Adverse effects of intrapleural instillation of tissue plasminogen activator in a horse: Suspected re‐expansion pulmonary oedema

This case report describes a 5‐year‐old pregnant Warmblood mare that was being treated for fibrinous bacterial pleuropneumonia. Since initial attempts to drain and lavage both pleural cavities were ineffective due to the presence of extensive intrapleural fibrin loculations, recombinant human tissue plasminogen activator (tPA) was instilled into both pleural cavities, to promote fibrinolysis and improve drainage. Within 1–2 h of instilling tPA, the horse became distressed, with increasing dyspnoea, tachycardia, pleurodynia and hypoxaemia. At 4 h post tPA instillation, diffuse bilateral pulmonary oedema was evidenced by the onset of widespread audible inspiratory crackles and ultrasonographic ring‐down artefacts. Ultrasonography demonstrated that tPA had induced pleural fibrinolysis, thereby removing the restrictive effects of pleural adhesions on lung motion and facilitating lung re‐expansion. Re‐expansion pulmonary oedema was suspected, although an adverse drug reaction could not be excluded. The complication resolved with nasal oxygen supplementation, and administration of frusemide, meloxicam, morphine and hydroxyethyl starch. Subsequent repetition of intrapleural tPA instillation and thoracic drainage had no apparent adverse effect. The mare was discharged from the hospital and subsequently foaled successfully. The pathogenesis, diagnosis and management of re‐expansion pulmonary oedema are reviewed.     

Bromide-associated lower airway disease: a retrospective study of seven cats

Seven cats were presented for mild-to-moderate cough and/or dyspnoea after starting bromide (Br) therapy for neurological diseases. The thoracic auscultation was abnormal in three cats showing increased respiratory sounds and wheezes. Haematology revealed mild eosinophilia in one cat. The thoracic radiographs showed bronchial patterns with peribronchial cuffing in most of them. Bronchoalveolar lavage performed in two cats revealed neutrophilic and eosinophilic inflammation. Histopathology conducted in one cat showed endogenous lipid pneumonia (EnLP). All cats improved with steroid therapy after Br discontinuation. Five cats were completely weaned off steroids, with no recurrence of clinical signs. In one cat, the treatment was discontinued despite persistent clinical signs. The cat presenting with EnLP developed secondary pneumothorax and did not recover. Br-associated lower airway disease can appear in cats after months of treatment and clinical improvement occurs only after discontinuing Br therapy.     

Intestinal lymphangiectasia in a dog

An eight-month-old female crossbred terrier was presented with a short history of diarrhoea, dyspnoea and abdominal distension. Clinical examination revealed thoracic effusion, ascites, and subcutaneous oedema. Hypoalbuminaemia, hypoglobulinaemia and lymphopaenia were all present. Histological examination of a jejunal biopsy confirmed a diagnosis of intestinal Iymphangiectasia. Full clinical recovery followed treatment by dietary management.     

Serial plasma glucose changes in dogs suffering from severe dog bite wounds

The objective of this study was to describe the changes in plasma glucose concentration in 20 severely injured dogs suffering from dog bite wounds over a period of 72 hours from the initiation of trauma. Historical, signalment, clinical and haematological factors were investigated for their possible effect on plasma glucose concentration. Haematology was repeated every 24 hours and plasma glucose concentrations were measured at 8-hourly intervals post-trauma. On admission, 1 dog was hypoglycaemic, 8 were normoglycaemic and 11 were hyperglycaemic. No dogs showed hypoglycaemia at any other stage during the study period. The median blood glucose concentrations at each of the 10 collection points, excluding the 56-hour and 64-hour collection points, were in the hyperglycaemic range (5.8- 6.2 mmol/l). Puppies and thin dogs had significantly higher median plasma glucose concentrations than adult and fat dogs respectively (P < 0.05 for both). Fifteen dogs survived the 72-hour study period. Overall 13 dogs (81.3 %) made a full recovery after treatment. Three of 4 dogs that presented in a collapsed state died, whereas all dogs admitted as merely depressed or alert survived (P = 0.004). The high incidence of hyperglycaemia can possibly be explained by the "diabetes of injury" phenomenon. However, hyperglycaemia in this group of dogs was marginal and potential benefits of insulin therapy are unlikely to outweigh the risk of adverse effects such as hypoglycaemia.     

Anaerobic peritonitis caused by Clostridium septicum as a complication of routine castration in a 2‐year‐old Warmblood horse

This case report describes an unusual case of anaerobic peritonitis in a 2‐year‐old horse following castration. The horse was evaluated 2 weeks following castration for signs of acute, severe abdominal pain and swelling surrounding a previous castration site. Physical examination revealed marked scrotal and ventral abdominal oedema that was cool and crepitant upon palpation. Ultrasonographic evaluation was unrewarding because gas shadowing distributed throughout the subcutis prevented imaging of the abdominal cavity. Ventral midline celiotomy revealed a copious amount of malodorous, serosangious, cloudy peritoneal fluid that was submitted for culture. Abdominal exploration revealed the gastrointestinal tract to be in its anatomically correct position. There was diffuse petechiation of the small intestine and large intestine, oedema and crepitant swelling surrounding the left inguinal ring and body wall. The abdomen was lavaged with 10 l of sterile saline prior to closure of the celiotomy and the left castration incision was opened digitally, releasing a large volume of serosanguinous fluid and gas that flowed freely from the incision site and deeper inguinal tissues. The horse was placed in the recovery box where it suffered cardiac arrest. Culture of the peritoneal fluid revealed heavy growth of Clostridium septicum. This case of anaerobic peritonitis represents an unusual complication following castration not previously reported in the horse.     

T cell rich,B cell lymphoma in the small colon of a yearling horse

A one‐year‐old, Thoroughbred colt presented for evaluation due to a one month history of fever of unknown origin and progressive weight loss. On initial presentation, the horse was febrile and showed signs localised to the respiratory tract. These included bilaterally increased bronchovesicular sounds and a moderate, diffuse interstitial pattern on thoracic radiographs. A transtracheal wash yielded mucopurulent debris, culture of which grew small numbers of Staphylococcus epidermidis and Aspergillus spp. The horse was discharged with a diagnosis of bronchointerstitial pneumonia and placed on antibiotic therapy. Ten days after initial presentation, he developed abdominal pain that was unresponsive to on‐farm treatment. The horse was febrile, displayed increased respiratory rate and effort, and showed moderate signs of abdominal pain. On rectal examination, a firm, 8–10 cm mass was palpated on midline. The colt was admitted to the hospital and scheduled for exploratory laparotomy, but died a short time later before surgery could be performed. This report describes the clinical, diagnostic and histopathological findings of a case of alimentary lymphoma in a yearling colt.     

Pansteatitis and severe hypocalcaemia in a cat

A 13-year-old Siamese cat was presented for investigation of lethargy and progressive abdominal enlargement. Serum chemistry revealed severe reduction of total and ionised serum calcium. The omentum appeared hyperechoic with scattered hypoechoic foci on abdominal ultrasound examination. Elevated serum parathormone and low fractional excretion of calcium excluded a parathyroid disorder and renal loss of the electrolyte. During laparotomy the omentum appeared opaque, white and firm. Post-mortem examination revealed that the thoracic and subcutaneous fat was also affected. Histopathology confirmed the diagnosis of pansteatitis with diffuse calcium soaps formation. While, severe hypocalcaemia is occasionally seen in cats, the association with pansteatitis has not been reported previously. In man, a cause-and-effect relationship between calcium soaps and hypocalcaemia is recognised, though the association is rare.     

Hyena disease in a Brown Swiss heifer

A heifer with developmental skeletal disorder was presented to the ruminant clinic of the University of Berne. Abnormal long bone growth and a wobbling gait were the main clinical signs. All long bones were examined radiologically, several parameters of body size were measured and the results were compared to the measurements of a healthy control animal. Haematology and blood chemistry were normal. Based on the poor prognosis the animal was slaughtered. The final diagnosis of hyena disease was based on the characteristic growth disturbances in the caudal parts of the body, giving the animal a hyena-like appearance. For the first time a case of hyena disease is reported in Switzerland.     

Atypical thymoma in a horse: Diagnostic approach and application of an alternative histological classification system

Thymoma is a rare condition in horses. This case of a 24-year-old Warmblood gelding that was presented with oedema and signs of vascular congestion of the left forelimb caused by a thoracic mass is described. The diagnostic work-up included blood chemistry, cytology of pleural effusion, ultrasonography, radiography and the visualisation and collection of a tissue sample by thoracoscopy. Finally, post-mortem findings and histopathology revealed thymic epithelial neoplasia with histomorphologic features previously unreported in horses. The unique mixture of spindle-shaped and epithelioid tumour cells in combination with clear features of malignancy suggested the application of the Moran and Suster histological classification system for thymomas in humans (Moran and Suster, 2008, Curr. Treat. Options Oncol., 9, 288), which has not been reported in an equine case before and fits well to the present case.     

Lymphosarcoma and associated immune-mediated hemolytic anemia and thrombocytopenia in horses

Three horses with equine lymphosarcoma were examined because of clinical signs including chronic weight loss, respiratory distress, peripheral edema, and chronic colic. Clinicopathologic findings included evidence of an immune-mediated hemolytic anemia. Immune-mediated thrombocytopenia also was diagnosed in 1 of the horses and suspected in another. One horse died in spite of treatment, 1 died 5 hours after surgical removal of a tumor encircling the jejunum, and 1 was euthanatized because of deteriorating condition. Necropsy of each horse revealed extensive neoplastic infiltration of peripheral lymph nodes and abdominal or thoracic viscera with neoplastic lymphocytes.     

Acute corneal hydrops of presumed traumatic origin: An uncontrolled case series (three horses)

This case series describes acute corneal hydrops in three young horses. Due to similarities in the clinical appearance and progression of the disease with that which is reported in humans and cats with acute corneal hydrops, traumatic Descemet’s membrane rupture was suspected to be the underlying aetiology in these equine cases. The horses presented with acute severe corneal oedema with intrastromal bullae formation and anterior bulging of the corneal contour. Focal posterior corneal changes were also seen in two of three cases. Mild anterior uveitis was also present. Other causes of corneal oedema (e.g. glaucoma) were ruled out based on presentation and clinical examination. Treatment approaches were medical and included various combinations of prophylactic topical antimicrobial therapy in case of secondary corneal ulceration, anti-inflammatory therapy for uveitis, targeted oedema therapy with topical hypertonic saline and corneal cross-linking, and placement of a temporary partial tarsorrhaphy for corneal tamponade. The outcome was excellent in all cases, with rapid resolution of the ocular changes. Acute corneal hydrops of presumed traumatic Descemet’s membrane rupture origin should be considered in cases of young horses presenting with acute corneal oedema. However, further studies are warranted to better characterise the disease and to try to confirm the suspected aetiology.     

Successful treatment of intra‐abdominal eumycotic mycetoma caused by Penicillium duponti in a dog

A 2‐year‐old female neutered golden retriever was presented for investigation of an intra‐abdominal mass. Computed tomography revealed a mass associated with the caudal pole of the right kidney. Incisional biopsy findings were consistent with eumycotic mycetoma. The mass was subsequently removed in conjunction with right ureteronephrectomy. Two years later, the dog re‐presented with a splenic mass and fungal plaques located throughout the peritoneum. Splenectomy was performed and the mass was diagnosed as eumycotic mycetoma caused by Penicillium duponti. Indefinite systemic treatment with 10 mg/kg itraconazole orally once a day was initiated. Thirty‐two months after the last surgery, there were no clinical signs apart from mild polydipsia. Haematology and biochemistry results were unremarkable. To the authors’ knowledge, this is the first report of successful treatment of intra‐abdominal eumycotic mycetoma with a combination of surgery and systemic antifungal therapy in the dog. Penicillium duponti has not apparently been reported to cause disease in animals or humans.     

Anuric renal failure in a dog after red-bellied black snake (Pseudechis porphyriacus) envenomation

A case of Red-bellied Black snake envenomation resulting in intravascular haemolytic anaemia, rhabdomyolysis and anuric renal failure is described in the dog. A 12-year-old female desexed Golden Retriever was presented with a 15 hour history of profuse salivation, progressive lethargy, obtundence, inappetence and collapse. Significant findings on clinical examination were pallor, icterus, tachypnoea and dyspnoea with increased respiratory sounds and crackles in all lung fields. Generalised abdominal and muscular pain was apparent and dark red-brown urine was present around the perineal region. A diagnosis of Red-bellied Black snake (Pseudechis porphyriacus) envenomation was made and the dog was treated with intravenous fluid therapy, Tiger/Brown snake antivenom, packed red cell transfusions and Intermittent Positive Pressure Ventilation. Continued clinical deterioration occurred and a diagnosis of acute renal failure secondary to myohaemoglobinuric pigmenturia was made 12 hours after admission. Intensive treatment was attempted with diuresis and volume expansion. Oliguria and subsequent anuria ensued and the dog was euthanased due to a grave prognosis and lack of clinical response to treatment. Necropsy examination revealed muscular necrosis, accumulation of fluid in the thoracic and peritoneal cavities, and marked renal tubular necrosis with intraluminal occlusion secondary to pigmentary casts.     

Lymphoscintigraphy in healthy dogs and dogs with experimentally created thoracic duct abnormalities.

Lymphoscintigraphic evaluation of the thoracic duct (TD) was performed in 10 healthy and 12 dogs with experimentally created TD abnormalities (6 dogs with TD lacerations and 6 dogs with cranial vena ligations). Complete imaging took 4 hours and caused no adverse effects or complications. Lymphoscintigraphy of healthy dogs failed to image the TD; however, background activity in the abdomen and thorax, and radioactivity in the kidneys, bladder, liver, and heart were noticed. Lacerations and transections of the TD were experimentally created in 6 dogs to ascertain whether TD rupture could be detected with lymphoscintigraphy. Lymphoscintigraphy was performed within 48 hours of creating the TD defect. There was no significant difference in the scintigraphic pattern of healthy dogs and those with experimentally created TD defects. Ligation of the cranial vena cava was performed in 6 dogs; 3 dogs developed chylothorax. In those 3 dogs, diffuse radioactivity was imaged in the thorax and was compatible with thoracic lymphangiectasia. In one of these dogs, linear activity consistent with the TD and localized regions of radioactivity cranial to the heart (compatible with the mediastinal lymph nodes) were noticed. Lymphoscintigraphic findings in these dogs correlated with lymphangiographic findings.     

Focal canine tetanus: diagnostic value of electromyography

A four-year-old, male Italian hound was presented with severe spasticity of both thoracic limbs that worsened with external stimuli. The remainder of the neurological and general physical examination was normal. Complete blood cell count, chemistry profile, and serology for protozoal diseases were within normal limits. Survey radiography of the cervicothoracic spine and abdominal ultrasonography showed no abnormalities. Electromyography of the thoracic limbs demonstrated the presence of "doublets" and simultaneous activity in both agonist and antagonist muscles. These abnormalities may be explained by a defective glycinergic inhibition at the spinal cord level. Together with the history, progression of signs, and clinical findings, electromyography supported a presumptive diagnosis of focal tetanus. The dog received tetanus antitoxin and antibiotic treatment and gradually improved over four months.     

Yellow fat disease (steatitis) in 20 equids: Description of clinical and ultrasonographic findings

Diagnosis of steatitis can be challenging due to nonspecific clinical signs and ultrasonography might be a useful aid for making a diagnosis. The objective of this retrospective clinical case study was to describe history, clinical signs, ultrasonographic findings, treatment and outcome in equids with steatitis. The medical records of all equids presented to the Department of Large Animal Internal Medicine, Ghent University between January 2008 and December 2015 were reviewed retrospectively to identify horses suffering from steatitis. A total of 20 cases with steatitis were reviewed. History included dullness, recumbency, decreased appetite and weight loss. Fever, ventral oedema, stiff/painful gait and a painful neck were found. Low haematocrit, low vitamin E and selenium and increased levels of creatinine kinase and particularly lactate dehydrogenase were almost consistent findings. On ultrasound, ventral oedema was found. Ventral extraperitoneal, perirenal, mesenteric, coronary and caudal mediastinal fat showed homogenously increased echogenicity. The ventral extraperitoneal fat in particular was surrounded by oedema or free fluid. Increased amounts of abdominal, thoracic and pericardial fluid were often found. Fat biopsies were taken in the neck, or from the ventral extraperitoneal fat in the ventral flank. Steatitis was confirmed in all horses where a fat biopsy was taken (n = 13). Treatment consisted of selenium and vitamin E (intramuscular injection followed by oral treatment) supplementation and anti-inflammatory treatment (dexamethasone or prednisolone parenteral or oral) for at least 1–4 weeks. A total of 15 animals (75%) survived. Full recovery took about 2–6 months. In conclusion, steatitis is an uncommon disease in young horses usually seen during winter. It may be underdiagnosed because of nonspecific clinical signs. Ultrasonography is a useful aid for the diagnosis of yellow fat disease based upon the increased echogenicity of ventral extraperitoneal, perirenal, mesenteric, coronary and caudal mediastinal fat and increased amount of surrounding fluid.     

Nocardial peritonitis in a cat

Objective To illustrate a successfully managed case of nocardial peritonitis in a cat.
Design Case report.
Animal An 8 year old neutered male Burmese cat presented for nonspecific signs of depression, anorexia, pallor and mild dehydration. Pyrexia, loss of weight and abdominal distension developed despite treatment with amoxycillin-clavulanate and supportive therapy.
Procedure Various medical and surgical procedures were used.
Results Haematology revealed severe inflammatory left shift. Biochemistry showed mild prerenal azotemia. A "ground glass" appearance to the abdomen was seen on radiographs. Fluid collected by abdominocentesis contained "sulphur granules" and had characteristics of a septic exudate. Laparotomy allowed drainage of peritoneal fluid and extensive lavage of the peritoneal cavity. Culture of the fluid revealed Nocardia sp. Sensitivity testing resulted in a change of antimicrobial therapy to trimethoprim-sulphadiazine.
Conclusion Response to surgical drainage and change in antibacterial therapy was excellent. No toxic side effects were encountered during the 3 months course of trimethoprim-sulphonamide. The cat made a complete recovery.     

Clinicopathological features of lymphosarcoma involving the thoracic cavity in the horse

The clinical and post mortem features of 11 cases of lymphosarcoma involving the thoracic cavity are reviewed. The clinical findings included inappetence, weight loss, pectoral oedema, dyspnoea, pleural effusion and distension of the jugular veins. Dysphagia was present in three cases. At post mortem examination lesions were found in the abdomen as well as the chest in eight cases; clinical signs of abdominal disease were present in two cases. The features of nine other similar cases recorded in the literature are reviewed.     

A case of idiopathic eosinophilic pneumonia in a Quarter Horse gelding

A 16-year-old Quarter Horse gelding was presented to the Kansas State Veterinary Health Center for acute onset of diffuse, nonpruritic, generalised and coalescing urticaria. A single dose of dexamethasone resulted in resolution of the urticaria within 24 h; however, 48 h after discharge, he presented with mild colic. The patient was febrile and thoracic ultrasound was abnormal, evidenced by bilateral pleural echogenic irregularities, mild pulmonary consolidation and slight unilateral pleural effusion. Thoracic radiographs also revealed caudoventral soft tissue opacity in the same region of the ultrasonographic abnormalities. Transtracheal wash was performed and broad spectrum antimicrobials initiated. Poor clinical response to therapy and marked peripheral eosinophilia resulted in the necessity for bronchoalveolar lavage, which revealed a predominance of pulmonary eosinophils. A diagnosis of acute idiopathic eosinophilic pneumonia was made. Treatment included a tapering dose of dexamethasone over 4 weeks. Due to incomplete disease resolution, the patient was moved to an alternate environment which resulted in disease resolution.     

Sequential magnetic resonance imaging changes after suspected global brain ischaemia in a dog

Sequential magnetic resonance imaging studies over a period of 18 months were performed in a two-year-old pug dog after suspected global brain ischaemia following an anaesthetic accident. The dog was presented with seizures and neurological deficits consistent with a left brainstem and multifocal/diffuse forebrain lesion after an asymptomatic interval of 72 hours following the ischaemic event. Magnetic resonance imaging scans were performed three hours, six weeks, seven and 18 months after the incident. In the acute stage, signal hyperintensity was evident in the occipital and parietal regions of the cerebral cortex and in both rostral caudate nuclei. Slight involvement of the white matter was also noticed. In the chronic phase, the signal hyperintensity in the affected areas of the cortex was diminished and smaller in size, whereas the white matter did not appear to be compromised anymore.