Questionnaire‐based Analysis of Owner‐reported Scratching and Pain Signs in Cavalier King Charles Spaniels Screened for Chiari‐like Malformation and Syringomyelia

Background

Chiari‐like malformation (CM) and syringomyelia (SM) cause a pain syndrome in Cavalier King Charles spaniels (CKCS). Clinical signs are not consistently apparent on neurologic examination, and owner reporting of signs provides vital clinical history. However, owner questionnaires for this disease are not well developed.

Objectives

To develop a tool to capture owner‐reported clinical signs for use in clinical trials and to compare owner‐reported signs with the presence of pain on neurologic examination and SM on magnetic resonance imaging (MRI).

Animals

Fifty client‐owned CKCS.

Methods

Owners completed a questionnaire and pain/scratch map. Each dog underwent a neurologic examination and craniocervical magnetic resonance imaging (MRI). Questionnaire responses were developed into scores, area of shading for pain/scratch maps was measured, and consistency of responses between these tools was assessed. Owner‐reported findings were compared with neurologic examination findings and presence and severity of SM on MRI.

Results

Thirty‐three dogs were symptomatic and 17 asymptomatic; 30 had SM. The most common sign of pain was crying out when lifted (n = 11). Extent of shaded areas on maps positively correlated with questionnaire scores for pain (r² = 0.213, P = 0.006) and scratch (r² = 0.104, P = 0.089). Owner‐reported findings were not significantly associated with presence or severity of SM or neurologic examination findings. Owner‐reported lateralization of signs was significantly associated with SM lateralization (P < 0.0001).

Conclusions

The questionnaire and maps may be useful for clinical trials. Lack of association of owner‐reported signs with SM highlights our lack of understanding of the pathophysiology of pain in this disease.     

Mitral valve and tricuspid valve dysplasia in a 9‐week‐old Standardbred colt

A 9‐week‐old Standardbred colt was presented for investigation of dull demeanour, exercise intolerance and heart murmurs. Cardiac auscultation revealed a grade 5/6 holosystolic murmur and a grade 5/6 pansystolic murmur over the left and right cardiac apex respectively, and an irregularly irregular cardiac rhythm. Electrocardiographic examination findings were consistent with atrial fibrillation and tachycardia. Echocardiographic examination identified marked atrioventricular regurgitation and atrial dilation bilaterally, thickening of the mitral and tricuspid valves and dilation of the pulmonary artery consistent with pulmonary hypertension. No ventricular or atrial septal defect was present. Cardiomegaly and diffuse pulmonary oedema were evident on examination of lateral thoracic radiographs. Dysplasia of the mitral and tricuspid valves, eccentric cardiomegaly and pulmonary oedema were confirmed by post mortem examination. Dysplasia of the atrioventricular valves represents a rare cause of biventricular failure in the horse.     

Cladosporium cladosporioides‐complex infection in a mixed‐breed dog

A 3‐year‐old female mixed‐breed dog was referred with a 2‐day history of serious dyspnea, coughing, lethargy, anorexia, and a low‐grade right anterior lameness. At presentation, the dog had an increased respiratory rate, dull heart and lung sounds, and cyanotic mucous membranes. It was hyperthermic and slightly dehydrated. Laboratory findings showed mild neutrophilia with a left shift, while serum biochemistry variables were in the normal range. However, urinalysis revealed mild proteinuria and rare erythrocytes and leukocytes on sediment examination. Thoracic radiographs showed a diffuse mixed interstitial and alveolar pattern with an air bronchogram, while appendicular radiographs showed a right humeral interrupted brush‐like periosteal reaction. Thoracic ultrasonography revealed mediastinal lymph node enlargement. Cytology from a fine‐needle aspirate of mediastinal lymph nodes revealed a pyogranulomatous lymphadenitis with numerous fungal hyphae. Culture on Sabouraud dextrose agar isolated dark fungal colonies with microscopic features consistent with Cladosporium spp. Sequencing of the internal transcribed spacer region identified the fungus as a species of the Cladosporium cladosporioides‐complex.     

Aortic rupture causing cardiac tamponade in a 24‐day‐old Friesian colt with concurrent colonic Chlamydiosis and Balantidiasis

A 24‐day‐old Friesian colt died suddenly and a physical examination the morning the foal died showed no abnormalities and serum IgG levels >8.0 g/l. Necropsy examination revealed haemopericardium and a 2 cm transverse tear at the root of the aorta. The foal was also found to have Chlamydophila spp. in the epithelium and Balantidium coli on the mucosal surface of the large colon. An aortic rupture is a novel finding in a foal, colonic Chlamydiosis has not been previously reported in horses and Balantidium coli has not been reported in equids in North America.     

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.     

FC‐54 Evaluation of IgE‐mediated late‐phase reactions in the skin of normal placebo‐ and prednisolone‐treated dogs: cellular,cytokine and chemokine responses

IgE‐mediated late‐phase reactions can be induced in the skin of normal and atopic dogs by intradermal injections of anti‐IgE antibody. The histology of these reactions is very similar to that of naturally occurring atopic dermatitis. To characterize the cellular, cytokine and chemokine responses in the skin of placebo‐ and prednisolone‐treated dogs, normal beagles received either placebo or 0.5 mg/kg prednisolone twice daily for three days prior to intradermal injection of polyclonal rabbit anti‐canine IgE. Eight‐millimetre punch biopsy skin samples were taken before injection and at the injection sites after 6, 24 and 48 h. Histological and immunohistochemical examination revealed a rapid cellular influx. Eosinophil and neutrophil numbers increased from <1 to 61.4 ± 14.1, and from 7 to 62.2 ± 10.8 cells/mm², respectively, within 6 h after injection, and remained moderately elevated 48 h later. The numbers of CD1c+, CD3+ and CD4+ mononuclear cells were also increased by 6 h. Taqman analysis demonstrated 2.5‐ to 72‐fold increases in mRNA expression for IL‐13, IL‐5, MCP (CCL2), RANTES (CCL5) and TARC (CCL17). Levels of mRNA for IL‐2, IL‐4, IL‐6, and IFNγ remained negligible. Prednisolone administration suppressed the influx of neutrophils and eosinophils, and the expression of IL‐13, CCL2, CCL5 and CCL17 (33, 97, 58, 86, 73 and 90%, respectively), as well as the influx of CD1c+ and CD3+ cells. These data document the cytokine and chemokine response to anti‐IgE injection and demonstrate the anti‐inflammatory effect of prednisolone. Funding: Schering‐Plough Animal Health.     

Primary hyperparathyroidism in a 17‐year‐old Arab × Welsh Cob pony mare with a functional parathyroid adenoma

Primary hyperparathyroidism was identified in a 17‐year‐old Arab × Welsh Pony mare that experienced weight loss for 6 months and was presented with mild facial asymmetry, right forelimb lameness and weight shifting amongst all limbs. Osteodystrophia fibrosa was demonstrated on radiographic examination of the head and there was radiographic evidence of osteopenia of the appendicular skeleton. The horse had persistent hypercalcaemia (4.0 mmol/l), hypophosphataemia (0.59 mmol/l) and an increased concentration of circulating parathyroid hormone (1401 pg/ml). On scintigraphic examination, a subjective focal increase in uptake of ^99mtechnetium‐sestamibi was identified in the right thyroid gland and at the thoracic inlet in delayed images. Surgical exploration of the thyroid region was unrewarding, whereas surgery at the thoracic inlet was not undertaken. One year later, the horse developed a pathological fracture of the third metacarpal bone and was subjected to euthanasia. At post mortem examination, a parathyroid adenoma was found at the level of the thoracic inlet adjacent to the trachea. Gross and histological examination also confirmed severe osteodystrophia fibrosa and osteopenia.     

Erythrophagocytic low‐grade extranodal T‐cell lymphoma in a cat

Abstract: A 13‐year‐old male castrated domestic shorthair cat was presented to the referring veterinarian with a 2‐month history of weight loss and lethargy. Splenomegaly, hepatomegaly, nonregenerative anemia, neutropenia, and hyperbilirubinemia were noted. Results of testing for feline immunodeficiency virus, feline leukemia virus, Toxoplasma gondii, and Mycoplasma sp. were negative. On cytologic examination of aspirates from the enlarged spleen and liver, a population of erythrophagocytic round cells was observed. Splenectomy and a liver biopsy were done which revealed a population of CD3+/CD79a– erythrophagocytic mononuclear round cells localized in the hepatic and splenic sinusoids. T‐cell PARR (PCR for antigen receptor gene rearrangements) analysis of bone marrow and spleen demonstrated a single band indicative of a clonal proliferation of T cells. Based on the marked splenomegaly, sinusoidal infiltration, lack of lymphadenopathy, and results of cytology, PARR, and immunophenotyping, a diagnosis of low‐grade extranodal T‐cell lymphoma was made. The cat was treated with chlorambucil and prednisolone; clinical and laboratory abnormalities resolved and the cat has remained clinically normal for 2.5 years. To our knowledge, this report documents the first case of an erythrophagocytic T‐cell lymphoma in a cat. The clinicopathologic findings were suggestive of hepatosplenic T‐cell lymphoma, a neoplasm described previously only in humans and dogs.     

Treatment of sustained monomorphic narrow‐complex ventricular tachycardia in a 16‐year‐old Arab mare with a constant rate of infusion of lidocaine and oral propranolol

A 16‐year‐old Arab mare was referred for treatment of a tachydysrhythmia detected on electrocardiogram by the referring veterinarian. Monomorphic, narrow‐complex ventricular tachycardia (VT) was confirmed by electro‐cardiogram in a normal base‐apex configuration. Subsequent diagnostic testing, including echocardiography and measurement of plasma cardiac troponin concentration, did not reveal a definitive cause for the dysrhythmia. Conversion of VT to ventricular bigeminy occurred following treatment with magnesium sulfate and lidocaine hydrochloride, administered intravenously. Treatment with orally administered propranolol subsequently led to conversion to sinus rhythm with intermittent ventricular premature complexes (VPCs). Oral prednisolone treatment was also initiated to address the possibility that VT resulted from underlying myocarditis. The mare was discharged with oral propranolol, a tapering course of prednisolone, and exercise restriction. Follow‐up cardiac examination 6 weeks later revealed persistent, intermittent VPCs and reversion to VT occurred during exercise. Sinus rhythm with intermittent VPCs was re‐established following the administration of lidocaine. The mare was again discharged with oral propranolol therapy, which was subsequently replaced with oral sotalol. Sudden death occurred 4 weeks later but a post mortem examination was not performed.     

Caecal duplication in a 13‐year‐old Thoroughbred

A 13‐year‐old Thoroughbred gelding was presented for evaluation of recurrent colic of 4 weeks duration. These colic episodes were mild and responsive to medical therapy. Episodes of colic became more frequent and more painful. Exploratory laparotomy revealed a large intestine duplication with a cystic structure located at the caecocolic junction that was unable to be exteriorized and therefore not amenable to surgical correction. Thirty‐six hours following surgery, the horse became acutely painful, sweaty, and febrile suggesting gastrointestinal rupture. Post mortem examination showed a 0.6 × 1 m duplication and a 0.5 × 0.6 m cystic dilation that was probably associated with the caecum. There was a 10 × 30 cm area of rupture located within the duplication. Histological evaluation confirmed the presence of a true duplication.     

Nonregenerative immune‐mediated anemia associated with a diffuse large B‐cell lymphoma in a captive jaguar (Panthera onca)

An 18‐year‐old male castrated jaguar (Panthera onca) was presented with anorexia and continuous bleeding from the oral cavity after a history of fighting with the partner animal. Clinical evaluation revealed ulcerating lesions on the gingiva and hard palate and a hematoma on the tongue. Computed tomography of the head and endoscopic examination of the esophagus and stomach were unremarkable. Hematology and clinical chemistry revealed severe nonregenerative anemia, mild thrombocytopenia, and moderate azotemia. Several PCRs for feline hemotropic mycoplasmas (Mycoplasma haemofelis, M heamominutium, M turicensis), Babesia felis, and Bartonella spp., as well as an FeLV antigen test were negative. The cytologic examination of a bone marrow aspirate was consistent with ineffective erythropoiesis, most likely due to immune‐mediated destruction of the erythroid precursor cells. Prednisolone therapy was initiated (1.25 mg/kg/day), and the CBC returned to normal 16 days after the initiation of the therapy. Anemia relapsed after 4 months and severe splenomegaly was noted. A repeat bone marrow aspirate revealed active erythropoiesis in the presence of erythroid precursor phagocytosis suggesting an immune‐mediated process. Splenic fine‐needle aspiration and tissue biopsies were taken, and all findings including histology and immunohistochemistry were consistent with a diffuse large B‐cell lymphoma (DLBCL). Five days later, the clinical condition deteriorated and the jaguar died. Histopathology following necropsy showed infiltration with neoplastic lymphoblasts in the spleen, liver, and abdominal lymph nodes. This case report describes a nonregenerative immune‐mediated anemia associated with a DLBCL in a jaguar.     

Dominant follicles development and estradiol‐17β concentrations in non‐ovulating and ovulating post‐partum Bulgarian Murrah buffaloes

This study was designed to evaluate the dominant follicles development and the estradiol‐17β concentrations in non‐ovulating and ovulating post‐partum buffaloes. Sixteen Bulgarian Murrah buffaloes were submitted to transrectal ultrasonographic examination from the 1st post‐partum day until day 50, 3 days apart. The follicular diameter of the different categories of follicles and the ovulations was recorded. The animals were allocated into two groups: I (n = 6) non‐ovulating and II (n = 10) ovulating buffaloes. Serum estradiol‐17β concentrations on the days for dominant follicle registration were measured by enzyme‐linked immunosorbent assay. The results were statistically processed by analysis of variance, non‐parametric and correlation analysis. The mean intervals between calving and first dominant follicle detection differed significantly (p < .05) among the groups (19.5 ± 6.2 vs. 13.8 ± 5.1 days), while the mean intervals between registered dominant follicles from two successive waves were comparable. The mean follicular diameters for the same category follicles in both groups were similar. Different estradiol‐17β concentrations (p < .05) for the first dominant follicle between non‐ovulating (23.5 ± 7.0 pg/ml) and ovulating (33.3 ± 8.4 pg/ml) buffaloes were determined. The cumulative percentages of buffaloes with firstly detected dominant follicle and ovulating animals correlated positively (r ≥ .84; p < .05) to post‐partum days. In conclusion, non‐ovulating and ovulating post‐partum Bulgarian Murrah buffaloes showed differences in the development of the first dominant follicle and estradiol‐17β concentrations during the time of dominant follicles detection.     

Keratitis and periocular lesions associated with equine herpesvirus‐3 in a 3‐month‐old filly

A 3‐month‐old Quarter Horse filly presented with corneal ulceration in the right eye with extensive coalescing periocular ulcerations, erosions, and cutaneous crusts. Similar periocular lesions were present around the left eye, on the gingival mucosa, and on the cutaneous and mucosal surfaces of the lips. Based on the severity of the filly's corneal lesions, expense and duration of treatment, euthanasia was elected. Histological post mortem examination revealed numerous hyperplastic and/or dysplastic epithelial cells adjacent to areas of ulceration and erosion with intranuclear viral inclusion bodies. Equine herpesvirus‐3 (EHV‐3) was identified by polymerase chain reaction from the right cornea and lip. The virus was isolated from the right cornea, right eyelid and lip. The dam presented with multifocal to coalescing perineal vesicles. EHV‐3 was confirmed by polymerase chain reaction from the vulvar lesions and the mare recovered spontaneously. This is the first case of EHV‐3 corneal infection reported in horses and emphasises that EHV‐3 should be included as a differential diagnosis for vesicular lesions involving the equine periocular and oronasal epithelium.     

Recurrent colics in a 9‐year‐old Arabian stallion due to several congenital anomalies

A 9‐year‐old Arabian stallion was presented for evaluation of recurrent colic problems of 2 years' duration. These colic episodes were associated with a right sided abdominal distension. An exploratory laparotomy revealed a colonic diverticulum that was resected en bloc. Two days later, following signs of acute colic, a second laparotomy showed incarceration of the distal jejunum into a mesodiverticular band combined with haemorrhage of a mesenteric arterial branch. In addition, an abnormally short jejunum (10 m) was also observed. An end‐to‐end jejunojejunostomy was performed. Following surgery the horse developed septic peritonitis, ptyalism and became dysphagic. Ten days after the second surgery, an infected oesophageal diverticulum causing regional inflammation was diagnosed endoscopically and euthanasia was performed. Post mortem examination showed a 40 cm long diverticulum lateral to the oesophagus. Histology suggested a congenital nature of the colonic and oesophageal diverticuli.     

Congenital Abnormality of the Vagina Complicated by Haemato‐Pyocolpos in a 1‐Year Labrador Retriever

A 1‐year‐old female Labrador retriever was referred with a few days history of haematic‐like vulvar discharge. Physical examination, vaginal inspection and palpation did not reveal any remarkable finding. Transabdominal ultrasound showed echogenic fluid accumulation in the vagina suggesting haemato‐pyocolpos. An exploratory laparotomy was performed: a well‐delimited ectasic vagina was identified. Ovariohysterectomy and partial vaginectomy and vaginoplasty were performed to spay the bitch and to remove the ectasic vagina. Post‐operative recovery and 12‐month follow‐up were uneventful. Clinical, morphological and histological findings were consistent with a congenital abnormality of the muscular layer of the vagina complicated by haemato‐pyocolpos. The disorganization of the vaginal tunica muscularis may have acted as locus minoris resistentiae in the vaginal wall. The organ was dilated and atonic due to the gradual accumulation of physiological fluids complicated by an overgrowth of genital bacteria. This congenital disorder has to be taken into account as differential diagnosis of haemato‐pyocolpos with vaginal discharge in young bitches.     

Stress Response of Veterinary Students to Gynaecological Examination of Horse Mares – Effects of Simulator‐Based and Animal‐Based Training

Invasive procedures in animals are challenging for veterinary students who may perceive a gynaecological examination of mares as stressful. Simulator‐based training may reduce stress. In this study, students received equine gynaecology training 4 times either on horses (group H; n = 14) or a teaching simulator (group SIM; n = 13). One day and 14 days thereafter, their diagnostic skills were tested on horses (skills tests 1 and 2). During the skills tests, the students’ stress response was analysed by heart rate, heart rate variability (HRV) parameters SDRR (standard deviation of beat‐to‐beat [RR] interval) and RMSSD (root‐mean‐square of successive RR differences), and salivary cortisol. In addition, students answered a questionnaire on their perceived stress. Sympathetic activation with increased heart rate (p < 0.001) occurred in both skills tests. In test 1, this increase was more pronounced in SIM than in H students (time × group p < 0.01). HRV decreased in students of both groups (p < 0.001). In skills test 1, this decrease was more pronounced for SIM than for H students (between groups and time × group p < 0.01 for SDRR and p < 0.05 for RMSSD). High cortisol concentrations before the skills tests may indicate an anticipatory stress response. Subjective stress perception of students was higher in skills test 1 vs 2 (p < 0.01). In skills test 2, H students felt more stressed than SIM students (p < 0.01). Self‐assessment thus differed from physiological stress parameters. In conclusion, gynaecological examination of mares evoked a moderate stress response in veterinary students, which was more evident after simulator‐based than animal‐based training.     

Ataxia and weakness as uncommon primary manifestations of hepatic encephalopathy in a 15‐year‐old trotter gelding

A 15‐year‐old trotter gelding was evaluated because of an acute onset of ataxia in all 4 limbs. There was no known history of trauma. The gelding showed grade 2/5 ataxia in all 4 limbs, which was localised after clinical neurological examination to the cervical vertebral spinal cord. Initial therapy consisted of oral anti‐inflammatory doses of prednisolone and antimicrobial treatment with potentiated sulphonamides. The ataxia progressed to grade 3/5 at Day 10 of hospitalisation. Additionally, the horse was slightly depressed and showed spontaneous yawning during examination. Facial sensation was blunted. Blood chemistry revealed a marked elevation of liver specific enzymes and blood ammonia levels. Transcutaneous abdominal ultrasonography revealed hepatomegaly. Due to a guarded prognosis, the horse was subjected to euthanasia. At necropsy the left lateral liver lobe was markedly enlarged and showed a firm texture, whereas the cranial part and the right and quadratic liver lobe displayed a severe and diffuse atrophy. Histopathologically, the left lateral liver lobe revealed a moderate to severe cirrhosis with a severe, diffuse hepatocellular iron‐accumulation. Increased numbers of Alzheimer type II astrocytes in the cerebral cortex and cerebral white matter vacuolisation were indicative for encephalopathy. These findings were interpreted as haemosiderosis and cirrhosis of the liver with consecutive hepatic encephalopathy. Aetiologically, haemosiderosis should be considered as a cause of liver cirrhosis with consecutive hepatic encephalopathy. Although hepatic encephalopathy in horses usually presents with predominating cerebral signs, it has to be taken into account as a differential diagnosis in cases of acute onset generalised ataxia.     

Immunohistochemical Detection of Mycoplasma agalactiae in Formalin‐Fixed,Paraffin‐Embedded Tissues from Naturally and Experimentally Infected Goats

Samples from the mammary tissue of 14 lactating goats (12 naturally infected and two experimentally infected) were examined for the presence of Mycoplasma agalactiae. A monoclonal antibody (5G12) was applied to formalin‐fixed, paraffin‐wax‐embedded sections and labelled by the avidin–biotin peroxidase complex (ABC) method. Histological examination of tissue sections revealed strong immunoreactivity in all animals included in the study. Mycoplasma agalactiae antigen was mainly detected in the cellular debris at the periphery of purulent exudates present within lactiferous sinuses, and lactiferous and interlobular ducts. In addition, M. agalactiae organisms appeared in the cytoplasm of the epithelium of ducts, and in infiltrating macrophages and neutrophils within the ducts, alveoli, interstitial tissue and regional lymph node sinuses. It is concluded that this monoclonal antibody‐based immunohistochemical technique is an efficient and specific method for the post‐mortem detection of M. agalactiae in cases of clinical mastitis as well as being a useful tool for the study of the route of infection and cellular types involved during mastitis caused by this organism.     

Systemic Scedosporium prolificans infection in an 11‐month‐old Border collie with cobalamin deficiency secondary to selective cobalamin malabsorption (canine Imerslund‐Gräsbeck syndrome)

An 11‐month‐old Border collie presented collapsed and continued to deteriorate rapidly despite supportive treatment. The dog had a history of failure to thrive and recurring respiratory infection. Laboratory abnormalities included neutrophilic leucocytosis, Heinz body anaemia, hyperammonaemia, hyperbilirubinaemia, proteinuria and hypocobalaminaemia. Post‐mortem examination revealed multi‐focal necrosis within the heart, kidneys, pancreas, liver, meninges and cerebral cortex. Fungal hyphae in lesions were identified as Scedosporium prolificans following culture. Subsequent genotyping confirmed that the dog carried the CUBN:c.8392delC mutation in a homozygous state, verifying hereditary cobalamin deficiency (a.k.a. Imerslund‐Gräsbeck syndrome). Cobalamin deficiency may have been a predisposing factor for the development of systemic fungal infection in this dog.     

Antemortem diagnosis of congenital glaucoma in a white‐bellied caique (Pionites leucogaster)

A 34‐day‐old, male, white‐bellied caique (Pionites leucogaster) was presented for a complaint of bilateral buphthalmos. Clinical examination was unremarkable apart from the ophthalmic findings. The ophthalmologic examination was negative for direct, consensual, and dazzle reflexes in both eyes. The intraocular pressure exceeded 40 mm Hg OU. Fluorescein stain demonstrated corneal surface lesions suggestive of exposure keratopathy subsequent to bilateral buphthalmos. Diagnostic imaging tests were conducted to perform ocular biometric measurements and investigate the intraocular structures, including the iridocorneal angle and lens, by means of high‐resolution ultrasonography (HRUS). The presence of congenital glaucoma in this young parrot was strongly suspected after clinical and ophthalmological examination and the results of diagnostic imaging. Pharmacological treatment to reduce intraocular pressure was initiated using dorzolamide hydrochloride 2% and timolol maleate 0.5%. A month later, the parrot's eyes did not show any visual improvement, but the intraocular pressure had returned to normal. The parrot was unable to feed itself and died during a feeding procedure. Postmortem examination revealed ab ingestis pneumonia. Both eyes were submitted for histopathology, with severe anterior segment dysplasia and goniodysgenesis found OU. Histological findings added to the clinical presentation, the ophthalmologic examination and the imaging findings, confirmed the presence of congenital glaucoma.