Feline Aortic Thromboembolism Diagnosed by Thermography

Background: In cats, arterial thromboembolism is one of the most devastating diseases, with an acute presentation, and is often caused by undiagnosed cardiomyopathy. Defined as the obstruction of one or more arterial lumens by emboli, the arterial thromboembolism is responsible for hypoperfusion signs. As the temperature of the skin surface is directly related to tissue perfusion,thermography can be promising for the early diagnosis of thromboembolism. Therefore, this study reports the importance of thermography as a complementary examination for the diagnosis of thromboembolism in the abdominal aorta of a domestic cat.Case: A 4-year-old mixed-breed cat weighing 2.95 kg was presented with a history of sudden onset paraplegia, apathy, and pain when handled, with greater intensity in the sacro-coccidian region. During physical exam, it was noted that the femoral artery pulse was undetectable bilaterally during manual pulse measurement. Superficial and deep sensitivity in the pelvic limbs and proprioception were also absent and the plantar cushions and nail beds of the posterior limbs were pale to cyanotic. Thermographic images revealed that the temperature of both hind limbs was lower than that of forelimbs, with difference of 3.2ºC and 2.9ºC between the left and right limbs, respectively. Doppler ultrasonography revealed the absence of pulse and flow in the femoral arteries bilaterally. Electrocardiography revealed sinus tachycardia, with a heart rate of 250 bpm. Echocardiography revealed dilation of the left atrium and concentric cardiac hypertrophy. After 24 h, due to the worsening of the clinical condition and unfavorable prognosis, the animal was euthanized and sent for necropsy. Necropsy revealed that the arterial lumen of the caudal abdominal aorta and bifurcation of the iliac arteries were obliterated, with a 0.6 cm saddle thrombus adhered to the arterial wall. In addition, left ventricular thickening indicative pf hypertrophic cardiomyopathy was observed. In the left atrium, a thrombus was observed that filled the entire chamber.Discussion: Thermography is a fast and non-invasive method, and therefore, it is a tool of great relevance in emergencies. Previous study showed that a minimum temperature difference of 2.4°C between the affected and unaffected limbs has excellent specificity and high sensitivity for the diagnosis of feline aortic thromboembolism. In this report, the temperature differences between the affected and unaffected limbs on the left and right sides were found to be 3.2°C and 2.9°C, respectively, corroborated this finding. Cats with cardiomyopathies are predisposed to the development of thrombi, and rarely manifest heart disease. Here, the cat was diagnosed with hypertrophic cardiomyopathy during the diagnostic investigation for arterial thromboembolism, which is consistent with the usual findings because feline hypertrophic cardiomyopathy progresses silently with few clinical manifestations in the early stages. Clinical diagnosis of arterial thromboembolism can be made based on the presence of some physical examination findings, such as pain and paralysis of the affected limbs, absence of a femoral pulse, cold extremities, and pale or cyanotic cushions. In this report, thermography proved to be an accurate, quick, and non-invasive method for the assessment of vascular alterations that affected the pelvic limbs of the cat. Complementary examinations confirmed the presence of hypertrophic cardiomyopathy and necropsy revealed the presence of thrombus.Keywords: cyanosis, hypertrophic cardiomyopathy, ischemia, temperature

Polymyositis Associated with Brainstem Signs in a Dog

Background: Polymyositis is a generalized inflammatory myopathy which can lead to rhabdomyolysis. This affection may have several origins, including degenerative, metabolic, autoimmune, or infectious inflammation, ischemic, traumatic, by drug use, induced by toxins and also of idiopathic origin. Diagnosis is made with seric dosage, electrodiagnostic tests and muscle biopsy. Lesions in the rostral oblong medulla may affect the central vestibular system, and there may be signs such as opisthotonos, nystagmus, and strabismus. The aim of this report is to describe a case of a mixed breed dog with manifestation of polymyositis associated with brainstem signs of probable idiopathic origin. Case: A 5-year-old mixed breed male dog was attended with opisthotonos episodes for 2 days, and pelvic limbs extension and thoracic limbs flexion that lasted 10 to 20 min at intervals of approximately 1 h. The animal was anorexic and had also presented one episode of emesis. Upon neurological examination, ventromedial strabismus and Horner’s syndrome was observed on the right side, besides vertical nystagmus, flaccid tetraparesis and absence of proprioception in the four limbs. Biochemical analyses revealed creatine kinase (CK) increased (2,433,9 UI/L - reference: 1.5-28.4 UI/L), and urinalysis showed presence of occult blood without erythrocyturia and dark colored urine. Electrocardiogram (ECG) showed QS wave and deviation of the electrical axis. Treatment with prednisolone (1 mg/kg, BID), phenobarbital (2 mg/kg, BID), maropitant citrate (1 mg/kg in 2 doses), and crystalloid fluid therapy (50 mL/kg/day) were prescribed. On the 4th day, the dog was more active and feeding without a tube, so it recommended keep the treatment at home. On the 10th day, the animal had proprioception present on the 4 limbs and normorexia. Biochemical analyses and urinalysis showed no alterations, but normochromic normochromic anemia with thrombocytopenia and leukocytosis by neutrophilia showed in blood count exam. PCR to Ehrlichia canis, Hepatozoon sp., and Babesia canis resulted negative. On the 15th day, blood count, biochemical analyses and urinalysis showed no alterations. Neurological examination revealed only positional vertical nystagmus. which remained as a sequel. Discussion: Polymyositis may be accompanied by rhabdomyolysis, characterized by acute muscle necrosis, increased CK and myoglobinuria. The animal had polymyositis of acute onset, with myoglobinuria and elevated CK values, whose presentation included myalgia and muscle weakness. In humans, polymyositis is accompanied by changes in electrocardiographic tracing without clinical alterations. In dogs, the first report that showed cardiac involvement was compatible with myocarditis. The changes in ECG in the present case was attributed to failure in myocardial electrical conduction. The patient also showed signs of brainstem and central vestibular system injuries. Stress myopathy, intoxication, snakebite, infectious and metabolic diseases were discarded leading to a clinical suspicion as idiopathic origin. Similar to a published case, the patient of this report received symptomatic and supportive treatment, being discharged from the hospital 20 days after the onset of clinical signs. Thus, polymyositis may be accompanied by signs indicative of brainstem injury. Patients with rhabdomyolysis require intense monitoring due to the high risk of developing acute renal failure. Since no causative agent was identified, symptomatic treatment combined with the prevention of possible complications were fundamental for the maintenance of the animal's life. Keywords: myoglobinuria, rhabdomyolysis, Horner’s syndrome

Exogenous Tracheal Bone Structure in a Cat

Background: Acute dyspnea is a clinical emergency with a presentation similar to several etiologies. Cats are usually referred with complaints of anorexia, abdominal breathing, cyanosis, and open mouth breathing, and veterinarians should stabilize the animals as soon as possible. The incidence of aspiration of foreign bodies is low, particularly in this species. The diagnosis consists of observing the foreign structure in the lumen of the trachea, commonly performed using radiography or bronchoscopy. This report describes a case of a feline with a tracheal foreign body, with a detailed description of the clinical findings and successful treatment.Case: A 10-year-old female feline exhibited severe dyspnea and cyanosis. During the anamnesis, the owner stated that the clinical signs suddenly presented one day prior, after the animal ingested a piece of fish. Physical examination revealed changes in pulmonary auscultation, which was bilaterally muffled, and intense respiratory distress, as observed by the evident signs of exhaustion (sternal decubitus, reduced muscle tone), in addition to cyanotic mucous membranes. The animal was intubated and maintained under anesthesia with propofol infusion and respiratory support (ambu) for 1 h, during which complementary examinations were performed. Chest radiography showed the presence of a radiopaque structure (approximately 0.5 cm) in the tracheal region. Thus, we decided to remove the structure using bronchoscopy. The foreign body was located above the main bronchial bifurcation and was removed. There was an improvement in oxygenation after 20 min of maintenance of ventilatory support, followed by weaning of the animal's successful respiratory support. Antibiotic therapy and analgesia were prescribed at home, and the animal exhibited full recovery after 10 days.Discussion: Dyspnea is a clinical sign that should be treated as an emergency, as it is associated with high mortality. In these cases, positive pressure ventilation is indicated in three situations: persistent hypoventilation, severe hypoxemia unresponsive to oxygen therapy, and excessive respiratory effort or fatigue. Dyspnea may be due to impairment of the upper or lower airway or restrictive conditions. Clinically, felines with tracheal foreign bodies have a sudden onset of dyspnea, tachypnea, cough, and lethargy. In these patients, the reduction in lung sounds is a common finding, as observed in the present case. The occurrence of tracheal foreign bodies in cats is rare and, depending on the type of foreign body and its location in the airway, complete obstruction of the respiratory tract may occur. In the present case, it was possible to observe the foreign body in the trachea on radiographic images. Felines with tracheal foreign bodies generally present a structure located close to the carina, as observed in the present case. Bronchoscopy using a flexible or rigid tube is considered the gold-standard technique for removing foreign bodies from the respiratory tract, and the greatest difficulty during the removal procedure is ensuring that the airways are not obstructed by the instruments used. The use of these materials is not free of complications, as they may be responsible for the development of pneumothorax, pneumomediastinum, dyspnea, and respiratory failure. In the present case, there were no complications during or after the procedure, and the patient recovered completely

Liver Cysts in a Kitten with Platynosomum sp.

Background: Hepatic cysts are rarely described in association with infections by Platynosomum sp. Infected animals are most often asymptomatic, and the severity of symptoms is associated with the number of biliary tract parasites, which may lead to cholangitis and cholangiohepatitis. Although platinosomiasis is often associated with cholangitis and cholangiohepatitis, it rarely is with polycystic disease. For the parasite’s life cycle to occur, the infected cat must eliminate the eggs in the feces and three intermediate hosts are needed: snails, terrestrial isopods and vertebrates like the frog or the gecko. The eggs are ingested by the snails, then the miracids are released and matured into the mother sporocyst form, which originates child sporocysts containing the cercariae, that leave the mollusks for the soil and are ingested by the terrestrial isopod in which the cercariae matures until metacercariae. Vertebrates ingest terrestrial isopods and are ingested by felines. The present study aimed to report an unusual case of platinosomiasis with the development of multiple hepatic cysts.Case: A mixed breed male kitten was admitted with a history of apathy, hyporexia, increased abdominal volume and jaundice. In the ultrasound examination, we could see hepatomegaly and several hypoecogenic rounded structures, similar to cysts. There was an increase of serum concentration of the hepatic enzymes alanine transaminase and gamma glutamyl transferase enzyme. The parasite’s eggs were investigated in the patient’s feces using the simple sedimentation method, with a negative result. The animal was submitted to celiotomy and it was possible to observe several cystic structures in the liver. The cysts content was sent to cytology and culture. Cytology result was compatible with liver cyst and there was no bacterial growth in the culture. Bile fluid was collected and sent for Platynosomum sp. research using the centrifugal sedimentation test in formalin-ether solution, which allowed the parasite’s eggs to be observed. The cat was treated with praziquantel,silymarin, S-Adenosyl methionine, and ursodeoxycholic acid. The patient gradually improved from jaundice and there was a reduction in abdominal volume. Discussion: This report describes a case of platinossomiasis associated with polycystic liver disease in a domestic cat, which seems to be an uncommon presentation. Most infected cats are asymptomatic, but some animals may exhibit anorexia, apathy, increased abdominal volume due to hepatomegaly and/or ascitis and jaundice. Although infestation in domestic cats is relatively common, its association with liver cysts is rare or poorly reported in the literature, representing a diagnostic challenge, which makes mandatory the inclusion of this differential diagnosis in polycystic liver diseases in cats. The diagnosis of this parasitosis can be made based on the association among clinical signs, laboratory tests and ultrasound examination, but the definitive diagnosis is usually made by visualizing the parasite’s eggs. In the case described, it was not possible to observe parasite’s eggs in the patient’s feces, but in the bile. Platynosomum sp. infection should always be considered as a differential diagnosis in cases of polycystic liver disease in cats, especially in countries with tropical or subtropical climate. Early diagnosis and appropriate treatment were fundamental for the improvement of the patient’s clinical condition.Keywords: feline, liver, platinosomiasis, polycystic disease, jaundice, cystic lesions

Pneumocephalus and Suppurative Meningoencephalitis in a Dog after Craniofacial Trauma

Background: Pneumocephalus is characterized by the presence of gas in the intracranial compartment, and it can develop because of trauma or craniofacial surgery or spontaneously. Clinical signs start within days or months after the injury and vary according to the site of involvement. Computed tomography is the ideal diagnostic tool, however skull radiography can also be used. Treatment varies according to the severity of the case, and it can be conservative or associated with surgical intervention in the most severe cases. The purpose of this report is to describe the case of a dog that developed pneumocephalus and suppurative meningoencephalitis after head trauma caused by a bite from another dog. Case: A 2-month-old bitch, mixed breed, with 3.2 kg, was referred to the veterinary hospital because it had been bitten on the head by another dog. Shortly after the incident, the animal showed no clinical signs. However, 2 days later, the bitch became depressed and in persistent lateral decubitus. A lesion with a crust of approximately 0.5 cm was found close to the occipital region, with bone irregularity on palpation. The animal was in lateral decubitus with muscular hypotonia, bilateral mydriasis unresponsive to light and stupor. Radiographic images showed parietal fracture and pneumocephalus. Based on the findings of physical and laboratorial exams, diagnosis of suppurative meningoencephalitis and pneumocephalus secondary to craniofacial trauma was established. Empirical broad-spectrum antimicrobial therapy was started in addition to mannitol, corticoids, and analgesics. The animal was referred for surgical debridement by trepanation, when samples were collected to bacterial culture, which was negative. Despites the care, the animal died 14 h after the surgical procedure. Histopathological examination of the frontal cortex was performed, being the histological changes compatible with suppurative meningoencephalitis. Discussion: Dog bites on the head and neck are particularly severe, and can create intracranial bleeding, disfigurement of the face, damage to peripheral structures or cranial fractures. In this report, through radiographic images, it was found that the patient had an intracerebral aerocele, since there was presence of gas in the intracranial compartment. This alteration should always be considered in animals with neurological alterations and a history of craniofacial trauma. The main neurological changes observed in the reported case were unresponsive to mydriasis and altered mental status 2 days after the trauma, and this delay in the onset of clinical signs is frequently reported in cases of pneumocephalus. Neutrophilia and leukocytosis observed can be justified by the suppurative meningoencephalitis, confirmed by the histopathological exam. Antimicrobial therapy should be started as soon as possible, and the choice must be based on their capacity to cross the blood-brain barrier and the broad spectrum. The administration of antibiotics before collecting the material for bacterial culture may explain the negative result of this test, so that it is not possible to determine whether the intracranial gas observed on the radiograph may have developed from the trauma or because of gas-producing bacteria. Head trauma can induce suppurative meningoencephalitis and pneumocephalus even in the absence of perforating wounds at the time of the consultation. The neurological signs can start days after the trauma. Besides the clinical and surgical treatments, the prognosis of any bacterial infection of the central nervous system is poor. Keywords: aerocele, brain syndrome, Glasgow scale, radiography, trepanation.

Eosinophilic Folliculitis in a Dog

Background: Canine eosinophilic folliculitis is a dermatological disease of acute onset with development of erosive to ulcerative papular lesions, especially on the nasal bridge, that may cause severe skin abnormalities leading to discomfort and pain to the patient. The aim of this report was to characterize a case of a canine eosinophilic folliculitis with papular, ulcerative and crusting dermatitis on the nasal bridge, papules on eyelid and pinna, with confirmed diagnosis based on aspiration cytology, history and response to immunosuppressive therapy with glucocorticoid.Case: A 1-year-old intact Daschund was attended showing an acute onset (over 4 h) of generalized urticarial reaction and nonpruriginous lesion at the muzzle with mild serosanguineous exudate, which persisted for 96 h when the dog was evaluated. It was observed a papular and ulcerative dermatitis with serosanguineous exudate and hematic crusts at nasal bridge, papules measuring 2 mm in diameter in the medial and lateral canthus of the left eyelid, ulcerative papule with hematic crust in the border of left ear pinna, multifocal papules on the skin, dyskeratosis and generalized hair loss. The patient was anesthetized for blood sampling (CBC and serum biochemistry), lesions fine-needle aspiration, scraping and imprint for cytological examination, bacterial culture and nasal turbinates radiography. Fragments for histopathological evaluation were also collected. Erythrogram and platelet evaluation were unremarkable. Leukogram revealed leukocytosis (neutrophilia, lymphocytosis, monocytosis and eosinophilia). Serum biochemistry revealed hyperalbuminemia and discrete hyperproteinemia; values of alanine aminotransferase, creatinine and globulins were within normal range. In cytological examination, intense cellularity was observed with predominance of eosinophils (60%), neutrophils (35%), macrophages performing cytophagocytosis (5%) and degenerated cells. There was no bacterial growth within 48 h after incubation of nasal bridge lesion swab. There were no abnormalities identified at radiographic evaluation of nasal turbinates. As the patient was already with antibiotic therapy and steroidal anti-inflammatory, it was opted to maintain it, since interruption between the day of examination and laboratory results could cause more prejudice than benefit, corticosteroid dose, however, was readjusted (prednisone 2 mg/kg/per os/every 24h). After 1 week of treatment the owner reported significant improvement of clinical signs without any further complaint.Discussion: Typically, type I hypersensitivity reactions such as insect bites do not exceed clinical signs of erythema, local edema and pruritus, with spontaneous remission of clinical signs within few hours after exposure to the antigen. Eosinophilic folliculitis, however, may cause more severe clinical alterations, such as pain, apathy and hyporexia. Nasal bridge is the predominant site described to be affected in cases of eosinophilic folliculitis, being auricular pinna, thorax and limbs considered atypical presentations which can delay proper diagnosis, since in endemic regions for diseases such as visceral leishmaniasis, infectious etiology may be listed first. Differential diagnosis also includes superficial pyoderma, juvenile cellulitis, pemphigus foliaceus and pharmacodermia. The case described in this report emphasize the importance of an accurate diagnosis as well as an early and adequate treatment in order to promote satisfactory response. Also, highlights inadequate use of antimicrobials as a direct consequence of lack of laboratorial investigation.Keywords: skin, eosinophilia, furunculosis, dermatitis, insects

Chemodectoma in a Bitch

Background: Chemodectomas, better known as tumors of the base of the heart, arise from aortic bodies, respiratory chemoreceptors located near or inside the aortic arch or originate from receptors located in the carotid arteries. Relatively rare, they affect dogs and, to a lesser extent, felines. They gain great importance when they influence the function of the cardiovascular system, with animals showing clinical signs related to congestive heart failure. Clinical diagnosis is based on symptomatology and complementary tests such as radiography, electrocardiography and echocardiography, while the definitive diagnosis is obtained by cytological and histopathological exams. This study aims to reports a case of malignant chemodectoma in a bitch, whose main symptomatology was neurological and not cardiovascular. Case: A 1-year-old Rottweiler bitch was attended with neurological alterations compatible with vestibular syndrome, hyporexia, dysphagia, apathy, melena, emesis, and purulent nasal discharge on the right nostril. On physical examination, the animal showed depressed level of consciousness, poor body condition, bilateral quemosis, paralysis of the right eye, inspiratory dyspnea and muffling of cardiac auscultation, besides a subcutaneous nodule between the scapulae. On neurological evaluation, horizontal nystagmus, head tilt to the right side, ventromedial strabismus and facial nerve paralysis on the right side were observed so that the localization of the lesion was set in peripheral vestibular system. During anesthesia for esophageal tube placement, a mass from the hard palate to the oropharynx was noted, making endotracheal intubation impossible to perform. Biopsy of this nodule was performed, and tracheostomy was indicated, but the owner opted for euthanasia before the procedure. Necropsy revealed white soft masses in the bilateral retromandibular region, on the subcutaneous tissue near the scapulae, in the right ear and since nasopharynx to the soft palate, in addition to sparse white nodules in the heart, lung, carotid artery, kidneys, right ovary, mesentery near to the spleen, and axillary lymph node. Histologically, the nodules were characterized by neoplastic cells population organized in short bundles or cords, arranged around small blood vessels surrounded by delicate connective tissue. Neoplastic cells infiltrated muscles and blood and lymphatic vessels were filled by multiple neoplastic emboli. The histological pattern of the cells allowed the diagnosis of chemodectoma. Discussion: The bitch from this case had 1-year-old when diagnosed with chemodectoma, differently from most cases from literature, that are between 7 to 15 years old. Furthermore, primarily cardiac tumors are considered rare, being chemodectoma the most common, often reported in Boxer and Boston Terrier dogs, but unusual in Rottweilers. Despites some articles mentioning seizure and Horner Syndrome secondary to a carotid body chemodectoma, neurological signs are not commonly observed in these cases. The presence of the tumor in the middle ear region of the right side supports the occurrence of peripheral vestibular syndrome and facial nerve paralysis on the same side. Because it is a neoplasm that is usually detected late during the course of the disorder, most patients either cannot obtain diagnosis in vivo, as in this reported animal, which was in such a critical condition that underwent euthanasia, or there are no more possible therapeutic choices. In the patient described, there were numerous metastatic masses and nodules spread throughout the body. Although the typical clinical signs in animals with chemodectomas are often related to heart disease, neurological signs may also be present. This report emphasizes the importance of chemodectoma being included as a differential diagnosis in young dogs and even in breeds such as Rottweiler. Keywords: aortic body neoplasia, paraganglioma, vestibular syndrome

Non-Epitheliotropic Cutaneous Lymphoma with Systemic Dissemination in a Dog

Background: Cutaneous lymphoma is a highly malignant neoplasm, which can originate in the epidermis or dermis, as well as be disseminated to other organs such as lung, heart, arm, liver and bone marrow. It comes in the form of nodes of various sizes, erythematous and alopecic, itching may or may not occur. The diagnosis is made by cytological and histopathological examination of the compromised tissue. However, it is important to perform complementary tests for clinical staging and prognostic characterization. The objective is to report a case of non-epitheliotropic cutaneous lymphoma with systemic dissemination in a dog.Case: A female mixed bred adult canine was attended at the Veterinary Hospital of the Federal University of Mato Grosso do Sul with a history of progressive weight loss and the presence of alopecic and non-pruritic subcutaneous nodules in the torso, nasal plane and pelvic limbs, starting 4 months ago. After approximately 20 days, the presence of rapidly evolving ulcerated nodules was noted. On physical examination, generalized lymphadenomegaly was observed and among the dermatological findings were multiple nodules of varying sizes with the presence of ulceration in the center of the lesions, alopecia, erythema and raised edges, in the region of the nasal sinus, pelvic and thoracic limbs, tail, thoracolumbar and abdominal region. The animal also presented right pelvic limb edema with painful sensibility to manipulation CBC and biochemical tests (albumin, alanine aminotransferase, creatinine, urea, alkaline phosphatase, globulins, total proteins and fractions) were performed, being observed as normocytic normochromic type anemia alteration (erythrocytes: 2.78 106/µL; hemoglobin: 6.8 g/µL; globular volume: 18.8%), leukopenia (4,000/mm³) with presence of metamyelocytes (120/mm³) and rods (1,080/mm³) and lymphopenia (80/mm³). Three samples of the nodules were collected for histopathological examination and a definitive diagnosis of cutaneous lymphoma was obtained. The material was then submitted to immunohistochemical examination, which showed that it was a non-epitheliotropic cutaneous lymphoma of T immunophenotype. Due to the compromised quality of life and unfavorable prognosis, the owner opted for euthanasia of the animal. In the necropsy examination, lymph nodes, subcutaneous tissue, skeletal muscle, heart, pericardial sac, tongue and multifocal infiltrate of neoplastic cells were observed, findings suggestive of multicentric lymphoma or infiltrations by dissemination of cutaneous lymphoma.Discussion: Non-epitheliotropic skin lymphomas exhibit rapid progression and infiltration into lymph nodes and subsequent systemic involvement. The diagnosis is based on clinical-dermatological signs, fine needle cytology, histopathological and immunohistochemical examination. Normocytic normochromic anemia is the most observed alteration in patients with lymphoma, followed by leukocytosis, leukopenia, thrombocytopenia, neutrophilia and leukoerythroblastic reactions.  Dogs with T-cell lymphoma have a worse prognosis for life span and disease-free intervals than those with B-cell lymphoma, so immunophenotyping is critical to determine prognosis. In the present report, histopathological and immunohistochemical examinations were decisive for the diagnosis of the present report, because the expression CD3 and the negativity for CD79a proved that the neoplasm is of T lymphocyte lineage. The definitive diagnosis was obtained by histopathology, however, immunohistochemistry determined the immunophenotype of the neoplasia as non-epitheliotropic T lymphocyte.