CLINICAL,PATHOLOGIC, AND MAGNETIC RESONANCE IMAGING CHARACTERISTICS OF CANINE DISC EXTRUSION ACCOMPANIED BY EPIDURAL HEMORRHAGE OR INFLAMMATION

Our aim was to characterize the magnetic resonance (MR) imaging features of canine disc extrusion accompanied by epidural hemorrhage or inflammation. We correlated the imaging characteristics of this type of disc extrusion in 46 dogs and compared these features with clinical signs and pathologic findings. Data from 50 control dogs with MR imaging features of a disc extrusion with no associated hemorrhage or inflammation, characterized by a T2‐hypointense extradural mass, were used for comparison of the relative location of the two types of lesions and prognosis. Disc extrusion causing epidural hemorrhage or inflammation is more common in the caudal aspect of the lumbar spine than disc extrusions that do not cause signs of hemorrhage or inflammation (P<0.05) in MR images. In dogs with disc extrusion and associated epidural hemorrhage or inflammation, there was no association between MR imaging features and signalment, the presence or absence of hemorrhage, or pathologic findings. The appearance of the lesion created by disc extrusion with epidural hemorrhage and inflammation encompasses a wide variety of imaging features, likely related to the duration of the hemorrhage and associated inflammatory changes. In 10 of 46 dogs these secondary changes masked identification of the disc extrusion itself in the MR images. An awareness of the variety of MR imaging features of disc extrusion accompanied by extradural hemorrhage or inflammation is important to avoid making an incorrect diagnosis and to facilitate a proper surgical approach. The prognosis of dogs with disc extrusion accompanied by hemorrhage or inflammation does not appear to be different than for dogs with disc extrusion and without imaging signs of epidural hemorrhage or inflammation.     

Intraluminal hemorrhage from small intestinal ulceration in two cows.

Two adult Holstein cows were admitted with signs of acute gastrointestinal hemorrhage. Abomasal ulceration was diagnosed tentatively in both cows, but was later ruled out in 1 cow that had an abomasotomy performed through a right paramedian approach. Both cows failed to respond to treatment of blood loss and hypovolemic shock and became recumbent; one cow died and the other was euthanatized. Post-mortem examination determined the source of hemorrhage in both cows to be ulcerated small intestine with severe intraluminal hemorrhage. The cause of ulceration was undetermined. Small intestinal hemorrhage should be considered in cattle with signs of acute gastrointestinal hemorrhage.     

Sudden death in turkeys with perirenal hemorrhage: pathological observations and possible pathogenesis of the disease.

A pathological study was conducted on 32 turkeys that died of sudden death with perirenal hemorrhage syndrome. Turkeys were selected from routine necropsy cases in a diagnostic laboratory. A higher incidence was observed in heavy tom turkeys. In addition to the characteristic gross lesions of perirenal hemorrhage, splenomegaly, and pulmonary congestion, turkeys in most cases had a hypertrophic cardiopathy. Microscopic lesions included moderate-to-marked acute passive congestion of all tissues examined (32/32), severe perirenal hemorrhage (32/32), and splenic lymphoid depletion (25/32). Changes in the thyroid follicular epithelium of most birds suggested an increased glandular activity. No lesions suggestive of arterial hypertension were observed. Adenoviral infection was detected in only four of 32 birds. Bacteriological cultures revealed no significant pathogen. Results suggest that sudden death in turkeys with perirenal hemorrhage is caused by an acute congestive heart failure consecutive to a hypertrophic cardiopathy. The perirenal hemorrhage would be a consequence of a severe passive congestion in kidneys.     

Lack of agreement between thermodilution and echocardiographic determination of cardiac output during normovolemia and acute hemorrhage in clinically healthy, anesthetized dogs

Objective and hypothesis: To determine whether or not there is agreement between the thermodilution and echocardiographic measurement of cardiac output (CO) during normovolemia and acute hemorrhage. The hypothesis was that there will be agreement between echocardiographic measurement of CO (ECO) and thermodilution measurement of CO (TDCO) during normovolemia and acute hemorrhage. Design: CO was measured by both thermodilution and echocardiography during α‐chloralose anesthesia in dogs before and 15 and 30 minutes following acute arterial hemorrhage. Setting: Laboratory investigation. Animals: Eighteen clinically healthy dogs, weighing 20–25 kg, anesthetized with α‐chloralose. Interventions: Acute arterial hemorrhage of approximately 50% of the total blood volume. CO was measured by thermodilution and echocardiography before and 15 and 30 minutes following hemorrhage. Measurements and main results: Acute hemorrhage resulted in a significant decrease in CO. There was a lack of agreement between the 2 methods to measure CO at each time and at all anatomic points of measurement in the aorta and pulmonary artery. Conclusion: There is a lack of agreement between the 2 methods; thus, determination of CO by echocardiography may not be a clinically useful tool following hemorrhage in dogs.     

Nd:YAG Laser Treatment of a Vestibulovaginal Varicosity in a 15-Year-Old Pregnant Mare

A 15-year-old, pregnant Dutch Warmblood mare was exhibiting intermittent hemorrhage secondary to a large vestibulovaginal varicosity. The vessel was reduced with transendoscopic Nd:YAG laser photocoagulation. This technique is minimally invasive compared with traditional surgical ligation, and significantly decreases the risk of severe hemorrhage, especially with advancing pregnancy. One laser treatment resulted in complete reduction in vessel size and allowed the pregnancy to continue to term without incident or further vaginal hemorrhage.     

Sudden death attributable to exercise-induced pulmonary hemorrhage in racehorses: nine cases (1981-1983)

Pathologic changes are described in 11 horses that died during racing or training; 9 died of acute pulmonary hemorrhage (exercise-induced pulmonary hemorrhage), 1 died of exsanguination, and 1 died of CNS trauma. Cardiac lesions were not found in any horse. Severe engorgement of pulmonary vessels, with hemorrhage into alveoli, airways, interstitium, and subpleural tissues, was observed in all 9 horses that died of exercise-induced pulmonary hemorrhage. Infiltration of eosinophils and/or lymphocytes around vessels and airways was seen in 6 horses. Focally extensive fibrosis was observed in the pleura and interstitium of 6 horses, and collections of siderophages were seen in the fibrous tissue and in the airways. Focal occlusion of bronchioles with inspissated mucus, such as that associated with small airway disease, was found in 4 horses. Underlying respiratory tract lesions, particularly those associated with small airway disease or bronchiolitis, may have a role in fatal pulmonary hemorrhage.     

Packed red blood cell transfusions in dogs with gastrointestinal hemorrhage: 55 cases (1999-2001)

Fifty-five dogs received packed red blood cell (PRBC) transfusions for gastrointestinal (GI) hemorrhage during a 26-month period (1999 to 2001), accounting for 11.7% of the PRBC transfusions in that time. Thirty-nine (61%) dogs had an intestinal pathology (primary or secondary) as the cause of GI hemorrhage, including intestinal masses, gastroenteritis, hepatic disease, and renal disease. Nonsteroidal and steroidal anti-inflammatory drug use was found frequently in dogs with GI hemorrhage. Sixteen (39%) dogs were identified as having immune-mediated thrombocytopenia (IMT) and associated GI hemorrhage. Dogs with IMT received more transfusions of PRBC than nonIMT dogs (P<0.03) and received a significantly larger total volume of PRBC (P<0.01) during hospitalization.     

Disseminated hemangiosarcoma in a horse

A 6.5-year-old horse with a history of exercise-induced pulmonary hemorrhage was admitted because of acute onset of epistaxis, dyspnea, high respiratory rate, pale mucous membranes, and dark feces. There was no clinical or laboratory evidence of a bleeding disorder, and the horse's anemia was considered to be secondary to pulmonary hemorrhage. The cause of the hemorrhage was not found on thoracic sonograms or from cytologic examination of transtracheal aspirates. Despite supportive care, the horse's health deteriorated, and it was euthanatized. Necropsy revealed blood in the thoracic and peritoneal cavities and reddish black masses in many tissues. Histologic examination confirmed a diagnosis of hemangiosarcoma. Hemangiosarcoma is a rare tumor in horses; however, as this case demonstrates, it can cause pulmonary hemorrhage and respiratory distress and may be difficult to diagnose before death.     

Evaluation of a canine D-dimer point-of-care test kit for use in samples obtained from dogs with disseminated intravascular coagulation, thromboembolic disease, and hemorrhage

OBJECTIVE: To evaluate a canine D-dimer point-of-care (cD-d POC) test kit for use in healthy dogs and dogs with disseminated intravascular coagulation (DIC), thromboembolic disease (TED), and hemorrhage. ANIMALS: 12 healthy dogs, 18 dogs with DIC, 23 dogs with TED (19 acute and 4 chronic), and 18 dogs with hemorrhage. PROCEDURE: The cD-d POC, canine D-dimer ELISA (cD-d ELISA), human D-dimer latex agglutination (hD-d LA), and fibrin degradation product (FDP) tests were performed on citrated plasma. RESULTS: All healthy dogs had negative cD-d POC test results and mean cD-d ELISA value of 0.2 U/mL. All dogs with DIC had positive cD-d POC test results and mean cD-d ELISA value of 44 U/mL. Dogs with acuteTED had a mean cD-d ELISA value of 34 U/mL, and 17 of 19 had positive cD-d POC test results. Mean cD-d ELISA value in dogs with hemorrhage was 14 units/mL, and 15 of 18 had positive cD-d POC test results. The cD-d ELISA values in dogs with hemorrhage were significantly higher than those of healthy dogs but lower than those of dogs with DIC and acute TED. The cD-d POC, cD-d ELISA, and hD-d LA tests were comparable in differentiating healthy dogs from dogs with DIC, acute TED, or hemorrhage and appeared to be superior to measurement of FDPs. CONCLUSIONS AND CLINICAL RELEVANCE: The cD-d POC test kit can be quickly and easily used and reliably detects dogs with DIC or acute TED. Positive results may also be seen in dogs with internal hemorrhage.     

Pathology of ocular lesions associated with gas supersaturation in white seabass

Cultured juvenile white seabass Atractoscion nobilis (WSB) can suffer from intraocular emphysemas and exophthalmia in the hatchery environment. To identify the cause, two size-groups of WSB were exposed to five gas saturation levels, ranging from 98% to 122% total gas pressure (TGP), over a 96-h exposure period in 18 degrees C and 23 degrees C seawater. Histological examination revealed that the gross and subgross lesions associated with gas supersaturation included corneal and orbital emphysema, along with subretinal, optic nerve, and iridial hemorrhage. Corneal emphysema was the most prominent gross lesion, with the severity and prevalence increasing between size-groups and water temperatures as TGP increased. Following the same pattern was orbital emphysema, which affected more than 93% of the fish examined and caused hemorrhage in the subretinal space, around the optic nerve, in the iris, or a combination thereof. Iridial hemorrhage occurred in 91% of the fish examined and decreased significantly with fish size. The prevalence and severity of hemorrhage in the subretinal space increased significantly with TGP and fish size but not with temperature. Optic nerve hemorrhage was absent in small fish exposed at 18 degrees C but increased significantly with temperature and fish size. The reverse was true for the large fish.     

Factor XII and partial prekallikrein deficiencies in a dog with recurrent gastrointestinal hemorrhage

Factor XII deficiency and impaired prekallikrein activity were diagnosed in a 1-year-old Chinese Shar Pei. The dog experienced repeated episodes of intestinal hemorrhage and diarrhea. Laboratory findings were compatible with blood loss (iron deficiency anemia and hypoproteinemia). Necropsy findings suggested mild infiltrative bowel disease that could have been responsible for the dog's diarrhea, but no explanation for the severe recurrent gastrointestinal hemorrhage could be found. Factor XII deficiency is uncommon in the dog and is not associated with hemorrhagic tendencies. The factor XII deficiency in this case may have contributed to the gastrointestinal hemorrhage.     

Varices with thrombosis in the cervix and uterus of a mare.

Cervical and uterine varices with thrombosis were observed at the necropsy of a virgin 16-year-old Peruvian Paso that had previous episodes of hemorrhage from the uterus. Practitioners and pathologists should be alert to the possibility of ruptured varices in mares with hemorrhage into the uterus or from the vulva.     

INTRACRANIAL SUBARACHNOID HEMORRHAGE FOLLOWING LUMBAR MYELOGRAPHY IN TWO DOGS

Intracranial subarachnoid hemorrhage is a rare but serious complication of lumbar puncture in humans. Possible sequelae include increased intracranial pressure, cerebral vasospasm, or mass effect, which can result in dysfunction or brain herniation. We describe two dogs that developed intracranial subarachnoid hemorrhage following lumbar myelography. In both dogs, myelography was performed by lumbar injection of iohexol (Omnipaque). Both the dogs underwent uneventful ventral decompressive surgery for disk herniation; however, the dogs failed to recover consciousness or spontaneous respiration following anesthesia. Neurologic assessment in both dogs postoperatively suggested loss of brain stem function, and the dogs were euthanized. There was diffuse subarachnoid hemorrhage and leptomeningeal hemorrhage throughout the entire length of the spinal cord, brain stem, and ventrum of brain. No evidence of infectious or inflammatory etiology was identified. The diagnosis for cause of brain death was acute subarachnoid hemorrhage. Our findings suggest that fatal subarachnoid hemorrhage is a potential complication of lumbar myelography in dogs. The cause of subarachnoid hemorrhage is not known, but may be due to traumatic lumbar tap or idiosyncratic response to contrast medium. Subsequent brain death may be a result of mass effect and increased intracranial pressure, cerebral vasospasm, or interaction between subarachnoid hemorrhage and contrast medium.     

Exsanguination due to gastric ulceration in a foal

An Arabian foal with a congenital heart disease died due to hemorrhage secondary to a large gastric ulcer. Previously, death of foals with gastric ulcers has been due to diffuse peritonitis resulting from gastric ulcer perforation. The foal in this case report died due to hemorrhage secondary to a large gastric ulcer.     

URINARY BLADDER MURAL HEMORRHAGE ASSOCIATED WITH SYSTEMIC BLEEDING DISORDERS IN THREE DOGS

The sonographic appearance of three dogs with diffuse bladder wall thickening due to mural hemorrhage is described. Two dogs were diagnosed with immune-mediated thrombocytopenia and the third dog with vitamin K antagonist toxicity. Urinary bladder wall thickening ranged from 5 to 12 mm on initial sonographic examination. In the two surviving dogs, the bladder wall returned to normal thickness. One dog, euthanatized for refractory hematuria, had submucosal hemorrhage in the urinary bladder at necropsy. Urinary wall thickening sonographically resolved at a rate of approximately 1 mm per day. Mural hemorrhage should be considered in patients with concurrent bleeding disorder and urinary bladder wall thickening.     

Use of recombinant human factor VIIa in 2 patients with postoperative noncompressible,abdominal hemorrhage

Objective

To describe the clinical presentation, clinical course, and successful management of noncompressible, abdominal hemorrhage with recombinant human factor VIIa (rFVIIa) in 2 postoperative patients.

Case Summary

A 14-year-old neutered female Border Terrier and a 9-year-old neutered male domestic shorthair were treated with rFVIIa to treat noncompressible abdominal hemorrhage in the postoperative period. The dog presented for a septic abdomen following endoscopic intestinal biopsies 10 days prior and was found to have a jejunal perforation along with a fractured liver lobe and hepatic lymphoma at the time of exploratory laparotomy. The cat presented for a spontaneous hemoabdomen associated with hepatic amyloidosis. Clinically significant hemorrhage occurred in the perioperative and postoperative period and both patients received massive transfusions and antifibrinolytic therapy. Despite these interventions, the patients continued to have ongoing abdominal hemorrhage and surgical attempts at hemostasis were not attempted due to the friable nature of the liver at the time of surgery. Both patients received rFVIIa intravenously every 3 hours at a dose between 70 and 90 μg/kg as indicated by the clinical picture, which subsequently decreased transfusion requirements.

New or Unique Information Provided

This case report describes the use of rFVIIa in a cat and a dog with severe, noncompressible abdominal hemorrhage in combination with standard hemostatic interventions.     

Massive liver hemorrhage in Ontario broiler chickens

A massive liver hemorrhage (MLH) recognized in Ontario broiler chickens had a characteristic clinical course and pathological lesions. Affected flocks had a higher death rate than normal, with no obvious clinical signs. Deaths from MLH began at two weeks of age; the mortality rate returned to a normal level by four weeks. The main necropsy finding was massive multiple liver hemorrhage with consequent profuse hemoperitoneum.     

Mares admitted to a referral hospital for postpartum emergencies: 163 cases (1992–2002)

Objective: To identify and describe the physical, historical, and clinicopathologic characteristics of diseases requiring emergency treatment in postpartum mares, and to evaluate the utility of these characteristics in making an accurate diagnosis in these mares. Design: Retrospective study. Setting: University large animal hospital. Animals: One hundred and sixty‐three mares admitted for emergency treatment within 30 days following parturition between the years 1992 and 2002. Interventions: None. Measurements and main results: Information obtained from the medical records included age, breed, date of admission, sex of the foal from this parturition, time from parturition to admission, duration of clinical signs prior to admission, and any report of dystocia or normal attended delivery, physical examination and clinicopathologic findings and diagnosis. Urogenital hemorrhage and large colon volvulus were the most common diagnoses, comprising 16.6% and 15.9% of total cases, respectively. Older mares were more likely to have a diagnosis of urogenital hemorrhage than younger mares. Mares with urogenital hemorrhage had a median age of 13 years and were admitted to the hospital significantly closer to parturition than mares with other diagnoses. Anemia, hypoproteinemia, and hypofibrinogenemia were significantly associated with a diagnosis of urogenital hemorrhage and occurred in 32%, 36%, and 26% of the mares with urogenital hemorrhage, respectively. Dystocia was more commonly reported (70%) in mares with metritis. Leukopenia was more common (88%) in mares with uterine tears. Conclusions: Careful evaluation of clinicopathologic data can aid the emergency clinician in making a correct diagnosis in postpartum mares with emergent problems.     

Fatal hemoptysis after bronchoscopic biopsy in a dog

An 8‐year‐old 24.6 kg mixed breed dog underwent bronchoscopy for evaluation of a persistent progressive cough. Bronchoscopy documented a markedly thick and irregular, cobblestone appearance of the mucosa. A bronchoscopic biopsy was obtained; immediately after the biopsy, a large amount of hemorrhage poured from the endotracheal tube. Multiple efforts to control the hemorrhage were unsuccessful and the dog suffered a cardiopulmonary arrest and could not be revived. A necropsy was performed, which was significant for pallor, evidence of prior heartworm disease, prominent bronchial arteries, and erosion of the submucosal vessels at the site of the biopsy. The cause of death was hemorrhage associated with transbronchial biopsy of an enlarged bronchial artery associated with heartworm disease. This report describes a rare complication of a routine diagnostic procedure.