Endoscopic Retrieval of Esophageal and Gastric Foreign Bodies in Cats and Dogs: A Retrospective Study of 92 Cases.

Esophageal and gastric foreign bodies (FBs) commonly occur in small animal practices, and their endoscopic removal has been previously reported. However, few studies reported the endoscopic instruments used for the retrieval attempt and the time spent for endoscopic removal. Therefore, the aim of this study is to evaluate the factors that can influence the success rate and timing of the endoscopic retrieval of FBs. The medical records of 92 animals undergoing endoscopic removal of esophageal (n = 12) and gastric (n = 84) FBs have been reviewed. Two dogs had FBs in both the esophagus and stomach. From medical records and video recordings, there were extrapolated data on signalment, clinical signs, endoscopic devices used, success of retrieval, and duration of endoscopy. Endoscopic removal of FBs was successful in 88% cases, and the mean time spent for the extraction was 59.74 min (range, 10-120 min). The success rate and timing for the removal of endoscopic foreign bodies (EFBs) are influenced by several factors in our population: medium-breed dogs, adult animals, and localization of FBs in the body of the stomach increased the probability of failure during the endoscopic retrieval attempt. Conversely, the success and timing of the retrieval of EFBs were higher in puppies and with increasing operator's experience. Moreover, the use of combination devices such as polypectomy snare and grasping forceps negatively influenced the success of extraction of FBs. Further prospective and comparative studies in a large and multicentric population of patients can be useful to create interventional endoscopic guidelines, as in human medicine.

Application of Ultrasound in Detecting and Removing Migrating Grass Awns in Dogs and Cats: A Systematic Review.

Migrating grass awns are an important cause of disease in dogs and cats. Plant awns can migrate into several body tissues and cavities because of their fusiform shape and backward-pointing barbs. Their migration causes inflammatory tissue reaction and clinical signs depend upon their localization. Ultrasound has been described as a useful, noninvasive, and readily available tool to identify and guide vegetal foreign bodies removal in animals. The aim of this systematic review was to summarize current knowledge on the application of ultrasonography in the identification and removal of grass awns from various anatomic locations in dogs and cats. We selected and analyzed 46 papers on the application of ultrasonography in dogs and cats affected by migrating grass awns. The ultrasonographic appearance of grass awns is characteristic, although their size and location can influence the visualization and the attempt of removal. In some cases, migrating grass awns are not directly visualized by ultrasonography, but the lesions caused by their migration can be easily seen. Ultrasonography can be considered a useful diagnostic tool to localize and remove migrating grass awns; however, when the migration occurs in less accessible locations or discrete foreign bodies are present, this diagnostic tool should be considered as a part of a multidisciplinary approach with advanced diagnostic imaging modalities.

Risk factors for atrial fibrillation in dogs with dilated cardiomyopathy.

Introduction: Atrial fibrillation secondary to dilated cardiomyopathy (DCM) frequently affects large-breed dogs. The aim of the present study was to identify risk factors for the development of atrial fibrillation in dogs of different breeds with an echocardiographic diagnosis of DCM. Methods: In this multicenter retrospective study, we searched the electronic databases of five cardiology referral centers for dogs with an echocardiographic diagnosis of DCM. A comparison of clinical and echocardiographic variables was performed between dogs developing atrial fibrillation and those not developing atrial fibrillation and the ability to distinguish between these two groups of dogs was evaluated by receiver operating characteristic curve analysis. Univariate and multivariable logistic regression analysis estimated the odds ratio (OR) with 95% confidence interval (CI) of developing atrial fibrillation. Results: We included 89 client-owned dogs with occult and overt echocardiographic DCM. Of these, 39 dogs (43.8%) had atrial fibrillation, 29 dogs (32.6%) maintained a sinus rhythm, and 21 dogs (23.6%) showed other cardiac arrhythmias. Left atrial diameter had high accuracy (area under the curve = 0.816, 95% CI = 0.719-0.890) to predict the development of atrial fibrillation at the cut-off of >4.66 cm. After multivariable stepwise logistic regression analysis, only increased left atrial diameter (OR = 3.58, 95% CI = 1.87-6.87; p < 0.001) and presence of right atrial enlargement (OR = 4.02, 95% CI = 1.35-11.97; p = 0.013) were significant predictors of atrial fibrillation development. Discussion: Atrial fibrillation is a common complication of DCM in the dog and is significantly associated with increased absolute left atrial diameter and right atrial enlargement.

Intracardiac Porcupine Quill Migration in a Dog: Multimodality Imaging Findings and Surgical Management.

The porcupine is a nocturnal quill-bearing rodent common throughout Italy. When threatened, it defends itself by erecting its quills, rattling its tail, and running sideways or backyard into predators. The quills are released upon contact with assailants and tend to migrate into several body tissues or cavities due to the unique inverted cuticles (crenate) directed downwards to the quill base (a sort of "harpoon effect"). Intracardiac migration of porcupine quills has been reported in a few dogs with severe clinical signs. This case report describes a single porcupine quill [Hystrix cristata, (HC)] migration through the heart in a dog and the use of multimodality imaging for the diagnosis and surgical approach. A 4-year-old 25 kg female mixed-breed dog was presented for evaluation of recurrent fever. Transthoracic echocardiographic examination showed a linear, hyperechoic foreign body traversing the interventricular septum from the heart base to the cardiac apex. Computed tomography and transesophageal echocardiography confirmed the presence of a single structure resembling a quill; a later esophageal endoscopy showed no anatomical alterations or mucosal injuries. Following median sternotomy and after accurate localization by intraoperative ultrasound, the quill was successfully removed. The dog had a good recovery without evidence of severe cardiac injury secondary to an intracardiac quill. To the best of the authors' knowledge, the identification of an intracardiac HC quill by ultrasonography and CT and its successful removal by ultrasound guide has not been previously reported.

Base-apex electrocardiographic examination in healthy cows of Chianina breed.

Background: The electrocardiography is a useful diagnostic tool for the characterization of the cardiac rhythm in veterinary medicine. In cattle, standard electrocardiographic (ECG) exam is commonly performed using the base-apex lead system and reference values for ECG parameters have been reported for different breeds of cows. However, no ECG studies have been conducted in Chianina breed. Aim: To determine the feasibility and normal values for standard base-apex electrocardiography in clinically healthy Chianina cows. Methods: A standard base-apex ECG examination was acquired in 45 Chianina cows. All the cows were considered healthy based on history and physical examination. The following ECG parameters were evaluated: heart rate (HR); morphology of P wave, QRS complex, and T wave; amplitude and duration of P wave, QRS complex, and T wave; duration of PR and QT intervals. Correlations between ECG parameters and clinical variables were analyzed. Results: Morphology of the ECG waves/complexes and values for all ECG parameters recorded in the 45 clinically healthy Chianina cows were reported. Correlations between HR and body weight (BW), QT interval and BW, QT interval and HR, P wave amplitude and HR, PR interval and HR, R wave amplitude and age were observed. Statistical difference between HR in pregnant and non-pregnant cows was also found. Conclusion: Base-apex electrocardiogram is suitable for monitoring heart rhythm in clinically healthy Chianina cows and reference values for main ECG parameters have been reported for this breed. This study can be a useful contribution to the literature, updating current knowledge on the electrocardiography in cattle.

Mural Endocarditis and Embolic Pneumonia Due to Trueperella pyogenes in an Adult Cow with Ventricular Septal Defect.

Bacterial endocarditis represents one of the most frequently acquired cardiac diseases in adult cattle. Congenital heart diseases as a ventricular septal defect can facilitate bacterial endocarditis as a consequence of turbulent blood flow through the defect, causing damage to the endocardium. We describe a case of mural endocarditis associated with a ventricular septal defect in an eight-year-old female Holstein Friesian cow. The cow's history revealed that she had presented dysorexia and a sudden decrease of milk production in the last 10 days prior to the examination. On clinical examination, jugular pulses, tachycardia with irregular heart rate and tachypnea with harsh bronchovesicular sounds were evident. Electrocardiographic examination allowed the diagnosis of an atrial fibrillation with high ventricular response rate. Transthoracic echocardiography revealed a large vegetation originating from the endocardium between the tricuspid and pulmonic valves in the right ventricle outflow. On post-mortem examination, a small muscular septal defect under the right coronary cusp of the aortic valve and a mural vegetative endocarditis were found. An abscess in the chondro-costal junction of the third right rib and metastatic pneumonia were also observed. This case report describes a rare consequence of a small ventricular septal defect that had not been previously diagnosed in an adult cow.

Ultrasound-Guided Radiofrequency Ablation of Chemodectomas in Five Dogs.

Chemodectomas are low prevalence tumors with complex clinical management. Many present as an incidental finding however, in other dogs, they produce pericardial effusion and/or compression, leading to the appearance of severe clinical signs. There are currently several approaches: surgery, radiotherapy, stent placement and chemotherapy. This is the first description of percutaneous echo-guided radiofrequency ablation of aortic body tumors. This minimally invasive treatment is based on high frequency alternating electrical currents from an electrode that produces ionic agitation and generates frictional heat, causing coagulation necrosis. Five dogs with an echocardiographic and cytological diagnosis of chemodectoma underwent percutaneous echo-guided radiofrequency ablation. At the time of presentation, all the dogs showed clinical signs, such as ascites and/or collapse. There were no complications either during the procedure or in the following 24 hours. Rapid clinical improvement associated with a reduction in size and change in sonographic appearance of the mass were achieved with no complications. Six months follow-up was carried out in all dogs. A second percutaneous echo-guided RFA was performed eight months after the first procedure in one dog. Based on our experience, radiofrequency ablation seems to be a feasible and safe technique, making it a potential alternative therapeutic approach in the clinical management of aortic body tumors leading to severe clinical compromise.

Left Atrial Mural Thrombosis and Hemopericardium in a Dog with Myxomatous Mitral Valve Disease.

A 14-year-old mixed-breed dog with a 2-year history of myxomatous mitral valve disease was examined for collapse and lethargy. At the presentation, pale oral mucous membranes, rapid and weak femoral pulses, and muffled heart sounds with a moderate left apical systolic murmur were revealed. Echocardiographic examination showed pericardial effusion with organized echogenic material originating from the left atrial wall. Tamponade of the right atrium and severe left atrial enlargement were also observed. Multiple views of the left atrium and left auricle allowed to visualize a hyperechoic mass adherent to the endocardium of the left atrial wall. Contrast-enhanced ultrasonography study allowed to rule out active intrapericardial hemorrhages, and echo-guided pericardiocentesis was performed. No recurrence of pericardial effusion was observed, but the dog suddenly died after 10 days. The postmortem examination confirmed multifocal left atrial thrombosis attached to the endomyocardial tears.

Double-Outlet Right Ventricle in a Chianina Calf.

Congenital heart defects have been occasionally reported in cattle and ventricular septal defect represents the most frequently encountered anomaly. The double-outlet right ventricle is a rare congenital ventriculoarterial malformation reported only in certain cattle breeds. We describe this rare and complex congenital cardiac malformation observed in a 10-day-old male Chianina calf. Clinical examination showed tachycardia, tachypnea, jugular pulses, cyanotic mucous membranes and a right apical systolic murmur. Transthoracic echocardiography revealed severe dilation of the right-sided cardiac chambers with a markedly hypoplastic left ventricle. Both aorta and pulmonary artery leaving the right ventricle in parallel alignment with the tricuspid valve were suggestive of a dual-outlet right ventricle. Interventricular and interatrial septal defects were also visualized. Post-mortem examination confirmed the echocardiographic findings. To the authors' knowledge, a similar complex congenital cardiac malformation has not been reported in calves of the Chianina breed to date.

Prostatic Localization of a Migrating Grass Awn Foreign Body in a Dog.

A 13-year-old male mixed-breed dog was examined because of hematuria and pyrexia. Ultrasonographic examination of the genitourinary tract showed the presence of a migrating grass awn in the right prostatic lobe. Laparotomy allowed, under ultrasonographic guidance, to remove entirely the migrating grass awn from the prostatic parenchyma. The recovery was uneventful and four months after the surgery the owner reported that the dog showed the complete resolution of the clinical signs and full return to normal activity. To our knowledge, this case report describes for the first time the clinical presentation, imaging findings, management and outcome for a dog with prostatic localization of a migrating grass awn.

Ultrasonographic assessment of abdominal aortic elasticity in hypertensive dogs.

BACKGROUND: Systemic hypertension (SH) is a persistent and pathological increase in arterial blood pressure (BP). Chronic SH leads to an increase in aortic (Ao) stiffness, and measuring Ao elasticity is useful for estimating Ao stiffness in humans. Currently, no literature in veterinary medicine describes noninvasive assessment of abdominal Ao elasticity in dogs with SH. OBJECTIVE: Compare ultrasonographic-derived abdominal Ao strain (AoSt) between hypertensive (HT) and normotensive (NT) dogs. ANIMALS: Fifty privately-owned dogs with clinical signs, conditions, or both potentially associated with SH. METHODS: Prospective observational case-control study. Aortic stiffness was estimated by calculating AoSt as follows: AoSt = ([AoDs - AoDd]/AoDd) × 100, where AoDs and AoDd are the Ao diameter in systole and in diastole, respectively. Aortic stiffness was calculated from 2 different Ao transverse sections, the first caudal to the left renal artery (K_AoSt), and the second cranial to the external iliac arteries (I_AoSt). RESULTS: Thirty-two dogs were included in the HT group and 18 in the NT group. Both K_AoSt and I_AoSt in HT dogs were significantly lower (P < .05) than in NT dogs (7.4 ± SD 3.6) vs 10.3 (±3.8) and 5.7 (interquartile range [IQR], 3.9-7.5) vs 8.1 (IQR, 7-10.3), respectively. Only K_AoSt was significantly influenced by age. CONCLUSIONS AND CLINICAL IMPORTANCE: Ultrasonographic Ao elasticity assessment was feasible to compare HT and NT dogs. Results indicated that K_AoSt and I_AoSt indices can be used to assess SH-related Ao stiffness, especially when indirect BP measurements are inconsistent or inaccurate. Additional studies to assess the AoSt in healthy dogs of various ages are needed.

Assessment of Longitudinal Left Ventricle Deformation by 2-Dimensional Speckle Tracking Echocardiography Obtained from Different Views in Cats.

Two-dimensional speckle tracking echocardiography (STE) is a novel, angle-independent imaging technique useful to assess myocardial function by strain and strain rate analysis in human and veterinary medicine. Commonly, the left apical four-chamber (LAP4Ch) view is used to assess left ventricular (LV) longitudinal deformation in dogs and cats. However, the right parasternal four-chamber (RP4Ch) view is often more easily obtained than the LAP4Ch view in cats. No studies exist comparing longitudinal strain and strain rate values using STE from different echocardiographic views in cats. Therefore, we examined the agreement between RP4Ch and LAP4Ch for assessment of LV longitudinal strain and strain rate in cats. We acquired 2D echocardiographic cineloops from RP4Ch and LAP4Ch views and analyzed LV longitudinal strain and strain rate in 50 cats (31 healthy cats and 19 cats with different disease states) using XstrainTM software. Peak systolic strain and strain rate values of endocardial and epicardial border were used for the analysis. The two echocardiographic views were compared using limits-of-agreement analyses and intra-observer measurement variability was assessed. We could obtain longitudinal strain and strain rate from the RP4Ch view in all cats. Strain, but not strain rate, had good intra-observer measurement variability (<10% vs. <20%). However, only endocardial strain values obtained with the two views agreed sufficiently to be used interchangeably (95% limits of agreement: -3.28, 2.58). Epicardial strain/strain rate and endocardial strain rate values did not agree sufficiently to be used interchangeably (95% limits of agreement: -11.58, 9.19; -2.28, 1.74; -1.41, 1.36, respectively). Our study suggests that RP4Ch view was feasible for assessment of the LV longitudinal deformation analysis by STE in cats, but only endocardial longitudinal strain values obtained from the two different views were interchangeable.

Severe Pleural Effusion in a Dog Affected by Larval Mesocestodiasis.

A 4-year-old, 20 kg, female mixed breed dog was referred to our Veterinary Teaching Hospital for severe respiratory distress. Thoracic ultrasonography revealed severe pleural effusion with multiple anechoic cystic structures within the fluid. Abdominal cavity presented few small and irregular cystic structures. Diagnosis of infection by larval stages of Mesocestoides spp. on the basis of a PCR approach was performed and therapy with oral fenbendazole was started. Due to an incomplete clinical response, the dog underwent to remove metacestodes cysts by surgical debridement. The dog showed no recurrence of clinical signs for 12 months after the surgery. Pleural larval cestodiasis should be added as a differential diagnosis in the list of diseases causing pleural effusion in dogs.

Cystic thymic degeneration with pseudoepitheliomatous hyperplasia in a Beagle puppy: an idiopathic lesion?

A 6-mo-old female Beagle dog was inappetent and depressed. The radiographic, ultrasonographic, and computed tomographic examination of the chest revealed a 10 × 7 cm multicystic mediastinal structure interpreted as altered thymus, in association with moderate pleural effusion that laboratory tests confirmed as hemothorax. No history of trauma or anticoagulant drug intoxication was reported, and no coagulation disorders were detected. Afterward, medial cranial sternotomy was performed to remove the altered tissue. Histologically, this tissue was compatible with a thymic remnant, characterized by numerous cystic lesions, mostly blood filled and lined by flattened-to-cuboidal epithelial cells, occasionally projecting into the surrounding stroma, and forming cytokeratin-positive ribbons, trabeculae, and papillae. Lymphocytes were scant, and numerous areas of congestion and hemorrhage were present throughout the samples. This case of idiopathic thymic hemorrhage with cystic degeneration of the thymus and pseudoepitheliomatous hyperplasia was an incidental finding; the dog recovered from surgery uneventfully.

Transverse Right Ventricle Strain and Strain Rate Assessed by 2-Dimensional Speckle Tracking Echocardiography in Dogs with Pulmonary Hypertension.

Right ventricular (RV) strain analysis using 2-dimensional speckle tracking echocardiography (2D STE) permits practitioners to assess regional and global deformation of the myocardium. Recently, assessment of the longitudinal right ventricle (RV) strain and strain rate using 2D STE has been reported in dogs. Although longitudinal deformation is the dominant component of the RV systole, RV myocardial fibers of the superficial layer are oriented circumferentially and these contribute to the RV pump function (radial deformation). Because this strain component has not been investigated in dogs, we have assessed radial RV strain and strain rate using 2D STE in healthy dogs and dogs with pulmonary hypertension (PH). We have recruited 74 dogs (40 healthy dogs and 34 dogs with PH) in which we have analyzed radial RV free wall strain and strain rate using XstrainTM software. We have used the left apical 4-chamber view optimized for the RV for analysis of the radial strain and strain rate variables (XstrainTM software denoted radial strain as "transverse"). Seven dogs were excluded during the analysis for low quality images. Transverse strain and strain rate obtained in healthy dogs showed no relationship with heart rate, body weight or age (r2 < 0.09 and p > 0.05 for all variables). Moreover, no relationship between transverse strain/strain rate variables and left atrial-to-aortic ratios was observed (r2 < 0.06 and p = 0.2, for both). Transverse strain and strain rate obtained in dogs with PH, showed weak negative relationships with tricuspid regurgitation velocity (r2 < 0.25 and p = 0.006, for both). Transverse RV strain and strain rate using 2D STE is feasible in most dogs and decrease with worsening of the PH, but these advanced echocardiographic indices do not help in identifying dogs with PH.

Transthoracic M-mode echocardiographic assessment of pulmonary vein-to-pulmonary artery ratio in healthy horses.

Equine cardiovascular structures and function are routinely assessed by transthoracic echocardiography. Recently, investigators have described the echocardiographic visualization of equine pulmonary vein ostia. In companion animals, the right pulmonary vein (RPV) to right pulmonary artery (RPA) ratio has been used as an index to estimate the severity of cardiac diseases resulting in left ventricular volume overload. We sought to assess the feasibility of measuring RPV and RPA dimensions, and sought to provide various previously examined RPV and RPA variables in clinically healthy horses that could be used to assess cardiopulmonary disease status. Echocardiographic examination was prospectively performed in 70 healthy horses. The RPV and RPA were visualized using a modified right parasternal long-axis view and maximum and minimum diameters of both vessels were measured from 2D guided M-mode traces. The aortic diameter (Ao) was measured from the right parasternal short-axis view in early diastole. These measurements were then used to produce various ratio indices. RPV and RPA were imaged in all 70 horses. Median of the minimum and maximum RPV/RPA was 0.51 and 0.60, respectively. Median fractional dimensional change of vessels was 33% for RPV and 22% for RPA. The medians of the minimum and maximum RPV/Ao and RPA/Ao were 0.18, 0.28, 0.35 and 0.46, respectively. No relationships between either bodyweight or heart rate and any of the vein or artery variables were identified (maximum r2 = 0.04). Inter- and intra-observer measurement variability was very good for all RPV and RPA measurements. Measuring of RPV and RPA diameters using M-mode transthoracic echocardiography is feasible in healthy horses. Further studies of these variables in horses with cardiac diseases are needed to determine the clinical applicability and utility.

Functional endoscopic sinus surgery in a cat with nasal tumor.

An 11-year-old, 5.8-kg, male European cat was presented with a 4-month history of sneezing, nasal discharge, respiratory distress and bilateral conjunctivitis. Physical examination showed bilateral hemorrhagic mucopurulent nasal discharge and stertorous respiratory sounds. An irregular shaped mass involving the aboral portion of the right nasal cavity and sphenoidal sinus was identified by computed tomography. The mass was localized endoscopically in the medium meatus and an endoscopic-guided biopsy was performed. B-cell lymphoma was diagnosed by histopathological and immunochemistry exams. Functional endoscopic sinus surgery allowed to completely remove the tumor and restore a normal nasal flow. The cat showed no recurrence of the neoplasia for 15 months after the functional endoscopic sinus surgery.

A specific laryngeal finding in dogs with bronchial vegetal foreign bodies: a retrospective study of 63 cases.

Grass awns commonly cause respiratory disease in dogs; when located in the trachea or bronchi, they cause severe bronchial inflammation and sepsis. The interplay of cough, bronchoconstriction, and mucus secretion can result in a less effective expulsive cough phase, especially when the causal factor persists. The bronchial exudate could consequently become trapped in the upper respiratory tracts of dogs with bronchial vegetal foreign bodies. We retrospectively reviewed endoscopic findings of the upper respiratory tract in dogs that underwent bronchoscopy in our hospital and correlated these findings with the presence of bronchial grass awns. Muco-purulent exudate in the ventral larynx region, between the vocal cords and laryngeal ventricles, was frequently associated with the presence of bronchial grass awns. This laryngeal finding could be secondary to an altered response to grass awn localization in the bronchi. These results should be carefully considered, particularly in countries where grass awns are commonly found.

Two-dimensional echocardiographic estimates of left atrial function in healthy dogs and dogs with myxomatous mitral valve disease.

OBJECTIVES: To provide reference intervals for 2-dimensional linear and area-based estimates of left atrial (LA) function in healthy dogs and to evaluate the ability of estimates of LA function to differentiate dogs with subclinical myxomatous mitral valve disease (MMVD) and similarly affected dogs with congestive heart failure (CHF). ANIMALS: Fifty-two healthy adult dogs, 88 dogs with MMVD of varying severity. METHODS: Linear and area measurements from 2-dimensional echocardiographs in both right parasternal long and short axis views optimized for the left atrium were used to derive estimates of LA active emptying fraction, passive emptying fraction, expansion index, and total fractional emptying. Differences for each estimate were compared between healthy and MMVD dogs (based on ACVIM classification), and between MMVD dogs with subclinical disease and CHF that had similar LA dimensions. Diagnostic utility at identifying CHF was examined for dogs with subclinical MMVD and CHF. Relationships with bodyweight were assessed. RESULTS: All estimates of LA function decreased with increasing ACVIM stage of mitral valve disease (p<0.05) and showed negative relationships with increasing LA size (all r2 values < 0.2), except for LA passive emptying fraction, which did not differ or correlate with LA size (p=0.4). However, no index of LA function identified CHF better than measurements of LA size. Total LA fractional emptying and expansion index showed modest negative correlations with bodyweight. CONCLUSIONS: Estimates of LA function worsen with worsening MMVD but fail to discriminate dogs with CHF from those with subclinical MMVD any better than simple estimates of LA size.