Postpartum Massive Hematoma within the Broad Ligament of the Uterus in a Broodmare Possibly Caused by Rupture of the Uterine Artery

A broodmare showed mild signs of abdominal discomfort and anemia after normal delivery. Ultrasonographic examination revealed a massive hematoma within the broad ligament adjacent to the uterine horn. Internal bleeding into the peritoneal cavity (hemoabdomen) was not seen. Following treatment, the clinical signs improved. Hemorrhage caused by rupture of the arteries within the broad ligament of the uterus may be a cause of hematoma. Prepartum and postpartum rupture of the arteries supplying the reproductive organs in the mare, which is not uncommon, can be fatal if severe hemoabdomen occurs. In the present case, the hematoma was considered to be tightly encapsulated between two serosal membrane layers of the broad ligament, and the membranes had remained intact. Thus, the serosal membranes did not split open, and massive bleeding into the peritoneal cavity did not occur. For this reason, the present broodmare avoided potentially fatal hemorrhagic shock.     

CT findings in five dogs with surgically confirmed colonic torsion

Colonic torsion is a life‐threatening condition that results in colonic ischemia, necrosis, perforation, sepsis, and eventual death. The aim of this multicenter, retrospective case series study was to describe the CT findings in dogs with surgically confirmed colonic torsion. Medical records were searched for dogs with surgically confirmed colonic torsion following abdominal CT. Five dogs met the inclusion criteria. Three had a history of chronic intermittent diarrhea prior to presentation. Two dogs presented with acute vomiting, diarrhea, and abdominal pain and one dog presented with acute vomiting and lethargy. Computed tomographic findings in all dogs with surgically confirmed colonic torsion include: “whirl sign,” displacement and distension of the cecum and colon, focal narrowing of the colon, and distension of the mesenteric vasculature in all dogs (5/5); streaky peritoneal fat and peritoneal effusion (4/5), pneumatosis coli (2/5), small intestinal distension (2/5), portal vein thrombosis (1/5), and reduced colonic wall contrast enhancement (1/5). In all dogs (5/5), the torsion site was the descending colon and demonstrated an anticlockwise rotation. At surgery, three of the five dogs had a partial colonic torsion with hyperemia at the site of obstruction and two of the five dogs had a complete torsion with marked necrosis of the colonic wall. Displacement of the colon and cecum, segmental distension and focal narrowing of the colon, the presence of a “whirl sign” and distension of the mesenteric vasculature are CT findings highly suggestive of colonic torsion.     

CT characteristics of primary splenic torsion in eight dogs

Splenic torsion is a rare potentially life‐threatening condition characterized by rotation of the spleen around the gastrosplenic and phrenosplenic ligaments leading to occlusion of venous drainage and arterial supply. This retrospective study describes the CT characteristics for dogs with surgically confirmed splenic torsion from 2013 to 2018 using the submissions to a large multinational teleradiology database. Eight dogs had the splenic torsion confirmed with surgery. Seven of eight cases had histology confirming congestion, hemorrhage, and necrosis, and one had concurrent myelolipoma infiltration. The CT characteristics included an enlarged (8/8), rounded (7/8), folded C‐shaped spleen (8/8) with a difference of median parenchymal attenuation between pre‐ and postcontrast of +1.15 HU (Hounsfield units). Other common features included a mainly homogeneous parenchyma on pre‐ and post‐contrast images (6/8), lack of subjective and objective vascular and parenchymal contrast enhancement (6/8) and free peritoneal fluid (6/8). A “whirl sign” was seen in the majority of cases (7/8) alongside a strongly hyperattenuating center (95‐416 HU) on the precontrast images (5/7), which has not been previously described in the veterinary literature. Gastric position was normal in all cases. More variable CT characteristics of the confirmed torsions were attributable to suspected partial torsion and myelolipomatous infiltration. Overall, primary splenic torsion confirmed with surgery showed consistent characteristics on CT.     

Computed tomographic findings may be useful for differentiating small intestinal adenocarcinomas,lymphomas, and spindle cell sarcomas in dogs

An improved understanding of the CT characteristics for histologically confirmed primary intestinal tumors would be helpful for guiding prognosis and treatment plans in affected dogs. This retrospective, multi-center, analytical study aimed to evaluate the CT characteristics for the differentiation of adenocarcinoma, lymphoma, and spindle cell sarcoma (SCS) in dogs. Thirty-seven dogs who underwent contrast CT and histopathological examinations were included (adenocarcinomas, n = 11; lymphomas, n = 12; SCS, n = 14). Quantitative and qualitative CT parameters, including tumor morphology, contrast enhancement pattern, Hounsfield unit (HU) value, and presence or absence of intraabdominal lymphadenopathy, were evaluated for each included small intestine tumor CT case. Adenocarcinomas tended to show endophytic growth, intestinal obstruction, and a heterogeneous enhancement pattern. Lymphomas tended to show exophytic growth, contrast enhancement of the intestinal tumor mucosal layer, a homogeneous enhancement pattern, and the presence of lymphadenopathies in the abdominal cavity. SCSs tended to show lobulated growth, a large cystic portion within the tumor, a heterogeneous enhancement pattern, a large size with fat stranding sign, and lower HU values in postcontrast images. Cut-off values of the minimum diameter/fifth lumbar vertebral mid-body height (≥5.80; area under the curve [AUC] = 0.97, P < 0.001) and minimum HU value/HU value of the aorta (≤0.26; AUC = 0.96, P < 0.001) were derived to discriminate SCS from the two other tumor types. In conclusion, contrast CT characteristics may be useful in differentiating small intestinal adenocarcinomas, lymphomas, and SCSs in dogs.     

ASSESSMENT OF RESPIRATION‐INDUCED DISPLACEMENT OF CANINE ABDOMINAL ORGANS IN DORSAL AND VENTRAL RECUMBENCY USING MULTISLICE COMPUTED TOMOGRAPHY

Respiratory‐induced organ displacement during image acquisition can produce motion artifacts and variation in spatial localization of an organ in diagnostic computed tomography (CT) examinations. The purpose of this prospective study was to quantify respiratory‐induced abdominal organ displacement in dorsal and ventral recumbency using five normal dogs. All dogs underwent CT examinations using 64 multidetector row CT (64‐MDCT). A “3‐dimensional (3D) apneic CT exam” of the abdomen was acquired followed by a “4‐dimensional (4D) ventilated CT exam.” The liver, pancreas, both kidneys, both medial iliac lymph nodes, and urinary bladder were delineated on the 3D‐apneic examination and the organ outlines were compared to the maximum alteration in organ position in the 4D‐ventilated examination. Displacement was measured in dorsal‐to‐ventral (DV), right‐to‐left (RL), and cranial‐to‐caudal (CC) directions. Respiratory‐induced displacement of canine abdominal organs was not predictable and showed large variability in the three directions evaluated. For most canine abdominal organs, dorsal recumbency provided overall the least amount of displacement among all directions evaluated except for liver and urinary bladder. For liver, a large variability was found for all directions and a statistically significant difference was found only in the RL direction with ventral recumbency exhibiting less displacement (P = 0.0099). For the urinary bladder, ventral recumbency also provided less displacement but this was statistically significant only in the RL direction (P < 0.0001). Findings from this study indicated that dorsal recumbency may be preferred for minimizing respiratory motion artifacts in whole abdomen studies, but ventral recumbency may be preferred for liver and urinary bladder studies when respiration cannot be controlled.     

Pleural endometriosis in an aged rhesus macaque (Macaca mulatta): a histopathologic and immunohistochemical study

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity and is one of the most common reproductive abnormalities encountered in women as well as Old World primates. The majority of endometriosis cases in Old World primates occur within the abdominal cavity, with spread to extraabdominal sites considered to be a rare event. A 19-year-old multiparous female rhesus macaque (Macaca mulatta) presented to necropsy for difficulty breathing and weight loss. Grossly, the animal had marked abdominal endometriosis and severe hemoabdomen and hemothorax, the latter of which was accompanied by marked pleural fibrosis. Histologic examination confirmed the abdominal endometriosis and also revealed numerous uterine glands and stroma embedded within the pleural fibrosis. Rafts of endometrial tissue were present within pulmonary lymphatics and the tracheobronchial lymph nodes. Immunohistochemically, all ectopic endometrial tissue had varying degrees of positive immunoreactivity to cytokeratin, vimentin, progesterone and estrogen receptors, and calretinin but was negative for desmin and carcinoembryonic antigen. Pleural endometriosis is an extremely rare manifestation of endometriosis in nonhuman primates. This case report emphasizes lymphatic spread as a likely mechanism for extrauterine endometriosis.     

CONTRAST-ENHANCED COMPUTED TOMOGRAPHY AS A PREOPERATIVE INDICATOR OF VASCULAR INVASION FROM ADRENAL MASSES IN DOGS

The purpose of this study was to determine if contrast-enhanced computed tomography (CT) accurately reflected vascular luminal invasion by adrenal masses in dogs. Medical records of 15 dogs with 17 adrenal masses that underwent preoperative CT imaging were reviewed. Presence or absence of vascular invasion was confirmed by surgery or necropsy/histology. Vascular invasion was identified correctly using contrast-enhanced CT in 11/12 dogs. The sensitivity and specificity of contrast-enhanced CT for vascular invasion compared with surgery or necropsy was 92% and 100%, respectively. The positive predictive value and negative predictive value of contrast-enhanced CT was 100% and 90%, respectively. The accuracy was 95%. In one dog, invasion of the phrenicoabdominal vein was not identified on CT images. Six of eight masses with vascular invasion where a histologic diagnosis was obtained were malignant. Four of four pheochromocytomas invaded adjacent vasculature. Contrast-enhanced CT provided accurate preoperative assessment of adrenal masses. Vascular invasion by adrenal masses in this study occurred by way of the lumen of the phrenicoabdominal vein with subsequent intraluminal extension into other veins, rather than by erosion through vessel walls.     

PREVALENCE AND CHARACTERIZATION OF SMALL TYMPANIC BONE SPICULES AND DRUMSTICK‐LIKE HYPEROSTOTIC TYMPANIC BONE SPICULES IN THE MIDDLE EAR CAVITY OF DOGS

Rounded, sessile, hyperattenuating structures detected in computed tomography (CT) studies of canine tympanic bullae have been termed “otoliths.” These have been proposed to represent dystrophic mineralizations or heterotopic bone formations in the middle ear that are potentially related to chronic otitis media. Aims of the current study were to describe the prevalence, macroscopic, and histological features of structures consistent with “otoliths” in the canine tympanic cavity. Tympanic bullae from 50 routinely necropsied dogs and 139 retrospectively retrieved CT scans of canine clinical cases were examined. Small tympanic bone spicules with pointed or clubbed tips essentially arising from the free margin of the septum bullae were bilaterally present in the tympanic cavities of all 50 of the necropsied dogs. In 48% of the dogs, “otolith”‐like CT‐detectable bone spicules carrying drumstick‐like hyperostoses that were 1–6 mm in diameter were also present. In the retrospective survey of bulla CT scans of 139 cases, the prevalence of hyperostotic tympanic bone spicules (HTBS) was 20%. Findings from the current study indicated that the presence of small tympanic bone spicules in adult dogs is most likely due to physiological bone growth in the septum bullae and that HTBS represent osseous proliferations of small tympanic bone spicules. However, the factors inducing formation of hyperostotic spicules from small tympanic bone spicules remain unknown. The high prevalence of HTBS displaying a similar appearance in bulla CT scans in dogs suggests that these spicules should be included in a differential diagnosis list for “otoliths.”     

IMAGING DIAGNOSIS—PULMONARY ALVEOLAR PROTEINOSIS IN A DOG

A young dog was presented for cyanosis and right heart failure. Radiographic and CT characteristics included right heart/pulmonary artery enlargement, hepatomegaly, abdominal effusion, and severe, generalized air‐space filling. Focal increased opacities were present in the peripheral lung, as were multiple pulmonary blebs and bullae. Echocardiographic findings were consistent with cor pulmonale and pulmonary hypertension. Bronchoscopic findings were consistent with chronic inflammation. Pulmonary alveolar proteinosis (PAP) was confirmed at necropsy. Pulmonary alveolar proteinosis is an interstitial lung disease that results in accumulation of phospholipoproteinaceous material and should be included as a differential diagnosis for dogs with these clinical and imaging characteristics.     

Radiographic findings and clinical factors in dogs with surgically confirmed or presumed colonic torsion

Colonic torsion is a life‐threatening condition in dogs and radiographic findings for this condition have not been well described. The purpose of this retrospective case series was to describe radiographic findings and clinical signs in a group of dogs with colonic torsion. Inclusion criteria were dogs presenting during the period of 2006 and 2016, and that had abdominal radiography and a surgically confirmed or presumed diagnosis of colonic torsion. For each dog, clinical data were recorded from medical records and imaging findings were recorded from retrieved plain radiographs and positive contrast radiographs in which barium enema was performed. Fourteen dogs met inclusion criteria. Of these, nine dogs had colonic torsion confirmed at surgery, with five dogs having surgical confirmation of colonic congestion or mesenteric torsion. Radiographic findings included segmental distention of the colon (14/14), focal narrowing of the colon (11/14), displacement of cecum (11/14), displacement of descending colon (14/14), and mild to no small intestinal distention (14/14). In cases where barium enema was performed, focal narrowing of the colon and longitudinal striations that course in a helical pattern were identified, termed the “torsion sign.” Vomiting was the most common clinical sign observed (12/14), followed by abdominal pain in a small majority of cases (8/14). Severe abdominal pain and hypovolemic shock were uncommon in the patients reported (3/14). Colonic torsion should be considered as a differential diagnosis for dogs with radiographic segmental colonic distention with displacement of the descending colon and cecum. Barium enema is recommended for more definitive diagnosis.     

Traumatic urothorax in a dog: a case report

Pleural effusion caused by post-traumatic extravasation of urine from the abdominal cavity to the pleural cavity (urothorax) is an uncommon complication following traumatic injury. To the authors' knowledge, this is the first report of a case of traumatic urothorax in a dog presented with pleural and abdominal urine effusion. Combined urothorax and uroabdomen should be included in the differential-diagnosis list for dogs with recent trauma and a bicavitary effusion. The diagnosis can be confirmed by elevated creatinine concentrations in both effusates, compared to its serum concentration.     

COMPUTED TOMOGRAPHIC CHARACTERISTICS OF PRESUMED NORMAL CANINE ABDOMINAL LYMPH NODES

Though identification of lymph nodes is essential in staging cancer patients, little has been reported about the CT features of canine abdominal lymph nodes. The purpose of this retrospective study was to describe the visibility, location, and characteristics of abdominal lymph nodes in abdominal CT studies of dogs considered unlikely to have lymphadenopathy. The relationship between the number of identified lymph nodes and intraabdominal fat ranking, body weight, and slice thickness was also investigated. A total of 19 dogs were included. At least two jejunal lymph nodes and both left and right medial iliac lymph nodes were identified in all dogs. Colic lymph nodes were not identified in any of the dogs. Visualization of all other lymph nodes varied. There were significantly more lymph nodes visible in dogs with more intraabdominal fat (P < 0.0001). No correlation between the number of identified lymph nodes and body weight (P = 0.64) or slice thickness (P = 0.76) was found. Though most of all identified lymph nodes had an elongated shape, a rounded shape was most common in splenic, pancreaticoduodenal, renal, ileocolic and caudal mesenteric lymph nodes. Most lymph nodes had a homogeneous structure before and following the intravenous administration of contrast medium. Some lymph nodes had a slightly irregular structure or were relatively more hyper attenuating in the periphery than centrally before and/or after contrast administration. Mean attenuation before contrast was 37 Hounsfield Units (HU) (range 20–52 HU), and 109 HU after contrast (range 36–223 HU). Findings indicated that the CT visibility, characteristics of different abdominal lymph nodes may be variable in dogs.     

Splenic Infarction in 16 Dogs: A Retrospective Study

Sixteen dogs with splenic infarction due to causes other than splenic torsion were identified. Dogs with splenic infarction often had multiple concurrent diseases, and surgical management of splenic infarction was associated with high mortality. Splenic infarction occurred in dogs with hypercoagulable conditions associated with liver disease, renal disease, and hyperadrenocorticism, or as a consequence of uniform splenomegaly, neoplasia, or thrombosis associated with cardiovascular disease. Clinical signs and common laboratory findings generally reflected the underlying disease process. A variety of splenic abnormalities were detected by abdominal ultrasound in 15 dogs, with the ventral extremity of the spleen being most often abnormal. Four dogs were euthanized or died because of the presence of severe systemic disease, whereas 12 dogs underwent laparotomy. Complete splenectomy was performed in 9 dogs and partial splenectomy was performed in 2 dogs. Seven dogs died in the immediate postoperative period, 3 required chronic veterinary care, and 2 had uncomplicated long-term recoveries. Splenic infarction should be regarded as a sign of altered blood flow and coagulation, rather than as a primary disease, and surgical management should be reserved for patients with life-threatening complications such as hemoabdomen or sepsis.     

Clinical and pharmacokinetic characteristics of intracavitary administration of pegylated liposomal encapsulated doxorubicin in dogs with splenic hemangiosarcoma

BACKGROUND: Canine splenic hemangiosarcoma (HSA) is a fatal malignancy, and most affected dogs die within a few months of diagnosis. Most dogs present with signs from tumor rupture, resulting in hemoabdomen and intra-abdominal dissemination. The abdomen is also the main site of disease recurrence. HYPOTHESIS: Intraperitoneal (IP) administration of doxorubicin will delay or prevent intra-abdominal tumor recurrence and prolong survival in dogs with HSA. ANIMALS: Fourteen dogs with splenic HSA. METHODS: A prospective, unmasked, uncontrolled clinical trial. After staging of disease status and splenectomy, pegylated liposomal encapsulated doxorubicin was administered intraperitoneally (1 mg/kg body weight) every 3 weeks for 4 cycles. All dogs were monitored for recurrence of HSA. Samples of plasma and abdominal fluid were collected for measurement of doxorubicin concentration and pharmacokinetic analysis. Nonlinear mixed-effect modeling was used to describe the pharmacokinetics of liposomal doxorubicin administered IP. RESULTS: All 14 dogs died, 12 because of HSA and 2 from other causes. Postmortem examination was performed on 12 dogs. All 12 dogs died because of HSA-related causes and had hepatic metastases and hemoabdomen. The IP-treated dogs had fewer serosal, mesenteric, and omental metastases than historical controls treated with systemic doxorubicin. Results of the postmortem examination and pharmacokinetic analysis confirmed that IP delivery of doxorubicin resulted in an effective drug concentration with a clearance comparable with that after i.v. delivery. CONCLUSIONS AND CLINICAL IMPORTANCE: IP pegylated liposomal encapsulated doxorubicin administration did not prevent intraabdominal recurrence of HSA in dogs.     

Clinical signs,diagnosis and treatment of three dogs with angiostrongylosis in Ireland

: Infection with Angiostrongylus vasorum was diagnosed at necropsy on a dog that died from acute pulmonary haemorrhage, and on recovery of L1 larvae by Baermann examination of faeces from two dogs, one of which had abdominal pain and retroperitoneal haemorrhage, while the other had right-sided heart failure due to cor pulmonale. The presenting signs included syncope (one dog), exercise intolerance (two dogs), cough (two dogs), abdominal pain (one dog) and depression (one dog). One-stage prothrombin time and activated partial thromboplastin time were prolonged in two dogs, buccal mucosal bleeding time was prolonged in one dog and globulin was elevated in all three dogs. Two dogs were treated with fenbendazole and recovered.     

Computed Tomography of the Prostate Gland in Healthy Intact Dogs and Dogs with Benign Prostatic Hyperplasia

To date, there is only scarce data on the evaluation of the prostate gland in dogs using computed tomography (CT). The aims of our study were to describe CT features of BPH in dogs and to determine the size of the prostate gland in healthy male dogs and dogs with benign prostatic hyperplasia (BPH) through CT. Additionally, we aimed to compare and establish the most useful parameters for CT measurements of the prostate in patients with BPH. The study population consisted of 20 healthy intact male dogs and 20 male intact dogs with confirmed BPH. Pre‐ and post‐contrast CT studies were evaluated. The most common CT features in dogs with recognized BPH were symmetrical prostatomegaly and heterogeneity of the prostatic parenchyma. The mean prostatic density (D) was 56HU (±4.39) in pre‐contrast CT images and 84HU (±8) in post‐contrast images in dogs with BPH. The mean prostatic length (L) was 43.87 mm (±11), the mean width (W) amounted to 48.95 mm (±8.76) and the mean height (H) reached 44.9 mm (±9.48) in clinically affected patients. The mean ratios were: rL ? 2,12 (±0.5); rW ? 2.39 (±0.53) and rH ? 2.16 (±0.39) in the BPH group. The prostate should be considered to be enlarged when rL exceeds 3.05; rW exceeds 3.38 and rH exceeds 2.94. Our findings indicated that CT is a useful tool in diagnosing prostate disorders, including BPH. The heterogeneity, density and ratios of prostatic length, width and height can be useful parameters in the diagnosis of BPH.