Tratamento de tromboembolismo e preparo para implantação de prótese osteointegrada com oxigenioterapia hiperbárica em uma gata / Treatment of tromboembolism and preparation for an osseointegrated prothesis fixation with hyperbaric oxygen therapy in a kitten

Background: Ischemic neuromyopathy is the most common reason for amputation in cats. In veterinary medicine, the use of prosthetic limbs is not widespread; therefore, in most cases total limb amputation is indicated. However, hyperbaric oxygen therapy (HBOT) is an alternative with several benefits for the treatment of vascular disorders with reperfusion, ischemia, and infection. Therefore, this study aimed to report the positive effects of HBOT on the treatment of ischemic neuromyopathy secondary to arterial thromboembolism on the patient's clinical improvement, and on the preparation of the patient for insertion of an osseointegrated prosthesis. Case: A 6-month-old mixed-breed kitten returned for treatment after undergoing surgery seven days earlier for reduction of traumatic diaphragmatic hernia, during which it suffered a cardiorespiratory arrest. The patient presented with acute pelvic limb paralysis with 24-h evolution, absent femoral pulse, plantar cushions and dorsal part of the limbs cold and pale. After supportive therapy and diagnosis of aortic thromboembolism by arterial Doppler, the patient started adjunctive treatment with HBOT from the first day of hospitalization. Sessions took place in an exclusive hyperbaric chamber for animals and lasted 60 min at a pressure of 2.5 absolute atmospheres and 100% oxygen, initially every 12 h. However, during the first 5 days of hospitalization, the distal region of both pelvic limbs began to show tissue devitalization and edema, and hematologic parameters showed changes on the 7th day. The right pelvic limb (RPL) showed more involvement of superficial tissues, extending to the tarsometatarsal joint region. After 8 days of hospitalization, the devitalized tissue was debrided. The RPL had an extensive devitalized area with exposed bone in the phalanges and necrosis in the pads. The left pelvic limb (LPL) suffered minor complications, with involvement of the phalangeal region. After 12 days, with HBOT every 48 h, exuberant granulation tissue was observed. After 17 days, the patient was discharged, and HBOT sessions were performed weekly. Gangrene of the midfoot and lack of proprioception were observed in RPL, while LPL showed bone divulsion of the 1st, 3rd, and 4th phalanges. Because of the poor prognosis for limb viability, the RPL was partially amputated, and a self-threaded intraosseous prosthesis was inserted. Discussion: The cardiorespiratory arrest that occurred during the surgical procedure to reduce the diaphragmatic hernia without thromboprophylaxis may have contributed to the peripheral ischemia. HBOT was proposed for the adjuvant treatment of ischemic injury because it is especially indicated for cases of ischemia-reperfusion injury. The main hematological parameters were evaluated at an average interval of 7 days. While the platelet count and hematocrit increased, the leukocytosis decreased. This demonstrates the benefit of oxygen therapy in the reported patient. The use of HBOT in orthopedic injuries is known to result mainly in stimulation of osteoblasts, promoting osseointegration of the prosthesis. We conclude that the adjuvant treatment with HBOT helped to preserve a large segment of both pelvic limbs, prevent the progression of necrosis, and provide a healthy bed for fixation of an osseointegrated prosthesis in the RPL, resulting in clinical improvement of the patient.

Aortic thrombosis in a dog with chronic lymphocytic leukemia / Trombose aórtica em cão com leucemia linfocítica crônica

The aim of this report was to describe a case of aortic thrombosis (AT) secondary to chronic lymphocytic leukemia (CLL). Although, different types of neoplasms are described as possible causes of aortic thrombosis, CLL was not yet considered. The dog showed signs of lameness that worsened with exercise. The diagnosis of AT was made by ultrasound examination. The diagnosis of CLL was made by necropsy, which showed the presence of small lymphocytes with the appearance of mature lymphocytes in the bone marrow, spleen, liver and kidneys. The importance of including CLL in the possible causes of AT in dogs, in addition to the suspicion of AT in cases of neuromuscular disease, was highlighted.(AU)

O objetivo do presente relato é descrever um caso de trombose aórtica (AT) secundária a leucemia linfocítica crônica (LLC). Embora diferentes tipos de neoplasmas sejam descritos como possíveis causas de trombose aórtica, a LLC ainda não foi considerada. O cão mostrou sinais de claudicação que pioravam com o exercício. O diagnóstico de AT foi realizado por exame ultrassonográfico. O diagnóstico de LLC foi feito por necropsia, que mostrou a presença de pequenos linfócitos com aparência de linfócitos maduros na medula óssea, baço, fígado e rins. Destaca-se a importância da inclusão da LLC nas possíveis causas de AT em cães, além da suspeita de AT em casos de doença neuromuscular.(AU)

Neuromiopatia isquêmica em cinco cães (2008-2016)

ABSTRACT: This study aimed to present epidemiological, clinical and anatomopathological data of five dogs with ischemic neuromyopathy secondary to aortic thrombosis or thromboembolism. The dogs were females, with eleven years of age or more, that had paraplegia (80%) or hind limb monoplegia (20%). Forty percent of the cases (n=2) had lameness previously the motor disfunction. The main clinical findings include absence of unilateral or bilateral femoral pulse, cool hind limbs extremities, muscle pain above the knee joint and absence of nociception (deep pain) on the hind limbs digits. Four dogs were euthanized due to the poor prognosis, and the last one died within 24 hours of hospital admission. The necropsy findings were cardiac lesions in three dogs, neoplastic disease in one, and unknown cause on the other. The thrombi were located on the abdominal aorta, extending to the iliac arteries. Even with low incidence, the ischemic neuromyopathy should be included in the differential diagnosis of dogs with lameness, paraparesis, or unilateral or bilateral paraplegia, when neurological signs are compatible with lower motor neuron lesion (L4-S3) and acute or chronic progression. The digital and/or vascular doppler evaluation of the femoral pulse must be used and can assist on the disease diagnosis, avoiding treatments for other illnesses.

RESUMO: O objetivo deste estudo foi apresentar dados epidemiológicos, clínicos e anatomopatológicos de cinco cães com neuromiopatia isquêmica secundária a trombose ou tromboembolismo aórtico. Os cães eram fêmeas, com idade 11 anos, que apresentavam paraplegia (80%) ou monoplegia (20%) de membro pélvico. Em 40% dos casos (n=2) foi relatada claudicação previamente à disfunção motora. Os principais achados clínicos foram ausência de pulso femoral uni ou bilateral, extremidade de membros pélvicos frias, dor muscular acima da articulação do joelho e ausência de nocicepção (dor profunda) nos dígitos dos membros pélvicos. Quatro cães foram submetidos à eutanásia devido ao prognóstico desfavorável e um veio a óbito em menos de 24 horas de internação. Na necropsia foi encontrada alteração cardíaca em três cães, neoplásica em um e, sem causa determinante em outro caso. Os trombos estavam localizados na aorta abdominal e se estendiam até as artérias ilíacas. Mesmo sendo baixa a incidência, a neuromiopatia isquêmica deve ser incluída no diagnóstico diferencial de cães com claudicação, paraparesia ou paraplegia uni ou bilateral, quando os sinais neurológicos são compatíveis com lesão de neurônio motor inferior (L4-S3) e de evolução aguda ou crônica. A avaliação do pulso femoral digital e/ou por doppler vascular deve ser empregada e pode auxiliar no diagnóstico da doença evitando que os animais iniciem tratamento para outras afecções.

Neuromiopatia isquêmica em cinco cães (2008-2016) / Ischemic neuromyopathy in five dogs (2008-2016)

O objetivo deste estudo foi apresentar dados epidemiológicos, clínicos e anatomopatológicos de cinco cães com neuromiopatia isquêmica secundária a trombose ou tromboembolismo aórtico. Os cães eram fêmeas, com idade ≥11 anos, que apresentavam paraplegia (80%) ou monoplegia (20%) de membro pélvico. Em 40% dos casos (n=2) foi relatada claudicação previamente à disfunção motora. Os principais achados clínicos foram ausência de pulso femoral uni ou bilateral, extremidade de membros pélvicos frias, dor muscular acima da articulação do joelho e ausência de nocicepção (dor profunda) nos dígitos dos membros pélvicos. Quatro cães foram submetidos à eutanásia devido ao prognóstico desfavorável e um veio a óbito em menos de 24 horas de internação. Na necropsia foi encontrada alteração cardíaca em três cães, neoplásica em um e, sem causa determinante em outro caso. Os trombos estavam localizados na aorta abdominal e se estendiam até as artérias ilíacas. Mesmo sendo baixa a incidência, a neuromiopatia isquêmica deve ser incluída no diagnóstico diferencial de cães com claudicação, paraparesia ou paraplegia uni ou bilateral, quando os sinais neurológicos são compatíveis com lesão de neurônio motor inferior (L4-S3) e de evolução aguda ou crônica. A avaliação do pulso femoral digital e/ou por doppler vascular deve ser empregada e pode auxiliar no diagnóstico da doença evitando que os animais iniciem tratamento para outras afecções.(AU)

This study aimed to present epidemiological, clinical and anatomopathological data of five dogs with ischemic neuromyopathy secondary to aortic thrombosis or thromboembolism. The dogs were females, with eleven years of age or more, that had paraplegia (80%) or hind limb monoplegia (20%). Forty percent of the cases (n=2) had lameness previously the motor disfunction. The main clinical findings include absence of unilateral or bilateral femoral pulse, cool hind limbs extremities, muscle pain above the knee joint and absence of nociception (deep pain) on the hind limbs digits. Four dogs were euthanized due to the poor prognosis, and the last one died within 24 hours of hospital admission. The necropsy findings were cardiac lesions in three dogs, neoplastic disease in one, and unknown cause on the other. The thrombi were located on the abdominal aorta, extending to the iliac arteries. Even with low incidence, the ischemic neuromyopathy should be included in the differential diagnosis of dogs with lameness, paraparesis, or unilateral or bilateral paraplegia, when neurological signs are compatible with lower motor neuron lesion (L4-S3) and acute or chronic progression. The digital and/or vascular doppler evaluation of the femoral pulse must be used and can assist on the disease diagnosis, avoiding treatments for other illnesses.(AU)

Neuromiopatia isquêmica em cinco cães (2008-2016) / Ischemic neuromyopathy in five dogs (2008-2016)

O objetivo deste estudo foi apresentar dados epidemiológicos, clínicos e anatomopatológicos de cinco cães com neuromiopatia isquêmica secundária a trombose ou tromboembolismo aórtico. Os cães eram fêmeas, com idade ≥11 anos, que apresentavam paraplegia (80%) ou monoplegia (20%) de membro pélvico. Em 40% dos casos (n=2) foi relatada claudicação previamente à disfunção motora. Os principais achados clínicos foram ausência de pulso femoral uni ou bilateral, extremidade de membros pélvicos frias, dor muscular acima da articulação do joelho e ausência de nocicepção (dor profunda) nos dígitos dos membros pélvicos. Quatro cães foram submetidos à eutanásia devido ao prognóstico desfavorável e um veio a óbito em menos de 24 horas de internação. Na necropsia foi encontrada alteração cardíaca em três cães, neoplásica em um e, sem causa determinante em outro caso. Os trombos estavam localizados na aorta abdominal e se estendiam até as artérias ilíacas. Mesmo sendo baixa a incidência, a neuromiopatia isquêmica deve ser incluída no diagnóstico diferencial de cães com claudicação, paraparesia ou paraplegia uni ou bilateral, quando os sinais neurológicos são compatíveis com lesão de neurônio motor inferior (L4-S3) e de evolução aguda ou crônica. A avaliação do pulso femoral digital e/ou por doppler vascular deve ser empregada e pode auxiliar no diagnóstico da doença evitando que os animais iniciem tratamento para outras afecções.(AU)

This study aimed to present epidemiological, clinical and anatomopathological data of five dogs with ischemic neuromyopathy secondary to aortic thrombosis or thromboembolism. The dogs were females, with eleven years of age or more, that had paraplegia (80%) or hind limb monoplegia (20%). Forty percent of the cases (n=2) had lameness previously the motor disfunction. The main clinical findings include absence of unilateral or bilateral femoral pulse, cool hind limbs extremities, muscle pain above the knee joint and absence of nociception (deep pain) on the hind limbs digits. Four dogs were euthanized due to the poor prognosis, and the last one died within 24 hours of hospital admission. The necropsy findings were cardiac lesions in three dogs, neoplastic disease in one, and unknown cause on the other. The thrombi were located on the abdominal aorta, extending to the iliac arteries. Even with low incidence, the ischemic neuromyopathy should be included in the differential diagnosis of dogs with lameness, paraparesis, or unilateral or bilateral paraplegia, when neurological signs are compatible with lower motor neuron lesion (L4-S3) and acute or chronic progression. The digital and/or vascular doppler evaluation of the femoral pulse must be used and can assist on the disease diagnosis, avoiding treatments for other illnesses.(AU)

Aortic thromboembolism as a consequence of bacterial endocarditis causing acute ischemic neuromyopathy in a dog / Tromboembolismo aórtico decorrente de endocardite bacteriana causando neuromiopatia isquêmica em um cão

Background: Aortic thromboembolism (ATE) is a potentially fatal and rare condition in dogs. Ischemic neuromyopathy is main consequence, characterized by paraparesis or paraplegia, loss of femoral pulses, pain and hypothermia in distal part of affected limbs. In felines, affection is primarily associated with heart problems, whereas in dogs, condition is due to diseases which compromise the blood flow, such as, hyperadrenocorticism, immune-mediated hemolytic anemia, disseminated intravascular coagulation, sepsis, and more rarely cardiac problems. The aim of this article is describe a case of acute aortic thromboembolism due to bacterial endocarditis in a dog. Case: A female, 9-year-old dog, weighing 28.5 kg, was referred for examination due to acute paraparesis and pain. Patient showed cyanosis in nail beds and cold extremities in hind limbs, heart murmur degree V / IV, and bilateral absence of femoral arterial pulse. Due to suspicion of ATE, patient was treated with heparin, aspirin and tramadol, however it came to die less than 24 h after initial care. At necropsy, there was pulmonary edema, moderate hyperemia and severe tricuspid mitral valve. A thrombus with 3.0 cm of diameter in left atrium was found. At beginning of aorta there was also a thrombus measuring 5.0 cm x 0.3 cm x 0.3 cm and other thrombus in abdominal aortic trifurcation measuring 3.0 cm x 0.5 cm x 0.5 cm. [...]

Aortic thromboembolism as a consequence of bacterial endocarditis causing acute ischemic neuromyopathy in a dog / Tromboembolismo aórtico decorrente de endocardite bacteriana causando neuromiopatia isquêmica em um cão

Background: Aortic thromboembolism (ATE) is a potentially fatal and rare condition in dogs. Ischemic neuromyopathy is main consequence, characterized by paraparesis or paraplegia, loss of femoral pulses, pain and hypothermia in distal part of affected limbs. In felines, affection is primarily associated with heart problems, whereas in dogs, condition is due to diseases which compromise the blood flow, such as, hyperadrenocorticism, immune-mediated hemolytic anemia, disseminated intravascular coagulation, sepsis, and more rarely cardiac problems. The aim of this article is describe a case of acute aortic thromboembolism due to bacterial endocarditis in a dog. Case: A female, 9-year-old dog, weighing 28.5 kg, was referred for examination due to acute paraparesis and pain. Patient showed cyanosis in nail beds and cold extremities in hind limbs, heart murmur degree V / IV, and bilateral absence of femoral arterial pulse. Due to suspicion of ATE, patient was treated with heparin, aspirin and tramadol, however it came to die less than 24 h after initial care. At necropsy, there was pulmonary edema, moderate hyperemia and severe tricuspid mitral valve. A thrombus with 3.0 cm of diameter in left atrium was found. At beginning of aorta there was also a thrombus measuring 5.0 cm x 0.3 cm x 0.3 cm and other thrombus in abdominal aortic trifurcation measuring 3.0 cm x 0.5 cm x 0.5 cm. [...](AU)

Pheochromocytoma in a Dog as a Cause of Aortic Thromboembolism

A thirteen-year-old female German Spitz dog was referred to Veterinary Hospital of the Universidade Estadual de Londrina, with acute paraplegia and pain in pelvic limbs for two days. The clinical sings, as lack of femoral pulse and cold distal limbs, were consistent with ischemic neuromyopathy due to aortic thromboembolism. Soon after the examination, she had a severe epistaxis and died. On postmortem examination it was observed a thrombus adhered to the aorta trifurcation and a mass occupying the position of the right adrenal gland, which was diagnosed as pheochromocytoma on histological and immunohistochemistry examinations.(AU)

Pheochromocytoma in a dog as a cause of aortic thromboembolism

A thirteen-year-old female German Spitz dog was referred to Veterinary Hospital of the Universidade Estadual de Londrina, with acute paraplegia and pain in pelvic limbs for two days. The clinical sings, as lack of femoral pulse and cold distal limbs, were consistent with ischemic neuromyopathy due to aortic thromboembolism. Soon after the examination, she had a severe epistaxis and died. On postmortem examination it was observed a thrombus adhered to the aorta trifurcation and a mass occupying the position of the right adrenal gland, which was diagnosed as pheochromocytoma on histological and immunohistochemistry examinations.