Chylothorax caused by Paragonimus westermani in a native Californian.

Paragonimiasis is a parasitic infection endemic in Asia but uncommon in the United States. It presents most frequently with cough and hemoptysis. Pleural effusions are common and can manifest occasionally as a pseudochylothorax, but a true chylothorax has, to our knowledge, never been reported. We report a case of a chylothorax from infection with Paragonimus westermani. The case is also unique because it occurred in a native Californian who had not traveled to Asia and was infected by eating raw crabs at a local sushi restaurant. The freshwater crabs had been imported from Asia.

Transvenous heartworm extraction in a ferret with caval syndrome.

A 10-month-old ferret was diagnosed with heartworm disease and caval syndrome. Associated clinical signs included weakness and a green-colored urine, identified as biliverdinuria. Despite the animal's small size, removal of three heartworms via transvenous heartworm extraction was successfully performed. Although at least one female worm remained in the right ventricle, the majority of clinical signs related to the presence of the heartworms resolved. The ferret was subsequently managed medically with corticosteroids and monthly heartworm prevention. This case documents the presence of biliverdinuria associated with caval syndrome and successful transvenous heartworm extraction in a ferret.

Use of a nitinol gooseneck snare catheter for removal of adult Dirofilaria immitis in two cats.

CASE DESCRIPTION: 2 cats were examined because of congestive heart failure secondary to heartworm infection. CLINICAL FINDINGS: One cat had severe abdominal distention and the other had dyspnea secondary to chylothorax. Both had loud right-sided heart murmurs, precordial thrills, and jugular distension. Thoracic radiography revealed cardiomegaly and enlarged caudal pulmonary arteries. Echocardiography revealed tricuspid regurgitation and multiple hyperechoic structures consistent with adult Dirofilaria immitis within the right atrium, right ventricle, and main pulmonary artery. Pulmonary hypertension was documented by means of Doppler echocardiography in 1 cat. TREATMENT AND OUTCOME: Cats were anesthetized, and a nitinol gooseneck snare catheter was introduced into the right side of the heart via a jugular venotomy. In the first cat, the snare was used to retrieve 5 female and 2 male adult D immitis. The catheter was then passed into the main pulmonary artery in an unsuccessful attempt to retrieve remaining heartworms. In the second cat, 2 adult female D immitis were removed from the right atrium with the nitinol snare. In both cats, clinical signs resolved within 4 weeks after the procedure. CLINICAL RELEVANCE: Findings suggested that use of a nitinol gooseneck snare catheter may be a safe and effective technique for removing adult D immitis from the right atrium and ventricle in cats and that successful removal of adult heartworms in infected cats may resolve clinical signs of right-sided congestive heart failure and chylothorax. In addition, findings in 1 cat suggested that removal of all adult heartworms may not be necessary for clinical signs to resolve.

Surgical removal of heartworms from a cat with caval syndrome.

Caval syndrome was diagnosed in a 4-year-old male domestic shorthair cat with severe dyspnea attributable to chylothorax. The diagnosis of heartworm infection was made on the basis of the ultrasonographic detection of a large number of adult heartworms in the right side of the heart and positive results for modified Knott's and heartworm antigen tests. Heartworms were surgically removed through an incision in the jugular vein, using a string-type horsehair brush and an alligator forceps. All clinical signs resolved after the surgery. Although treatment with agents that would kill the adult heartworms was considered, surgical treatment was used on the cat reported here. Surgical treatment may be the method of choice for use in cats with severe or persistent clinical signs attributable to infections with large numbers of heartworms.