IMAGING DIAGNOSIS—GASTRIC PNEUMATOSIS IN A CAT

Gastrointestinal foreign bodies were removed surgically from a 9‐year‐old Siamese cat. Two days later the cat became lethargic and started regurgitating. A degenerative leukocytosis and drop in packed cell volume were present. Gastric wall thickening with intramural gastric air was detected radiographically and sonographically. Gastric ulceration with a focal necrotic area was seen endoscopically. At surgery, the stomach wall was emphysematous. Clinical signs resolved following partial gastrectomy and medical management. Intramural gastric air with declining clinical course was a significant impetus to return to surgery.     

Suspect severe gastroenteritis associated with ingestion of caterpillar setae fragments in a cat

A 6-month-old male neutered Domestic Shorthair cat was assessed for a 24-h history of anorexia, lethargy, depressed mentation, mild abdominal pain and persistent bradycardia. Abdominal ultrasound revealed marked thickening of the gastric wall, gastric distension, free abdominal fluid, distension and corrugation of the small intestine. Full-thickness histopathological biopsy of the gastric wall demonstrated intralesional chitinous structures whose morphology (size and presence of obvious barbs) supports these structures being urticating hairs (setae). A processionary caterpillar is considered most likely as these are the most common urticating caterpillars in Australia. This is the first case of suspected severe gastroenteritis associated with the ingestion of caterpillar setae fragments in a cat.     

Stomach wall evaluation using helical hydro-computed tomography

In helical hydro-computed tomography (helical hydro-CT), water is used as a neutral luminal contrast medium together with intravenous iodine contrast medium for the diagnosis and staging of human gastric neoplasia. We evaluated the feasibility of helical hydro-CT in 11 healthy animals (nine dogs and two cats). Adequate uniform gastric distension was obtained with 30 ml water/kg body weight. Fourteen client-owned dogs and four cats with suspected or diagnosed gastric neoplasia then underwent helical hydro-CT followed by intravenous contrast medium administration. Focal thickening with moderate contrast enhancement was found in 10 dogs and 3 cats. The extent of the lesion was assessed easily in all these patients. Three dogs and one cat had a normal stomach wall. One dog had multifocal thickening of the antrum but no histopathologic diagnosis was made. Helical hydro-CT, followed by intravenous contrast medium administration, is a simple technique for assessing the stomach wall.     

Gastric inflammatory pseudotumour secondary to <Emphasis Type="Italic">Actinomyces hordeovulneris</Emphasis> infection in a cat

Background

The authors report the first case of feline gastric actinomycosis associated with infection by Actinomyces hordeovulneris.

Case presentation

A 4-year-old, neutered male, semi-feral European cat, with a 1 year history of chronic vomiting, was referred to the clinic. Abdominal ultrasound examination identified a hypoechoic focal transmural thickening with loss of normal wall layering and hyperechoic speckles at the gastric body. Initial gastroscopic examination showed a tumour-like gastric mass with an ulcerated depression at the level of the greater curvature. Histologic examination of endoscopic biopsy specimens was consistent with a severe lymphoplasmacytic gastritis. After 2 months, due to persistence of abdominal discomfort, surgical exploration and intraoperative sampling of gross abnormalities was recommended. Full thickness gastric wall biopsies, and fine needle aspiration of the gastric thickening and gastric lymph node, were performed. Histopathological examination identified a transmural pyogranulomatous gastritis. Aspirate samples of the gastric wall cultured positive, with colony morphology, biochemical testing and PCR of the 16 s rRNA gene compatible with Actinomyces hordeovulneris. After 4 months of treatment with cefovecin (8 mg/kg subcutaneously every 14 days), the vomiting completely resolved, as well as the ultrasonographic gastric alteration.

Conclusion

This case report of feline gastric actinomycosis, caused by Actinomyces hordeovulneris, suggests that gastric bacterial infection should be considered in cases of focal gastric wall thickening associated with chronic vomiting in the cat, which may otherwise closely resemble neoplastic disease. Once a diagnosis of actinomycosis was obtained, a correct treatment with antibiotic therapy can resolve it.

     

ULTRASONOGRAPHIC DIAGNOSIS-SMALL BOWEL INFARCTION IN A CAT

An 8-year-old, domestic short hair cat with a known history of hypertrophic cardiomyopathy and previous aortic thromboembolism was presented for 24 h of vomiting and pyrexia. Initial abdominal radiographs were unremarkable. On an upper gastrointestinal series, delayed gastric emptying and prolonged small intestinal transit time were found. An initial abdominal ultrasound revealed a focal region of aperistaltic small intestine with mild wall thickening, however, intestinal wall layering in this area appeared normal. By 72 h, there was a diffusely hypoechoic portion of thickened small bowel (0.51 cm) with loss of the normal layering and hyperechoic mesentery surrounding this segment of bowel. A small bowel infarction and focal peritonitis were suspected and confirmed at surgery.     

Leiomyosarcoma of the urinary bladder in a cat.

An 81/2-year-old female domestic short-haired cat was admitted with signs of chronic cystitis. Radiography revealed marked and irregular thickening of the bladder wall. Biopsy revealed the thickening to be a malignant tumor of muscle origin and treatment with proteolytic enzymes was instituted. After one month, the cat was euthanatized because of uremia associated with progressive tumor growth. At necropsy the bladder was grossly thickened. The histopathologic diagnosis was leiomyosarcoma.     

B-cell immunoblastic lymphoma with multinucleated giant cells in a cat

A 10-year-old male mixed breed cat died after six months history of intermittent vomiting and weight loss. At necropsy, large white-colored foci were found in both kidneys, and whitish thickening of the gastric wall was present at the pyloric part of the stomach. Histopathological examination revealed that both lesions consisted of proliferation of large-sized neoplastic lymphocytes intermingled with multinucleated giant cells. Immunohistochemically, the neoplastic cells were positive for both B-cell antigen receptor complex (CD 79 alpha cy) and MHC class II, although multinucleated giant cells were negative. The present case was diagnosed as B-cell immunoblastic lymphoma with multinucleated giant cells.     

ULTRASONOGRAPHIC APPEARANCE OF FELINE ALIMENTARY LYMPHOMA

Abdominal ultrasonography was performed in seven cats with intestinal lymphoma and four cats with gastric lymphoma. Ultrasonographic abnormalities included the presence of a hypoechoic mass associated with the gastrointestinal tract, focal or diffuse thickening of the gastric wall, symmetric thickening of the bowel wall, loss of the normal layered appearance of the gastrointestinal wall, and abdominal lymphadenopathy. The thickness of the stomach wall ranged from 8 to 22 mm in cats with gastric lymphoma, and the thickness of the bowel wall ranged from 5 to 20 mm in cats with intestinal lymphoma. Fine needle aspiration of a gastrointestinal lesion was performed without complication in six cats, and was diagnostic for lymphoma in five out of six. Results of this study indicate that ultrasonography is an effective noninvasive means of identifying lesions consistent with alimentary lymphoma in cats.     

ULTRASONOGRAPHY OF GASTRIC ULCERATION IN THE DOG

The clinical, ultrasonographic and, when available, histopathologic findings of gastric ulceration in 7 dogs were reviewed. The most common clinical signs were vomiting, hematemesis, melena, weight loss and anemia. Ultrasonographic features of gastric ulcer included local thickening of the gastric wall, possible loss of the 5-layer structure, the presence of a wall defect or "crater", fluid accumulation in the stomach and diminished gastric motility.The localized gastric thickening varied from 9 to 16 mm. The ulcer crater was often located in the center of the thickened site and appeared as a mucosal defect associated with persistent accumulation of small echoes, most likely representing microbubbles. In this preliminary study, there was no definitive ultrasonographic distinction between benign and malignant ulcers.     

ULTRASONOGRAPHIC FINDINGS IN CANINE GASTRIC NEOPLASIA IN 13 PATIENTS

The ultrasonographic findings in 13 canine patients with histopathologically proven gastric tumors were reviewed. The echogenicity of gastric wall lesions was variable and independent of the type of tumor. All dogs had an increase in gastric wall thickness and in only one dog was the wall layering intact. Regional lymph node involvement was a common finding, but abnormalities within the liver were seen in only one patient. Gastric neoplasia was observed most commonly in middle-aged and old, medium- to large-sized dogs. Carcinoma was the most common tumor found. In this study, with a limited number of animals and limited tumor types, it appeared that thickening of the gastric wall, accompanied by loss of gastric wall layering and enlargement of regional lymph nodes were ultrasonographic signs likely to be found with gastric neoplasia. In this limited study the histologic type of gastric tumor could not be predicted on the basis of the ultrasound examination.     

SONOGRAPHIC APPEARANCE OF UREMIC GASTROPATHY IN FOUR DOGS

Gastrointestinal signs are common in dogs with uremia. Structural changes in the stomach associated with uremia in dogs include ulceration, edema, necrosis, gastric wall thickening, submucosal arteriopathy, and mineralization of the gastric mucosa and submucosa. Upon ultrasonographic evaluation of the abdomen in four dogs with severe uremia due to chronic renal disease, a thickened gastric wall, thickened rugal folds, and a hyperechoic line at the mucosal-luminal interface due to mineralization of the gastric mucosa were found. Ultrasonography was more sensitive than survey radiography for the identification of gastric lesions associated with uremia in these dogs.     

ULTRASONOGRAPHY OF CANINE GASTRIC EPITHELIAL NEOPLASIA

Signalment, clinical and ultrasonographic findings from 16 dogs with histologically confirmed gastric epithelial neoplasia were reviewed. The most common clinical findings were vomiting, anorexia and weight loss. Hematemesis and melena were uncommon findings. Ten (10/16) dogs were female and there were four Chows. The most common ultrasonographic findings were transmural thickening of the gastric wall associated with altered wall layering. A poorly echogenic lining often was noted on the innermost and/or the outermost portions of the gastric wall, separated by a more echogenic central zone. The distribution of these changes was variable. This ultrasonographic feature, called pseudolayering, was present in 14 dogs. It was believed to most likely correlate to the unevenly layered tumor distribution noted histopathologically. The maximum wall thickening ranged from 1 cm to 2.7 cm. Regional lymphadenopathy was identified ultrasonographically in 15 dogs. Ultrasound-guided fineneedle aspiration biopsy or automated microcore biopsy, endoscopic biopsy, surgical biopsy or necropsy resulted in the diagnosis of carcinoma in 15 dogs and of carcinoid tumor in one dog. The results of this study suggested that ultrasonography was a useful tool for the detection and diagnosis of canine gastric epithelial neoplasia. Furthermore, ultrasonography can assist in obtaining diagnostic samples and in clinical staging of the tumor.     

Rectal prolapse associated with urinary bladder neoplasia in a cat

A case of feline rectal prolapse which appeared to be secondary to transitional cell carcinoma of the urinary bladder is described. The cat was reported to be incontinent and treatment was declined by the owners. Euthanasia was performed and necropsy revealed an extensive nodular thickening of the entire urinary bladder wall. A diagnosis of urinary bladder transitional cell carcinoma was made on histopathological examination.     

Ultrasonographic appearance of primary gastric neoplasia in 21 dogs

The ultrasonographic findings in 21 dogs with histologically confirmed primary gastric neoplasia were reviewed. Location, shape of the gastric lesion, evidence of gastric wall thickening, wall layers affected, presence of ulceration, evidence of extension through the gastric wall and lymphadenopathy were recorded. Twelve dogs with carcinoma shared many ultrasonographic features with six dogs that had lymphoma, the majority having sessile masses that appeared to involve all layers of the gastric wall; many also had evidence of ulceration and lymphadenopathy. Signs of extension of the lesion through the serosal surface of the stomach were identified ultrasonographically only in dogs with carcinoma. In contrast, three dogs with leiomyoma or leiomyosarcoma each had a focal mass affecting the gastric antrum, and lymphadenopathy was not identified ultrasonographically in these dogs. Even without any specific patient preparation, ultrasonography enables a morphological assessment of gastric neoplasms that may prompt a tentative diagnosis of gastric neoplasia and stimulate further investigation.     

GASTRIC LYMPHOSARCOMA IN A DOG: A CASE REPORT

A 9-year-old female spayed mixed-breed dog was presented with a ten-week history of vomiting. A survey abdominal radiograph showed a soft tissue mass on the lesser curvature of the stomach and an adjacent thickened greater curvature. A barium contrast study confirmed the presence of this mass. The radiographic diagnosis was gastric tumor. Radiographic signs of gastric neoplasia include soft tissue masses or thickening of the stomach wall, delayed gastric emptying, immobility of portions of the stomach wall, and residual stomach-wall staining by barium. Necropsy revealed a gastric lymphosarcoma that had infiltrated the entire circumference of the pyloric antrum. The most common gastric malignancy in the dog is adenocarcinoma. Gastric lymphosarcoma is considered rare.     

A case of hyperplastic gastropathy in a cat

Primary hyperplastic gastropathy is an uncommon human disease characterized by giant gastric mucosal folds and is associated with a spectrum of histopathological changes. Diagnosis is usually made on radiological and gastroscopic findings followed by full-thickness biopsy of the stomach wall. The aetiology is unknown and symptomatic treatment is usually disappointing. A similar condition has been described in a small number of dogs. A case of hyperplastic gastropathy is reported in a cat and compared with the findings in man and dogs. The cat presented with chronic vomiting and weight loss. Radiological and gastroscopic examinations revealed enlarged gastric rugae. Medical and surgical treatment was unsuccessful and the cat was destroyed. The pathological findings were similar to those described in man.     

Chronic myocardial infarction due to arteriosclerosis of coronary arteries followed by acute thromboembolism of caudal abdominal aorta in a cat

A 10-year-old cat with the paresis of hind limbs was initially diagnosed as a hypertrophic cardiomyopathy followed by acute thromboembolism of caudal abdominal aorta from the findings of the medical examinations. However, this case was proved to be an chronic myocardial infarction due to arteriosclerosis of coronary arteries by the pathologic diagnosis. In the left ventricular, the hypertrophy and the narrowing were slight, and a coagulative infarction was seen obviously. The intramural coronary arteriosclerosis showed thickening of the wall due to medial hyperplasia by fibrosis, and arterial stenosis. Myocardial infarction and arteriosclerosis are scarcely any reports of these lesions in cats. This case is valuable for an extremely rare case of myocardial infarction in the cat.     

Chronic emesis caused by a nematode-induced gastric nodule in a cat.

A spirurid nematode-induced gastric nodule was believed to be responsible for chronic gastric irritation and vomiting in a domestic short-hair cat. Clinical improvement was noticed following surgical removal of the parasitic nodule in the wall of the pylorus. Morphologic characteristics of the parasite were most consistent with Spirocerca lupi. Infection with Spirocerca lupi is most commonly reported in Canids, often resulting in chronic granulomatous disease of the distal portion of the esophagus. In some animals, the lesions transform into fibrosarcomas and osteogenic sarcomas.     

ULTRASONOGRAPHIC APPEARANCE OF CANINE GASTRIC POLYPS

Benign gastric polyps are uncommon in dogs and most are discovered incidentally. Polyps protruding into the pyloric antrum can cause gastric outflow obstruction. Clinical and ultrasonographic findings in seven dogs with histologically confirmed benign mucosal gastric polyps were reviewed. Sonographic findings such as shape, size, echogenicity, location, evidence of gastric wall thickening, wall layering, and size of regional lymph nodes were recorded. Five sessile and two pedunculated masses of different sizes (range 7–60 mm) and echogenicities were found. They primarily arose from the mucosal layer and protruded into the gastric lumen. Only one dog had a large inhomogeneous mass with a poorly visualized gastric wall layering. The polyps were all single, and were located in the pyloric antrum in six out of seven dogs. Although the ultrasonographic appearance allowed a presumptive diagnosis of mucosal gastric polyp, the final diagnosis was determined from histopathologic examination.     

Presumptive Intramural Gastric Hemorrhage Secondary to Rodenticide Intoxication in a Dog

A dog being treated for demodicosis with ivermectin was presented for intermittent vomiting. The vomiting progressed to hematemesis and an underlying coagulopathy was diagnosed. The etiology of the coagulopathy was determined to be ingested brodifacoum. Ultrasound evaluation of the abdomen revealed thickened gastric wall that was suspected to be intramural hemorrhage. Most likely, the intramural hemorrhage and resulting thickening of the stomach wall led to the clinical signs and metabolic alkalosis. This case represents an typical presentation of hemorrhage secondary to rodenticide intoxication. (J Vet Emerg Crit Care 2001; 11(1):27–31, 2001).