Liver lobe torsion in dogs: 13 cases (1995-2004)

OBJECTIVE: To determine history, results of diagnostic testing, surgical findings, complications, and outcome for dogs with liver lobe torsion (LLT). DESIGN: Retrospective case series. ANIMALS: 12 dogs (1 with 2 episodes). PROCEDURE: Signalment, clinical signs, clinicopathologic findings, radiographic and ultrasonographic findings, surgical and histologic findings, complications, and hospitalization time were evaluated. RESULTS: The most common clinical signs were nonspecific abnormalities (eg, vomiting, lethargy, and anorexia) of acute or chronic duration. All dogs were large-breed dogs (median body weight, 37.2 kg [82 lb]). Biochemical abnormalities included high alanine amino-transferase (n = 12) and aspartate aminotransferase (11) activities. Results of abdominal ultrasonography were supportive of the diagnosis in 5 of 8 cases. Affected lobes included the left medial lobe (n = 4), left lateral lobe (3), papillary process of the caudate lobe (2), caudate lobe (1), and right lateral lobe (1). Exploratory celiotomy and liver lobectomy were performed in 12 of 13 cases, and in 11 of those 12 cases, the dog survived. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that development of nonspecific clinical signs of vomiting, lethargy, and anorexia in conjunction with high serum hepatic enzyme activities and mature neutrophilia in a medium-sized or large-breed dog should increase the index of suspicion for LLT. Abdominal ultrasonography with Doppler assessment may be useful in establishing the diagnosis. The long-term outcome for dogs that survive the hospitalization period is excellent.     

Liver Lobe Torsion in Rabbits: 16 Cases (2007 to 2012)

The objective of this retrospective case series was to determine the clinical signs, diagnostic test results, treatment protocols, and outcomes of rabbits treated for liver lobe torsion during a 5-year period at a large referral institution. A total of 16 rabbits diagnosed with liver lobe torsion at Angell Animal Medical Center (Boston, MA USA) during January 2007 to March 2012 were included in the study. The diagnosis of liver lobe torsion was made at surgery, during abdominal ultrasound, or on postmortem examination. Medical records of the subject animals were reviewed for signalment, history, clinical signs, results of clinical pathology testing, diagnostic imaging findings, treatment, surgical and histopathology findings, hospitalization time, and outcome. The most common clinical signs of rabbits diagnosed with liver lobe torsion in this study included anorexia, lethargy, and decreased fecal production lasting 1 day. Lop breeds, particularly mini lops, were overrepresented. Anemia was the most common hematologic abnormality, while elevated levels of alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, blood urea nitrogen, and creatinine were the most common serum biochemical abnormalities. Abdominal ultrasonography with Doppler assessment was used in 14 rabbits and provided a diagnosis of liver lobe torsion in all cases. The caudate lobe was involved in 10 rabbits (62.5%, 95% CI: 38.8 to 86.2), followed by the right lateral lobe (n = 5; 31.25%, 95% CI: 8.6 to 53.9), the left lateral lobe (n = 2; 12.5%, 95% CI: 3.7 to 28.7), and the right medial lobe (n = 1; 6.25%, 95% CI: 5.6 to 18.1). Two rabbits had more than 1 torsed liver lobe. Exploratory laparotomy and liver lobectomy were performed in 9 rabbits, and all of them survived. Supportive care alone was provided for 7 rabbits, 3 of which survived. The results suggest that nonspecific clinical signs of anorexia, lethargy, and decreased fecal production, in conjunction with anemia and high serum hepatic enzyme activities, should increase the index of suspicion for liver lobe torsion in rabbits. Abdominal ultrasonography with Doppler assessment is useful to confirm the diagnosis. The long-term prognosis for rabbits undergoing liver lobectomy and surviving the hospitalization period is excellent.     

Lung lobe torsion in dogs: 22 cases (1981-1999)

OBJECTIVE: To identify breed disposition, postoperative complications, and outcome in dogs with lung lobe torsion. DESIGN: Retrospective study. ANIMALS: 22 client-owned dogs. PROCEDURE: Information on signalment; history; clinical findings; results of clinicopathologic testing, diagnostic imaging, and pleural fluid analysis; surgical treatment; intra- and postoperative complications; histologic findings; and outcome were obtained from medical records. RESULTS: All 22 dogs had pleural effusion; dyspnea was the most common reason for examination. Fifteen dogs were large deep-chested breeds; 5 were toy breeds. Afghan Hounds were overrepresented, compared with the hospital population. One dog was euthanatized without treatment; the remaining dogs underwent exploratory thoracotomy and lung lobectomy. Eleven dogs recovered from surgery without complications, but 3 of these later died of thoracic disease. Four dogs survived to discharge but had clinically important complications within 2 months, including chylothorax, mediastinal mesothelioma, gastric dilatation, and a second lung lobe torsion. Six dogs died or were euthanatized within 2 weeks after surgery because of acute respiratory distress syndrome, pneumonia, septic shock, pneumothorax, or chylothorax. Chylothorax was diagnosed in 8 of the 22 dogs, including 4 Afghan Hounds. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that lung lobe torsion is rare in dogs and develops most frequently in large deep-chested dogs, particularly Afghan Hounds. Other predisposing causes were not identified, but an association with chylothorax was evident, especially in Afghan Hounds. Prognosis for dogs with lung lobe torsion was fair to guarded.     

Clinical outcome of congenital extrahepatic portosystemic shunt attenuation in dogs aged five years and older: 17 cases (1992-2005)

OBJECTIVE: To assess the outcome of extrahepatic portosystemic shunt (EHPSS) treatment in dogs aged 5 years and older. DESIGN: Retrospective case series. ANIMALS: 17 client-owned dogs. PROCEDURES: Medical records for dogs (> or = 5 years old) that underwent surgical attenuation of an EHPSS (1992 through 2005) were evaluated; data, including clinical signs, clinicopathologic findings, surgical procedure, and outcome, were recorded. Follow-up information was obtained via patient examination or telephone interview with veterinarians and owners. RESULTS: Dogs (5 to 9 years old [median age, 6.6 years]) had neurologic (n = 12), urinary tract (8), and gastrointestinal tract (6) EHPSS-associated clinical signs. Serum bile acids and ammonia concentrations were abnormal in all evaluated dogs. Treatment of EHPSSs included complete (n = 6 dogs) or partial (2) suture attenuation or ameroid constrictor placement (9). Two dogs died following surgery. Follow-up information (6 to 120 months) was available for 13 dogs. Deaths were attributable to heart failure (n = 1), bacterial hepatitis (2; with pyelonephritis in 1 dog), and unknown causes (3). At a median of 23 and 25 months, serum bile acids concentrations had almost normalized in 5 of 8 dogs and ammonia concentrations were within reference limits in 3 of 5 dogs, respectively; dogs with abnormal liver function test results had no associated clinical signs. Median long-term survival time was 72 months. CONCLUSIONS AND CLINICAL RELEVANCE: Attenuation of EHPSS in > or = 5-year-old dogs ameliorated signs of liver dysfunction in surviving dogs, although return of normal liver function occurred less frequently than expected.     

Dietary Management of Hepatic Copper Accumulation in Labrador Retrievers

Background: Copper-associated chronic hepatitis (CACH) recently has been recognized in the Labrador Retriever as an inherited disorder with a late onset of clinical signs. No studies have investigated dietary management for the long-term treatment of this disease or for its potential in delaying the onset of clinical signs in subclinical cases.
Objectives: To investigate the effects of a low-copper diet and zinc gluconate on hepatic copper concentrations in Labrador Retrievers with abnormal hepatic copper concentrations.
Animals: Twenty-four client-owned Labradors that were related to patients affected with CACH and that had been diagnosed with increased hepatic copper concentrations.
Methods: Hepatic copper concentrations were assessed before and after an average of 8 and 16 months of treatment. During this time, all dogs were fed exclusively a low-copper diet. In addition, dogs were assigned to 1 of 2 groups in a randomized double-blind manner to receive a supplement of zinc gluconate or placebo.
Results: Twenty-one dogs completed the study. Hepatic copper concentrations decreased in both groups at recheck 1 (n = 21; group 1, P < .001; group 2, P = .001) and at recheck 2 (n= 16; group 1, P = .03; group 2, P = .04). No difference in hepatic copper concentrations was found between the 2 groups before treatment ( P = .65), at recheck 1 or at recheck 2 ( P = .52–.79).
Conclusions and Clinical Relevance: Feeding low-copper diets to Labradors is effective in decreasing hepatic copper concentrations. Adjunctive treatment with zinc does not appear to increase the copper-lowering effects of dietary management.     

Hepatic lobe torsion in 3 dromedary camels

Hepatic lobe torsion is a rare condition in domestic animals. Clinical signs are variable, with some cases remaining subclinical and others resulting in death. Most cases are diagnosed either by laparotomy or during postmortem examination. During postmortem inspection of 670 slaughtered dromedary camels, hepatic lobe torsion of the quadrate lobe was detected in 3 adult female camels. Clinical signs had not been noted on antemortem veterinary inspection, and hepatic lobe torsion was likely an incidental finding. Histologically, the affected liver lobe exhibited severe hepatocellular loss with replacement by fibrous connective tissue. When investigating abdominal pain in camels, veterinarians should include hepatic lobe torsion in the list of differential diagnoses.     

Clinical and magnetic resonance imaging characteristics of quadrigeminal cysts in dogs

BACKGROUND: Quadrigeminal cysts (QC) are the most common intracranial intra-arachnoid cysts in dogs, primarily affecting small breeds. Clinical significance is controversial. HYPOTHESIS: Male, brachycephalic, small breed dogs are predisposed to QC, and objective measurement of parenchymal compression can distinguish clinically relevant QC from incidental findings. ANIMALS: A total of 4,100 client-owned dogs. METHODS: A retrospective study that recorded signalment, history, clinical signs, and magnetic resonance imaging features. The degree of brain compression was evaluated in the presence of relevant clinical signs. The percentage compression of cerebellum and forebrain was calculated by comparing the expected to the actual diameter and longitudinal dimension, respectively. RESULTS: QC were diagnosed in 28 dogs, of which 21 (75%) were small breed dogs. Fifteen dogs (54%) were brachycephalic. Eighteen dogs were male, and 10 were female. Cerebellar, occipital lobe, or compression in both areas occurred in 86% (24/28 dogs). Clinical signs included focal and generalized seizures in 5 dogs and cerebellar signs in 6 dogs. Mean occipital lobe compression was 17% (SD = 4) in clinically affected and 10% (SD = 3) in normal dogs (P = .006). Occipital lobe compression >14% was always associated with clinical signs. The mean cerebellar compression was 18%, but there was no association between compression and clinical signs. The animals were more likely to develop clinical signs if both areas were compressed (P = .04). CONCLUSIONS AND CLINICAL IMPORTANCE: Parenchymal compression by QC can be incidental, and other central nervous system diseases must be excluded when assessing the clinical significance of QC. However, occipital lobe compression over 14% is likely to cause clinical signs.     

Diagnosis and treatment of arthrosis of cervical articular facet joints in Scottish Deerhounds: 9 cases (1998-2002)

OBJECTIVE: To determine diagnostic features and efficacy of treatment of arthrosis of the cervical articular facet joints between C2 and C3 in Scottish Deerhounds. DESIGN: Retrospective study. ANIMALS: 9 client-owned dogs. PROCEDURE: Medical records of affected dogs were reviewed. Diagnosis was confirmed by results of clinical examination (signs of severe pain from unilateral or bilateral flexion of the cervical vertebral column), radiography, myelography, and computed tomography. Treatment consisted of fluoroscopy-guided intra-articular injection of corticosteroids and lidocaine. RESULTS: Unilateral or bilateral arthrosis of the cervical facet joints between C2 and C3 was detected in all dogs. In 7 dogs, signs of pain were elicited by flexion of the side of the neck in which affected joints were detected radiographically. Two dogs had signs of pain during right lateral flexion, although bilateral lesions were detected. Five dogs had unilateral lesions, and 4 dogs had bilateral lesions; sclerosis and hypertrophy of the articular process were common. Two dogs had bridging of the articular space. Use of computed tomography confirmed the diagnosis. Myelography did not reveal abnormalities of the spinal cord or canal. After treatment, 8 dogs had rapid marked improvement of clinical signs, and 7 dogs remained free of clinical signs for > 4 months. CONCLUSIONS AND CLINICAL RELEVANCE: Arthrosis of the cervical facet joints in Scottish Deerhounds is a severely painful condition for which conventional radiography is a useful screening test. Intra-articular administration of corticosteroids and anesthetic is efficacious, long-lasting, and minimally invasive.     

Hepatotoxicity associated with CCNU (lomustine) chemotherapy in dogs

One hundred seventy-nine tumor-bearing dogs were treated with 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) between 1995 and 2001. CCNU was given as a single dose of 50-110 mg/m2 body surface area PO. Treatment interval varied, but the minimal interval between CCNU doses was 3 weeks. After treatment, 11 dogs (6.1%) developed hepatic toxicity. The median number of CCNU doses and the median total cumulative CCNU dose were significantly higher in dogs that developed hepatic toxicity (4 doses; 350 mg/m2) than in dogs without hepatic damage (3 doses; 230 mg/m2). Median duration to detection of hepatic toxicity from the last dose of CCNU was 11 weeks (range 2-49 weeks). Common biochemical abnormalities were abnormally high serum liver enzyme activities and hypoalbuminemia. Six dogs with CCNU-associated hepatic toxicity had ascites, and 3 dogs had concurrent pleural effusion. Serum concentrations of bile acids were abnormally high in 4 of 5 dogs tested. Percutaneous ultrasound-guided liver biopsies were performed in 10 dogs, and findings were nonspecific and chronic in nature. Seven dogs were euthanized because of progressive liver failure, and their median survival from diagnosis of liver disease was 9 weeks. Three dogs died of other causes and 1 dog of unknown cause. Although clinical signs resolved in 3 dogs, biochemical abnormalities and histopathologic lesions persisted 4 to 38 months from the time of diagnosis of liver disease. Our findings suggest that CCNU can cause delayed, cumulative dose-related, chronic hepatotoxicity that is irreversible and can be fatal.     

Lung lobe torsion in association with a chronic diaphragmatic hernia and haemorrhagic pleural effusion in a cat

CLINICAL SUMMARY: This report describes torsion of the right cranial lung lobe in a cat with haemorrhagic pleural effusion and a chronic diaphragmatic hernia. Surgical treatment comprising lung lobectomy without de-rotation, and repair of the diaphragmatic defect, led to an uneventful recovery. PRACTICAL RELEVANCE: Lung lobe torsion is a rare condition in cats. While spontaneous lung lobe torsions may occur, a frequent association with underlying thoracic disease has been recognised in cats. However, neither haemorrhagic pleural effusion nor diaphragmatic hernia have been previously described in cats with lung lobe torsions, although they have been documented in dogs and humans. In a cat with suspected lung lobe torsion, a thorough search for an underlying disease should be undertaken.     

Chronic active hepatitis in 26 Doberman pinschers

Chronic active hepatitis with increased hepatic copper concentration was diagnosed in 25 female and 1 male Doberman Pinscher dogs. Common clinical signs included polyuria/polydipsia, weight loss, anorexia, icterus, and ascites. Increased liver enzyme activities and abnormal liver function test results were the most consistent clinicopathologic changes. The dogs were assigned to 3 groups on the basis of clinical course of the disease. Group 1 dogs (n = 12) had clinical signs of advanced liver failure and died within one week. Group 2 dogs (n = 7) had less severe clinical signs of liver disease and died within one month. Group 3 dogs (n = 5) did not have clinical signs of illness or had mild clinical signs of liver disease and died 1 to 42 months after initial evaluation. One dog could not be reevaluated and another dog was alive 3 months after initial examination. Treatments consisted of supportive care for dogs in group 1, and dietary manipulations and corticosteroids for dogs in groups 2 and 3. The association of increased liver copper concentration and chronic active hepatitis is not known.     

Surgical management of gallbladder mucoceles in dogs: 22 cases (1999-2003)

OBJECTIVES: To describe preoperative, surgical, and postoperative findings and determine prognostic indicators and treatment recommendations in dogs treated surgically for gallbladder mucocele. DESIGN: Retrospective study. ANIMALS: 22 client-owned dogs. PROCEDURES: Medical records of dogs with gallbladder mucoceles that were treated surgically were reviewed. History, clinical signs, results of selected clinicopathologic analyses and abdominal ultrasonography, surgical procedure performed, results of histologic examination of a liver biopsy specimen, and survival time were recorded. Follow-up information was obtained via telephone interview with owners and referring veterinarians. RESULTS: Dogs were 7 to 15 years of age and had non-specific clinical signs (vomiting, anorexia, and lethargy). Physical examination findings included icterus, signs of depression, and signs of discomfort on palpation of the abdomen. Sixteen dogs had a definitive diagnosis and 6 dogs were strongly suspected of having a gallbladder mucocele on the basis of results of abdominal ultrasonography. Fifteen dogs survived after surgery; 3 of these dogs had bile-induced peritonitis, and 4 had pancreatitis. One dog was euthanatized as a result of severe pancreatitis, and 1 was euthanatized because of acute renal failure; 5 dogs died as a result of pancreatitis, cholecystitis, or bile-induced peritonitis. Hepatic abnormalities were detected histologically in all dogs. CONCLUSIONS AND CLINICAL RELEVANCE: No predictors of survival were identified. No associations between outcome of surgical treatment (survival vs nonsurvival) and preoperative findings, biliary rupture, surgical procedure performed, results of histologic examination of the liver, or development of pancreatitis were found. Cholecystoduodenostomy and cholecystectomy appear to be acceptable treatments for gallbladder mucocele.     

Skin-fold advancement flaps for closing large proximal limb and trunk defects in dogs and cats

OBJECTIVE: To describe the use of skin-fold advancement flaps for covering large skin defects in dogs and cats. STUDY DESIGN: Clinical study. ANIMALS: Eight client-owned animals: 6 dogs and 2 cats. METHODS: Six dogs and 2 cats underwent reconstruction of soft-tissue wounds resulting from traumatic, neoplastic, or infectious lesions. Skin-fold flaps were created by division of the medial and lateral attachment to the proximal limb or the dorsal and ventral attachment to the trunk, enabling closure of adjacent defects on the trunk or proximal limb, respectively. RESULTS: Skin-fold flaps proved effective for closing defects in all animals. Necrosis of a portion of the flap occurred in 2 dogs due to technical errors, but the resultant defects remained amenable to primary closure. All wounds ultimately healed primarily, without major complications. CONCLUSION AND CLINICAL RELEVANCE: The skin-fold advancement flap is a versatile technique that lends itself to use in a variety of locations, depending on which attachments are divided. The clinical results are comparable with those reported for axial pattern and subdermal plexus flaps.     

Surgical treatment of degenerative lumbosacral stenosis in dogs

OBJECTIVE: To study the epidemiology, clinical findings, and long-term outcome of surgical treatment of degenerative lumbosacral stenosis (DLSS) in dogs. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: 131 client-owned dogs with DLSS. METHODS: The medical records of dogs with DLSS treated by dorsal laminectomy and dorsal fenestration were reviewed. The clinical diagnosis had been verified by diskography, epidurography or myelography, or a combination thereof. RESULTS: The German shepherd breed was over-represented (56.5%), and males were more often affected than females (2:1). Historically, reluctance or pain when jumping, rising from a prone position, or climbing stairs (92.4%) and signs of pain or stiffness during extensive physical activity (85.5%) were the most frequent concerns. The most common physical and neurologic examination findings were pain in the lumbosacral area during hyperextension (97.7%) and on direct digital palpation (84.7%). A total of 93.2% of the dogs were improved clinically within the follow-up period (mean 26 +/- 17 months). Recurrence of clinical signs resembling DLSS was reported by the owner or diagnosed by clinical examination in 17.6% of the dogs with a mean onset of signs at 18 +/- 13 months postoperatively. CONCLUSIONS: Surgical treatment of DLSS with dorsal laminectomy and fenestration generally resulted in good to excellent clinical outcome.     

Torsion of the caudate lobe of the liver in the domestic rabbit (Oryctolagus).

Torsion of the caudate lobe was an incidental necropsy finding in three livers of 984 rabbits. The affected rabbits were mature (18-24 months), without a common background, and did not have clinical signs related to hepatic torsion. No lesions secondary to lobar torsion were seen.     

Portal Vein Thrombosis in Cats: 6 Cases (2001–2006)

Background: Portal vein thrombosis (PVT) in cats is sparsely reported.
Purpose of Study: To evaluate the clinical signs and diseases associated with PVT in cats.
Animals: 6 client-owned cats.
Methods: Medical records for cats with a portal vein thrombus diagnosed on abdominal ultrasound or at necropsy were reviewed. Signalment, historical data, underlying disorders, clinical findings, clinicopathologic and histopathologic data, diagnostic imaging findings, treatment, and outcome were recorded.
Results: All 6 cats identified with PVT also had hepatic disease. Evidence of a congenital portosystemic shunt was present in 3/6 cats. Two cats had primary or metastatic hepatic neoplasia. One cat had acute cholangitis, acute pancreatitis, and locally extensive acute centrilobular hepatic necrosis. Two cats were suspected to have acute thrombi and 4 cats had chronic thrombi.
Conclusion and Clinical Significance: PVT might be an important concurrent finding in cats with hepatic disease.     

Portal vein thrombosis in cats: 6 cases (2001-2006).

BACKGROUND: Portal vein thrombosis (PVT) in cats is sparsely reported. PURPOSE OF STUDY: To evaluate the clinical signs and diseases associated with PVT in cats. Animals: 6 client-owned cats. METHODS: Medical records for cats with a portal vein thrombus diagnosed on abdominal ultrasound or at necropsy were reviewed. Signalment, historical data, underlying disorders, clinical findings, clinicopathologic and histopathologic data, diagnostic imaging findings, treatment, and outcome were recorded. RESULTS: All 6 cats identified with PVT also had hepatic disease. Evidence of a congenital portosystemic shunt was present in 3/6 cats. Two cats had primary or metastatic hepatic neoplasia. One cat had acute cholangitis, acute pancreatitis, and locally extensive acute centrilobular hepatic necrosis. Two cats were suspected to have acute thrombi and 4 cats had chronic thrombi. CONCLUSION AND CLINICAL SIGNIFICANCE: PVT might be an important concurrent finding in cats with hepatic disease.     

Hepatic Volume Measurements in Dogs with Extrahepatic Congenital Portosystemic Shunts before and after Surgical Attenuation

Background: In dogs with congenital portosystemic shunts (CPSS), the ability of the hypoplastic liver to grow is considered important for recovery after surgical shunt attenuation.
Objectives: This study investigated hepatic growth after extrahepatic shunt attenuation in dogs using magnetic resonance imaging (MRI) and computed tomography (CT).
Animals: Ten client-owned dogs with single extrahepatic CPSS.
Methods: Abdominal MRI, CT, or both were performed before and 8 days, 1, and 2 months after shunt attenuation. Liver volumes were calculated from the areas of the MRI or CT images.
Results: Before surgery, median liver volume was 18.2 cm³/kg body weight. Liver volume increased significantly after surgery. Growth was highest between days 0 and 8 and decreased afterward. Median liver volume was 28.8 cm³/kg at 2 months after attenuation. No significant differences in growth were found between dogs with complete or partial shunt closure or between dogs with complete or incomplete metabolic recovery. Volumes measured from consecutively performed MRI and CT images correlated well ( r = 0.980), but volumes from MRI images were significantly larger than volumes from CT images (6.8%; P = .008).
Conclusion and Clinical Importance: After shunt attenuation, rapid normalization of liver size was observed. Hepatic growth was not decreased in dogs after partial closure of CPSS or in dogs with subclinical, persistent shunting 2 months after surgery. CT is the preferred imaging method for volumetric estimation because of speed.