Peliosis Hepatis with Chylous Ascites in a Dog.

A 6-year-old spayed female Toy Poodle dog was referred to the Hokkaido University Veterinary Teaching Hospital for abdominal distension. Abdominocentesis yielded ascitic fluid that had a mildly increased total protein concentration and a 2.7-fold higher triglyceride concentration than plasma, and was interpreted as chylous ascites. The patient had an enlarged liver, which contained multiple, small, nodular masses and cyst-like structures. Microscopically, these lesions were multifocal dilated spaces containing lymphocytes, endothelial cells, fibrin and islands of hepatocytes. Increased α-smooth muscle actin-positive cells were observed in hepatic sinusoids. Based on these findings, we diagnosed peliosis hepatis with chylous ascites, which is likely to have been due to lymphangiectasia and disrupted hepatic sinusoids. Neither Bartonella spp DNA nor mutations in ACVRL1 and MTM1 genes were detected, although there was a 47-fold increase in hepatic ACVRL1 expression compared with age-matched control liver. To the authors' knowledge, this is the first report of chylous ascites resulting from peliosis hepatis in any species.

Incidence of chyloabdomen diagnosis in dogs and cats and corresponding clinical signs, clinicopathologic test results, and outcomes: 53 cases (1984-2014).

OBJECTIVE To determine the incidence of chyloabdomen diagnosis in cats and dogs and characterize and compare between species the corresponding clinical signs, clinicopathologic test results, and outcomes. DESIGN Retrospective case series. ANIMALS 36 cats and 17 dogs in which chyloabdomen was diagnosed at a veterinary teaching hospital between 1984 and 2014. PROCEDURES Medical records were reviewed, and data retrieved included patient signalment; clinical signs at initial evaluation; results of physical examination, diagnostic tests, and imaging studies; and outcomes. Survival analyses, descriptive statistics, and comparisons between species were completed. RESULTS The incidence of chyloabdomen at the veterinary teaching hospital during the study period was 2.0 cases/100,000 admissions for cats and 2.8 cases/100,000 admissions for dogs. The mean age at diagnosis of chyloabdomen in cats was 11.3 years, compared with 6.9 years in dogs. The most common clinical signs in dogs and cats combined were lethargy (39/51 [76%]) and anorexia (37/51 [73%]), but fewer (23/53 [43%]) had abdominal distention. Chylothorax was a common comorbidity (25/53 [47%]), with malignant neoplasia being the most common underlying diagnosis (24/53 [45%]). Survival analyses included 44 patients; median survival time from diagnosis of chyloabdomen was 31 days overall, 8 days for patients with malignant neoplasia, and 73 days for patients without neoplasia. CONCLUSIONS AND CLINICAL RELEVANCE There were multiple causes of chyloabdomen in dogs and cats of the study, and outcome depended on underlying cause. Because of this and the rarity of chyloabdomen, a multicenter prospective study of disease progression, treatment response, and clinical outcome for dogs and cats with chyloabdomen is needed.

Chylous ascites associated with abdominal trauma and intestinal resection-anastomosis in a pet ferret (Mustela putorius furo).

CASE DESCRIPTION A 10-week-old 0.73-kg (1.6-lb) castrated male domestic ferret (Mustela putorius furo) was referred for exploratory laparotomy because of pneumoperitoneum and possible septic peritonitis after being bitten by the owner's dog. CLINICAL FINDINGS Abdominal exploration revealed a large laceration of the duodenum, tears of the jejunal mesentery, and 2 small tears in the abdominal wall. Chylous abdominal effusion developed 48 hours after surgery. TREATMENT AND OUTCOME Postoperative care included supportive treatment, analgesia, and antimicrobials. An abdominal drain was placed during the laparotomy and enabled monitoring of abdominal fluid production. Enteral feeding was provided through an esophagostomy tube. The chylous fluid production rapidly decreased after treatment with octreotide was initiated, and the ferret improved. Chyloabdomen resolved after 8 days of hospitalization and medical treatment. CLINICAL RELEVANCE Findings suggested that chylous ascites can potentially develop secondary to blunt abdominal trauma in ferrets. In this ferret, chyloabdomen was successfully treated with octreotide administration and abdominal drainage.

Chylous ascites in a hedgehog (Atelerix albiventris).

An African pygmy hedgehog (Atelerix albiventris) was diagnosed as chylous ascites with biliary cirrhosis. Abdomenocentesis revealed a milky fluid with a 324 mg/dl triglyceride level. On serum biochemical examination, the hedgehog had hypoalbuminemia, hypoglycemia, and high blood urea nitrogen. There was no cytologic or genomic evidence of infection, and a blood culture was negative. Histopathologic examination revealed a liver with proliferative bile ducts that were often surrounded by prominent septa of fibrous connective tissue. In the area of ductular reaction, proliferative cells positive for CD66, an embryogenic antigen of epithelial cells, were revealed. The potential association between chylous ascites and liver cirrhosis is undetermined but could be an aspect of future study. This is the first description of chylous ascites in a hedgehog.

Ultrasonographic characteristics of the cisterna chyli in eight dogs and four cats.

Ultrasonography of the cisterna chyli has been used in humans to diagnose increased lymphatic flow or lymph flow obstruction and to guide percutaneous embolization of the thoracic duct via the cisterna chyli. The aim of this study was to describe the ultrasonographic characteristics of the dorsal portion of cisterna chyli in dogs and cats with chylous ascites or chylothorax and in a group of healthy dogs and cats. The aorta and the cranial mesenteric artery were used as anatomic landmarks. Ultrasonography was performed before and 2 h after a fatty meal in healthy dogs and cats. The visualized structure was confirmed to be a dilated cisterna chyli at necropsy in a dog with chylous ascites. The confirmed or presumed cisterna chyli was consistently detected using ultrasonography in nonfasted healthy animals and clinically affected animals and appeared as an anechoic tubular structure, without detectable flow, at the right dorsolateral aspect of the aorta. It had a similar ultrasonographic appearance in patients with chyloabdomen and in nonfasted healthy dogs and cats. There was considerable overlap in diameters of the cisterna chyli for affected and healthy animals. The shape and size of the cisterna chyli in an individual animal were variable during the same ultrasound examination and between different examinations. This study demonstrated the appearance of the presumed dorsal portion of the cisterna chyli by ultrasonography and might provide useful preliminary data for further studies into the feasibility of ultrasound-guided injections or aspirations of the cisterna chyli in dogs and cats.

Chylous ascites in a cheetah (Acinonyx jubatus) with venoocclusive liver disease.

An 11-yr-old female cheetah (Acinonyx jubatus) was diagnosed clinically with hepatic and renal disease and euthanatized after an extended illness. Postmortem examination revealed 8-10 L of milky white fluid in the abdominal cavity and markedly dilated lymphatic vessels within the intestinal mesentery. The abdominal fluid was a chylous effusion based on the cytologic predominance of lymphocytes and macrophages and comparison of cholesterol and triglyceride levels in the fluid and in serum. Gross and histopathologic lesions in the liver were consistent with a diagnosis of venoocclusive liver disease. Chylous ascites is uncommon with human chronic liver disease and is rarely identified in animals.

Hyponatremia and hyperkalemia associated with chylous pleural and peritoneal effusion in a cat.

A 6-year-old, castrated male shorthair was evaluated for chylous effusion in the thorax and abdomen. An underlying disease process was not determined. The cat developed hyponatremia and hyperkalemia, which was attributed to the mechanical drainage of pleural fluid and to the decreased urinary excretion of potassium.

Chyloabdomen in a mature cat.

A mature, castrated male cat presented with progressive lethargy and a severely distended abdomen. Abdominal radiographs, abdominocentesis, and evaluation of the fluid obtained led to a diagnosis of chyloabdomen. The underlying pathology, etiology, diagnosis, and treatment associated with this disease are discussed.

Chylous abdominal effusion in a cat with feline infectious peritonitis.

A 10-year-old cat was diagnosed with chyloperitoneum based on the effusion characteristics. Feline coronavirus serology was positive. The owner declined further evaluation and elected euthanasia. Necropsy revealed vasculitis with multifocal areas of necrosis and lymphocytic-plasmacytic inflammation in multiple solid organs, most likely due to feline infectious peritonitis (FIP). Immunohistochemistry was negative for FIP antigen. Notwithstanding, the final diagnosis of FIP was based on the characteristic histopathological lesions. Underlying causes of chyloperitoneum in cats and humans are discussed, and possible pathogenesis of the chyloperitoneum in association with a vasculitis such as FIP is discussed.

Chyloperitoneum and abdominal adhesions in a miniature horse.

Chyloperitoneum is a potential cause of colic in horses. Although rare in horses, chyloperitoneum can develop secondary to tearing of mesenteric adhesions and rupture of mesenteric lymphatic vessels. The prognosis for horses with chyloperitoneum depends on the underlying cause and the response to treatment.

Chylothorax and chylous ascites in a dog with mediastinal lymphangiosarcoma.

A 10-year-old, male toy poodle presented for evaluation of a progressively worsening, harsh, nonproductive cough. Chylous pleural effusion, lymphopenia, thrombocytopenia, normoblastemia, and recurrent subcutaneous bruising were diagnosed. Surgical exploration of the cranial mediastinum revealed extensive, redundant connective tissue which was confirmed by histopathology to be mediastinal lymphangiosarcoma (LAS). During surgical placement of a fenestrated silastic mesh for passive pleuroperitoneal drainage, chylous ascites also was diagnosed. The patient was euthanized two days postoperatively due to persistent chylothorax. The etiopathogenesis of chylothorax and chylous ascites are discussed. Previous case reports of lymphatic endothelial neoplasia are reviewed.

Postcaval thrombosis and delayed shunt migration after pleuro-peritoneal venous shunting for concurrent chylothorax and chylous ascites in a dog.

Simultaneous chylothorax and chylous ascites related to intestinal lymphangiectasia was diagnosed in a 4-year-old spayed female dog. Palliative pleural and peritoneal drainage was accomplished by placement of fenestrated silastic sheeting into surgically created diaphragmatic defects, and implantation of a pleuro-peritoneal venous shunt. The immediate postoperative period was complicated by acute renal failure secondary to postcaval thrombosis originating at the site of placement of the efferent pump catheter and extending to the level of the renal veins. Rapid resolution of this complication was accomplished with systemic anticoagulation. Clinical signs related to fluid accumulation resolved for 10 weeks after which acute decompensation occurred and the dog was euthanatized. Postmortem examination showed that reaccumulation of fluid was associated with migration of the efferent limb of the shunt from the caudal vena cava.

Chyloabdomen in a neonatal foal.

A 12-hour-old female standardbred foal developed signs of abdominal pain, tachycardia, tachypnoea and fever associated with chylous ascites. Small intestinal obstruction was due to segmental, mid-jejunal lymphangiectasia. Post mortem examination revealed a lack of communication between afferent and efferent lymphatic vessels in the mesenteric lymphocentre, a defect which was suspected to be congenital.

Use of mesenteric lymphangiography in a calf with chylothorax and chyloperitoneum.

Lymphatic abnormalities resulting in chylous effusion into a body cavity are uncommon in domestic animals. In a 6-day-old calf admitted to our hospital because of failure to suckle and abdominal distention, however, mesenteric lymphangiography revealed an obstruction of lymphatic flow. Laparoscopic examination of the abdomen was unsuccessful. Fluid accumulation was resolved in this calf by drainage. In cattle with chylothorax and concurrent chyloperitoneum in which a traumatic lesion of the thoracic duct is possible, conservative management, with drainage and supportive treatment, should be attempted prior to considering surgical intervention.

Chylous ascites in cats: nine cases (1978-1993).

Medical records of 9 cats with chylous ascites that underwent exploratory celiotomy were reviewed. In 7 cats, chylous ascites was associated with intra-abdominal neoplasia: 4 cats had an unresectable tumor (hemangiosarcoma, 3 cats; paraganglioma, 1 cat) within the mesenteric root; 2 had malignant lymphoma of the small intestine and mesenteric lymph nodes; and 1 had lymphangiosarcoma of the abdominal wall. In 2 cats, chylous ascites was associated with nonneoplastic diseases: 1 cat had severe biliary cirrhosis and an extrahepatic portosystemic shunt; the other had steatitis caused by vitamin E deficiency. Three cats were euthanatized or died at the time of surgery, and 5 cats were euthanatized within 3 months of surgery. One cat with malignant lymphoma responded well to chemotherapy and lived for 14 months after surgery.

Chylous ascites in three dogs.

Chylous ascites was diagnosed in 3 dogs. Mesenteric lymphangiography was performed in 2 dogs and helped delineate abnormalities of the lymphatic system. The cause of chylous ascites in each dog appeared to be different. In 1 dog, a ruptured mesenteric lymphatic was identified at surgery. Evidence of abdominal lymphatic obstruction was found in another dog. Chylous ascites in the third dog appeared to be a complication of mesenteric lymphangiography for chylothorax.