-activated thromboelastography, D-dimers and cardiac troponins.ResultsBased on predefined criteria, four dogs were classified as pulmonary thromboembolism positive, three dogs were suspected to have pulmonary thromboembolism and the remaining five dogs had negative scans. The four dogs identified with pulmonary thromboembolism all had discrete filling defects in main or lobar pulmonary arteries. None of the contemporaneous tests was discriminant for pulmonary thromboembolism diagnosis, although the small sample size was limiting.Clinical SignificanceCT pulmonary angiography can be successfully performed in dogs under sedation, even in at-risk patients with respiratory distress and can both confirm and rule out pulmonary thromboembolism in dogs.
Highlights
Pulmonary thromboembolism (PTE) is the obstruction of the pulmonary artery or its branches by thrombi and is a major cause of morbidity and mortality in dogs with immune-mediated haemolytic anaemia (IMHA) (Reimer et al 1999, Scott-Moncrieff et al 2001)
Apical sparing of right ventricular hypokinesis was subjectively identified in three patients, but this finding did not correlate with computed tomography pulmonary angiography (CTPA) diagnosis
This study describes the use of CTPA to establish definitive antemortem diagnoses of naturally occurring PTE in dogs with IMHA
Summary
Pulmonary thromboembolism (PTE) is the obstruction of the pulmonary artery or its branches by thrombi and is a major cause of morbidity and mortality in dogs with immune-mediated haemolytic anaemia (IMHA) (Reimer et al 1999, Scott-Moncrieff et al 2001). Rapid, multi-slice spiral computed tomography pulmonary angiography (CTPA) is central to PTE diagnosis (Fesmire et al 2011). Occlusive or partial filling defects in pulmonary arteries are diagnostic for PTE (Wittram et al 2004), while a normal CTPA study helps to rule out PTE as the cause of respiratory distress, unless the index of suspicion is very high (Torbicki et al 2008). Multi-slice CT angiography has been used for experimental PTE studies (Takahashi et al 2008), and to identify a descending aortic thrombus in a dog with spirocercosis (Kirberger & Zambelli 2007). CTPA has been used to investigate the incidence of PTE following non-cemented total hip arthroplasty in dogs, no evidence of PTE was identified (Tidwell et al 2007). CTPA has been successfully used to diagnose pulmonary embolism in dogs with naturally occurring heartworm disease (Jung et al 2010)
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