case_images: PMC10752369_01
case_images: Diagram showing lung ultrasound examination protocol.
case_images: fvets-10-1275929-g001.jpg
case_images: PMC10752369_01_fvets-10-1275929-g001.jpg
case_images: fig1
case_images: Three-view thoracic radiographs (TXRs) (ventrodorsal, dorsoventral, and right lateral), taken without sedation, revealed a bilateral bronchial pattern in the caudal lung regions and a cranial alveolar pattern, which was more prominent on the right (Supplementary Figure S1). The lung ultrasound examination followed the VetLus protocol Figure 1, created by the authors (K.K. and M.G.).
case_images: Color doppler still image of a triangular shaped consolidation within the lung referred to as a "wedge sign". An absence of blood flow within the consolidated region is visible, giving the impression the blood flow is "amputated" ( ), which is referred to as the "vascular sign". A comet-tail artifact (C-line) extends from the lower edge of the consolidation ( ). Short artifacts originating at the pleural line ( ) are also visible, referred to as I-lines. Finally, hyperechoic vertical artifacts, believed to be B-lines are also visible (*). To confirm these are B-lines the depth should be extended (10-15 cm) to ensure these vertical white artifacts continue to reach the far field. Performed at presentation. Thyroid presets.
case_images: fvets-10-1275929-g002.jpg
case_images: PMC10752369_01_fvets-10-1275929-g002.jpg
case_images: fig2
case_images: The echocardiographic evaluation revealed a scant amount of pericardial effusion (PE) at the cardiac apex of the right ventricle, severe eccentric and concentric hypertrophy of the right ventricle in diastole (RVDd), and systole (RVDs) (Supplementary Figure S2), paradoxical motion of the interventricular septum, and tricuspid valve regurgitation (TVR) with a high-velocity regurgitant jet. Both triangular-shaped and basket-shaped lesions were classified as "wedge signs" due to shared LUS and color Doppler imaging characteristics and their resemblance to the anatomical shape of a pulmonary lobule (Figure 2). Spared lung areas (normal aerated lung) were identified in addition to consolidated lung regions and B-lines, as well as short, needle-like vertical artifacts, referred to as I-lines (Figure 2). Vascular characteristics identified on color Doppler imaging included a "vascular sign" described in the human literature which was found in the right cranial lung lobe (Figure 2) within two basket-shaped consolidations. The findings of a "wedge sign" and "vascular sign" in this case report prompted consideration of PTE as a differential diagnosis (Figure 2).
case_images: Color doppler imaging of the triangular lung consolidation "wedge sign", demonstrating recanalization of the consolidation over time ( ), ( ) spared areas. Performed on day 6-recheck. Thyroid presets.
case_images: fvets-10-1275929-g003.jpg
case_images: PMC10752369_01_fvets-10-1275929-g003.jpg
case_images: fig3
case_images: Irregularly shaped consolidations were predominantly restricted to the caudodorsal lung lobes and had visible static and dynamic air bronchograms (Supplementary Figure S3). C-lines, were also noted. Color Doppler imaging identified perfused vessels within these consolidations, indicating that the vascular system was intact and followed the anatomical course of blood vessels, thus taking on the shape of a tree (Supplementary Figure S3). On LUS examination, recanalization (return of blood flow-based on color Doppler) of the wedge-sign consolidations was noted, as well as a reduced numbers of B-lines (Figure 3; Figures 4A,B).
case_images: Color doppler still image of a triangular shaped consolidations "wedge sign" with a no flow, long hypoechogenic consolidation (A). Early recanalization of the consolidation using color doppler was seen 6 days following initiation of therapy ( ) (B). Lung presets.
case_images: fvets-10-1275929-g004.jpg
case_images: PMC10752369_01_fvets-10-1275929-g004.jpg
case_images: fig4
case_images: On LUS examination, recanalization (return of blood flow-based on color Doppler) of the wedge-sign consolidations was noted, as well as a reduced numbers of B-lines (Figure 3; Figures 4A,B). The shred sign consolidations, supportive of inflammatory lung disease and located in the caudodorsal lobes, decreased in size, with some changing in appearance to take on a rounder, smaller hypoechoic shape, similar to a nodule sign (Supplementary Figure S4).