Abstract
Simple SummarySome neoplasia—such as adrenal and thyroid glands tumors—have been associated with “tumor thrombi” both in humans and dogs. The detection and characterization of these venous tumor thrombi is important for both surgical planning and prognosis. In human medicine, contrast-enhanced ultrasonography (CEUS) is considered an accurate diagnostic technique for differentiating malignant from benign portal vein thrombosis in hepatocellular carcinomas. Data regarding the characteristics of tumor thrombi in dogs are currently lacking. Therefore, the aim of this study was to assess the feasibility of CEUS for the characterization of malignant venous thrombosis in dogs. On the basis of our results, CEUS appeared to be useful in the detection of malignant intravascular invasion; contrast uptake of the thrombus was present in all cases. In addition, CEUS may clearly detect newly formed vessels within the thrombus, and arterial-phase enhancement and washout in the venous phase were the main features in malignant thrombosis in our dogs. As CEUS is an easy to perform, noninvasive technique, its application in the detection of malignant thrombosis in dogs may be used to improve the diagnosis in oncological canine patients.Tumors of adrenal and thyroid glands have been associated with vascular invasions—so-called tumor thrombi, both in humans and dogs. The detection and characterization of venous thrombi is an important diagnostic step in patients with primary tumors for both surgical planning and prognosis. The aim of this study was to describe the use of contrast-enhanced ultrasonography (CEUS) for the characterization of tumor thrombi. Dogs with tumor thrombus who underwent bi-dimensional ultrasound (B-mode US) and CEUS were included. Seven dogs were enrolled in this retrospective case series. On B-mode US, all thrombi were visualized, and vascular distension and thrombus-tumor continuity were seen in three and two cases, respectively. On color Doppler examination, all thrombi were identified, seemed non-occlusive and only two presented vascularity. On CEUS, arterial-phase enhancement and washout in the venous phase were observed in all cases. Non-enhancing areas were identified in the tumor thrombi most likely representing non-vascularized tissue that could potentially be embolized in the lungs after fragmentation of the tumor thrombi. On the basis of these preliminary study, CEUS appeared to be useful for the characterization of malignant intravascular invasion.
Highlights
Tumor thrombi are defined as tumors extending into a vessel—typically a vein
Medical records of dogs admitted to the Veterinary Teaching Hospital of the University of Bologna from January 2012 through January 2016 were reviewed and dogs with primary masses and associated venous thrombi were selected
Dogs were included in the study if they had a complete US examination of the mass and associated thrombus, including B-mode US, CFD examination and contrast-enhanced ultrasonography (CEUS)
Summary
Tumor thrombi are defined as tumors extending into a vessel—typically a vein. It is crucial to distinguish tumor thrombi from non-malignant thrombi in the setting of neoplasia, as this often impacts staging and treatment approaches [1,2,3,4,5,6]. Tumors of the adrenal glands have been associated with tumor thrombi in humans and dogs [1,2,3,5]; previous studies reported that dogs with caval tumor thrombi may have a poorer long-term prognosis [3,7]. Fast and less invasive surgical techniques have been recently described in dogs with caval invasion, with good results [8,9], despite the presence of a post-hepatic thrombus or long caval occlusion time [9]. According to another recent study, dogs with post-diaphragmatic tumor thrombi still showed a worse prognosis [10]. Detection and characterization of tumor thrombi is of great importance in patients with primary tumors for both surgical planning and prognosis
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