Allogenic blood patch pleurodesis for management of pneumothorax in a Cavalier King Charles Spaniel puppy with multiple pulmonary blebs and bullae.

A 9-week-old male intact Cavalier King Charles Spaniel was presented for evaluation of acute onset dyspnea caused by left-sided pneumothorax. Thoracic computed tomography (CT) identified multiple pulmonary bullae and blebs in multiple lung lobes. Rupture of ≥1 pulmonary blebs or bullae, precipitated by low impact trauma, was the suspected cause of pneumothorax. A volume of 7.5 mL/kg of fresh whole blood was collected from a type-matched donor dog and administered into the left pleural space using a thoracostomy tube. The pneumothorax was successfully resolved and no adverse effects of blood patch pleurodesis were noted. The dog was clinically normal 12 months later.

Dysplastic gangliocytoma of the cerebellum in a cat.

A 2.5-year-old cat presented with progressive ataxia and lethargy. Magnetic resonance imaging (MRI) showed enlargement of the cerebellum and herniation of cerebellar vermis. Postmortem examination confirmed the MRI findings, and histopathology showed numerous large dysplastic neurons populating and displacing the Purkinje cell layer and extending into the molecular and granular layers of the cerebellum. The lesion was diagnosed as dysplastic gangliocytoma of the cerebellum. In humans, this tumor is often associated with Cowden syndrome, a genetic disorder characterized by multiple hamartomas and an increased risk of developing certain neoplasms, known to be linked to a germline mutation of the phosphatase and tensin homolog (PTEN) gene. Reduction in PTEN nuclear and cytoplasmic immunohistochemical labeling of dysplastic neurons in this case suggested a possible PTEN mutation involved in the tumorigenesis. This report provides a detailed pathology description of the tumor and the use of neuronal and PTEN markers which will help guide pathologists presented with this rare condition in the future.

Pulmonary mass-like lesion caused by Toxoplasma gondii in a domestic shorthair cat.

A 2-year-old male neutered domestic shorthair cat underwent investigations for acute onset of lethargy, hyporexia, and cough. Computed tomography of the thorax identified a large mass-like lesion in the left cranial lung lobe and bilateral pleural effusion. Thoracotomy and left cranial lung lobectomy were performed. Histopathology of the pulmonary mass was consistent with a localized Toxoplasma gondii pneumonia, confirmed by positive polymerase chain reaction on the affected lung lobe. After adjunctive medical management with a 28-day course of clindamycin (12.5 mg/kg PO q12h), clinical signs resolved and repeat thoracic radiographs documented no abnormalities. The cat remains clinically well 1 year after surgery.

Suspected congenital hyperinsulinism in a Shiba Inu dog.

A 3-month-old male intact Shiba Inu dog was evaluated for a seizure disorder initially deemed idiopathic in origin. Seizure frequency remained unchanged despite therapeutic serum phenobarbital concentration and use of levetiracetam. The dog was documented to be markedly hypoglycemic during a seizure episode on reevaluation at 6 months of age. Serum insulin concentrations during hypoglycemia were 41 U/µL (reference range, 10-29 U/µL). The dog was transitioned to 4 times per day feeding, diazoxide was started at 3.5 mg/kg PO q8h, and antiepileptic drugs were discontinued. No clinically relevant abnormalities were identified on bicavitary arterial and venous phase contrast computed tomographic imaging. The dog remained seizure-free and clinically normal at 3 years of age while receiving 5.5 mg/kg diazoxide PO q12h and twice daily feeding. Seizures later occurred approximately twice per year and after exertion, with or without vomiting of a diazoxide dose. Blood glucose curves and interstitial glucose monitoring were used to titrate diazoxide dose and dosing interval. Congenital hyperinsulinism is well recognized in people but has not been reported in veterinary medicine.

Relationship between serum iohexol clearance, serum SDMA concentration, and serum creatinine concentration in non-azotemic dogs.

BACKGROUND: Serum creatinine and symmetric dimethylarginine (SDMA) are used as surrogate markers of glomerular filtration rate (GFR) in clinical practice. Data pertaining to the correlations between GFR, SDMA, and serum creatinine in client-owned dogs are limited. OBJECTIVES: To describe the relationship between GFR, SDMA, and serum creatinine in a population of client-owned dogs, and to compare clinical utility of SDMA to GFR estimation for detecting pre-azotemic chronic kidney disease. ANIMALS: Medical records of 119 dogs that had GFR estimation performed via serum iohexol clearance between 2012 and 2017. METHODS: Prospective study using archived samples. GFR, SDMA, and serum creatinine results were reviewed and submitting practices contacted for outcome data. All dogs included in the study population were non-azotemic. Correlations between GFR, SDMA, and serum creatinine were determined by regression analysis. Sensitivity, specificity, and positive and negative likelihood ratios of different cutoffs for SDMA and serum creatinine for detecting decreased GFR were calculated, using a 95% confidence interval. RESULTS: Serum creatinine and SDMA were moderately correlated with GFR (R2 = 0.52 and 0.27, respectively, P < .0001) and with each other (R2 = 0.33, P < .0001). SDMA >14 µg/dL was sensitive (90%) but nonspecific (50%) for detecting a ≥40% decrease in GFR. Optimal SDMA concentration cutoff for detecting a ≥40% GFR decrease was >18 µg/dL (sensitivity 90%, specificity 83%). CONCLUSIONS AND CLINICAL IMPORTANCE: In non-azotemic dogs being screened for decreased renal function, using a cutoff of >18 µg/dL rather than >14 µg/dL increases the specificity of SDMA, without compromising sensitivity.

Clinical utility of estimation of glomerular filtration rate in dogs.

BACKGROUND: Glomerular filtration rate (GFR) estimation is the gold standard for assessment of renal function, although the clinical utility of this test is unclear. OBJECTIVES: To describe the clinical utility of GFR estimation in dogs. ANIMALS: Medical records of 132 dogs that had serum iohexol clearance measured between 2012 and 2017. METHODS: Iohexol clearance and clinical records were reviewed and submitting practices contacted to obtain outcome data. Dogs were classified into 4 groups based on the reason for performing GFR estimation: A1 (screening for pre-azotemic chronic kidney disease [CKD], n = 105), A2 (confirmation of azotemic CKD, n = 3), B (screening for pre-azotemic acute kidney injury, n = 19), and C (miscellaneous causes, n = 5). Descriptive review of the clinical utility of GFR estimation is provided. RESULTS: For dogs in Group A1, renal disease was diagnosed in 9/9 dogs with a GFR ≥40% decreased below the mean GFR of their body weight category, in 5/6 dogs with a ≥30% but <40% reduction in GFR and in 7/9 dogs with a ≥20% but <30% reduction in GFR. CONCLUSIONS AND CLINICAL IMPORTANCE: Glomerular filtration rate estimation is useful for the diagnosis of CKD before the onset of azotemia.

Leishmaniosis in a dog with no travel history outside of the UK.

A 3-year-old male neutered Shih Tzu cross was presented for investigation of a three-week history of weight loss, seborrhoea, vomiting and diarrhoea. Initial clinicopathological findings included pancytopenia, mild hypercalcaemia and marked hyperglobulinaemia. Subsequent bone marrow and skin biopsies revealed the presence of Leishmania amastigotes. Quantitative serology was positive for Leishmania species and PCR on the bone marrow sample confirmed a Leishmania infantum infection. The patient had been in the owner's possession since a puppy, had no travel history outside of the UK and had never received a blood transfusion or been used for breeding. However, another dog in the household that had been imported from Spain had been euthanased six months previously due to severe leishmaniosis. To the authors' knowledge, this is the first reported case of canine leishmaniosis in the UK without a history of travel to an endemic area, and most likely represents a case of dog-to-dog transmission.