Challenging diagnostic work-up of a massive fluid-filled structure in the cranial abdomen of a cat.

A 9-year-old female, neutered European shorthair cat was presented with acute vomiting, obvious jaundice and painful enlargement of the abdomen. Icteric skin and mucous membranes in addition to severe bilirubinaemia (mainly direct bilirubin) and a large increase in liver enzyme activities were the main findings at the initial examination. Radio- and ultrasonographic evaluation revealed a massive fluid-filled structure caudal to the liver displacing abdominal organs, in particular the stomach. As this structure with a diameter of 8-10 cm occupied considerable space in the cranioventral abdomen, a detailed ultrasonographic examination of the liver and the gallbladder, and determination of the structure's association with a particular abdominal organ was initially impossible. Via ultrasound-assisted puncture under general anaesthesia 300 ml of an almost clear fluid could be aspirated. Cytological examination revealed a cyst content-like fluid with cell detritus.Further ultrasonographic and computed tomographic diagnostics followed by abdominal laparotomy finally enabled diagnosis of a cystic dilatation of the entire common bile duct and accumulation of white bile. Histopathological examination after euthanasia (requested by the owner) identified lymphoplasmacytic cholangitis and necrosis of the duodenal papilla. The massive dilatation of the common bile duct complicated its definite diagnosis by diagnostic imaging methods. It was most likely caused by a longer-standing obstruction of the bile flow by lymphoplasmacytic cholangitis with necrosis and granulation tissue formation in the area of the duodenal papilla. An interesting but initially misleading feature was the presence of white bile. The etiology of this extremely rare condition remains obscure but in the described case a manifestation of impaired hepatocyte function secondary to biliary stasis is suspected to be the cause.

Urospermia indicating ectopic ureters in breeding dogs - 3 cases.

An Entlebucher Mountain Dog (57 months old, case 1), a Labrador Retriever (24 months, case 2) and an Irish Soft-Coated Wheaten Terrier (31 months old, case 3) were presented for breeding soundness evaluation to the clinic. During semen collection in all 3 dogs, the pre-secretion and the sperm-rich fraction showed normal consistency and colour, whereas the prostatic secretion (3 rd ejaculate fraction) appeared strikingly yellow. In cases 1 and 2, a severely decreased sperm motility (asthenozoospermia) and an increased amount of abnormal spermatozoa (teratozoospermia), and in case 3, a moderately decreased total sperm count (oligozoospermia) were detected. Sonographical examination revealed abnormal findings regarding the uretero-vesical junction and ectopic ureters. Therefore it is concluded that urine admixture to the 3 rd ejaculate fraction may indicate the presence of ectopic ureters and may cause impairment of semen quality and fertility. The present cases raise questions regarding urospermia concerning: 1. its incidence in dogs in general and in connection with ectopic ureters and 2. its relevance as a cause of deficient ejaculate quality and subfertility or infertility.

Diagnosis and treatment of infraspinatus tendon-bursa ossification in a Eurasian Dog.

A 4-year-old male Eurasian Dog presented at our veterinary clinic with a history of perpetual forelimb lameness in both thoracic limbs. In the clinical exploration, direct pressure over the infraspinatus tendon of insertion caused pain in both thoracic forelimbs and a firm band-like structure was palpable. No improvement was observed after treatment with rest, non-steroidal anti-inflammatory drugs and an intralesional injection of a long-acting glucocorticoid. Radiographic examination, ultrasonographic exploration and computed tomography were performed, identifying ossified structures lateral to the proximal humerus and an irregular roughened periosteum at the insertion and tendon of the infraspinatus muscle on both sides. There were more distinct alterations on the right thoracic limb. The imaging results led to a diagnosis of an infraspinatus tendon-bursa ossification accompanied by a chronic tendinopathy/tendovaginitis, accentuated on the right side. The dog was subjected to physiotherapy and autologous conditioned plasma (ACP) was injected into the insertion of the infraspinatus muscle of both thoracic limbs. After 5 months of physiotherapy and two injections of ACP with an interval of one week in both forelimbs, the dog showed no signs of lameness. This case report describes the diagnosis and management of infraspinatus tendon-bursa ossification in a Eurasian Dog. To the authors' knowledge, this condition has previously not been described in this breed of dog.

[Comparison of ultrasound guided femoral and sciatic nerve block versus epidural anaesthesia for orthopaedic surgery in dogs]. / Ultraschallgesteuerte Nervenblockade des Nervus femoralis und ischiadicus im Vergleich zur Epiduralanästhesie bei orthopädischen Eingriffen am Hund.

OBJECTIVE: Comparison of ultrasound-guided femoral and sciatic nerve block versus epidural anaesthesia with bupivacaine and morphine for orthopaedic surgery of the pelvic limb in dogs with respect to analgesic effectiveness, clinical utility and side effects. MATERIAL AND METHODS: The study included 22 dogs (American Society of Anesthesiologists, ASA grades I and II) undergoing orthopaedic surgery distal to the mid-femoral bone. The study was designed as a randomized, prospective, blinded clinical trial. All dogs were randomly assigned to receive 0.5 mg/kg bupivacaine (0.5%) and 0.1 mg/kg morphine sulphate (1%) either as epidural anaesthesia (group EPI) or by ultrasound-guided femoral and sciatic nerve block (group LA). During surgery, the heart rate, respiratory rate, mean arterial pressure (MAP), end-tidal isoflurane concentrations and dose of rescue analgesia (fentanyl boluses of 5 µg/kg i. v.) were measured. Pain severity was scored (short form of the Glasgow Composite Measure Pain Scale, GCMPS) before surgery and postoperatively at 2, 4, 6, 12 and 24 hours after extubation. Post-operative rescue analgesia consisted of methadone (0.2 mg/kg i. v.), and was applied when the GCMPS > 6. For statistical analysis, the Chi-square, Fisher, and Wilcoxon tests and one- and two-way ANOVA were applied. Differences were considered statistically significant at p < 0.05. RESULTS: Only the MAP was significantly different between the two treatment groups. Intra- and postoperative MAP of group LA (111.2 ± 11.2 mmHg and 119.3 ± 18.2 mmHg, respectively) was higher than in group EPI (86.6 ± 8.7 mmHg and 95.2 ± 13.1 mmHg, respectively). None of the dogs developed urinary retention or ambulatory deficits when completely recovered from anaesthesia. No other side effects were noted. CLINICAL RELEVANCE: In conclusion, femoral and sciatic nerve blocks and epidural anaesthesia ensure comparable analgesic effects in canine patients undergoing orthopaedic surgery of the pelvic limb. The lower mean arterial blood pressure of group EPI was not of clinical relevance.

[The anatomy of the heart of tortoises (Testudinidae)]. / Die Anatomie des Herzens der Landschildkröte (Testudinidae).

25 formalin-fixed hearts of different tortoise species (Testudinidae) underwent gross-anatomical examination. The aim of the study was to illustrate the specific anatomy of the heart of these species in comparison to the data available in the literature. The examined tortoises showed the well-known basic structure of a reptile heart with two atria and a ventricle composed of three interconnected chambers. The right atrium was consistently slightly larger than the left atrium. The atrioventricular (AV-) valves emerged as double-flap valves, whereby the lateral leaflets were only present in a rudimentary form. Neither papillary muscles nor chordae tendineae could be detected macroscopically. A vertical septum in order to subdivide the dorsal chambers was missing. However, the muscular ridge between Cavum venosum and Cavum pulmonale was well developed. The Cavum pulmonale represented itself as the smallest chamber respectively rather as a small passageway to the Truncus pulmonalis. Apart from two-parted aortic valves also multicuspidated valves of the Truncus pulmonalis could be visualized.

[Echocardiopgraphy in European tortoises (Testudo spp.)]. / Echokardiografische Untersuchung bei Landschildkröten (Testudo spp.).

An echocardiographic examination was carried out in 71 European tortoises (Testudo spp.) via the cervical-brachial acoustic windows. Simultaneously an electrocardiographic examination was performed. The inflow- and outflow tract of the heart were presented in frontal and sagittal longitudinal sections in B-mode. Within B-mode the size (diameter and area) of the atria and the ventricle (Cavum dorsale), the ventricular wall thickness and the diameter of the origin of the right aorta and of the right Arteria pulmonalis were measured. Also, the fractional shortening (FS%) and a fractional area shortening (FAS%) were calculated for the Cavum dorsale. Standard values for these cardiac parameters were determined for four different tortoise groups (depending on their carapace lengths). The direction of blood flow within the heart could be assessed via colour flow Doppler. By using pulsed-wave Doppler examinations of the inflow- and outflow tract the velocities, pressure gradients, velocity-time-integrals and acceleration- and deceleration times could be determined from the recorded inflow and outflow patterns and standard values were established for these parameters as well.

Occurrence of mitral valve insufficiency in clinically healthy Beagle dogs.

Chronic degenerative valve disease (CDVD) is the most common cardiac disease in dogs, usually resulting in mitral valve insufficiency (MVI). The goal of this study was to investigate the occurrence of MVI in clinically healthy Beagle populations. A total of 79 adult healthy Beagles (41 females and 38 males; age: 5.6 ± 2.7 years, range 1.4 to 11.7 years) were examined. The diagnosis of MVI was based on the detection of a systolic murmur heard above the mitral valve, and was confirmed by colour flow Doppler (CFD) echocardiography. Systolic mitral valve murmurs were detected in 20/79 dogs (25.3%), of them 11 males and 9 females with no statistically significant gender difference (P = 0.6059). The strength of the murmur on the semi-quantitative 0/6 scale yielded intensity grade 1/6 in 10 dogs, grade 2/6 in 4 dogs, and grade 3/6 in 6 dogs. Mild to moderate MVI was detected by CFD in all these 20 dogs with systolic murmurs. Of them, 17 dogs had mild and 3 demonstrated moderate MVI, showing 10-30% and 30-50% regurgitant jets compared to the size of the left atrium, respectively. The age of dogs with MVI was 7.1 ± 2.3 years, which was significantly different from that of dogs without MVI (5.1 ± 2.7 years, P = 0.0029). No significant differences in body weight (P = 0.1724) were found between dogs with MVI (13.8 ± 2.8 kg) and those without MVI (12.8 ± 3.0 kg). Mitral valve disease causing MVI is relatively common in Beagle dogs, just like in other small breed dogs reported in the literature.

Quantification of left ventricular volumes and function in anesthetized beagles using real-time three-dimensional echocardiography: 4D-TomTec™ analysis versus 4D-AutLVQ™ analysis in comparison with cardiac magnetic resonance imaging.

BACKROUND: Real-time three-dimensional echocardiography (RT3DE) enables accurate volume determination of the left ventricle (LV), since measurements in foreshortened depicted views are avertable. Different analyzing programs are available for this RT3DE. The commonly used semi-automatic software 4D-AutLVQ™ showed underestimation of LV volumes in comparison with CMRI in healthy anesthetized dogs (Am J Vet Res 74(9):1223-1230, 2013). TomTec 4D LV-Function™ is an offline analysis program for morphological and functional analyses of the left ventricle by using manual measurement optimization, showing excellent agreement with CMRI in human medicine (Echocardiography 27(10):1263-1273, 2010; Eur J Echocardiogr 11(4):359-368, 2010; Echocardiography 24(9):967-974, 2007). The aim of the present study was to compare these different RT3DE analyzing software programs to test the possibility of one performing better than the other by assessing accuracy and reproducibility in comparison with the reference method cardiac magnetic resonance imaging (CMRI) by determining the left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF). RT3DE and CMRI were performed during anesthesia in 10 healthy beagles. The analyzing programs 4D-AutLVQ™ (based on semi-automated border detection) and TomTec 4D LV-Function™ (primary manual tracking with semi-automated border detection) were used for RT3DE volume analysis of the left ventricle. Left ventricular EDV, ESV, SV and EF were measured and compared to those measured by the reference method CMRI. Repeated measurements were performed to determine inter- and intra-observer variability. RESULTS: Both, 4D-AutLVQ™ and 4D-TomTec™ showed small but significant underestimation for EDV and ESV with quite good correlation (r = 0.34-0.69) in comparison with CMRI, without significant difference between each of them. Ejection fraction (EF) measured by 4D-TomTec™ showed no significant differences compared to CMRI (p = 0.12), while 4D-AutLVQ™ significantly underestimated LV-EF (p = 0.03). Analyzing time was shorter using 4D-AutLVQ™ compared to 4D-TomTec™. The inter-observer variability was higher using 4D-TomTec™ than with 4D-AutLVQ™, whereas both methods present excellent intra-observer variability. CONCLUSION: 4D-TomTec™ and 4D-AutLVQ™ are feasible RT3DE analyzing programs, allowing accurate volume quantification of the left ventricle, albeit with significant underestimation of ventricular volumes in comparison with the gold standard CMRI. 4D-AutLVQ™ is performed faster with less inter-observer variability than 4D-TomTec™. Therefore, 4D-AutLVQ™ is the more practicable measurement method when comparing the different analyzing programs.

Quantification of right ventricular volume in dogs: a comparative study between three-dimensional echocardiography and computed tomography with the reference method magnetic resonance imaging.

BACKGROUND: Right ventricular (RV) volume and function are important diagnostic and prognostic factors in dogs with primary or secondary right-sided heart failure. The complex shape of the right ventricle and its retrosternal position make the quantification of its volume difficult. For that reason, only few studies exist, which deal with the determination of RV volume parameters. In human medicine cardiac magnetic resonance imaging (CMRI) is considered to be the reference technique for RV volumetric measurement (Nat Rev Cardiol 7(10):551-563, 2010), but cardiac computed tomography (CCT) and three-dimensional echocardiography (3DE) are other non-invasive methods feasible for RV volume quantification. The purpose of this study was the comparison of 3DE and CCT with CMRI, the gold standard for RV volumetric quantification. RESULTS: 3DE showed significant lower and CCT significant higher right ventricular volumes than CMRI. Both techniques showed very good correlations (R > 0.8) with CMRI for the volumetric parameters end-diastolic volume (EDV) and end-systolic volume (ESV). Ejection fraction (EF) and stroke volume (SV) were not different when considering CCT and CMRI, whereas 3DE showed a significant higher EF and lower SV than CMRI. The 3DE values showed excellent intra-observer variability (<3%) and still acceptable inter-observer variability (<13%). CONCLUSION: CCT provides an accurate image quality of the right ventricle with comparable results to the reference method CMRI. CCT overestimates the RV volumes; therefore, it is not an interchangeable method, having the disadvantage as well of needing general anaesthesia. 3DE underestimated the RV-Volumes, which could be explained by the worse image resolution. The excellent correlation between the methods indicates a close relationship between 3DE and CMRI although not directly comparable. 3DE is a promising technique for RV volumetric quantification, but further studies in awake dogs and dogs with heart disease are necessary to evaluate its usefulness in veterinary cardiology.

Assessment of left ventricular volumes by use of one-, two-, and three-dimensional echocardiography versus magnetic resonance imaging in healthy dogs.

OBJECTIVE: To quantify left ventricle (LV) volumes by use of 1-D, 2-D, and 3-D echocardiography versus MRI in dogs. ANIMALS: 10 healthy Beagles. PROCEDURES: During anesthesia, each dog underwent an echocardiographic examination via the Teichholz method, performed on the basis of standard M-mode frames (1-D); the monoplane Simpson method of disk (via 2-D loops); real-time triplane echocardiography (RTTPE) with a 3-D probe; and real-time 3-D echocardiography with a 3-D probe. Afterward, cardiac MRI was performed. Values for the LV end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) were compared between each echocardiographic method and the reference method (cardiac MRI). RESULTS: No significant differences for EDV, ESV, and EF were detected between RTTPE and cardiac MRI. Excellent correlations (r = 0.97, 0.98, and 0.95 for EDV, ESV, and EF, respectively) were found between RTTPE and values for cardiac MRI. The other echocardiographic methods yielded values significantly different from cardiac MRI and results correlated less well with results of cardiac MRI for EDV, ESV, and EF. Use of the Teichholz method resulted in LV volume overestimation, whereas the Simpson method of disk and real-time 3-D echocardiography significantly underestimated LV volumes. CONCLUSIONS AND CLINICAL RELEVANCE: Use of RTTPE yielded excellent correlations and nonsignificant differences with cardiac MRI and is a suitable method for routine veterinary cardiac examination.

Comparison of multi-detector row computed tomography with echocardiography for assessment of left ventricular function in healthy dogs.

OBJECTIVE: To evaluate the use of retrospectively ECG-gated, contrast-enhanced, multi-detector row computed tomography (MDCT) for assessment of left ventricular function in dogs and to compare the results with those obtained by use of 2-D and M-mode echocardiographc techniques. ANIMALS: 10 healthy Beagles. PROCEDURES: Dogs underwent MDCT (performed by use of a 64-detector row CT system) and echocardiography under general anesthesia. Left ventricular end-systolic volume (ESV), end-diastolic volume (EDV), and ejection fraction (EF) were determined in MDCT-generated multiplanar reformatted images by use of Simpson and biplane area-length calculation methods. Results were compared with left ventricular ESV, EDV, and EF determined in echocardiographc images by use of Teichholz and bullet method calculations. Results were evaluated via Deming regression analysis and Pearson correlation tests. Bland-Altman analysis was used to assess limits of agreement and systematic errors between the 2 methods. RESULTS: Mean values for EDV and ESV determined by use of MDCT were highly correlated with those determined by use of echocardiography, regardless of the calculation methods compared (r = 0.91 to 0.96); volumes determined by use of MDCT appeared to be higher than those determined by use of echocardiography, although most differences were nonsignificant. Mean EF determined by use of MDCT with the Simpson calculation method was highly correlated with that determined by use of echocardiography with bullet method calculations (r = 0.90). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that assessment of left ventricular volume and function in dogs is feasible with MDCT. To estimate left ventricular EF with MDCT. use of the Simpson calculation method is advised.

Sedative, cardiovascular, haematologic and biochemical effects of four different drug combinations administered intramuscularly in cats.

OBJECTIVE: To compare effects of four drug combinations on sedation, echocardiographic, haematologic and biochemical variables and recovery in cats. STUDY DESIGN: Experimental randomized 'blinded' cross-over study. ANIMALS: Six healthy cats. MATERIALS AND METHODS: Treatments were administered intramuscularly: midazolam 0.4 mg kg(-1) and butorphanol 0.4 mg kg(-1) (MB); midazolam 0.4 mg kg(-1), butorphanol 0.4 mg kg(-1) and ketamine 3 mg kg(-1) (MBK); midazolam 0.4 mg kg(-1), butorphanol 0.4 mg kg(-1) and dexmedetomidine 5 µg kg(-1) (MBD); ketamine 3 mg kg(-1) and dexmedetomidine 5 µg kg(-1) (KD). Sedation was evaluated at time-points over 10 minutes post injection. Echocardiography, systolic arterial blood pressure (SAP) measurement and blood sampling were performed at baseline and from 10 minutes after treatment. Quality of recovery was scored. Data were analysed by anova for repeated measures. p < 0.05 was considered significant. RESULTS: The lowest sedation score was obtained by MB, (median 10.5 [7; 20]), highest by KD (36.5 [32; 38]). Quality of recovery was best with KD (0.5 [0; 2]), and worst with MB (7.5 [4; 11]). Relative to baseline measurements, treatments decreased SAP by 17%, 25%, 13%, 5% in MB, MBK, MBD and KD, respectively. Heart rate decreased (p < 0.05) after MBD (44%) and KD (34%). All treatments decreased stroke volume by 24%, 21%, 24%, 36%, and cardiac output by 23%, 34%, 54%, 53% in MB, MBK, MBD and KD, respectively. Packed cell volume was decreased (p < 0.05) by 20%, 31%, 29% in MBK, MBD and KD, respectively. Plasma glucose was increased after MBD (31%) and KD (52%) and lactate concentration was decreased (p < 0.05) after MBK (58%), MBD (72%) and KD (65%). CONCLUSIONS AND CLINICAL RELEVANCE: The MB combination did not produce sedation in healthy cats. Treatment MBK led to acceptable sedation and minimal cardiovascular changes. Both treatments with dexmedetomidine produced excellent sedation and recovery but induced more cardiovascular depression and haematologic changes.

Ventricular septal defect with aortic valve insufficiency in a New Zealand White rabbit.

A heart murmur was detected in a 10 mo old, female New Zealand White rabbit. Auscultation revealed cardiac murmurs both at the left and right hemithorax. Phonocardiography confirmed the systolic-diastolic nature of the left-sided and the systolic character of the right-sided murmur. Electrocardiography showed normal sinus rhythm; tall R waves and large T waves in lead II; and deep S waves in leads II, III, and aVF. Thoracic radiography demonstrated generalized cardiomegaly with prominent pulmonary vasculature. Echocardiography revealed a perimembraneous ventricular septal defect with aortic insufficiency. Signs of biventricular volume overload, relative pulmonic stenosis, and pulmonary valve insufficiency were also seen as consequences of the defect. Necropsy demonstrated a ventricular septal defect just below the aortic valve, a dilated pulmonary trunk, dilated and hypertrophied ventricles, dilated atria, and rightward displacement of the aortic root. Cardiac histopathology showed ventricular cardiomyocyte degeneration (swelling and hypereosinophilia of the cytoplasm with a loss of cross striation, and nuclear hyperchromasia), cartilaginous metaplasia of the aorta, and subendocardial fibrosis of the right ventricular flow tract.

Sound recording and digital phonocardiography of cardiac murmurs in dogs by using a sensor-based electronic stethoscope.

The goals of this study were to present a technique of digitalised sound recordings and phonocardiograms (dPCGs), and to analyse its diagnostic capabilities. Heart sounds of 20 dogs were auscultated in vivo (on-line) and recorded with dPCGs by two authors using a Welch Allyn Meditron Stethoscope System. Sound recordings were auscultated off-line and blindly by four different observers having various auscultatory experiences, then listened to while viewing dPCGs. The results were compared to echocardiographic diagnoses. There was a significant agreement (p < 0.001) between on-line and off-line auscultatory findings regarding the four observers, ranging from 45% to 75% (weighted kappa values: 0.72 to 0.87). The best agreement was achieved by Observer 1 having the highest experience. Significant differences (p < 0.05) were found between Observer 1 and Observer 4 (with the lowest experience) in judging the quality of the murmurs during the off-line and blind auscultation. However, there were only minimal differences (95% to 100% agreements) in dPCG analyses among the four observers regarding intensity and quality of the murmurs while simultaneously listening to and viewing the dPCGs. Significant correlations were found between the traditional '0 to 6 scale' and a new '0 to 3 scale' murmur intensity gradings by all observers (correlation coefficients 0.640 to 0.908; p < 0.01 to p < 0.001). Analysis of dPCGs might be a valuable, additional tool helping with the diagnosis of canine cardiac murmurs, especially for those with less cardiological experience.

Evaluation of the association between plasma concentration of N-terminal proatrial natriuretic peptide and outcome in cats with cardiomyopathy.

OBJECTIVE: To determine whether plasma N-terminal proatrial natriuretic peptide (NT-proANP) concentration could predict the outcome (survival duration) of cats with cardiomyopathy (CM). DESIGN: Case-control study. ANIMALS: 51 cats with CM (25 with and 26 without congestive heart failure [CHF]) and 17 healthy cats. PROCEDURES: Cats were thoroughly examined and assigned to 1 of 3 groups (control, CM with CHF, and CM alone). Plasma NT-proANP concentrations were measured by use of a human proANP(1-98) ELISA. Survival durations were compared between CM groups. RESULTS: Plasma NT-proANP concentrations differed significantly among the 3 groups, and survival durations differed significantly between the 2 CM groups. Median (range) NT-proANP concentration was 413 fmol/mL (52 to 940 fmol/mL) in the control group, 1,254 fmol/mL (167 to 2,818 fmol/mL) in the CM alone group, and 3,208 fmol/mL (1,189 to 15,462 fmol/mL) in the CM with CHF group. At a cutoff of 517 fmol/mL, NT-proANP concentration had a sensitivity of 90% and specificity of 82% for detecting CM. Multivariate analysis revealed that only the variable left atrium-to-aortic diameter ratio was a significant predictor of survival duration. CONCLUSIONS AND CLINICAL RELEVANCE: Plasma NT-proANP concentration may have potential as a testing marker for distinguishing healthy cats from cats with CM. It may also be useful for distinguishing CM cats with CHF from those without CHF The value of NT-proANP concentration as a predictor of survival duration was not supported in this study and requires further evaluation.