Detection of Active Intra-Abdominal Bleeding from Malignant Tumors in Two Dogs Using Contrast-Enhanced Ultrasonography

Contrast-enhanced ultrasonography (CEUS) has been applied to evaluate parenchymal organs in human and veterinary medicine. However, to our knowledge, there is no report on the identification of active bleeding and the bleeding site in veterinary clinical patients. Herein, we describe the use of CEUS in two cases of abdominal bleeding caused by ruptured lesions with malignant abdominal tumors. One dog had a splenic hemangiosarcoma, which had metastasized to the liver; the other dog had hepatic cell carcinomas in the left hepatic lobe, which were lobectomized, and another nodule was identified in the right hepatic lobe. Immediately after the rupture of these oncogenic lesions was suspected, CEUS was performed to identify the bleeding sites. The active bleeding sites were confirmed by hyperechoic pooling signs in the arterial phase, and extravasation could be observed within the defects showing hypoechoic perfusions in the delayed phase of the CEUS. Microbubbles were also observed in the ascites; thus, CEUS could detect the presence of hemorrhage and accurately identify the bleeding site. Collectively, the study findings suggest the usefulness of CEUS in emergent situations as it enables rapid and noninvasive evaluation of bleeding points in case of active bleeding in dogs.