Left medial liver lobe torsion and postoperative acute gastric rupture in a 2.5-year-old male-castrated Flemish Giant rabbit (Oryctolagus cuniculus).

A 2.5-year-old male-castrated rabbit presented with acute abdominal pain, lethargy, and anorexia. Digital radiography revealed increased left-sided hepatomegaly, gastric dilation, and decreased peritoneal serosal detail. Abdominal ultrasonography identified a torsed left liver lobe, gastric dilation, and peritoneal effusion. Surgery confirmed a left medial liver lobe torsion, with subsequent lobectomy and seven days of hospitalization. The patient re-presented 2 days after discharge and suddenly died while hospitalized, with acute gastric rupture, fulminant peritonitis, and multifocal hepatic infarcts diagnosed on necropsy. We believe this is the first recorded imaging diagnosis of a left medial liver lobe torsion in a rabbit.

Lung lobe torsion associated with chest wall defects in a dog.

An 8-year-old, spayed, female poodle presented with exercise intolerance, lethargy, respiratory distress, retching, hyporexia and diarrhoea. Thoracic radiographs revealed increased opacity in the left cranial thoracic region. The fifth and sixth ribs appeared to be bulging cranially to caudally, and CT and surgical exploration confirmed the presence of a thoracic wall defect in that area. CT showed abrupt occlusion of the bronchus that branches into the left cranial lobe and consolidation of the caudal segment of left cranial lung lobe, which led to the diagnosis of lung lobe torsion. A thoracotomy was performed, the twisted lung lobe was surgically excised, and the defect in the thoracic wall was repaired. Respiratory distress gradually improved after the surgery, and there were no identified complications within the 2-year period following the procedure. Based on our literature search, this is the first reported case of lung lobe torsion caused by a thoracic wall defect in a dog.

Clinicopathological findings in and prognostic factors for domestic rabbits with liver lobe torsion: 82 cases (2010-2020).

OBJECTIVE: To document clinicopathologic findings in domestic rabbits with liver lobe torsion and identify prognostic factors. ANIMALS: 82 rabbits. PROCEDURE: Medical records of 4 institutions were reviewed to identify rabbits with an antemortem diagnosis of liver lobe torsion that were examined between 2010 and 2020. RESULTS: The prevalence of liver lobe torsion was 0.7% (82/11,402). In all 82 rabbits, the diagnosis was made by means of abdominal ultrasonography. Fifty (60.1%) rabbits underwent liver lobectomy, 23 (28%) received medical treatment alone, and 9 (10.9%) were euthanized or died on presentation. Overall, 32 (39%) rabbits died within 7 days of initial presentation and 50 (61%) survived. Seven-day survival rate did not differ significantly between medical treatment alone and surgical treatment. However, median survival time following medical treatment (530 days) was shorter than that following surgical treatment (1,452 days). Six of 14 rabbits had evidence of systemic inflammatory disease on necropsy. Rabbits with right liver lobe torsion were less likely to survive for 7 days than were those with caudate torsions (P = 0.046; OR, 3.27; 95% CI, 1.04 to 11.3). Rabbits with moderate to severe anemia were less likely to survive for 7 days than were rabbits that were not anemic or had mild anemia (P = 0.006; OR, 4.41; 95% CI, 1.55 to 12.51). Other factors associated with a decreased 7-day survival rate were high heart rate at admission (P = 0.013) and additional days without defecation after admission (P < 0.001). Use of tramadol was associated with an increased survival rate (P = 0.018). CLINICAL RELEVANCE: The prognosis for rabbits with liver lobe torsions was more guarded than previously described. Rabbits that underwent liver lobectomy had a longer median survival time than did rabbits that only received medical treatment.

Retrospective analysis of liver lobe torsion in pet rabbits: 40 cases (2016-2021).

BACKGROUND: Liver lobe torsion (LLT) in rabbits can be under-recognised and potentially fatal. The clinical features of cases presented to an exotic animal veterinary service in Australia were retrospectively reviewed. METHOD: Medical records of confirmed rabbit LLT cases between 2016 and 2021 were reviewed for signalment, clinical signs and findings, diagnostic imaging results, management strategies and outcomes. Variables of interest were analysed for statistical association with outcome. RESULTS: A total of 40 rabbits were included. The mean presenting age was 56.2 months (SD 30.5). Neutered males (23/40, 57.5%) were over-represented. Common clinical signs and findings included reduced appetite (40/40, 100%), lethargy (32/40, 80.0%), reduced faecal production (16/40, 40.0%), a doughy distended stomach (20/40, 50.0%), pale mucous membranes (19/40, 47.5%) and hypothermia (17/40, 42.5%). Anaemia and elevated plasma alanine aminotransferase and blood urea nitrogen were common clinicopathologic findings. Computed tomography (CT) was performed in 34 of 40 rabbits, confirming the presence and position of LLT (34/34, 100%), stenosis of the caudal vena cava or portal system (28/34, 82.4%) and increased free peritoneal fluid (29/34, 85.3%). Fifteen (15/40, 37.5%) rabbits were medically managed, and surgical intervention was performed in 23 of 40 (57.5%) rabbits. Overall, 30 of 40 (75.0%) rabbits survived. Surgical intervention did not confer a significant difference in outcome compared to medical management (odds ratio 0.77, 95% confidence interval 0.15-4.10, p = 0.761). CONCLUSION: CT can be an invaluable diagnostic modality for rabbit LLT. Favourable outcomes can be achieved in selected cases with medical management alone.

Chronic splenic torsion in a dog with an accessory spleen.

A 4-year-old, neutered male, mixed breed Old English sheepdog was presented for evaluation and treatment of anorexia, vomiting, and diarrhea. Presumptive severe pancreatitis was diagnosed based on the referral bloodwork. Abdominal ultrasonography identified a suspected liver lobe torsion based on the presence of a normal spleen. However, an exploratory laparotomy identified a splenic torsion in addition to a grossly normal spleen. Key clinical message: This case demonstrates that a second, potentially large area of splenic tissue (ectopic or accessory) can be present in the dog; therefore, the presence of a normal appearing spleen on abdominal ultrasonography does not rule out splenic torsion.

Torsion splénique chronique chez un chien avec une rate accessoire. Un chien berger anglais de race mixte âgé de 4 ans, mâle castré, a été présenté pour évaluation et traitement d'anorexie, de vomissements et de diarrhée. Une pancréatite sévère présumée a été diagnostiquée sur la base des analyses sanguines. L'échographie abdominale a identifié une torsion suspectée du lobe hépatique basée sur la présence d'une rate normale. Cependant, une laparotomie exploratrice a identifié une torsion splénique en plus d'une rate grossièrement normale.Message clinique clé :Ce cas démontre qu'une deuxième zone potentiellement large de tissu splénique (ectopique ou accessoire) peut être présente chez le chien; par conséquent, la présence d'une rate d'apparence normale à l'échographie abdominale n'exclut pas une torsion de la rate.(Traduit par Dr Serge Messier).

Clinical characteristics and long-term outcome of lung lobe torsions in cats: a review of 10 cases (2000-2021).

CASE SERIES SUMMARY: Lung lobe torsion is rare in cats. The aim of this multi-institution retrospective study was to describe clinical and diagnostic findings, treatments and outcomes of lung lobe torsion (LLT) in 10 cats. Dyspnoea and tachypnoea were the most common clinical signs. Pleural effusion was present in nine cats at presentation. Fluid analysis confirmed chylothorax in three cats. Nine cats underwent CT and five cats had thoracic radiographs taken. A diagnosis was made preoperatively in six cats, while in the other four cats it was made at exploratory thoracotomy. Affected lung lobes were the right cranial (n = 4/11), left cranial (n = 4/11) and right middle (n = 3/11). One cat had a concurrent torsion of two lung lobes. Lung lobectomy was successfully performed in all cases. Based on clinical, diagnostic and lung histopathology findings, three cats had idiopathic and seven cats secondary LLT. Intraoperative complications included hypotension and hypothermia in four and five cats, respectively. Postoperative complications occurred in six cats and lead to euthanasia or death in four cats, whereas complications resolved in the other two cats. Three cats were euthanased within 5 weeks of discharge. For the three cats surviving long term, including one euthanased at 252 days postoperatively, owner-described outcomes and quality of life were considered good to excellent. RELEVANCE AND NOVEL INFORMATION: Secondary LLT associated with underlying thoracic pathology was associated with high complication rates and poor outcomes. Long-term outcomes of cats undergoing surgery for LLT and surviving the perioperative period were deemed good to excellent.

Ultrasonographic and CT diagnosis of a complete splenic duplication with right splenic torsion and presumed regional splenic vein hypertension in a dog.

An 8-year-old mixed breed dog, was referred for lethargy, abdominal discomfort, hematemesis, and melena. Abdominal ultrasound revealed mineralization of the "right splenic vein" with collateral spiraling and a suspected splenic duplication. Computed tomography confirmed the duplication along with torsion of the splenic pedicle. Exploratory laparotomy confirmed the splenic torsion associated with congestion of the gastrointestinal vessels, indicative of a chronic onset of secondary regional splenic vein hypertension.

Multiphase multidetector-row computed tomographic and ultrasonographic findings in dogs with spontaneous liver lobe torsion.

Liver lobe torsion (LLT) is an uncommon condition of unknown origin in dogs. Several reports describe the clinical features and outcome, but only few of them include the imaging characteristics of this disease. The aim of this descriptive case series was to describe the ultrasonographic (US) and multidetector-row computed tomographic (MDCT) features of LLT in a group of dogs. Five dogs were included in this single-center descriptive study, having both US, CT and surgical and histological confirmation of LLT available for review. Different US appearances have been found, both hypoechoic and hyperechoic liver lobes and heterogeneous mass-like lesions, with fluid and gas content. At three-phase MDCT examination, LLT appeared as fluid- and gas-filled lesions (consistent with abscess transformation), or as hypoattenuating hypovascular lobes. Two different vascular signs were also described: whirl sign or vascular interruption were seen in all cases, allowing a correct pre-surgical diagnosis in all the cases presented. Multiphase MDCT was a helpful imaging method for the correct pre-surgical diagnosis of LLT in dogs, and its use in the suspected cases is therefore advisable.

Gallbladder and Liver Lobe Torsion in a Young Cat Presented with Hemoabdomen.

An 11 mo old domestic shorthair presented with acute lethargy. The cat was hypothermic and bradycardic and had pale pink mucous membranes, poor pulses, and a distended abdomen. Point-of-care ultrasound identified significant abdominal effusion, which was diagnosed to be a hemoabdomen. Bloodwork revealed hyperlactatemia, regenerative anemia, neutrophilia, hypoproteinemia, hypoalbuminemia, and increased alanine aminotransferase. The cat received an allotransfusion and a subsequent canine xenotransfusion and received further supportive therapy. After stabilization, abdominal ultrasonography diagnosed a gallbladder and liver lobe torsion with hemoabdomen. Exploratory laparotomy confirmed the torsion of the right medial and quadrate hepatic lobes together with the gallbladder. Cholecystectomy and lobectomy of the affected lobes were performed using a surgical stapler. The cat was discharged after 4 days. Histopathology confirmed hemorrhagic infarction of the liver lobes and gallbladder, consistent with the described torsion, and the hepatic pseudocyst. It also demonstrated a mucocele in the gallbladder. One month postoperatively, the cat had totally recovered. Hepatic lobe torsion without neoplasia is a rare disease in cats, with variable clinical signs. Gallbladder torsion is a hitherto unreported condition in cats. This is the first report of gallbladder and liver lobe torsion with secondary hemoabdomen in a cat, successfully treated by one-stage surgery.

A three-dimensional computed tomographic volume rendering methodology to measure the tibial torsion angle in dogs.

OBJECTIVE: To describe a three-dimensional (3D) computed tomographic (CT) methodology to measure the tibial torsion angle (TTa) and to evaluate intrarater and interrater agreements and accuracy through comparison with anatomic measurements. STUDY DESIGN: Ex vivo cadaveric study. SAMPLE POPULATION: Thirty-six tibiae from 18 dogs. METHODS: Tibial torsion angle of each tibia was measured by using two CT techniques (axial and 3D volume rendering) by three raters who blindly measured TTa in duplicate. A semitransparent bone filter was used to enhance the visibility of the target anatomical landmarks for the 3D volume rendering CT technique. Tibial torsion angle was also quantitated in tibial specimens. Intrarater and interrater agreements were analyzed by using intraclass coefficients (ICC). Accuracy was evaluated by using adjusted R2 coefficients (R2 > 80% was considered acceptable). RESULTS: The 3D volume rendering CT technique had excellent intrarater and interrater agreements (ICC > 0.94) and an R2 value of 97%. The axial CT technique had good to excellent intrarater and interrater agreements (0.8 < ICC < 0.95) and an R2 of 86%. No difference was found between axial and 3D CT techniques. A mean internal TT angle of approximately -6° was found with CT and anatomic measurements. CONCLUSION: The 3D volume rendering and axial CT techniques were precise and accurate for measuring TTa in dogs unaffected by patellar luxation. CLINICAL RELEVANCE: Combining 3D bone manipulation with application of a semitransparent filter allows simultaneous visualization of anatomic landmarks, which may facilitate the evaluation of complex bone deformations. Internal tibial torsion may be present in nonchondrodystrophic dogs without patella luxation.

Computed tomography with Hounsfield unit assessment is useful in the diagnosis of liver lobe torsion in pet rabbits (Oryctolagus cuniculus).

Clinical signs of liver lobe torsion in rabbits are often nonspecific and mimic those that are also generally detected with gastrointestinal stasis. Nonspecific clinical signs may result in pursuit of full-body imaging such as computed tomography (CT). The aim of this multicenter, retrospective, case series study was to describe CT findings of liver lobe torsion in a group of rabbits. Computed tomography studies of six rabbits with confirmed liver lobe torsion by surgery or necropsy were evaluated. The caudate liver lobe was affected in six out of six rabbits and was enlarged, rounded, hypoattenuating, heterogeneous, and minimally to noncontrast enhancing, with scant regional peritoneal effusion. Precontrast, mean Hounsfield units (HU) of the torsed liver lobe (39.3 HU [range, 24.4-48.1 HU]) were lower than mean HU of normal liver (55.1 HU [range, 49.6-60.8 HU]), with a mean torsed:normal HU ratio of 0.71 (range, 0.49-0.91). Postcontrast, mean HU of the torsed liver lobe (38.4 HU [range, 19.7-48.9 HU]) were also lower than mean HU of normal liver (108.4 HU [range, 84.5-142.0 HU]), with a lower postcontrast mean torsed:normal HU ratio of 0.35 (range, 0.14-0.48) compared to precontrast. Mean HU of torsed liver lobes had little difference pre- and postcontrast (postcontrast HU 1.0 times the average precontrast HU [range, 0.81-1.1]), and contrast enhancement of the torsed liver lobes was on average 50% lower than in normal liver. Liver lobe torsion should be considered in rabbits with an enlarged, hypoattenuating, heterogeneous, minimally to noncontrast enhancing liver lobe, particularly the caudate lobe, and scant regional peritoneal effusion.

Hepatic lobe torsion in 3 dromedary camels.

Hepatic lobe torsion is a rare condition in domestic animals. Clinical signs are variable, with some cases remaining subclinical and others resulting in death. Most cases are diagnosed either by laparotomy or during postmortem examination. During postmortem inspection of 670 slaughtered dromedary camels, hepatic lobe torsion of the quadrate lobe was detected in 3 adult female camels. Clinical signs had not been noted on antemortem veterinary inspection, and hepatic lobe torsion was likely an incidental finding. Histologically, the affected liver lobe exhibited severe hepatocellular loss with replacement by fibrous connective tissue. When investigating abdominal pain in camels, veterinarians should include hepatic lobe torsion in the list of differential diagnoses.

Lung lobe torsion in 15 dogs: Peripheral band sign on ultrasound.

The diagnosis of lung lobe torsion in dogs is usually based on radiological, endoscopic, and CT features. Few ultrasonographic descriptions have been published. The purpose of this multicenter, retrospective, and prospective observational study was to investigate the presence of a hypoechoic area forming a pulmonary band or line at the periphery of the twisted lobe on ultrasonography and assess its significance by comparing it to CT and histological findings. Fifteen dogs with lung lobe torsion confirmed surgically or postmortem were included. All had received ultrasonography and CT examinations; 13 had additional histopathological examination performed. In 14 cases, thoracic ultrasonography revealed a peripheral hypoechoic band, overlying areas of scattered, hyperreflecting interfaces in the affected lobe. On CT, central emphysema was surrounded by a peripheral, soft tissue attenuation band, affecting the periphery in 14 cases. No band was observed in one case, in which the lobe was entirely consolidated. Histological examination yielded a comparable peripheral band, consisting of a thickened visceral pleura with or without hemorrhagic necrosis of the underlying pulmonary parenchyma. This peripheral band may be related to the specific fractal organization of airways and vessels, which plays an important role in lung perfusion and ventilation and makes the lung periphery more prone to ischemia. Our findings suggest that the presence of a peripheral hypoechoic band, associated with central emphysema in a noncollapsed lung lobe on ultrasonography, is suggestive of compromised blood supply and air flow, and lung lobe torsion should therefore be suspected.

Hydroureteronephrosis and fetal mummification secondary to uterine torsion in a Merino ewe.

A 6 year old pluriparous Merino ewe was presented for investigation of a large intra-abdominal mass. Post-mortem examination revealed a 360° clockwise uterine torsion was present with a mummifying fetus. The torsion involved the left ureter resulting in a severe hydroureteronephrosis. Uterine torsion is uncommon in the ewe, occurring in less than 0.1% of pregnancies in one report (Mahmoud et al. Livest Res Rural Dev 2018;30), but cases are likely to be undiagnosed, particularly under the extensive management conditions typical of Australia. The chronicity of the condition in this ewe would support this statement. To the authors' knowledge this is the first reported case of hydroureteronephrosis secondary to uterine torsion in any species.

Simultaneous Torsion of a Uterine Horn and Spleen in a Pregnant Two-Year-Old Crossbreed Bitch: A Case Report.

A pregnant 2-year-old mixed-breed dog was admitted with a 2-day history of lethargy, anorexia and painful abdominal distension. Clinical manifestations were unspecific and mainly suggested hypovolemic shock. Physical examination, ultrasonographic evaluation and radiographs confirmed mid-late pregnancy and evident signs of fetal death and peritoneal effusion. An exploratory laparotomy was immediately initiated which revealed torsion of the right gravid uterine horn over the left one and, simultaneously, the unexpected presence of splenic torsion and rupture, with a stretched omentum covering and exerting tension on the spleen's cranial pole. Histopathology revealed hemorrhagic infarction of the uterus and spleen. The animal recovered uneventfully and was later submitted to a preventive gastropexy.

A computed tomographic graphical approach to guide correction of femoral torsion.

OBJECTIVE: To report geometric methods to assess femoral transverse bone morphology and develop a virtual method to guide the surgical correction of femoral torsional deformities. STUDY DESIGN: Observational study. SAMPLE POPULATION: Sixteen client-owned dogs comprising 14 normal femurs and 14 femurs with angulation-rotation bone deformities. METHODS: Femoral torsion angle was measured with computed tomographic (CT) three-dimensional (3D) multiplanar reconstruction. Distal femoral transverse morphology was estimated with geometric methods and compared to direct measurements to span a target 20° angle on 3D reconstructions. A virtual correction of 20° was performed, and 3D-printed bone models were created. Femoral torsion of corrected bone models was compared to precorrection. RESULTS: Geometric estimates with an arc and chord of the metaphyseal area and chord of a best fit circle did not differ from direct measurement of femoral cortical length along the cranial cortex. Femoral torsion differed between normal femurs (25.8° ± 6°) and those with deformity (36.9° ± 8.4°, P < .001). Torsion that was measured on corrected 3D bone models did not differ from the expected torsion (preoperative +20°). CONCLUSION: Geometric methods provided an accurate estimate of distal femoral transverse bone morphology. Rotation of the distal femur based on geometric methods resulted in an accurate correction of torsion. CLINICAL SIGNIFICANCE: Femoral bone diameter can be measured on a CT cross-section, and rotation distance can be calculated to achieve a desired correction of torsion. This approach provides a simple and accurate method to guide the correction of femoral torsion.

Long-term survival after treatment of idiopathic lung lobe torsion in 80 cases.

OBJECTIVE: To report outcomes of dogs treated for lung lobe torsion (LLT) and to determine prognostic factors for survival. STUDY DESIGN: Retrospective multicenter study from four veterinary teaching hospitals. ANIMALS: Dogs (n = 80) with LLT. METHODS: Medical records were reviewed for clinical and histopathological findings. Long-term outcome was assessed with an owner questionnaire. Lung lobe torsion was classified as idiopathic or secondary on the basis of the etiology. RESULTS: The most represented breeds were pugs (47.5%) and sighthounds (16.2%). The cause of the LLT was considered primary in 77%, secondary in 21%, and unknown in 2% of dogs. Postoperative complications were recorded in 14% of dogs. Overall, 95% of dogs survived to discharge, and median follow-up was 1095 days (range, 7-3809). Owners assessed outcomes and quality of life as excellent in 93% and 89% of dogs, respectively. Primary LLT was associated with a longer survival (median not reached in the study) compared with secondary LLT (921 days; range, 7-2073; P = .001). CONCLUSION: Overall long-term survival after lung lobectomy for LLT was excellent. Primary LLT was associated with longer survival compared with secondary LLT. Long-term owner evaluation of clinical outcome for dogs undergoing lung lobectomy for LLT was considered excellent. CLINICAL IMPACT: Dogs with primary LLT undergoing lung lobectomy have a longer survival time compared with dogs with secondary LLT and have an excellent postoperative outcome.

Bilateral lung lobe torsions in a cat.

A 13-year-old spayed female domestic longhair cat was presented for tachypnea and was identified to have reduced lung sounds over the left hemithorax. Thoracic ultrasound examination and computed tomography identified changes consistent with bilateral lung lobe torsion. A median sternotomy confirmed torsion of both the cranial portion of the left cranial lung lobe and the right middle lung lobe. The affected lobes were resected. Pleural fluid analysis was indicative of a modified transudate and histopathology was consistent with a subacute to chronic torsion with no evidence of neoplasia or infection. The patient recovered without complication. Lung lobe torsion is an uncommon presentation across all species and is especially rare in cats. To the authors' knowledge, bilateral lung lobe torsion has not been previously reported in small animals.

Torsions bilatérales de lobes pulmonaires chez un chat. Une chatte domestique à poils longs âgées de 13 ans fut présentée pour tachypnée et on identifia une diminution des bruits respiratoires du côté de l'hémithorax gauche. Une échographie thoracique et un examen par tomodensitométrie (CT) identifièrent des changements compatibles avec une torsion bilatérale de lobes pulmonaires. Une sternotomie médiane confirma la torsion des portions crâniales du lobe pulmonaire crânial gauche et du lobe pulmonaire moyen droit. Les lobes affectés furent excisés. L'analyse du liquide pleural était indicatrice d'un transsudat modifié et l'histopathologie était compatible avec une torsion subaigüe à chronique sans évidence de néoplasie ou d'infection. La chatte récupéra sans complication. La torsion des lobes pulmonaires est une présentation peu commune chez toutes les espèces et est spécialement rare chez les chats. Selon les auteurs, une torsion bilatérale des lobes pulmonaires n'a pas encore été rapportée chez les petits animaux.(Traduit par Dr Serge Messier).

CT characteristics of primary splenic torsion in eight dogs.

Splenic torsion is a rare potentially life-threatening condition characterized by rotation of the spleen around the gastrosplenic and phrenosplenic ligaments leading to occlusion of venous drainage and arterial supply. This retrospective study describes the CT characteristics for dogs with surgically confirmed splenic torsion from 2013 to 2018 using the submissions to a large multinational teleradiology database. Eight dogs had the splenic torsion confirmed with surgery. Seven of eight cases had histology confirming congestion, hemorrhage, and necrosis, and one had concurrent myelolipoma infiltration. The CT characteristics included an enlarged (8/8), rounded (7/8), folded C-shaped spleen (8/8) with a difference of median parenchymal attenuation between pre- and postcontrast of +1.15 HU (Hounsfield units). Other common features included a mainly homogeneous parenchyma on pre- and post-contrast images (6/8), lack of subjective and objective vascular and parenchymal contrast enhancement (6/8) and free peritoneal fluid (6/8). A "whirl sign" was seen in the majority of cases (7/8) alongside a strongly hyperattenuating center (95-416 HU) on the precontrast images (5/7), which has not been previously described in the veterinary literature. Gastric position was normal in all cases. More variable CT characteristics of the confirmed torsions were attributable to suspected partial torsion and myelolipomatous infiltration. Overall, primary splenic torsion confirmed with surgery showed consistent characteristics on CT.