Suspected venous air embolism during urinary tract endoscopy in a standing horse

During cystoscopy, performed with air insufflation in a standing Argentinian gelding, the horse showed ataxia and fell to the ground with generalised muscular twitching and horizontal nystagmus, tachypnoea and tachyarrhythmia. General anaesthesia was induced. Arterial blood gas‐analysis before induction of anaesthesia revealed an increased pH, decreased partial pressure of carbon dioxide and decreased partial pressure of oxygen. Venous air embolism was suspected.     

Suspected venous air embolism in three horses

Venous air embolism was suspected in 3 hospitalised horses on the basis of an inadvertently open jugular venous line. Subsequently the 3 horses developed clinical signs including cardiovascular collapse, cardiac dysrhythmia, pulmonary oedema, behavioural abnormalities and neurological signs consistent with central nervous system injury. Treatment included intranasal oxygen therapy, i.v. fluid administration and anti‐inflammatory therapy. Specific therapy aimed at treating air embolism in man is reviewed, with pertinent therapy potentially applicable to horses emphasised.     

Transitional cell carcinoma of the urinary bladder in a 12‐year‐old Belgian Warmblood gelding

A 12‐year‐old Belgian Warmblood gelding was examined for haematuria and dysuria of 24 h duration. Cystoscopy revealed an intraluminal multinodular soft tissue mass originating from the dorsal bladder neck. Histopathological examination of biopsies identified transitional cell carcinoma. The bladder mass was surgically debulked via a temporary perineal urethrotomy. The horse commenced treatment with oral piroxicam. Follow‐up examination 18 months post operatively revealed no evidence of tumour recurrence. Neoplasia of the equine bladder is uncommon and this case describes the successful short‐term outcome of treatment of a transitional cell carcinoma by surgical debulking and oral piroxicam.     

Urinary bladder rupture secondary to penile and preputial squamous cell carcinoma in a gelding

Squamous cell carcinoma (SCC) is the most common external genital neoplasm. Early detection, diagnosis and treatment are paramount to successful outcome; overlooked or misdiagnosed SCC can rapidly invade tissues and metastasise, producing potentially fatal complications. This report describes a case of overlooked SCC that resulted in severe penile infiltration, urethral stricture, and subsequent urinary bladder rupture and peritonitis.     

Suspected fatal venous air embolism during anaesthesia in a Pomeranian dog with pulmonary calcification

CASE HISTORY: Death occurred in a 1.25 kg, 9-month-old female Pomeranian dog undergoing anaesthesia for surgical repair of partially healed fractures of the radius and ulna.

CLINICAL FINDINGS: Following sedation, anaesthesia was induced using thiopentone and maintained with halothane in oxygen. An acute decrease in the dog's end-tidal carbon dioxide (EtCO₂) measurements was noted approximately 50 min after induction, immediately following delivery of a 5-ml bolus of lactated Ringer's solution (LRS) administered to flush a small (0.06 ml) volume of fentanyl via a pre-placed intravenous (I/V) catheter. Venous air embolism (VAE) was suspected and the dog died despite interventive therapy. On post-mortem examination, several air bubbles were noted when the right ventricle was opened under water. Histologically, the kidneys appeared abnormal with immature glomeruli, and the lungs appeared diffusely mineralised. The origin of the air was probably small bubbles and microbubbles that may have been present in the extension set and 20 ml syringe used for the administration of fentanyl and I/V fluids to the dog.

DIAGNOSIS: Renal dysplasia and diffuse pulmonary calcification, with VAE as the probable cause of death.

CLINICAL RELEVANCE: In this case of VAE-associated anaesthetic death, it is further speculated that underlying pulmonary disease, in the form of pulmonary calcification, may have contributed to an increased sensitivity to the adverse effects of VAE.     

Conservative management of iatrogenic bladder rupture and uroperitoneum in a gelding with urolithiasis

This report details a case of iatrogenic bladder rupture in a gelding that was successfully treated with conservative management. Rupture occurred at the time of attempted cystoscopy, whilst the bladder was being insufflated with air for further investigation of stranguria and suspected urolithiasis. The gelding was treated with temporary perineal urethrostomy, peritoneal lavage and drainage of urine from the bladder and made a complete recovery.     

Suspected venous air embolism in a Finnhorse

Vascular air embolism (VAE) is the entrainment of air from the operative field or other communication with the environment into the venous or arterial vasculature, producing systemic effects. The horse described in this report, after having been discovered to have dislodged the extension set from the jugular vein catheter, demonstrated clinical signs considered most likely to have resulted from a VAE, and represents a case of primarily neurological signs resolving spontaneously. Emphasis is given to the prevention and prompt recognition of this event and to the use of all available tools in the management of cardiovascular complications.     

Polypoid cystitis as a cause of haematuria in a pony mare

A 15-year-old pony mare was presented for investigation of haematuria of 2 weeks' duration. On cystoscopy, multiple small pedunculated soft tissue structures were observed on the bladder mucosa. Histopathological analysis of the masses was consistent with chronic polypoid cystitis. The polypoid lesions and associated haematuria resolved following prolonged antibiotic treatment. Polypoid cystitis has not previously been described in horses. This condition should be considered a differential for haematuria, requiring cystoscopy and biopsy to confirm a diagnosis.     

Vascular air embolisation and expansile sphenopalatine sinus haematoma secondary to a fracture of the rostral skull in a horse

A 13-year-old Thoroughbred gelding presented with acute onset respiratory distress, muscle fasciculations and ataxia during ridden exercise. On physical examination, the horse was extremely distressed and had a markedly increased respiratory rate of 92 breaths/min and heart rate of 82 beats/min. Auscultation of the thorax revealed adventitious sounds throughout the lung fields. A continuous, loud, splashing (‘water-wheel’) murmur was evident on cardiac auscultation. A diffuse, marked interstitial and patchy alveolar pattern was present on thoracic radiographs and comet tail artefacts were found on thoracic ultrasonography. Echocardiography showed air embolisation, with the right ventricle and atrium markedly opacified with air bubbles. The horse deteriorated despite treatment with intranasal oxygen therapy, anti-inflammatories, antimicrobials, diuretics and glycopyrrolate. Post-mortem examination identified an expansile haematoma of the sphenopalatine sinus secondary to a rostral fracture of the skull, a previously unreported differential for vascular air embolism in the horse.     

Carcinoma in the urinary bladder of a cat: cytologic findings and a review of the literature

Percutaneous fine needle aspiration biopsy (FNAB) was used to diagnose a urinary bladder carcinoma in an aged cat. The cytologic appearance of specimens collected initially was similar to that reported for canine transitional cell carcinoma. However, impression smears of the tumor made at necropsy 7 weeks later consisted predominantly of atypical squamous epithelial cells compatible with squamous cell carcinoma. Histologically, the malignancy was noted to have intermixed areas of abnormal squamous and transitional cell proliferation. The neoplasia was interpreted as a transitional cell carcinoma with extensive transformation to squamous cell carcinoma. This report examines the use and limitations of FNAB in the diagnosis of feline urinary bladder carcinoma and the incidence and behavior of these tumors in the cat.     

Suspected air embolism associated with post-anesthetic pulmonary edema and neurologic sequelae in a horse

A 523 kg Quarter Horse was anesthetized for unilateral eye enucleation. The anesthetic period was unremarkable. During anesthetic recovery the cap on the jugular venous catheter became dislodged. Clinical signs of pulmonary edema associated with moderate arterial hypoxemia subsequently developed. Although pulmonary edema resolved with medical therapy, the day following anesthetic recovery, clinical signs of vestibular disease and blindness developed. Treatment included nasal oxygen insufflation, flunixin meglumine, furosemide, dexamethasone, thiamine, dimethylsulfoxide, antimicrobials, and phenylbutazone. The horse recovered and was discharged from the hospital after 7 days of treatment and was neurologically normal at 6 weeks. While venous air embolism was not confirmed in this case, the catheter cap complication followed by signs of pulmonary edema and neurologic sequelae support the presumptive pathogenesis of this horse's complications. Diagnostic confirmation of air embolism in horses with compatible acute clinical signs should be documented with echocardiography.     

Resection cystoplasty of a squamous cell carcinoma in a mare

A 22‐year‐old Arabian mare was examined for evaluation of haematuria of 2 months' duration. Complete blood cell count and chemistry revealed anaemia of chronic disease (i.e. normocytic, normochromic) and hypoproteinaemia. Cystoscopy revealed a haemorrhagic mass protruding into the lumen of the urinary bladder in the apical region. The mass was surgically removed by partial cystectomy performed through a caudal ventral midline laparotomy. Histological examination of the mass confirmed the diagnosis of squamous cell carcinoma. Tumours of the equine urinary bladder are rare, and when a partial cystectomy is indicated, a caudal ventral midline laparotomy may provide adequate surgical exposure even in adult horses.     

A case of spontaneous venous embolism with carbon dioxide during laparoscopic surgery in a pig

BACKGROUND: Carbon dioxide (CO2) embolism is a possible complication of capnoperitoneum during laparoscopic surgery. Experimentally induced venous CO2 embolism has been studied in pigs. In this paper we report a case of spontaneous CO2 embolism. OBSERVATIONS: A 4-month-old Large White pig weighing 20 kg underwent experimental laparoscopic surgery under general anaesthesia. Monitoring consisted of pulse oximetry, capnography, airway pressure, electrocardiography, invasive arterial and central venous blood pressures, and arterial blood-gas analysis. Shortly after the start of laparoscopy and onset of CO2 insufflation, sudden decreases in end-tidal CO2 (Pe'CO2), haemoglobin saturation of oxygen (SpO2), systolic arterial blood pressure and heart rate were observed. Airway pressure increased and pulmonary compliance decreased simultaneously. Insufflation was immediately discontinued and epinephrine (2 mg IV), atropine (0.5 mg IV) and a 50 mL bolus of a polygeline solution were administered without effect. At this time arterial blood-gas analysis revealed a pH of 7.29 and a PaCO2 of 6.8 kPa (51.2 mmHg); PaO2 was 26.6 kPa (199.5 mmHg). After 4 minutes asystole occurred. CONCLUSIONS: The sudden decrease of Pe'CO2 and lung compliance combined with the sudden decrease in systolic blood pressure, heart rate and a poor response to resuscitation suggest a case of fatal gaseous venous embolism.     

Sequence analysis of RAS and RAF mutation hot spots in canine carcinoma

Recent discovery of the BRAF V595E mutation in a variety of canine cancers indicates that mutant BRAF may represent a novel therapeutic target. Presence of RAS mutations is associated with poor tumour response to BRAF inhibition but has not been investigated in BRAF‐mutated canine cancers. The aim of this study was to evaluate the mutational status of three RAS genes (HRAS, KRAS and NRAS) in four types of canine carcinoma with and without the BRAF V595E mutation. Novel HRAS mutations were identified in 18% (3/17) of oral squamous cell carcinoma, whereas 17% (3/18) of pulmonary carcinoma carried KRAS or NRAS mutations. These RAS mutations and BRAF V595E were mutually exclusive, indicating similar functional consequence of these mutations (e.g. MAPK pathway activation). In contrast, RAS mutations were absent in 39 urothelial carcinoma and 19 prostatic carcinoma, adding another rational for BRAF‐targeted therapy for these canine cancers.     

Carcinoma of an accessory genital gland in a 23‐year‐old Camargue gelding

This report describes the case management, histopathological and post mortem findings in a 23‐year‐old gelding with a peri‐rectal mass. The mass was debulked surgically and submitted samples revealed it to be a poorly differentiated carcinoma. In the post operative period the horse developed signs of abdominal pain and dysuria and was subjected to euthanasia. Post mortem examination revealed a large infiltrative mass located between the rectum and urethra, consistent with a carcinoma of an accessory genital gland, most likely the seminal vesicle.     

Surgical resection of a squamous cell carcinoma in the perianal region of a 25-year-old crossbred American Paint gelding using sharp surgical excision,laser excision and chemotherapy

A 25 year-old American Paint gelding was referred to the Onderstepoort Academic Veterinary Hospital with an ulcerated lesion of nonpigmented skin at the right lateral aspect of the perianal region. An infiltrating squamous cell carcinoma was suspected. Surgical excision and ablation with sharp surgical excision and a diode laser was performed although complete excision was not possible due to the tumour location. Intralesional chemotherapy was performed at the completion of the surgical excision and continued in the post-operative period. Histological examination of the excised lesion confirmed a diagnosis of squamous cell carcinoma and revealed incomplete resection margins at the medial, dorsal and ventral aspects of the surgical site. The surgical site healed uneventfully and a re-examination at 6 months post-surgery revealed the gelding to have normal clinical parameters with no perianal lesions.