Ultrasonographic Diagnosis of the Bovine Genital Tract Disorders

Department of Animal Reproduction, Gynaecology & Obstetrics College of Veterinary & Animal Science, Bikaner

Cows brought to the clinics (85) for pregnancy diagonosis or treatment of various reproductive problems were examined by transrectal ultrasonography (TRUS). The various problems diagnosed were endometritis (23), post-partum metritis (6), pyometra (13), mucometra (7), follicular cyst (17), luteal cyst (5), abortion (2), mummified foetus (3), macerated foetus (1), adhesions (1), anestrus (6) and ovarian abscess (1). indicating that TRUS can be used efficiently for diagnosing reproductive disorders and the response to treatment thereafter.

In bovine practice, ultrasonography has become an important diagnostic tool for evaluating the female reproductive system. Its importance in diagnosis lies in the non-invasiveness of the instrument (Carriere et. al., 2002). In spite of its immense use in supplementing diagnosis during physiological states, its use in delineating different pathological conditions of the bovine genital tract continues to be less frequently described. This study was conducted on clinical cases presented to the veterinary gynaecology and obstetrics outdoor to record the sonographic appearance during different pathological conditions of genital tract.

Cows presented to the veterinary gynaecology and obstetrics outdoor (n=85) with different pathological conditions were included in the present study. Transrectal sonographic examination was performed using a portable ultrasound machine (AGROSCAN linear, ECM 1"6 BD de la Republique, F 16000 Angouleme, FRANCE), with a linear array dual frequency probe (5.0/7.5 MHz). The images were saved in a multimedia kit attached to the instrument and subsequently transferred to the computer. Animals were examined by rectogenital palpation and ultrasonography was done later to confirm / potentiate the clinical diagnosis. After administration of an appropriate treatment sonography was done again to determine the effect of treatment.

Among a total of 85 clinical cases investigated during present study, the different clinical conditions diagnosed were endometritis (23), post-partum metritis (6), pyometra (13), mucometra (7), follicular cyst (17), luteal cyst (5), abortion (2), mummified foetus (3), macerated foetus (1), adhesions (1), anestrus (6) and ovarian abscess(1). (Table 1)

The presence of anechoic fluid in cases of endometritis along with snowy echogenic particles observed during the present study (Fig. 1,2) was similar to previous reports of (Fissore et al. 1986; Kasaimanickam et al. 2004; Lenz et al. 2007; Barlunda et al. 2008). Amongst the various pathological conditions diagnosed during the present study endometritis was the most frequently diagnosed pathology. that caused repeat breeding in dairy cows as these cases were brought to the clinics with complaint of repeat breeding with an apparently normal cervico-vaginal discharge. This finding corroborated previous reports of (Miller et al. 1980; Le Blanc et al. 2002).
The sonographic features of post partum metritis were in part similar to endometritis; however, there was enormous amount of anechoic fluid in the distended uterus alongwith echogenic particles (Fig.3). falling in line with features reported by (Fissore et al., 1986; Melendez et al., 2004). Subsequent to therapy, the uterine diameter, fluid accumulation and echogenic particles got reduced (Fig.4).
In cases of pyometra, sonographically, echogenic pus inside the uterus was observed (Fig.5). Most of these cases were in fact presented for pregnancy diagnosis. Ultrasonographic appearance confirmed the diagnosis of pyometra. Diagnosis of pyometra by ultrasonography had previously been done on the basis of high volume of accumulated echogenic uterine content without fetus and cotyledons, closed cervix and corpus luteum on the ovary (Bon Durant, 1999; Sheldon and Dobson, 2004; Sheldon et al., 2006; Fissore et al., 1986). treatment of pyometric cows was instituted resulting into discharge of huge quantity of pus (Fig.6).
In cases of mucometra, a consistent ultrasonographic finding was thin walled uterus which was filled with anechoic fluid (Fig.7,8) similar to a observations of (Fissore et al., 1986. outl of 22 cases of ovarian cyst evaluated during the present study, 77.28% (17/22) were follicular cysts (Fig. 9) and 22.72% (5/22) were luteal cysts (Fig.11). A higher incidence of follicular cysts has been recorded by (Gaur and Purohit, 2007; Durocher et al., 2005). The sonographic difference between the two types of cysts was the appearance of distinct hypoechoic wall (2.5 mm) of luteal tissue in luteal cysts. The diameters of ovarian cysts varied from 30mm to 48mm. The proportion of cows that showed multiple follicular cysts was only 29.41% (5/17) of the total follicular cysts diagnosed. The sonographic features of cysts were simple fluid filled (anechoic) thin walled structures ³ 25mm (follicular cysts) or round to ovoid structures ³ 25mm with a thick wall and centrally an anechoic area falling in agreement with findings of (Fissore et al., 1986; Kuber and Jalakas, 2002; Farin et al. 1992; Ribadu et al., 1994; Farin et al., 1990; Naoki, 2007). previously ,Farin et al., 1990 consider sector scanning better for diagnosis of luteal cysts however,during the present study ovarian cysts could easily be diagnosed by linear array scanning (Kuber and Jalakas, 2002; Ribadu et al., 1994; Farin et al., 1992; Naoki, 2007) also used linear array scanning for such cases. The response to the treatment was good as evident by the sonographic disappearance of both the type of cysts (Fig.10,12) within 10-40 days of treatment, conforming previous reports of (Walton et al., 1990; Morales-Roura et al., 1998; Yavas and Walton, 2000). The diagnosis of single ovarian cysts is always found difficult by rectal palpation alone, but can easily be confirmed by ultrasonography. Farin et al., 1992 had previously recorded a sensitivity and specificity of 43.3% and 64.7%respectively for diagnosis of ovarian cysts by rectal palpation whereas it was 86.7% and 82.3% by ultrasonography In the cases of anestrus the sonographic findings were a persistent corpus luteum (Fig.13) in 33.3% (2/6) of the cases, or poor follicular growth in 66.67% (4/6) of the cases during the present study. The sensitivity and specificity of ultrasonography in diagnosing ovarian structures has been shown to be 95 and 100% respectively (Ribadu et al. 1994).
The sonogram also proved to be useful supplement to confirm abnormalities like mummified fetus, macerated fetus, adhesion, abortion (Fig.14-17) and ovarian abscess (Fig. 18). In conclusion ultrasonography of the bovine uterus and ovaries can help in definitive diagnosis of various pathological conditions.

Table 1: Transrectal ultrasonographic findings in various reproductive problems

Type of case	No. of animals (n)	Ultrasonographic finding
Endometritis	23	Moderate to large amount of anechoic fluid in lumen alongth with "snowy" echogenic particles. Uterine wall is thickened.
Post-partum Metritis	6	Uterine wall is thickened and uterine body is distended. Enormous amount of anechoic fluid is present in the lumen along with with echogenic particles.
Pyometra	13	Uterus distended and have thickened uterine wall. The viscous fluid inside the lumen contained diffused, echogenic particles, floating in it. Sonographic image resembles with uterine tissue.
Mucometra	7	Uterus is thin walled which is visible as white streak and appears to be filled with echogenic particles in the enormous anechoic fluid present inside it.
Follicular cyst	17	Imaged as thin walled (≤2mm) non-echogenic structures visible over the surface of the ovary. Size is ≥25 mm
Luteal cyst	5	Anechoic central cavity bordered by a distinct wall (2-5 mm) of luteinized tissue imaged over the ovarian surface. Size >25 mm.
Abortion	2	Hypoechogenic membrane loosed their tense appearance and begins to appear as floating with in the anechoic uterine lumen. The conceptus, with membranes may be imaged in any area of birth canal accompanied by anechoic fluid. CL generally maintains good size and echogenicity for a number of days post abortion.
Macerated fetus	1	Uterine wall were thickened and bone fragments were seen as dense echogenic areas shadowing the tissue below. Surrounding and between the bones purulent fluid was present with its typical appearance of a non echogenic background containing many small echogenic particles.
Mummified foetus	3	Uterine fluids were not evident in contrast to the snowy appearance of the lumen of uteri in which macerated foetus were seen. Uterine wall is thickened. Fetal parts are rarely identified and mostly appeared as a poorly defined echogenic mass.
Adhesions	1	Medium or thick band of hypoechoic streak is observed along the uterine wall.
Anestrus	6	In 2 of the cases CL was imaged as distinctly echogenic areas with in the ovarian stroma while in rest of the cases, on sonographic scanning, no echogenic area was imaged in the ovarian stroma and small follicles (2-5 mm diameter) was visible on the ovarian surface.
Ovarian abscess	1	A pus filled cavity is observed over the ovary imaged as fine dots of echogenic particles in the anechoic fluid matrix.

Fig. 1: Sonogram of bovine uterine horn with endometritis before treatment. Fig 2: Sonogram of bovine uterine horn with endometritis after treatment.



Fig. 3: Sonogram of bovine uterine horn with post-partum metritis before treatment. Fig 4: Sonogram of bovine uterine horn with post-partum metritis after treatment.



Fig. 5: Sonogram of bovine uterus with pyometra before treatment. Fig 6: Sonogram of bovine uterus with pyometra after treatment.



Fig. 7: Sonogram of bovine uterus with mucometra before treatment. Fig 8: Sonogram of bovine uterus with mucometra after treatment.



Fig. 9: Sonogram of bovine ovary showing follicular cyst (40 mm). Fig 10: Sonogram of bovine ovary after treatment for follicular cyst.



Fig. 11: Sonogram of bovine ovary showing luteal cyst (36.8 mm). Fig 12: Sonogram of bovine ovary showing follicular activity after treatment of luteal cyst.



Fig. 13: Sonogram showing persistent CL (24.0 mm)on bovine ovarian stroma. Fig 14: Sonogram of a bovine macerated fetus.



Fig. 15: Fig. 15: Sonogram of a bovine mummified fetus. Fig 16: Sonogram showing adhesions of bovine uterus.



Fig. 17: Sonogram of bovine uterus after abortion at mid gestation period. Fig 18: Sonogram of bovine ovary showing ovarian abscess.