Aortopulmonary fistula in a Warmblood mare associated with an aortic aneurysm and supravalvular aortic stenosis

This case report describes the clinical presentation, the necropsy findings, and genetic results of a 13-year-old Warmblood mare presented with colic and a bilaterally loud, holosystolic murmur. Echocardiographic examination revealed the presence of a thoracic aortic aneurysm, an aortic pseudoaneurysm, a periaortic hematoma (circumferential cuffing by perivascular hemorrhage), and aortopulmonary fistulation. A supravalvular aortic stenosis (SVAS) was visible during echocardiography. Necropsy confirmed that the thoracic aortic aneurysm had ruptured and connected to the pseudoaneurysm, which fistulated into the pulmonary artery. Histologically, the aneurysm wall revealed chronic lesions such as fibrosis, mucin depositions, mineralizations, and elastin fragmentation. The mid abdominal aorta showed lesions suggestive of a systemic elastin arteriopathy. Molecular analysis, however, could not attribute this disease to a variant in the elastin gene, the most common causative gene for SVAS. To the authors' knowledge, this case report describes a case of aortopulmonary fistulation in a Warmblood horse associated with the presence of SVAS and an aortic aneurysm.     

Small colon intussusception in a broodmare

A 9-year-old pregnant Standardbred broodmare was evaluated for signs of mild abdominal pain, failure to defecate, and mild abdominal distention. Rectal examination revealed the leading edge of a small colon intussusception, and peritoneal fluid analysis indicated suppurative peritonitis. Surgical management, including reduction of the intussusception and small colon resection with end-to-end anastomosis, resulted in successful outcome (1-year follow-up evaluation). Postoperative complications including dehiscence of the ventral midline surgical incision and simple obstruction at the anastomosis site necessitated a second surgical procedure. Small colon intussusception is an uncommon cause of signs of abdominal pain and is similar to type-IV rectal prolapse.     

Metallic foreign body in the ovary of a broodmare

A 12‐year‐old Thoroughbred broodmare was presented for laparoscopic removal of an abnormal ovary. Rectal examination and ultrasound revealed firm attachment of the enlarged right ovary to the ventral pelvis and right abdominal wall, and gas accumulation within the right ovary. Laparoscopic examination revealed extensive adhesion formation between the abnormal ovary, ispilateral uterine horn, ventral pelvis and the right abdominal wall. A flank laparotomy was then performed to improve visualisation of the area. Due to contamination of the abdomen during attempts to detach adhesions, the complexity of the structures involved and the poor prognosis for further reproduction, the decision was made to subject the mare to euthanasia. Post‐mortem evaluation revealed a large encapsulated abscess of the right ovary, with a small, linear wire foreign body within the centre of the abscess.     

Hand-assisted laparoscopic reattachment of a mesoduodenojejunal defect in a broodmare

In this report, a jejunal entrapment through a presumptive chronic mesenteric defect extending over approximately 20 cm of the duodenojejunal region was found as a cause of acute onset colic in a multiparous broodmare. Mesenteric reattachment during the initial exploratory laparotomy was deemed unsafe given the majority of the avulsion could only be palpated deep within the abdomen. Following recovery and an uneventful parturition 12 days later, the mare returned 18 days post-foaling for attempted, standing laparoscopic reattachment of the mesentery. The procedure was converted to a hand-assisted technique and reattachment completed using a mechanical suturing device and knotless, unidirectional barbed suture. The mare was discharged 3 days post-operatively, bred 28 days following discharge and a singleton pregnancy confirmed 15 days post-ovulation and 46 days following laparoscopy. There were no signs of abdominal discomfort noted in the first 8 months following surgery. In summary, a standing, right-sided hand-assisted laparoscopic approach provided effective visibility to the mesoduodenojejunal region.     

Proximal aortic dissection (dissecting aortic aneurysm) in a mature ostrich

The gross and histopathologic lesions observed in a case of spontaneous proximal aortic dissection (dissecting aortic aneurysm) in a mature ostrich are reported. At necropsy, a dissecting intramural hematoma was seen in the proximal aorta, extended about 12 cm distally from the aortic valves. Histopathologic changes in aortic dissection included fragmentation and disruption of elastic laminae, presence of cystic extracellular spaces, and pooling of ground substance in the tunica media. Hepatic copper levels were measured, and the low concentration found suggested that a copper deficiency together with other risk factors such as the elevation of blood pressure may have been implicated in the development of the aortic dissection seen in this ostrich.     

Nasal and ocular amyloidosis in a 15-year-old horse

Localized nasal, conjunctival and corneal amyloidosis was diagnosed in a 15-year-old pony with nasal and conjunctival masses and severe dyspnoea. Multiple swellings had been evident in the nostrils for at least two years and had gradually increased in size before presentation due to dyspnoea and exercise intolerance. Surgical debulking of the masses was performed and histological examination revealed large amounts of extracellular, hyaline, eosinophilic, Congo red positive material in the lamina propria of the nasal mucosa. A tentative diagnosis of localized nasal amyloidosis was made. The treatment relieved the clinical signs, however, the nasal masses recurred and bilateral conjunctival, papillary masses developed. The horse was euthanized. Nodular nasal and papillary conjunctival masses consisting of rubbery, grey to yellow tissue were found at necropsy. At the limbus this tissue infiltrated and expanded the cornea. The masses consisted of amyloid and moderate infiltrates of T lymphocytes and B lymphocytes were present in the tissue. No predominance of either cell type was observed and no distinct neoplastic mass could be identified. Ultrastructural examination of the nasal mucosa and cornea confirmed the presence of abundant extracellular deposits of non-branching fibrils ranging from 9–11 nm in diameter consistent with amyloid. Immunohistochemistry of amyloid revealed no labelling for AA amyloid, and no peptides representing serum amyloid A (SAA) were detected by microscopic laser dissection and subsequent mass spectrometry. Peptides from immunoglobulin kappa-like light chains were detected and are suggestive of AL amyloidosis, however the results were inconclusive and a final identification of the amyloid protein could not be made.Nasal amyloidosis is a clinical entity of localized amyloid deposits in the horse. Localized amyloidosis involving the conjunctiva of the horse is previously described in only seven cases and the present case is the first case of combined, localized nasal and corneal amyloidosis in the horse. In several reported cases surgical excision has provided clinical improvement and return to normal levels of exercise, while medical treatment has had no effect. The present case however, shows that rapid recurrence and progression of nasal amyloidosis to involve ocular tissues can occur and lead to recurrent respiratory obstruction.

Electronic supplementary material

The online version of this article (doi:10.1186/s13028-014-0050-6) contains supplementary material, which is available to authorized users.     

Laparoscopic repair of a small intestinal mesenteric rent in a broodmare

OBJECTIVES : To describe standing laparoscopic repair of mesoduodenal rent inaccessible by ventral median celiotomy. STUDY DESIGN : Clinical case report. SAMPLE POPULATION : A 6-year-old Thoroughbred broodmare with a right displacement of the dorsal colon and small intestinal incarceration in a mesoduodenal rent. METHODS : Two days after correction of a right dorsal displacement of the ascending colon, small intestinal incarceration, and partial closure of mesoduodenal rent, standing left and right flank laparoscopy was used to explore the abdomen to identify the mesoduodenal defect. The mesenteric rent was repaired from right flank portals by approximation with hemostatic clips. RESULTS : Approximation of the mesoduodenal rent was achieved with laparoscopic clips. No further complications or signs of abdominal pain occurred over the following year. CONCLUSIONS : Mesenteric rents in the mesoduodenum can be repaired by laparoscopic techniques in the standing horse. CLINICAL RELEVANCE : Use of laparoscopic techniques in the standing horse should be considered for mesoduodenal rents that are not accessible form a ventral median celiotomy.     

Distal aortic aneurysm presumed to be secondary to an infected umbilical artery in a foal

Abstract

CASE HISTORY:?A 3-month-old female Warmblood foal was presented after displaying signs of colic with pyrexia for 5 days.

CLINICAL AND PATHOLOGICAL FINDINGS:?The foal continued to show signs of colic, frequently passed urine, and was pyrexic with an elevated white blood cell count. The umbilical stalk was thickened but there was no evidence of purulent material. Exploratory laparotomy revealed an enlarged left umbilical artery remnant tightly adhered to the bladder wall. The left umbilical artery continued to an aneurysm involving the distal aorta. The foal was subject to euthanasia and post-mortem examination confirmed a spherical aortic aneurysm, in the dorsal midline caudal to the kidneys that contained a large thrombus. Histopathological examination revealed inflammation and necrosis of the tunica intima and tunica media of the left umbilical artery with suppuration and bacterial colonies evident in the periarterial tissues.

DIAGNOSIS:?Infected aortic aneurysm presumably caused by an umbilical artery infection.

CLINICAL RELEVANCE:?A previously undetected umbilical infection appears to have resulted in an unusual delayed complication causing signs of colic in a foal. Veterinarians should be aware of this condition, and the possibility that it may be a cause of signs of colic in foals. Diagnosis based on ultrasonography should be possible, but may require sedation, visceral analgesia and careful examination.     

Distal aortic aneurysm presumed to be secondary to an infected umbilical artery in a foal

ABSTRACT

Case History: Two calves delivered following elective caesarean section showed behaviour typical of neonatal maladjustment syndrome described in foals, i.e., indifference to environmental stimuli, lack of affinity for the dam, failure to find the udder, refusal to suck, aimless wandering or motionless standing. Calves were subjected to a clinical examination immediate after delivery and there were no signs of defects, illness, pain, dehydration, hypoxia, acidaemia or other causes for the unresponsive behaviour.

Clinical Findings and Treatment: Both calves were subjected to the thoracic squeeze technique, one at 6 hours and the other at 20 hours after delivery. A soft rope was looped around the thorax and gentle pressure was applied to the free end of the rope, squeezing the calf’s chest for 20 minutes. Both calves exhibited a sleep-like state manifested by closed eyes, no body movements, slow breathing and a decrease in heart rate, for the entire squeezing period. When the rope was removed the calves woke up immediately, rose and walked towards the dam. When led to the dam’s udder, the weaker calf began to suck. Both were reported, by the stockperson, to follow the dam and suck normally the following day.

Clinical Relevance: Provided all other disease processes are excluded, very young calves that exhibit indifference to environmental stimuli and lack of affinity for the dam may be good candidates for application of the thoracic squeeze technique that has been demonstrated to have clinical efficacy in foals with neonatal maladjustment syndrome.     

Familial aortic aneurysm in Leonberg dogs

A thoracic aortic aneurysm was diagnosed in a 6-month-old male Leonberg dog by use of radiography, transthoracic and transesophageal echocardiography, and magnetic resonance imaging. The aneurysm was associated with a twisted ascending aorta and dilatation of several other thoracic arteries (pulmonary trunk, brachiocephalic trunk, and left subclavian artery). Histologic examination of the aorta revealed cystic medial necrosis, with disruption of the elastic network, collagen fibers, and the muscle glycoprotein fibrillin-1. The dam and sire of the dog and 8 littermates were examined by use of transthoracic echocardiography. The sire and 1 male littermate also had an aneurysm of the ascending aorta. To the authors' knowledge, this is the first report of familial aortic aneurysm in dogs.     

Equine paranasal sinus cysts: a report of 15 cases

The clinical and radiographic features of 15 cases of paranasal sinus cysts are described. Breed, sex and side frequency were unremarkable but two distinct categories of age incidence emerged. Onset of signs had occurred before one year of age in three cases, while all but two of the remaining 12 animals were older than nine years. The most common clinical signs were nasal airway obstruction, facial swelling and nasal discharge, often occurring in combination. Radiographic changes were recorded in all horses. Sinus opacification was a consistent finding and in several cases the bone surrounding the sinus had increased in thickness. Increase in intra-maxillary sinus pressure was demonstrated by septal displacement on ventro-dorsal radiographs in almost half the cases. Less common signs included expansion, free fluid accumulation within the affected sinus, dental distortion and displacement and mineralisation. Two horses were destroyed without treatment but in 13 animals surgical exploration was performed. Two of these were destroyed, one at the time of surgery and one five days postoperatively. In the remaining 11 cases, all accessible parts of the cyst were removed through a facial flap and drainage to the nasal meati was established. All these horses recovered satisfactorily and were followed up for periods between three months and six years without evidence of recurrence. Thirteen cysts arose in the caudal maxillary sinus and one each in the frontal and rostral maxillary compartments. Histopathological examination of portions of the cyst walls suggests that, like ethmoidal haematomas, they may originate from episodes of haemorrhage beneath the upper respiratory tract mucosa.     

Abdominal aortic aneurysm associated with systemic fungal infection in a German shepherd dog

A 2 yr old spayed female German shepherd presented with a chief complaint of acute onset paraparesis and weight loss. At presentation, the dog was pyrexic, nonambulatory, and had generalized muscle wasting. Neurolocalization was consistent with a thoracolumbar spinal cord lesion. An abdominal ultrasound was performed and revealed a focal dilation (4 cm) of the terminal aorta with evidence of blood stasis consistent with an aortic aneurysm. The dog was euthanized shortly after admission to the hospital and a post mortem examination was performed. Fungal organisms were identified in the aortic aneurysm as well as from the thoracic vertebrae, mesenteric lymph nodes, axillary lymph nodes, spleen, kidneys, liver, lungs, and heart. Although the morphology was consistent with Candida spp., immunohistochemistry and PCR could not definitively identify the causative organism. Mycotic aortic aneurysms are a rare finding in humans and have not been previously reported in the dog. To the authors' knowledge, this is the first known report of an aortic aneurysm associated with systemic fungal infection in a dog.     

Echocardiographic detection of an intact aneurysm in a horse

Two-dimensional real-time echocardiographic examination of a 3-year-old Thoroughbred gelding with pleuropneumonia revealed an intact aneurysm of the right sinus of Valsalva, which was confirmed at postmortem examination. The horse had no clinical signs associated with the aneurysm.