Technique écho-guidée pour les ponctions épidurales chez les chiens

Ultrasound-guided epidural access in dog Summary Injections in the epidural space are commonly performed in veterinary medicine. To date, in dog ultrasound-guided epidural injection technique has not been described and herein our aim was to assess this technique. A cross sectional anatomic atlas of the lumbosacral region and ex-vivo ultrasound images were obtained in two cadavers to describe the ultrasound anatomy of the region and to identify the landmarks. Eighteen cadavers were used to establish two different variations of an ultrasound-guided technique, using spinal needles or epidural catheters. The technique was then performed in three cadavers in situations, considered similar to the daily clinical activity. Contrast medium was injected and a computed tomography examination of the region was performed to assess the success of this technique. The anatomic landmarks used to carry out the procedure were the seventh lumbar vertebra, the iliac wings and the first sacral vertebra. The target for the needle placement was the vertebral canal of the lumbosacral space, visualized in a parasagittal plane, which displayed a trapezoid-shaped echogenic image and the insertion of the spinal needle or epidural catheter was guided and followed in real time, until it reached the vertebral canal. In conclusion, we described the feasibility of an ultrasound-guided epidural access technique in dog

CT FEATURES OF A LACRIMAL GLAND TUMOR IN A DOG

Background: In the dog, neoplasms of the lacrimal gland are rare. Lacrimal cysts were also reported. Computed tomography (CT) scan findings of these lacrimal gland abnormalities have not been described in dogs. Purpose: The present report describes clinical and CT features of a lacrimal gland tumor in a dog. Methods: A 3,5 year old female intact Leonberger with a good general health status was presented with a progressive swelling at the level of the supero-temporal area of the left upper eyelid and of the bulbar conjunctiva since 3 weeks. Ocular examination revealed a slight enophthalmia and a ventronasal strabismus, the presence of a firm mass in the upper eyelid which was anteriorly well circumscribed and extending posteriorly between the globe and the orbital ligament. Findings: A CT scan pre- and post- contrast studies of the head were performed. A 3 cm hypoattenuating (+/- 10 HU) ovoid mass was observed dorsolateral to the indented left globe. This mass was well circumscribed by an unevenly thick irregular soft tissue- attenuating wall (50HU), which was strongly contrast-enhanced (150HU) and measured about 2 to 10mm in thickness. The left globe was displaced caudoventromedially. No adjacent bone lesion, or foreign body was observed. No normal left lacrimal gland was observed. These findings were suggestive of an abscess or an orbital tumor with a necrotic/cystic center; a lacrimal cyst was considered less likely because of the unevenness and the thickness of the wall. Complete surgical ablation was done by a modified lateral orbitotomy. Histopathology revealed a mixed benign tumor of the lacrimal gland and a lymphocytic necrotic adenitis. Six months postoperatively no recurrence is noted and the tear production is 15mm/min. Conclusion: The lacrimal gland is located dorsolateral to the globe and produces tears. In human medicine, a wide range of lacrimal gland pathologies were described and assessed by computed imaging techniques. Pleomorphic adenomas (mixed benign tumor) could reveal irregular bone erosion and could undergo malignant transformation. In dogs, lacrimal cysts were described as thin walled structures.4 Only few articles reported lacrimal gland tumor. To the authors knowledge, CT findings of a lacrimal gland tumor have not been described previously. In conclusion, lacrimal gland tumor should be included in the differential diagnosis of a firm ovoid cystic/necrotic mass dorsolateral to the orbit

TECHNIQUE, DIFFICULTY, AND ACCURACY OF COMPUTED TOMOGRAPHY-GUIDED TRANSLAMINAR AND TRANSFORAMINAL LUMBOSACRAL EPIDURAL AND INTRAARTICULAR LUMBAR FACET JOINT INJECTIONS IN DOGS.

In human medicine, spinal pain and radiculopathy are commonly managed by computed tomography (CT)-guided facet joint injections and by transforaminal or translaminar epidural injections. In dogs, CT-guided lumbosacral epidural or lumbar facet joint injections have not been described. The aim of this experimental, ex vivo, feasibility study was to develop techniques and to assess their difficulty and accuracy. Two canine cadavers were used to establish the techniques and eight cadavers to assess difficulty and accuracy. Contrast medium was injected and a CT scan was performed after each injection. Accuracy was assessed according to epidural or joint space contrast opacification. Difficulty was classified as easy, moderately difficult, or difficult, based on the number of CT scans needed to guide insertion of the needle. A total of six translaminar and five transforaminal epidural and 53 joint injections were performed. Translaminar injections had a high success rate (100%), were highly accurate (75%), and easy to perform (100%). Transforaminal injections had an moderately high success rate (75%), were accurate (75%), and moderately difficult to perform (100%). Success rate of facet joint injections was 62% and was higher for larger facet joints, such as L7-S1. Accuracy of facet joint injections ranged from accurate (37-62%) to highly accurate (25%) depending on the volume injected. In 77% of cases, injections were moderately difficult to perform. Possible complications of epidural and facet joint injections were subarachnoid and vertebral venous plexus puncture and periarticular spread, respectively. Further studies are suggested to evaluate in vivo feasibility and safety of these techniques

Clinical safety of computed tomography-guided lumbosacral transforaminal and translaminar epidural and facet joint steroid injections in dogs

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