Diagnosis by ultrasonography of congestion of the caudal vena cava secondary to thrombosis in 12 cows

This paper describes the clinical, ultrasonographic, radiographic and postmortem findings in 12 cows with thrombosis of the caudal vena cava. The principal clinical signs were chronic bronchopneumonia and fever in 11 cows; one cow had epistaxis and one cow bled from the mouth; eight cows had anaemia and leucocytosis, and the clotting time for the glutaraldehyde test was markedly decreased in all the cows; in nine of the cows the activity of gamma-glutamyltransferase was high, suggesting chronic hepatic congestion. The most important ultrasonographic finding was congestion of the caudal vena cava attributable to thrombosis of the vein. In all the cows the caudal vena cava was round to oval on cross-section, rather than the normal triangular shape. The hepatic, splenic and portal veins were dilated in five, three and one cow, respectively. The results of radiography and endoscopy supported a diagnosis of bronchopneumonia, but there were radiographic changes in the diaphragmatic lung lobes that supported a diagnosis of vena caval disease in only four cows. Postmortem there was a thrombosis of the caudal vena cava in all the cows, and the thrombi were located in the thoracic, subphrenic and abdominal part of the caudal vena cava at the level of the liver in four, one and seven cows, respectively. In three cows, the thrombus was situated where a hepatic abscess had broken into the caudal vena cava, and in one cow it was at the site of a diaphragmatic abscess. In another cow, there was a fistula between the major bronchus of the right diaphragmatic lung lobe and the caudal vena cava where the thrombus was situated. Three cows had liver abscesses that had not broken into the caudal vena cava. There was severe bronchopneumonia in 11 of the cows, some of which also had multiple pulmonary abscesses.     

Ultrasonographic measurement of caudal vena cava to aorta ratios for determination of volume depletion in normal beagle dogs

A noninvasive method for quantifying hydration status would be helpful for clinical management and for research applications in dogs. This prospective, experimental, pilot study aimed to assess the feasibility of ultrasonographic measurement of the caudal vena cava to aorta ratio as a method for quantifying volume depletion in dogs. In 12 normal beagle dogs, furosemide was administered intravenously at a dose of 1 mg/kg, every 2 h, for 8 h, to induce consecutive volume depletion. Every 30 min after administration, ultrasonographic images of the caudal vena cava and aorta, and physical and biological parameters related to dehydration were acquired. On transverse and longitudinal planes of caudal vena cava and aorta images, the height and area of the caudal vena cava and aorta were measured to calculate the caudal vena cava/aorta ratios. All images were acquired by approaching from the right intercostal space with the dogs in left lateral recumbency. A negative correlation was present between the percentage of weight loss in dogs and all four investigated caudal vena cava/aorta ratios (transverse plane width of the caudal vena cava [TW]/aorta; transverse plane height of caudal vena cava [TH]/aorta; longitudinal plane area of the caudal vena cava [TA]/aorta; and longitudinal plane maximal height of the caudal vena cava [L]/aorta). Significant differences (P < 0.001) were seen between dogs with and without clinical signs of dehydration for all caudal vena cava/aorta ratios. Findings indicated that ultrasonographic caudal vena cava/aorta ratios are feasible methods for quantifying volume depletion and for use as an adjunct to standard subjective methods for estimating hydration status in dogs.     

Descriptive anatomic study of the great vessels of the heart in the capuchin monkey Cebus apella (Linnaeus, 1758)

The aim of this study was to describe the anatomy of the great vessels of the heart in capuchin monkey (Cebus apella) and to compare with those of other primates, including humans. The hearts were prepared through fixation in 10% formalin and subsequently dissected using standard techniques and instruments. The arterial and venous systems were perfused with colored latex solution via the femoral vessels. An ascending cylindrical branch with relatively great caliber was identified in the aorta artery, in addition to an aortic arch, from which three great arteries were originated, the brachiocephalic trunk, the left common carotid artery and the left subclavian artery. After a course of variable extension, the pulmonary trunk divided into right and left pulmonary arteries. The caudal vena cava was morphologically similar to that of humans, except for its association with the cardiac lobe of the right lung, whereas the cranial vena cava was formed by the two braquiocephalic veins and received the azygos vein close to right atrium. The pulmonary veins, in number of six, ended at the posterior face of the left atrium, differently from both humans and other primates. In conclusion, the morphology of the great vessels of the heart in Cebus apella was similar to that of humans and other primates, although some differences are evidenced with regards to topography and number of anatomic structures, particularly the relationship of the caudal vena cava with the cardiac lobe of the right lung and the presence of six pulmonary veins in Cebus apella.     

Caudal vena cava kinking in dogs with ascites

A 9-year-old dog with spontaneous ascites was found to have hepatic vein distension and a tortuous vena cava on abdominal ultrasound. In right lateral recumbency, the caudal vena cava crossed the diaphragm and became kinked before entering into the right atrium. Following this observation, we performed an experimental study in a normal dog to determine whether kinking of the caudal vena cava could be the result and not the cause of ascites. Ascites was induced using warm saline injected through a needle inserted into the abdominal cavity. Venograms were collected from different body positions, under four conditions: before and after a total of one, two and 3 liters of saline had been injected. Caudal vena cava kinking was observed in the experimental dog after 2 liters of fluid had been injected. Vena cava obstruction may cause ascites, but we found that sometimes caudal vena cava kinking can be the result and not the cause of the peritoneal effusion.     

MULTIDETECTOR‐ROW COMPUTED TOMOGRAPHIC CHARACTERISTICS OF PRESUMED PREURETERAL VENA CAVA IN CATS

Preureteral vena cava (circumcaval ureter, retrocaval ureter) occurs in a third of the feline population and has been associated with ureteral strictures in humans. The aim of this retrospective cross‐sectional study was to describe the contrast‐enhanced multidetector row computed tomographic (MDCT) characteristics of presumed preureteral vena cava in a group of cats. Medical records from two institutions located in different continents were searched from 2010–2013 for cases with complete contrast‐enhanced MDCT examinations of the abdomen (i.e. included the entire course of the ureters and prerenal and renal segments of the caudal vena cava) and a diagnosis of preureteral caudal vena cava. For cases meeting inclusion criteria, CT scan data were retrieved and characteristics of the preureteral caudal vena cava were recorded. Presence of concomitant renal or ureteral diseases was also recorded. A total of 272 cats had contrast‐enhanced abdominal CT scans during the study period and of these, 68 cats (22.43 ± 4.96%) had a diagnosis of presumed preureteral vena cava. In all affected cats, a “reverse‐J ureter” was observed, i.e. a ureter running medially at the level of L4–5, passing dorsally to the caudal vena cava and then exiting ventrally between the caudal vena cava and aorta returning to its normal position. Having a preureteral vena cava resulted in an increased risk for concurrent urinary signs (OR = 3.00; CI: 95%; 1.28–6.99; P = 0.01). Findings supported the use of contrast‐enhanced MDCT for characterizing morphology of preureteral vena cava and its relation with ureters in cats.     

Partial anomalous pulmonary venous connection with portosystemic shunt in a cat

A nine-month-old castrated male domestic shorthair presented for evaluation with a three-month history of hematuria. Portosystemic shunts and calculi within the bladder were suspected, and computed tomography angiography was performed. Computed tomography angiography identified an extrahepatic portosystemic shunt and a partial anomalous pulmonary venous connection, with the lobar vein of the right caudal lobe draining into the caudal vena cava. After anesthesia was administered to the cat, tachypnea and wheezing respiratory sounds were observed, and thoracic radiography revealed the right middle lung lobe atelectasis and an unstructured interstitial pattern in the left cranial lobe. Echocardiography showed left and right atrial enlargement and slight interventricular septal flattening in diastole. Based on these findings, cardiogenic pulmonary edema was suspected, and the cat was treated with furosemide. The clinical symptoms were resolved the next day. Closure of the extrahepatic portosystemic shunt was performed on days 47 and 157. Left atrial enlargement and interventricular septal flattening were attenuated after the procedure. At the time of writing this report (seventeen months after diagnosis), the cat exhibited no clinical signs, but subjective right atrial enlargement remained at approximately the same level. This report represents the first case of a partial anomalous pulmonary venous connection and a portosystemic shunt in a cat.     

Congenital cardiac disease in dogs

Thoracic conformation, age, amount of body fat, and stage of respiration and cardiac contraction affect the cardiac silhouette. Deep-chested dogs have an upright, narrow cardiac silhouette about 2 1/2 intercostal spaces wide, while barrel-chested dogs have a round, wide silhouette about 3 1/2 intercostal spaces wide. On LAT films the vessels to a lung lobe should be of equal size and 0.25-1.2 times the diameter of the upper third of the 4th rib at the 4th intercostal space. On DV projections, vessels to the caudal lung lobe should be no larger than the diameter of the 9th rib. Signs of right ventricular enlargement include loss of the cranial waist, increased width of the cardiac silhouette, increased sternal contact of the heart, and an elevated cardiac apex. Signs of left ventricular enlargement include an elevated carina, loss of the caudal waist, and a more perpendicular caudal cardiac border. Signs of left atrial enlargement include separation of mainstem bronchi, compression of the bronchus to the left caudal lung lobe, and an increased distance from the carina to the dorsal border of the caudal vena cava. Enlargement of the aorta and main pulmonary artery segment on a LAT view appears as a soft tissue density obscuring the cranial waist. Pulmonary vascular fields are usually hypervascular in patent ductus arteriosus and interventricular septal defects, normal in uncomplicated aortic or pulmonic stenosis, and hypovascular in tetralogy of Fallot.     

Biometrical Studies on the Cornea in Some Domestic Animals

The ringed seal ( Phoca hispida ), as well as other seals, exhibit some unique anatomical properties when compared to their terrestrial counterparts. In the ringed seal, the most conspicuous adaptation is the aortic bulb, a large dilatation of the ascending aorta, which is comparable to that found in other seal species and marine mammals. Coronary arteries are similar to those of terrestrial mammals. The branches of the ascending aorta (brachiocephalic trunk, left common carotid artery and left subclavian artery) are similar to those of higher primates and man. The pulmonary trunk originates from the right ventricle near the ventral midline of the thorax. The peculiarities of the venous system are three pulmonary veins, a pericardial venous plexus, a caval sphincter, a hepatic sinus with paired caudal vena cavae and a large extradural venous system. Generally, three pulmonary veins (right, left, middle) empty into the left atrium. The right and left pulmonary veins drain the cranial and middle lung lobes of their respective lung, while the middle pulmonary vein drains both caudal lung lobes and the accessory lobe. The pericardial venous plexus lies on the pericardial pleura on the auricular (ventral) surface the heart. The azygous vein is formed from the union of right and left azygous veins near the 5th thoracic vertebra. The caval sphincter surrounds the caudal vena cava as it passes through the diaphragm. Caudal to the diaphragm, the vena cava is dilated excessively (the hepatic sinus) and near the kidneys it is biphid. Cardiovascular physiological studies have shown some of these anatomical variations, especially of the venous system and the ascending aorta, to be modifications for diving.     

The clinical usefulness of the ventrodorsal versus dorsoventral thoracic radiograph in dogs

Differences exist in the ventrodorsal (VD) and dorsoventral (DV) radiographic views of the canine thorax. One view may be preferred over another because of how it portrays different areas of interest or different disease conditions. The VD view is indicated for evaluation of the cranial and caudal mediastinum, the caudal vena cava, and the accessory lung lobe, and in cases of pleural effusion. Indications for the DV view include assessment of a consistent cardiac silhouette, evaluation of the pulmonary lobar vessels, and evaluation of the structures of the dorsal thorax, such as hilar lymph nodes, the caudal dorsal lungs, trachea, mainstem bronchi, and left atrium.     

Caudal vena cava thrombosis-like syndrome in a horse

A 9-year-old Quarter horse was presented for chronic refractory pneumonia. On necropsy, an hepatic abscess, caudal vena cava thrombosis, pulmonary thromboembolism, and embolic pneumonia were identified. Similar lesions have been reported in cattle as caudal vena cava thrombosis syndrome, however this syndrome has not previously been reported in horses.     

Aortic to caudal vena cava ratio measurements using abdominal ultrasound are increased in dogs with confirmed systemic hypertension

Chronically sustained systemic hypertension in dogs can damage the kidneys, eye, brain, heart, and vessels. In human medicine, systemic hypertension has been implicated as the most common risk factor for aorta dilation, which can progress to an aneurysm. Abdominal ultrasound has been commonly used to monitor the size of the abdominal aorta in people with systemic hypertension. In this retrospective cross‐sectional abdominal ultrasound study, evaluation of the size of the abdominal aorta relative to the caudal vena cava was performed in 18 control dogs and 128 dogs with confirmed systemic hypertension. Preexisting conditions contributing to systemic hypertension in these dogs were renal disease, hyperadrenocorticism, diabetes mellitus, adrenal tumors, and previous administration of phenylpropanolamine or palladia. The abdominal aorta and caudal vena cava were assessed from longitudinal images cranial to the trifurcation with measurements made from outer border to outer border of the walls, being careful not to compress the caudal vena cava that would alter its size. Our hypothesis was the ratio of the diameter of the abdominal aorta to caudal vena cava would be higher in dogs with systemic hypertension compared to dogs with normal blood pressure. The mean abdominal aorta‐caudal vena cava ratio was 1.028 in control dogs with a normal blood pressure and 1.515 in dogs with systemic hypertension. In dogs with confirmed systemic hypertension, the abdominal aorta was dilated compared to the caudal vena cava in the caudal abdomen. An increase in the abdominal aorta‐caudal vena cava ratio in a dog should raise suspicion for the presence of systemic hypertension and prompt evaluation of blood pressure.     

MULTIDETECTOR ROW COMPUTED TOMOGRAPHY AND ULTRASOUND CHARACTERISTICS OF CAUDAL VENA CAVA DUPLICATION IN DOGS

Caudal vena cava duplication has been rarely reported in small animals. The purpose of this retrospective study was to describe characteristics of duplicated caudal vena cava in a large group of dogs. Computed tomography (CT) and ultrasound databases from two hospitals were searched for canine reports having the diagnosis “double caudal vena cava.” One observer reviewed CT images for 71 dogs and two observers reviewed ultrasound images for 21 dogs. In all CT cases, the duplication comprised two vessels that were bilaterally symmetrical and approximately the same calibre (similar to Type I complete duplication in humans). In all ultrasound cases, the duplicated caudal vena cava appeared as a distinct vessel running on the left side of the abdominal segment of the descending aorta and extending from the left common iliac vein to the left renal vein. The prevalence of caudal vena cava duplication was 0.46% for canine ultrasound studies and 2.08% for canine CT studies performed at these hospitals. Median body weight for affected dogs was significantly lower than that of unaffected dogs (P < 0.0001). Breeds with increased risk for duplicated caudal vena cava were Yorkshire Terrier (odds ratio [OR] = 6.41), Poodle (OR = 7.46), West Highland White Terrier (OR = 6.33), and Maltese (OR = 3.87). Presence of a duplicated caudal vena cava was significantly associated with presence of extrahepatic portosystemic shunt(s) (P < 0.004). While uncommon in dogs, caudal vena cava duplication should be differentiated from other vascular anomalies when planning surgeries and for avoiding misdiagnoses.     

Thrombosis of the caudal vena cava presenting as an unusual cause of an abdominal mass and thrombocytopenia in a dog

Thrombosis of the caudal vena cava in a dog secondary to metastatic neoplasia is described. The dog had a palpable abdominal mass and persistent thrombocytopenia due to a thrombosed caudal vena cava that was surgically removed. A few days after its removal, the dog died and neoplastic cells of neural crest origin were identified at the edge of the thrombus. Massive thrombosis can be an unusual cause of platelet consumption, leading to thrombocytopenia and disseminated intravascular coagulation. Deep vein thrombosis of the vena cava can occur in dogs and may mimic an abdominal mass. Multiple mechanisms may be involved in the development of venous thrombosis, including endothelial damage by neoplastic cells and the presence of a hypercoagulable state secondary to neoplasia. Extensive collateral circulation may allow removal of diseased vena cava.     

Ultrasonographic findings in a cow with ascites due to thrombosis of the caudal vena cava.

This case report describes a three-year-old Swiss Braunvieh cow with ascites due to thrombosis of the caudal vena cava. Ultrasonography verified the ascites and revealed dilatation of the abdominal portion of the caudal vena cava (4.8 cm). It was presumed that the caudal vena cava was occluded by a thrombus or by perivenous compression cranial to the dilatation. Post mortem findings included: a massive accumulation of fluid in the abdominal cavity; a 15 cm long thrombus in the subphrenic region of the caudal vena cava; multiple pulmonary abscesses; severe thrombosis of the pulmonary vasculature; hepatic congestion; oedematous abomasal folds; and severe thrombophlebitis of the left jugular vein and both udder veins, due to poor intravenous injection technique. Ascites caused by thrombosis of the caudal vena cava is rare because collateral routes of venous return, including the udder veins, are usually established. It was therefore concluded that the ascites was attributable to bilateral thrombosis of the udder veins.     

IMAGING DIAGNOSIS: AZYGOUS CONTINUATION OF THE CAUDAL VENA CAVA WITH AND WITHOUT PORTOCAVAL SHUNTING

The CT angiographic features of azygous continuation of an interrupted caudal vena cava in dogs with and without portocaval shunting are described. Azygous continuation of a discontinuous caudal vena cava is usually an incidental finding, not associated with portosystemic shunting. Identification of an associated portosystemic shunt will determine the need for surgical intervention. CT angiography provides a means for making this distinction and details the course and size of the anomalous vessels. Focal widening of the caudal vena cava on a VD thoracic radiograph should raise suspicion for azygous vein distension.     

Extensive venous thrombosis and hind-limb edema associated with adrenocortical carcinoma in a dog.

A 10-year-old, spayed female, mixed-breed dog was referred for evaluation of bilateral hindlimb edema and weakness. Abdominal ultrasonography showed increased echogenicity of the lumen of the caudal vena cava from the level of the urinary bladder to the level of the cranial pole of the right kidney. Bilateral saphenous venograms displayed numerous filling defects in the caudal vena cava, right external iliac vein, right femoral vein, and the right common iliac vein. Extensive venous thrombosis was diagnosed, and the animal was euthanized. Necropsy confirmed the presence of venous thrombosis and revealed a right adrenocortical carcinoma that had invaded the caudal vena cava.     

Phaeochromocytoma treated by en bloc resection including the suprarenal caudal vena cava in a dog

A 10-year-old, neutered male Cairn terrier was examined after experiencing intermittent vomiting of several months' duration and sudden onset of acute depression. Abdominal ultrasound examination revealed an adrenal mass invading the suprarenal part of the caudal vena cava. The vascular invasion could not be corrected so en bloc ligation/excision of the adrenal neoplasm and the suprarenal part of the vena cava was performed. Microscopic examination identified an adrenal phaeochromocytoma. The dog recovered well and had no significant vascular or renal dysfunction at follow-up 20 months after surgery. To the authors' knowledge, this is the first report of a dog surviving long term after resection of the suprarenal caudal vena cava.     

Congenital Interruption of the Portal Vein and Caudal Vena Cava in Dogs: Six Case Reports and a Review of the Literature

Objective —To describe six dogs with congenital abnormalities involving the portal vein, caudal vena cava, or both.
Animals —Six client-owned dogs with congenital interruption of the portal vein or the caudal vena cava, or both.
Methods —Portal vein and caudal vena cava anatomy was evaluated by contrast radiography and visualization at surgery. Vascular casts or plastinated specimens were obtained in three animals.
Results —Portal blood shunted into the caudal vena cava in four dogs and the left hepatic vein in one. Two of these five dogs also had interruption of the caudal vena cava with continuation as azygous vein, as did an additional dog, in which the portal vein was normally formed. Portal vein interruption was present in 5 of 74 (6.8%) dogs with congenital portosystemic shunts evaluated at the Veterinary Teaching Hospital during the study period.
Conclusions —Serious malformations of the abdominal veins were present in more than 1 in 20 dogs with single congenital portosystemic shunts.
Clinical Relevance —Veterinarians involved in diagnosis and surgery for portosystemic shunts should be aware of these potential malformations, and portal vein continuity should be evaluated in all dogs before attempting shunt attenuation.     

The Great Vessels and Tributaries of the Heart of the Ringed Seal (Phoca hispida)

The ringed seal (Phoca hispida), as well as other seals, exhibit some unique anatomical properties when compared to their terrestrial counterparts. In the ringed seal, the most conspicuous adaptation is the aortic bulb, a large dilatation of the ascending aorta, which is comparable to that found in other seal species and marine mammals. Coronary arteries are similar to those of terrestrial mammals. The branches of the ascending aorta (brachiocephalic trunk, left common carotid artery and left subclavian artery) are similar to those of higher primates and man. The pulmonary trunk originates from the right ventricle near the ventral midline of the thorax. The peculiarities of the venous system are three pulmonary veins, a pericardial venous plexus, a caval sphincter, a hepatic sinus with paired caudal vena cavae and a large extradural venous system. Generally, three pulmonary veins (right, left, middle) empty into the left atrium. The right and left pulmonary veins drain the cranial and middle lung lobes of their respective lung, while the middle pulmonary vein drains both caudal lung lobes and the accessory lobe. The pericardial venous plexus lies on the pericardial pleura on the auricular (ventral) surface the heart. The azygous vein is formed from the union of right and left azygous veins near the 5th thoracic vertebra. The caval sphincter surrounds the caudal vena cava as it passes through the diaphragm. Caudal to the diaphragm, the vena cava is dilated excessively (the hepatic sinus) and near the kidneys it is biphid. Cardiovascular physiological studies have shown some of these anatomical variations, especially of the venous system and the ascending aorta, to be modifications for diving.     

IMAGING DIAGNOSIS—PORTAL VEIN APLASIA AND INTERRUPTION OF THE CAUDAL VENA CAVA IN THREE DOGS

Severe portal vascular anomalies have been reported previously accompanying azygos continuation of the caudal vena cava, polysplenia, and situs anomalies in dogs and people. Three dogs with portal vascular anomalies were identified by means of CT angiography as having portal vein aplasia with portal insertion into the caudal vena cava, azygos continuation of the caudal vena cava, and interruption of the pre‐hepatic caudal vena cava. This information confirms that complex embryological defects may occur in patients presenting for congenital portosystemic shunt, and that CT angiography is a non‐invasive method of completely evaluating these potentially non‐surgical portal vascular anomalies.