Treatment of a nasal angiofibroma in a cat using stereotactic body radiation therapy.

A 14-year-old cat presented with right-sided epistaxis, right facial swelling, hyporexia, and sneezing. A right nasal mass was diagnosed based on dental radiography and computed tomography (CT), and nasal angiofibroma was diagnosed based on histopathology. Treatment consisted of stereotactic body radiation therapy in three consecutive daily doses. Self-limiting grade 3 oral mucositis developed which resolved within 6 weeks. Recheck CT 169 days after treatment confirmed a partial response by RECIST(1) based on digital CT measurements . Disease progression was confirmed on CT 642 days after treatment, per RECIST criteria, with the longest tumor diameter measuring 3.4 cm.

A novel case of tracheal injury secondary to gunshot trauma in a white rhinoceros (Ceratotherium simum).

OBJECTIVE: To describe a case of tracheal injury secondary to gunshot trauma in a rhinoceros. ANIMALS: 5-year-old female white rhinoceros (Ceratotherium simum). CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES: The rhinoceros was found alive with an apparent bullet entry wound cranial to the left shoulder. The rhinoceros was agitated and had bilateral epistaxis and increased respiratory noise. Immobilization of the animal facilitated closer examination and initiation of medical therapy. Radiographs obtained of the neck region at this first examination were nondiagnostic. Subsequent immobilization events allowed for further diagnostics and treatment. TREATMENT AND OUTCOME: Initial treatment included a broad-spectrum antibiotic and a corticosteroid. Five days following the injury, the rhinoceros was considered stable, and the animal was immobilized to investigate the cause of the epistaxis and respiratory signs. Tracheoscopy revealed a full-thickness penetrating wound in the mid to caudal region of the trachea, and the surface of a metallic projectile was viewed within the wound. Medical treatment was continued and the rhinoceros was managed conservatively. At 14 days, radiographs of the neck made with a more powerful unit revealed tissue emphysema dorsal to the trachea. A subsequent tracheoscopy 54 days after injury revealed a granulated wound. Follow-up at 4 years after injury determined that the rhinoceros was reported to be behaving normally and had successfully calved. CLINICAL RELEVANCE: Gunshot wounds associated with poaching are a prevalent problem in rhinoceros in Africa. Although more aggressive therapy including surgery may likely be considered in zoo or domestic animals, limited conservative treatment was successful in this wild-managed rhinoceros.

Lateral rhinotomy and coblation for treatment of a nasal hamartoma in a dog.

CASE DESCRIPTION: A 4-year-old spayed female French Bulldog was referred for treatment of a suspected right-sided nasal angiofibroma associated with a 4-month history of unilateral nasal discharge and stertor. CLINICAL FINDINGS: The dog appeared healthy other than right-sided mucoid debris and decreased airflow through the right naris. The dog was anesthetized, and a large intranasal mass was observed obstructing the right nasal passage and abutting the nasal septum. TREATMENT AND OUTCOME: A lateral rhinotomy was performed, and rigid endoscopes (0° and 30°) were used to examine the right nasal cavity. The mass filled the anterior aspect of the nasal cavity and involved a portion of the nasal turbinates with some erosion. A coblation unit was used to ablate tumor tissue laterally to remove the tumor in piecemeal fashion. Recovery was routine with only minor epistaxis after surgery, and the dog was discharged the next day. Eight months after surgery, follow-up CT revealed right-sided nasal turbinate and conchal atrophy consistent with prior mass ablation. No macroscopic recurrence was detected, and the owners reported only rare, clear rhinorrhea. CLINICAL RELEVANCE: Findings suggested that coblation may be an alternative to radiation therapy for vascular tumors with minimal invasion and low metastatic potential.

Splenic malignant fibrous histiocytoma with concurrent hypertension and epistaxis in an Alaskan malamute dog.

BACKGROUND: Malignant fibrous histiocytoma has been uncommonly described in dogs. Several extranasal neoplasias have been reported to result hypertensive epistaxis. There are, however, no published case reports of extranasal malignant fibrous histiocytoma with concurrent hypertension and epistaxis in dogs. CASE PRESENTATION: A 10-year-old dog presented with a spontaneous massive epistaxis persisting for 5 days. The dog exhibited unstable hypertension, which was considered as a cause of epistaxis. The complete blood count, prothrombin time, and activated partial thromboplastin time were within the reference limits, and other systemic examination showed no abnormalities except for a splenic mass occupying more than one third of the abdomen. Histologic examination of the resected spleen revealed the characteristic features of a malignant fibrous histiocytoma. One week after splenectomy, the hypertension and epistaxis resolved clinically and did not recur on the 5-month follow-up. CONCLUSIONS: The dog's blood pressure and epistaxis normalized after malignant fibrous histiocytoma resection suggesting that hypertensive epistaxis may be a rare manifestation of canine malignant fibrous histiocytoma.

Diode laser coagulation for the treatment of epistaxis in a Scottish fold cat.

We report the case of a 4-year-old, castrated 4.2-kg Scottish fold cat with recurrent epistaxis that was unresponsive to medical therapy. Diathermocoagulation of the nasal mucosa with a diode laser controlled the epistaxis and there was no significant recurrence of epistaxis during 1 year of follow-up.

Coagulation à la diode laser pour le traitement de l'épistaxis chez un chat Scottish Fold. Nous signalons le cas d'un chat Scottish Fold castré âgé de 4 ans d'un poids de 4,2 kg atteint d'épistaxis récurrente qui n'a pas répondu au traitement médical. La diathermocoagulation de la muqueuse nasale à l'aide d'une diode laser a contrôlé l'épistaxis et il n'y pas eu de récurrence de l'épistaxis durant le suivi d'un an.(Traduit par Isabelle Vallières).

Percutaneous ultrasound-guided arterial angiography for transarterial coil placement in anesthetized and standing horses.

OBJECTIVE: To (1) describe ultrasound-guided percutaneous introduction of a transarterial angiographic catheter into the common carotid artery (CCA); (2) investigate the feasibility of using angiography of the carotid arteries in the guttural pouch region and assess transarterial coil (TAC) placement into the internal carotid artery (ICA). STUDY DESIGN: Experimental study. ANIMALS: Healthy Standardbred horses (n = 6), aged 5-8 years. METHODS: Six horses had ultrasound-guided percutaneous CCA catheterization and angiography under general anesthesia. Catheterization sites were ultrasonographically evaluated postoperatively. Ten weeks later using the same horses sedated and standing, the same procedure was combined with placement of a TAC in the ICA. RESULTS: Agitated contrast ultrasonography confirmed successful catheterization of the CCA. Needle puncture and introducer-set penetration of the CCA were the main technical difficulties. Radiography and fluoroscopy confirmed successful angiography and TAC placement. Mild hematoma formation was recorded in 4 of 12 procedures. CONCLUSION: Angiography and TCA placement in the ICA can be safely performed using a percutaneous approach to the CCA under ultrasound guidance, in standing or anesthetized horses. This approach might be used for TAC embolization procedure; however, technical difficulties and hematoma formation can impair the procedure.

Ultrasound guided transarterial coil placement in the internal and external carotid artery in horses.

OBJECTIVES: To assess ultrasound guided transarterial coil placement (UGTACP) for occlusion of the internal carotid artery (ICA) and external carotid artery (ECA) in horses. STUDY DESIGN: Cadaveric and in vivo study. ANIMALS: Cadaveric horses (n = 10), healthy horses (3), and 1 clinical case. METHODS: Cadaveric and in vivo (healthy horses): UGTACP was performed in the caudal part of the ICA and ECA. Coil placement in the rostral part of the ICA was performed blindly and controlled by conventional radiography. No coils were placed in the rostral part of the ECA. CLINICAL CASE: UGTACP of the ICA was in a horse with guttural pouch mycosis of the left guttural pouch. RESULTS: Accurate ultrasound-guided catheterization of the ICA and ECA was performed in all specimens. Ultrasound-guided coil placement was successfully performed in all cases except 1. No complications occurred in the in vivo study. The clinical case fully recovered and returned to its intended use. CONCLUSIONS: Based on our study, UGTACP of the ICA and ECA caudal part is a feasible alternative to fluoroscopy. An advantage of this technique is the accuracy with which you can catheterize both ICA and ECA and the ability to identify unusual branching at the origin of the ICA. Regarding the rostral part of the ICA, angiographic catheter guidance in this region is probably more precise using fluoroscopy as it is performed blindly. In a clinical situation, combination of US and fluoroscopy guidance can result in reduction of radiation exposure time.

Coil embolization of a palatine artery pseudoaneurysm in a gelding.

OBJECTIVE: To describe successful transarterial coil embolization of a palatine artery pseudoaneurysm that extended into the caudal maxillary sinus of a gelding. STUDY DESIGN: Clinical report. ANIMAL: A 24-year-old Morgan gelding with right-sided epistaxis. METHODS: The right maxillary sinus was imaged by radiography, computed tomography, and sinoscopy. Angiography was performed to locate the source of bleeding, and transarterial coil embolization of a right palatine artery pseudoaneurysm was performed. RESULTS: There was some mucoid nasal discharge and an intermittent cough postoperatively. No epistaxis was seen after embolization. There was moderate swelling of the surgical incision over the mid-cervical common carotid artery. The horse was discharged from the hospital 4 days after surgery, and had been doing well, with no signs of bleeding, for 2 months postoperatively. The horse had acute colic secondary to a strangulating lipoma at 2 months and was euthanatized after exploratory celiotomy. Placement of embolization coils in the right palatine artery was confirmed by CT and necropsy. CONCLUSIONS: Severe epistaxis in the horse may be caused by a ruptured major palatine artery pseudoaneurysm. Occlusion of this vessel can be successfully accomplished by transarterial coil embolization.

Radiographic appearance of maxillary sinus feed impaction in a horse.

A 15-year-old Belgian gelding presented in respiratory distress, with bilateral mucopurulent nasal discharge, and right-sided epistaxis. The horse had a 5-year history of dental disease and had been recently losing weight. Radiographs indicated tooth root abscessation of the right maxillary third molar tooth and probable maxillary sinus feed impaction. These findings were confirmed at surgery and necropsy. The stippled, granular radiographic appearance described here is highly characteristic of sinus feed impaction.

Treatment of acute epistaxis secondary to guttural pouch mycosis with transarterial nitinol vascular occlusion plugs in three equids.

CASE DESCRIPTION: 2 horses and 1 pony were evaluated for right-sided (1 horse and the pony) and left-sided (1 horse) acute epistaxis of 1 day's to 1 month's duration. CLINICAL FINDINGS: Endoscopic examination of the 3 equids revealed that the hemorrhage originated from the right maxillary artery in 2 equids and from the left internal carotid artery in the third. Mycosis of the auditory tube diverticulum (guttural pouch) was detected in all 3 equids. TREATMENT AND OUTCOME: All 3 equids underwent surgery, and transarterial nitinol intravascular plugs were placed to occlude affected blood vessels. All equids survived for a long period (ie, a minimum of 1 to 2 years) and returned to their previous use. All had complete regression of clinical signs of guttural pouch mycosis without additional medical treatment. CLINICAL RELEVANCE: The use of transarterial nitinol intravascular plugs appeared to be an effective alternative to other techniques for the treatment of epistaxis secondary to guttural pouch mycosis, including transarterial occlusion devices such as embolization coils.

Pheochromocytoma in an African warthog (Phacochoerus aethiopicus).

A 14-yr-old male African warthog (Phacochoerus aethiopicus) with a chronic history of intermittent unilateral epistaxis, degenerative osteoarthritis, and intermittent weakness in the distal lumbar trunk was evaluated to determine the source of epistaxis. No obvious cause was determined, and in light of severe osteoarthritis and a holosystolic cardiac murmur, the animal was euthanized. A tumor of the right adrenal gland involving the medulla was found at gross necropsy. Immunohistochemical staining of the tumor was positive for chromogranin and negative for neurofilament protein, which was diagnostic for pheochromocytoma. No lesions were observed in either nasal cavity. Systolic, diastolic, and mean arterial pressures measured at the time of immobilization were elevated when compared with another African warthog immobilized with a similar anesthetic regimen. Additionally, the warthog had pronounced serum norepinephrine dominance with a norepinephrine:epinephrine ratio of 10.0, compared with 0.36 from clinically normal warthogs. Practitioners should consider pheochromocytoma when evaluating warthogs or swine for epistaxis.

A retrospective study of 61 cases of spontaneous canine epistaxis (1998 to 2001).

OBJECTIVES: To determine the prevalence and identify possible clinicopathologic indicators of the diseases associated with canine epistaxis. METHODS: The medical records of 61 dogs with epistaxis were reviewed. RESULTS: Systemic diseases, diagnosed in fifty-six dogs, included canine leishmaniasis in twenty-three dogs, canine monocytic ehrlichiosis in twenty-two, concurrent canine leishmaniasis and canine monocytic ehrlichiosis in six, rodenticide toxicity in two and primary immune-mediated thrombocytopenia, suspected oestrogen toxicity and systemic arterial hypertension in one dog each. Intranasal diseases were documented in the remaining five dogs, including transmissible venereal tumour in three dogs, and nasal adenocarcinoma and nasal aspergillosis in one dog each. Mucosal pallor and a generalised bleeding tendency were significantly more common among dogs with canine monocytic ehrlichiosis compared with those with canine leishmaniasis, whereas the opposite was true for peripheral lymphadenomegaly. Also, dogs with canine monocytic ehrlichiosis presented with pancytopenia more frequently compared with those with canine leishmaniasis; in the latter dogs, the median values of haematocrit, leucocyte and platelet counts and serum total protein concentrations were higher. CLINICAL SIGNIFICANCE: Canine leishmaniasis and canine monocytic ehrlichiosis are the leading causes of canine epistaxis in Greece. Mucosal pallor, bleeding tendency and pancytopenia are more likely to be indicative of canine monocytic ehrlichiosis, as opposed to peripheral lymphadenomegaly and hyperproteinaemia in canine leishmaniasis.

Prevalence, clinical features, and causes of epistaxis in dogs: 176 cases (1996-2001).

OBJECTIVE: To determine prevalence, clinical features, and causes of epistaxis in dogs. DESIGN: Retrospective case series. ANIMALS: 176 dogs with epistaxis. PROCEDURES: Medical records were reviewed for information related to signalment, clinical features, diagnosis, and outcome. RESULTS: 132 (75%) dogs were initially examined by the hospital's emergency service; prevalence of epistaxis was 0.3%. Dogs with epistaxis were more likely to be old (> or = 6 years), male, and large (> or = 26 kg [58.5 lb]) than were dogs in a reference population. In 109 (62%) dogs with epistaxis, an underlying cause was identified; 115 underlying disorders were identified, with 90 classified as local and 25 classified as systemic. Local causes of epistaxis included nasal neoplasia (n = 35), trauma (33), idiopathic rhinitis (20), and periapical abscess (2). Systemic causes included thrombocytopenia (12), thrombocytopathia (7), coagulopathy (3), hypertension (2), and vasculitis (1). Dogs with local causes were more likely to have unilateral than bilateral epistaxis, but 11 of 21 (52%) dogs with systemic disorders also had unilateral epistaxis. Dogs with systemic disorders were more likely to have clinical signs of systemic disease. Duration of epistaxis (acute vs chronic), severity, and duration of hospitalization were similar for dogs with local versus systemic disorders. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that epistaxis was a common disorder in dogs and frequently regarded as an emergency. Local causes of epistaxis were predominant, but clinical features traditionally thought to be helpful in distinguishing local versus systemic causes could not be reliably used for this purpose.

Evaluation of factors associated with survival in dogs with untreated nasal carcinomas: 139 cases (1993-2003).

OBJECTIVE: To evaluate factors associated with survival in dogs with nasal carcinomas that did not receive treatment or received only palliative treatment. DESIGN: Retrospective case series. ANIMALS: 139 dogs with histologically confirmed nasal carcinomas. PROCEDURES: Medical records, computed tomography images, and biopsy specimens of nasal carcinomas were reviewed. Only dogs that were not treated with radiation, surgery, chemotherapy, or immunotherapy and that survived > or = 7 days from the date of diagnosis were included. The Kaplan-Meier method was used to estimate survival time. Factors potentially associated with survival were compared by use of log-rank and Wilcoxon rank sum tests. Multivariable survival analysis was performed by use of the Cox proportional hazards regression model. RESULTS: Overall median survival time was 95 days (95% confidence interval [CI], 73 to 113 days; range, 7 to 1,114 days). In dogs with epistaxis, the hazard of dying was 2.3 times that of dogs that did not have epistaxis. Median survival time of 107 dogs with epistaxis was 88 days (95% CI, 65 to 106 days) and that of 32 dogs without epistaxis was 224 days (95% CI, 54 to 467 days). CONCLUSIONS AND CLINICAL RELEVANCE: The prognosis of dogs with untreated nasal carcinomas is poor. Treatment strategies to improve outcome should be pursued.

Transarterial coil embolisation in 31 horses (1999-2002) with guttural pouch mycosis: a 2-year follow-up.

REASONS FOR PERFORMING STUDY: There have been no previously published large case series describing short- and long-term outcome of transarterial coil embolisation (TCE) in horses with guttural pouch mycosis (GPM). OBJECTIVES: To describe the clinical and surgical features of horses with GPM presented at the Veterinary School of Lyon during a 28 month period; and to evaluate immediate to long-term results of TCE as a treatment. METHODS: Medical records of all horses with GPM treated with TCE between February 1999 and July 2002 were analysed. To be included in the study, no other surgical or medical treatment for the mycosis was administered. Subject details, case history and results of initial clinical examination and endoscopy were reviewed. For all individuals, evaluation of long-term complications and case evolution was based on owner or trainer interviews between 24 and 41 months after surgery. RESULTS: Thirty-one horses were identified with unilateral (n = 25) or bilateral (n = 6) GPM affecting only the medial (n = 28), only the lateral (n = 2) or both compartments simultaneously (n = 7). Of the 23 individuals presented with epistaxis, 20 showed complete resolution of the problem. Of the 19 horses presented with neurological signs, 2 were subjected to euthanasia for persistence of severe dysphagia. Prognosis for survival was excellent (84%) and prognosis for return at the level expected by the owner or trainer was good (71%). CONCLUSIONS AND POTENTIAL RELEVANCE: TCE of horses affected with GPM is an effective method of preventing haemorrhage and resolving the majority of mycotic lesions without further specific treatment. Treated horses did not present relapse of mycosis during the follow-up period.

Clinical features of epistaxis in dogs: a retrospective study of 35 cases (1999-2002).

Epistaxis was retrospectively evaluated in 35 dogs. Systemic disease was diagnosed in seven dogs and intranasal disease in 29. Nineteen dogs with intranasal disease had neoplasia. Dogs with neoplasia were older (mean 10.0 years) than dogs with nonneoplastic intranasal disease (mean 5.6 years). Signs persisting for >1 month occurred more often in dogs with intranasal than systemic disease. Unilateral epistaxis did not distinguish intranasal from systemic disease. Only dogs with intranasal disease had facial deformity, decreased airflow, or regional sub-mandibular lymphadenopathy. Dogs with systemic disease had a lower packed cell volume (mean 31.8%) than dogs with intranasal disease (mean 42.7%).