A noncoding RNA is a potential marker of cell fate during mammary gland development
Ultrasonographic Findings of Mastitic and Normal Mammary Gland in Bitches
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INTRODUCTION The health of the mammary gland directly influences the survival and the development of the whelp, but can also cause discomfort and even death to the bitch (Khan, 2011). The health of the mammary gland is therefore very important and should be monitored both in lactation and in the state of inactivity. During the lactation period, the main problems that arise are inflammations of the parenchyma, while between lactations the main concern are neoplasms (Johnston et al., 2001; Mamont and Barber, 2006). It is also important to investigate all the mammary glands, even if the most active and with most often pathologies are the inguinal and abdominal ones (Budras et al., 1996; Done et al., 1996; Kahn, 2011). In present days, imagistic means of evaluation of the clinical state of animals are more and more Ultrasonographic Findings of Mastitic and Normal Mammary Gland in Bitches Iulia Maria BALACI 1* , Simona CIUPE 1 , A. R. POP 1 , Laura PARLAPAN 1 , Alexandra ARION 1 , I. VASIU 1 , R. PURDOIU 1 , I. PAPUC 1 , I. S. GROZA 1 1 University of Agricultural Sciences and Veterinary Medicine, Mănăştur Street, 3-5, Cluj-Napoca, Romania Corresponding author: [email protected] Bulletin UASVM Veterinary Medicine 72(1) / 2015, Print ISSN 1843-5270; Electronic ISSN 1843-5378 DOI:10.15835/buasvmcn-vm: 11018 Abstract The mammary gland is very important for the health of the offspring and the mother. It is subjected to multiple pathologies, the most important being mammary tumours and mastitis. The evaluation of mammary gland in bitches is done primarily by clinical exam, but imagistic means of diagnostic became more frequently used, especially when neoplasms are involved. In this context, the aim of this study was to identify the imaging characteristic of inflamed mammary parenchyma and to test the reliability of ultrasound in evaluating canine mastitis. This study involved 12 lactating bitches of different breed and ages included in two research groups: the first group counted in 7 animals that showed clinical signs of mastitis, while the second group had 5 clinically healthy animals, being the control group. All animals were subjected to a clinical exam, followed by an ultrasound examination and milk samples collection. The ultrasound examination was done in B mode and color Doppler using both linear and microconvex transducers at a frequency of 8Mz. Milk samples were checked for color, consistency and pH and were later submitted for bacteriological and bacterioscopic examinations. All data that followed from the examinations was collected and analyzed. The ultrasound examination highlighted the existence of a characteristic architecture of the layers of healthy mammary glands in the bitch. This architecture could not be seen in any of the inflamed glands. In some cases, the normal aspect of the parenchyma could still be seen at the periphery of the affected mammary gland. The inflamed parenchyma appeared either hypoechogenic (71.43% of cases) or hyperechogenic (28.57%) compared to healthy tissue. In 57.14% of cases there could be seen multiple hyperechogenic septa, alternating with hypo-echogenic areas while 42.86% of cases presented acoustic artefacts. The vascularisation was increased in the affected areas with blood flow being either linear (71.43%) or turbulent (21.57%). All cases diagnosed with mastitis were confirmed by bacteriologic and bacterioscopic studies. This study concluded that mammary glands in bitches can be investigated using ultrasound in grey scale B mode and color Doppler when mastitis is suspected. It offers irrefutable evidence of the inflammation of the glandular parenchyma and the spreading of the disease. Keywords: bitch, Doppler, mastitis, ultrasound.
Transcript of Ultrasonographic Findings of Mastitic and Normal Mammary Gland in Bitches
INTRODUCTIONThe health of the mammary gland directly
influences the survival and the development ofthewhelp,butcanalsocausediscomfortandevendeathtothebitch(Khan,2011).Thehealthofthemammarygland is thereforevery importantandshouldbemonitoredbothin lactationandinthestateofinactivity.Duringthelactationperiod,themainproblemsthatariseareinflammationsofthe
parenchyma, while between lactations the mainconcern are neoplasms (Johnston et al., 2001;Mamont and Barber, 2006). It is also importanttoinvestigateallthemammaryglands,evenifthemost active andwithmostoftenpathologies arethe inguinal and abdominal ones (Budras et al.,1996;Doneet al.,1996;Kahn,2011).
Inpresentdays,imagisticmeansofevaluationoftheclinicalstateofanimalsaremoreandmore
Ultrasonographic Findings of Mastitic and Normal Mammary Gland in BitchesIuliaMariaBALACI1*,SimonaCIUPE1,A.R.POP1,LauraPARLAPAN1,AlexandraARION1,I. VASIU1, R. PURDOIU1,I. PAPUC1,I.S.GROZA11UniversityofAgriculturalSciencesandVeterinaryMedicine,MănăşturStreet,3-5,Cluj-Napoca,RomaniaCorrespondingauthor:[email protected]
BulletinUASVMVeterinaryMedicine72(1)/2015,PrintISSN1843-5270;ElectronicISSN1843-5378DOI:10.15835/buasvmcn-vm:11018
AbstractThemammaryglandisveryimportantforthehealthoftheoffspringandthemother.Itissubjectedtomultiple
pathologies,the mostimportantbeingmammarytumoursandmastitis.Theevaluationofmammaryglandinbitchesisdoneprimarilyby clinical exam,but imagisticmeansofdiagnosticbecamemore frequentlyused, especiallywhenneoplasmsareinvolved.Inthiscontext,theaimofthisstudywastoidentifytheimagingcharacteristicofinflamedmammaryparenchymaandtotestthereliabilityofultrasoundinevaluatingcaninemastitis.
This study involved12 lactatingbitchesofdifferentbreedandages included in two researchgroups: thefirstgroupcounted in7animals thatshowedclinicalsignsofmastitis,while thesecondgrouphad5clinicallyhealthyanimals,beingthecontrolgroup.Allanimalsweresubjectedtoaclinicalexam,followedbyanultrasoundexaminationandmilksamplescollection.TheultrasoundexaminationwasdoneinBmodeandcolorDopplerusingbothlinearandmicroconvextransducersatafrequencyof8Mz.Milksampleswerecheckedforcolor,consistencyandpHandwerelatersubmittedforbacteriologicalandbacterioscopicexaminations.Alldatathatfollowedfromtheexaminationswascollectedandanalyzed.
Theultrasoundexaminationhighlightedtheexistenceofacharacteristicarchitectureofthelayersofhealthymammaryglandsinthebitch.Thisarchitecturecouldnotbeseeninanyoftheinflamedglands.Insomecases,thenormalaspectoftheparenchymacouldstillbeseenattheperipheryoftheaffectedmammarygland.Theinflamedparenchymaappearedeitherhypoechogenic(71.43%ofcases)orhyperechogenic(28.57%)comparedtohealthytissue.In57.14%ofcasestherecouldbeseenmultiplehyperechogenicsepta,alternatingwithhypo-echogenicareaswhile42.86%ofcasespresentedacousticartefacts.Thevascularisationwasincreasedintheaffectedareaswith blood flow being either linear (71.43%) or turbulent (21.57%). All cases diagnosedwithmastitis wereconfirmedbybacteriologicandbacterioscopicstudies.
This study concluded thatmammary glands in bitches canbe investigatedusingultrasound in grey scaleBmodeandcolorDopplerwhenmastitis issuspected.Itoffers irrefutableevidenceoftheinflammationoftheglandularparenchymaandthespreadingofthedisease.
Keywords: bitch, Doppler, mastitis, ultrasound.
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frequentlyused.Whenconsideringthemammarygland of bitches, most of the present studiesconcentrate on describing tumours and almostignoreotherpathologieslikemastitis(Boviet al.,2007;Manion,2006;Sorenmoet al.,2011).
The aim of this study was to identify thecharacteristic imaging aspects of the mammaryglandinflammationinbitchesandtoevaluatethereliabilityofultrasoundexaminationindiagnosingmastitis in this specie. These goals wanted toincrease the relevance of ultrasound use on thisorgan.
MATERIALS AND METHODSThe present study was made on 12 bitches
of different breeds, ages and weights, whichwere in lactation between April 2014 and June2014. The animalswere brought to the clinic ofReproduction, Obstetrics and Gynecology of theVeterinaryFacultyofCluj-Napocaforroutineexamor showing clinical signs of mastitis. All bitchesunderwent a general clinical examination andan examination of the mammary gland throughinspectionandpalpation.Milksampleswerealsocollectedandcheckedforcolour,consistencyandpH.Wheremastitiswassuspected,milkwassentto the Department of Infectious Diseases of theFaculty of Veterinary Medicine Cluj-Napoca forconfirmation.
After the examination, they were divided intwo studygroups, according to thephysiologicalstate theywere in. Thus, groupone consistedof
7 animals and represented the groupof animalswith clinical signs of mastitis, while group twoincluded5bitchesthatwereclinicallyhealthy.
Allanimals,afterbeingincludedinthestudy,were examined using an ultrasound in order toobserve the imagistic changes induced by theinflammation of mammary tissue. The imagingexam was conducted both with a linear and amicroconvextransducerwitharangefrom5MHzto 8 MHz, both in longitudinal and transverseorientationandtargetedallthemammaryglands,regardlessof clinical signs.Additionally, a colourDoppler examination was performed for allbitches.
Allthedatacollectedfromtheclinicalandtheimagingexamwasregisteredinoriginaldedicatedformsandanalyzedaccordingly.
RESULTS AND DISCUSSIONSOf theanimals included in the first groupof
the study, showing clinical signs ofmastitis, fivewerepurebredandtwoweremixedbreeds.Theywereallbetweenthefirstandforthlactation.Twoof thebitcheshadpreviousreportsofmammaryinflammation, while the others were in thisconditionforthefirsttime.Allanimalshadalreadygiven birth and were between the first and thefifthdayof lactation.Theiragesrangedbetween2 and 6 years old. This study didn’t prove anycorrelation between these epidemiological dataandtheincidenceofmastitis.
Fig. 1.Ultrasonographicaspectsofanabdominalmammaryglandofahealthy5yearsoldBeagle,with
microconvex(A)andlinear(B)transducersof8MHz.Theyellowarrowsidentifythespecificlayersofthehealthymammarygland:a)skin,b:mammaryparenchyma,c)muscles.
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Three of the animals that presented clinicalsignsof inflammationhad twomammaryglandsaffected,whiletheotherfourhadonlyoneglandinflamed.70%ofmastitisoccurredintheinguinalmammaryglands,inoneorbothofthem.Therestof30%affectedtheinferiorabdominalmammarygland,ontherightorleftside.Althoughwedidnotdetect inflammation in other mammary glands,itdoesnotmeanthatmastitisonlyoccurs inthe
regions described in this study. Other studiesreportmastitis evolving in anymammary gland,but thehighest incidence is in the inguinalones,followed by the posterior abdominal ones.(Johnstonet al.,2001;MomontandBarber,2003;Traschet al.,2007)
The animals included in the second groupwereagedbetween2and7andwereinthefirstweekoflactationaftergivingbirth.Threeanimals
Fig. 2.Ultrasonographicaspectsofaninflamedmammaryglandofa4yearsoldGermanShepard,with
microconvex(A)andlinear(B)transducersof8MHz.Notethelackofarchitectureanddelimitationbetweendifferenttissues.
Fig. 3.Ultrasonographicaspectsoftheperipheryofaninflamedmammaryglandof4yearsoldGermanShepard,withamicroconvextransducerof8MHz;theyellowarrowindicatesthehealthytissueattheextremityofthegland,whiletheredoneindicatestheareaclosertothemiddleoftheinflamedmammary
gland.
Fig. 4.Ultrasonographicaspectsofaninflamedmammaryglandof3yearsoldYorkshireTerrier;notethehypoechogenicaspectofthemammary
parenchyma.
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were purebred, while two were mixed breeds.Twobitcheswereintheirfirstlactation,whiletheotherswereintheirsecondorthirdlactation.
During the imaging examination, healthymammary glands could easily be differentiatedfrom inflamed ones. Healthy mammary glandshave a specific architecture that describes threeindividual layers. The upper layer is the skin,described as a clearmedium echogenic and finegrainedareaofdifferentwidth,dependingontheanimalandtheinvestigatedzone.Themiddlelayeris the mammary tissue, showing a heterogeniccoarse-grainedstructurewithsmallareasofhyperand hypoechogenity. Themost profound layer isthemusculartissue,separatedfromthemammarytissuebytheabdominalfascia;thefasciaappearsas a hiperechogenic,well defined line,while themusclesappearofmediumechogenitybutslightlyhiperechogenic compared to the parenchyma,coarse grained and heterogenous. These aspectscould easily be seen both using a microconvextransducer(Fig.1A)andalineartransducer(Fig.1B).
These aspects are in accordance with otherstudies that describe the imaging aspects ofcanine mastitis. (Nyman et al., 2006; Thrash et al., 2007). Comparing the two transducers, weconsidered the linear transducer more useful,especially with large animals. The microconvex
transducers, although it offers a larger view ofthetissue,provideslessinformationandoflowerqualitythanthelinearone.
In mammary glands that presented signs ofinfection,thearchitecturepresentedabovecouldnot be observed. The skin remained visible, buttherewasnodelimitationbetweenthemammaryparenchymaandthemoreprofoundtissuesoftheinvestigatedarea inall theexaminedcases,bothwith the microconvex (Fig. 2A) and the lineartransducers(Fig.2B).
In some cases, the normal architecture ofthemammaryglandcouldstillbeseenusingtheultrasoundattheperipheryofthegland,provingthattheinflammationstartedinthecenteroftheorgan and speeded to the exterior (Fig. 3). Thisaspect is to be expected since most mammaryglandinfectionsinthebitchareascending,havingasagatewaythepapillaryductthatopensduringsuckling.(Kahn2011;Schäfer-Somiet al.,2003)
The mammary parenchyma of the inflamedglandesappearedinallcasesmoreheterogeneousthan the healthy tissue, with numerous areas ofhyper-andhypoechogenity.Theseareashadvariablesizes(between1mmand3mm)anddistribution.In71.43%ofcasestheinflamedmammarytissuewasoverallmorehypoehcogenic than thehealthyone(Fig.4),butin28.57%theaffectedareawasslightlyhyperechogenic (Fig. 5). Other studies described
Fig. 6.Ultrasonographicaspectsofinflamedmammaryglandofa4yearsoldGermanShepard;notethemultiplehyperechogeniclinesinthecenteroftheaffectedareaandthemuscularfasciathatisonlyvisibleatthepheripheryoftheorganasathin
hyperechogenicline.
Fig. 5.Ultrasonographicaspectsofaninflamedmammaryglandofa6yearsoldRottweiler;notethemultiplehyperechogenicseptaintheparenchymaandtheoverallhyperechogenic
aspectofthemammarygland.
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the inflamedzoneasalwaysbeinghypoechogeniccomparedtothehealthytissue(Traschet al.,2007).Thisstudydidnotmentioninwhatdayoflactationthe exam took place, or at howmany days afterthe onset of the clinical signs. The inflamed zonenormallyappearsmorehypoechogenicbecauseoftheinfiltrationandoedemathattakesplaceintheaffected area, phenomena that is generally found
in mastitis. The hyperecogenic aspect appearedin bitches that were in the third to fifth day oflactation, suggesting the evolution of a chronicinflammation thatdidnothavevery clear clinicalsignsat thebeginning,ora flareofapathologicalprocess that originated in the previous lactation.Inruminants,inflamedmammaryglandhavebeen
Fig. 7.Ultrasonographicaspectsofaninflamedmammaryglandofa6yearsoldRottweiler;notethehyperechogeniclinethatcorrespondstothemuscularfasciaandendsabruptly,followedbyan
acousticenhancementartefact.
Fig. 8.Ultrasonographicaspectsofaninflamedmammaryglandofa6yearsoldRottweiler;notethemultipleanechogenicareaspresentinthe
parenchyma,theycorrespondtobloodvesselsandmilkducts;themuscularfasciacanbeseenattherightextremityoftheimageasahyperechogenic
line.
Fig. 10.UltrasonographicBmodeandcolorDoppleraspectsofaninflamedmammary
glandof3yearsoldYorkshire;theparenchymapresentsfewbiggervesselswithturbulent
bloodflow,aspointedoutbytheyellowarrow.
Fig. 9.UltrasonographicBmodeandcolorDoppleraspectsofaninflamedmammaryglandofa3yearsoldMixbreed;notetheincreasedbloodperfusionofthe
parenchyma;theyellowarrowindicatesthelinearbloodflow.
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reportedtobecomeeitherhipoorhyperechogenicaswell.(Santoset al.,2014)
In 57.14% of cases there were observedmany hyperechogenic lines in the affectedpart of the mammary parenchyma, alternatingwith hypoechogenic areas. The muscular fasciaappeared as a thinhyperechogenic line or couldnotbedistinguishedatall(Fig.6).
In 42.86% of cases there were foundacoustic artefacts of reverberation or acousticenhancement(Fig.7).Theseartefactsarecausedbytheinfiltrationthattakesplaceintheaffectedtissue.Therehasalsobeenobservedanincreaseinthenumberofanechogenicareasthatcorrespondtomilkductsorbloodvessels(Figure8).Similaraspectshavebeenfoundbyotherstudiesbothinbitchesandinothermammals(Santoset al.,2014;Traschet al.,2007).
ThecolourDopplerexaminationpointedoutanincreasedbloodperfusioninallexaminedcases.Thevesselsweredisposedinalltheparenchyma,butmostly at the periphery of the affected area(Fig. 9) and had linear (71.43%) or turbulent(21.57%) blood flow (Fig. 10). The milk ductsappearedanechogenic.
These signs of inflammation proved to besufficienttoputadiagnosisofmastitisusingtheultrasound. Both transducers proved good, withthe linear transductor giving more informationthan themicroconvex one. Also,when there hasbeen performed a caesarean on the white line,the tissular reaction produced determined signsof inflammation at mammary level when themicroconvextransducerwasused.Thiseffecthasnotbeenpresentwiththelineartransducer.
All the diagnosed cases of mastitis wereconfirmedbytheInfectiousDiseasesdepartmentaftermilkevaluation,while theclinicallyhealthyones did not have pathogenic bacteria in theirmilk.Afterthediagnosis,theanimalsweretreatedaccordingtotheantibiogram.
CONCLUSIONSThehealthofthemammaryglandoflactating
bitches is very important for the survival anddevelopment of the pups. Inflammation of themammaryparenchymacanposeathreatbothtotheoffspringandthemother.Thatiswhyspecialattentionshouldbegiventoitshealthbeforeandafter giving birth. The ultrasound examinationproved very useful in detectingmammary gland
inflammations when using both a linear anda microconvex transducer at the frequency of8MHz.Thelineartransducerprovedmorereliableand has given more information in the studiedcases.Healthy tissue can easily be differentiatedfrom inflamed one on consideration of tissuearchitecture, echogenity, homogeneity, artefactsandvascularization.
Acknowledgements.ThispaperwaspublishedundertheframeofEuropeanSocialFund,HumanResourcesDevelopmentOperationalProgramme2007-2013, project no. POSDRU/159/1.5/S/136893.
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