Blastomycosis granuloma involving the cranial vena cava associated with chylothorax and cranial vena caval syndrome in a dog

A four-year-old, sexually intact, male dachshund was diagnosed with pulmonary blastomycosis. Itraconazole was administered for 60 days, and the dog was considered to be disease-free at three- and 12-month reevaluations. Two years following discontinuation of itraconazole, the dog developed a granuloma of the cranial vena cava resulting in chylothorax and cranial vena caval obstruction. To the authors' knowledge, this is the first case of a blastomycotic granuloma involving the vena cava reported in the dog. Blastomycosis should be considered as a differential diagnosis for both chylothorax and cranial vena caval syndrome in the dog.     

Chylothorax associated with thrombosis of the cranial vena cava

This study reviewed confirmed cases of concurrent chylothorax and cranial vena caval (CrVC) thrombosis in dogs and cats, and determined predisposing factors for the development of chylothorax associated with CrVC thrombosis. The extent and location of the thrombus, the treatment regime, and the outcome are described. In all 4 cases, implantation of a jugular device was a predisposing factor to thrombosis of the CrVC, and there was extensive thrombosis of the CrVC extending from at least 1 jugular vein to just cranial to the heart. Chylothorax resolved in 3 of the 4 cases after medical and/or surgical intervention. The development of chylothorax concurrently with thrombosis of the CrVC in dogs and cats is likely dependent on the extent and location of the thrombus. Veterinary patients with indwelling jugular devices that develop acute respiratory signs should be assessed for chylothorax associated with thrombosis of the CrVC.     

Chylothorax associated with blastomycosis in a dog

Respiratory distress caused by pleural effusion resulted from chylothorax. Thoracic drainage and lowfat dietary therapy was effective in removing and preventing significant recurrence of the chylothorax; however, the patient died unexpectedly. At necropsy a blastomycotic granuloma found at the precava was considered the cause of the chylothorax. There had been no recognizable antemortem signs of blastomycosis. Blastomycosis can be considered as a rare cause of chylothorax.     

Feline aortic thromboemboli and the potential utility of thrombolytic therapy with tissue plasminogen activator

Feline aortic thromboembolism is a common and devastating clinical condition for which there is presently no effective therapy. Thrombolytic therapy with tissue plasminogen activator represents a promising, relatively noninvasive method for resolution of the clinical syndrome. In clinical trials in man, tissue plasminogen activator is proving to have advantages over previously available thrombolytic agents. Previously available thrombolytic agents require intensive monitoring and commonly cause complications that entail large monetary and manpower costs to monitor and control. Being specific for thrombus-associated plasminogen, t-PA enables more safe and effective thrombolysis without the hazards previously associated with thrombolytic therapy. In cats with aortic thromboemboli, early clinical trials are promising with regard to acute thrombolytic efficacy but raise questions concerning the risks and benefits of therapy and will require more controlled studies. It is estimated that t-PA therapy for a cat with aortic thromboemboli will cost approximately +500 to +1500, including hospitalization and drugs. This compares favorably with what most veterinary clients are willing to spend for quality veterinary care. However, before we can look upon t-PA therapy as a useful therapeutic advance, we must consider the etiopathogenesis and probability of rethrombosis. The results of controlled studies have not been published, but it is generally considered that there is a high probability of recurrence in cats. Fifty per cent of cats treated with t-PA have rethrombosed despite aspirin therapy at the recommended dose of 25 mg per kg every third day. Finding a cure for feline myocardial diseases (cardiomyopathies) and/or an effective method for safely anticoagulating cats at risk would help justify the monetary and manpower costs associated with thrombolytic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Lymphangiographic evaluation of experimentally induced chylothorax after ligation of the cranial vena cava in dogs

Ligation of the cranial vena cava (CrVC) distal to the entrance of the azygous vein resulted in chylothorax in 7 of 10 dogs. Of the remaining 3 dogs, 1 developed a serosanguineous effusion that did not become chylous, and 2 dogs did not develop pleural effusion. In 2 of the 7 dogs developing chylothorax, the pleural effusion became serosanguineous within 2.5 weeks after CrVC ligation. Mesenteric lymphangiography was performed 2 to 6 weeks after ligation of the CrVC. Lymphangiectasia was seen in 4 dogs with chylothorax, but was not seen in the 3 dogs with serosanguineous effusions or the 2 dogs that did not develop effusions. One dog with chylothorax died prior to repeat lymphangiography. Less dye entered the thoracic duct, and alternate lymphaticovenous communications to the caudal vena cava were evident in the dogs without chylothorax. Ligation of the thoracic duct at the lymphaticovenous junction was performed in 3 dogs. These dogs did not develop pleural effusion. Lymphangiography was performed immediately after ligation and indicated filling of abdominal lymphatics but not of the thoracic duct. Lymphangiographic findings 6 weeks after ligation also indicated filling of intestinal lymphatics. Results of the present study indicated that ligation of the CrVC causes chylothorax, and that thoracic lymphangiectasia is a consistent finding in animals with experimental chylothorax. Obstruction of the thoracic duct did not induce lymphangiectasia or chylothorax. Impedence of thoracic duct flow into the CrVC may be a cause of clinical chylothorax in the dog.     

Partial Right Ventriculectomy Using the Incised Patch Technique to Treat Double Chambered Right Ventricle and Chylothorax in a Cat

Objective— To report successful surgical treatment of double chambered right ventricle (DCRV) in a cat.
Study Design— Clinical report.
Animals— Cat with DCRV.
Methods— DCRV was diagnosed in a 5-month-old male Maine Coon cat using echocardiography and angiocardiography. At 2 years, despite medical therapy, chylothorax developed. A section of the right ventricular free wall that spanned the fibromuscular obstruction was excised under total venous inflow occlusion (TVIO) using the incised pericardial patch technique.
Results— Short-term recovery was complicated by return of chylothorax but this resolved after thoracocentesis and diuretic therapy. Three years after surgery, the cat is free of clinical signs and no longer on any medical therapy.
Conclusions— Partial right ventriculectomy can be performed under TVIO through an incised pericardial patch.
Clinical Relevance— DCRV in cat can be successfully treated by partial right ventriculectomy performed under TVIO through an incised pericardial patch.     

Cisterna chyli ablation with thoracic duct ligation for chylothorax: results in eight dogs

OBJECTIVE: To report use of combined cisterna chyli ablation (CCA) and thoracic duct ligation (TDL) for treatment of spontaneously occurring chylothorax in dogs. STUDY DESIGN: Retrospective study. ANIMALS: Eight dogs with chylothorax. METHODS: TDL was performed through a right caudal intercostal thoracotomy and CCA through a left flank paracostal approach or ventral median celiotomy. Long-term outcome (range, 2-48 months; median, 11.5 months) was evaluated by telephone communication with owners. RESULTS: Seven dogs were free of clinical signs related to chylothorax at last follow-up (range, 4-48 months; median, 15.5 months). One dog was euthanatized 2 months after surgery because of lack of improvement. No major complications occurred from CCA. CONCLUSION: CCA and TDL resolved chylothorax in most dogs (88%). CLINICAL RELEVANCE: CCA combined with TDL may improve the outcome of chylothorax in dogs.     

Chylothorax in cats: is there a role for surgery?

Chylothorax is a complex disease with many identified underlying causes including cardiac disease, mediastinal masses, heartworm disease and trauma. Management of this disease should be directed at identifying the cause, if possible, and treating the underlying disorder. In cats with idiopathic chylothorax, medical management is recommended initially because the condition may resolve spontaneously. Owners should be made aware of the potential development of fibrosing pleuritis in affected cats. When medical management is impractical or unsuccessful, surgical intervention should be considered. Surgical options include mesenteric lymphangiography and thoracic duct ligation, pericardiectomy, omentalisation, passive pleuroperitoneal shunting, active pleuroperitoneal or pleurovenous shunting, and pleurodesis. Of these, only thoracic duct ligation and pericardiectomy are preferred by the author because, if successful, the result is complete resolution of the chylothorax, thereby reducing the risk of developing fibrosing pleuritis. Omentalisation may be beneficial in some animals as adjuvant therapy, but this procedure may still allow fibrosing pleuritis to occur. Until the aetiology of the effusion in cats with idiopathic chylothorax is understood, the treatment success rate will be less than ideal. Future research needs to be directed at determining the pathophysiologic mechanisms underlying this disease in cats.     

Chylothorax in 34 dogs

Thirty-four dogs with chylothorax were studied retrospectively. In 24 dogs, chylothorax appeared to be idiopathic, with only 10 dogs having evidence of neoplasia or trauma. Rupture of the thoracic duct secondary to trauma appeared to be a much less common cause for the development of a chylous pleural effusion than that reported previously. The Afghan Hound was the breed most commonly affected, comprising 37.5% of the dogs in the idiopathic category and 26.5% of all dogs with chylothorax. A clear correlation between the cause of chylothorax and age was not apparent, and gender and neutering appeared to have no relationship to the development of chylothorax in the dog.     

Use of omentum as a physiologic drain for treatment of chylothorax in a dog

OBJECTIVES: To describe a novel technique for the surgical treatment of idiopathic chylothorax in a dog. ANIMALS: A 6-year-old, male Rhodesian Ridgeback, which presented with a history of reduced exercise tolerance and dyspnea. METHODS: Idiopathic chylothorax was diagnosed. Intermittent pleural drainage failed to resolve the problem. During surgery, extensive pleural fibrosis made it impossible to identify the thoracic duct. A dorsal omental pedicle was advanced through an incision in the diaphragm and into the cranial thoracic cavity to act as a physiological drain. RESULTS: The dog recovered well and has remained free from clinical signs of recurrence of the effusion (16 months at the time of writing). CONCLUSIONS: The disease-free interval achieved in this dog indicates that this novel technique is worthy of further consideration in the management of idiopathic chylothorax.     

Thrombolytic Therapy in Dogs and Cats

Objective: To review the thrombolytic agents most commonly used in humans, their mechanisms of action, potential uses, adverse effects, and reports of their use in dogs and cats.
Human data synthesis: Thrombolytic agents avaliable in human medicine include streptokinase, urokinase, tissueplasminogen activator (t-PA), single-chain urokinase plasma activator (scu-PA) and anisoylated plasminogen-strep-tokinase activator complex (APSAC). These agents were originally used for the management of proximal deep vein thrombosis and severe pulmonary embolism but more recently, use of these drugs has been extended to include the treatment of acute peripheral arterial disease, cerebrovascular disease (stroke) and acute coronary thrombosis. The most predictable side effect associated with the use of thrombolytic therapy is hemorrhage.
Veterinary data synthesis: Clinical experience with thrombolytic agents in small animals is limited to streptokinase and t-PA. It is possible, that as in humans, canine and feline patients with PTE and right ventricular dysfunction may benefit from thrombolytic therapy but there are no veterinary studies to support this theory to date. Successful use of streptokinase has been documented in a small number of canine patients with systemic thromboembolism. ⁶³ Thrombolytic therapy is relatively efficacious in cats with aortic thromboemboli but is associated with a high mortality rate. ^59,60,64 With regard to use of t-PA in veterinary medicine, the small number of animals treated with varying protocols makes it impossible to provide safe and effective dose recommendations at this time.
Conclusions: Future goals for thrombolytic therapy in veterinary medicine include determination of more specific clinical indications, as well as design of effective protocols that minimize mortality and morbidity.     

Thoracoscopic Thoracic Duct Ligation and Thoracoscopic Pericardectomy for Treatment of Chylothorax in Dogs

Objective— To report the use of thoracoscopic thoracic duct ligation (TDL) and pericardectomy for treatment of chylothorax.
Study Design— Case series.
Animals— Dogs with chylothorax (n=12).
Methods— Dogs with secondary or idiopathic chylothorax had thoracoscopy performed in sternal recumbency through 3 portals in the caudal right hemithorax for TDL and were then repositioned in dorsal recumbency for pericardectomy. Portals were placed in the 5th and 7th intercostal spaces of the right hemithorax with 1 transdiaphragmatic portal in the right paraxiphoid position. Follow-up was performed by recheck examination or telephone interview to determine outcome.
Results— Seven dogs (58%) had idiopathic chylothorax; 6 dogs (85.7%) had complete resolution of their effusion, whereas only 2 of the 5 nonidiopathic dogs (40%) had complete resolution.
Conclusions— Thoracoscopy is minimally invasive, provides excellent observation, and allows for ligation of the thoracic duct in the caudal thorax. Patients with idiopathic chylothorax may have a better prognosis after TDL and pericardectomy than dogs with nonidiopathic chylothorax.
Clinical Relevance— Thoracoscopy for ligation of the thoracic duct and pericardectomy is an acceptable surgical technique for treatment of chylothorax.     

Hyponatremia and hyperkalemia associated with idiopathic or experimentally induced chylothorax in four dogs

Two dogs with idiopathic chylothorax and 2 dogs with experimentally induced (ie, ligation of the cranial vena cava) chylothorax were treated by intermittent thoracic drainage. Of these 4 dogs, 3 that did not have evidence of renal failure had normal or near-normal serum sodium and potassium concentrations before thoracic drainage began, and all 3 developed repeatedly marked hyponatremia and hyperkalemia during thoracic drainage. Another dog became weak and depressed, ostensibly because of hyperkalemia. Serum sodium and potassium concentrations in 1 dog with spontaneous chylothorax returned to normal after chylothorax resolved and thoracic drainage was stopped. The other 3 dogs died or were euthanatized, and the effect of stopping thoracic drainage could not be evaluated. In 3 dogs in which it was measured, normal-to-high plasma cortisol concentration was observed before and after adrenocorticotropin administration, and 2 dogs also had hyperaldosteronemia. Hyponatremia was hypothesized to be caused by sodium loss via thoracic drainage whereas hyperkalemia may have been multifactorial in origin, but probably was attributable, at least, in part to decreased renal potassium clearance.     

Caudal vena caval thrombosis following treatment of deep digital sepsis

A diagnosis of caudal vena caval thrombosis was made by ultrasonography of a Holstein cow presented for lethargy and poor milk production. Medical treatment was unsuccessful and the cow was euthanized. The diagnosis was confirmed at necropsy and Fusobacterium necrophorum was isolated from the thrombus. This paper discusses potential novel sources of caval thrombosis in this case.     

Omentalization of the thorax for treatment of idiopathic chylothorax with constrictive pleuritis in a cat.

A 6-year-old, spayed female Himalayan cat with idiopathic chylothorax, which failed to respond to medical management, was successfully treated by advancement of the omentum into the thorax. Exploratory thoracotomy revealed severe, constrictive pleuritis as a sequela to chylothorax. Because of the poor prognosis for recovery from chylothorax in cats with thoracic duct ligation alone, and the lack of success in performing thoracic duct ligation in this cat, the omentum was advanced into the thorax through a hole created in the diaphragm and sutured within the thoracic cavity. The cat recovered from surgery and is clinically normal 13 months postoperatively. Omental advancement may be an effective surgical management technique for this challenging disease in cats.     

Resolution of chylothorax after resection of rib chondroma in a dog

A six-year-old, male dobermann was presented with a history of dyspnoea and bouts of coughing. Radiography and computed tomography of the thorax showed pleural effusion and a well-circumscribed, calcified mass of 10 cm in diameter, appearing to originate from the left first rib. Thoracocentesis revealed that the pleural fluid was chylous in nature. An incisional biopsy was performed, which gave a histological diagnosis of chondroma. Resolution of the chylothorax after en-bloc surgical removal of the tumour suggested that the rib tumour was the initiating cause of the chylothorax. Seventeen months later, rib neoplasia recurred without pleural effusion, and was removed successfully. To the authors' knowledge, rib chondroma, which is an unusual tumour in dogs, has not been previously documented as a cause of chylothorax.     

Idiopathic chylothorax and lymphedema in 2 whippet littermates

Idiopathic chylothorax and limb edema was diagnosed in two 2-year-old male whippet siblings. The fact that the 2 related animals developed similar clinical signs at a young age may suggest a congenital or hereditary etiology.     

Bovine Erythrocyte Haemolysates Enhance Plasminogen Activation by Tissue-Type Plasminogen Activator

Yamada, M., Horiuchi, T., Oribe, T., Yamamoto, S., Sugie, I. and Gentry, P.A., 1997. Bovine erythrocyte haemolysates enhance plasminogen activation by tissue-type plasminogen activator. Veterinary Research Communications, 21 (2), 75-84An active fraction that accelerates plasminogen activation by tissue-type plasminogen activator (t-PA) was purified from a haemolysate of bovine erythrocytes. When the haemolysate was mixed with t-PA, it produced a 2- to 3-fold increase in plasminogen activation as measured by an insoluble fibrinolytic assay system and a soluble amidolytic assay system with the chromogenic substrate S-2251. Zymographic analysis showed that, while the haemolysate increased t-PA activity, it did not alter the electrophoretic characteristics of the t-PA nor did it induce any fibrinolysis in the absence of t-PA or plasminogen. The haemolysate was devoid of plasmin and plasminogen activator activity but was most effective in accelerating plasminogen activation by t-PA in the presence of substrate. Based on the purification characteristics of the active fraction in the haemolysate, it appears to have a molecular weight of less than 10 kDa.     

Case report. Restrictive cardiomyopathy with chylothorax in a cat: the pathogenesis

A 8.5 year old castrated female domestic short-haired cat was presented because of progressive dyspnea, inappetence and weight loss. Special examinations revealed a chylothorax. In addition a restrictive cardiomyopathy was suspected. The cat was euthanized. The histopathologic examination of the heart confirmed the diagnosis of restrictive cardiomyopathy. The examination of the ductus thoracicus showed a intramural fibrosis with additional edema and a interstitial partly perivascular inflammation. The coherence between feline cardiopathy and chylothorax was discussed speculatively in previous reports. In this report we show a possible aetiopathology.     

Chylothorax in a dog with pulmonary lymphangiosarcoma

Lymphangiosarcoma of the pulmonary pleura was found to be the cause of persistent chylothorax in an eight-year-old, intact male golden retriever. After a two-month course of medical management, a lymphangiogram and thoracic duct ligation were performed with the objective of decreasing further effusion. At surgery, gross lung pathology was biopsied and yielded a histopathological diagnosis of pulmonary pleural lymphangiosarcoma. A relatively rare tumor, lymphangiosarcoma of the pulmonary pleura has not previously been documented as a source of chylothorax in the dog.