Ultrasonographic differentiation between portal venous and parenchymal gas may be important for the prognosis of canine and feline hepatic emphysema: 37 cases

Medical management of pneumoperitoneum, gastric pneumatosis, and hepatic venous gas secondary to 3% hydrogen peroxide toxicity in a dog

OBJECTIVE

To describe the medical management and outcome of a dog suffering severe hydrogen peroxide toxicity.

CASE SUMMARY

A 3-year-old neutered female Bichon Frise was presented to an emergency and referral practice after ingestion of 10-20 mL/kg 3% hydrogen peroxide. On presentation, the dog was obtunded, was tachypneic, and had severe gastric tympany. Abdominal radiographs revealed pneumoperitoneum, gastric pneumatosis, and hepatic venous gas. The dog was managed conservatively with supportive care and oxygen therapy. Repeat radiographs 6 hours later showed complete resolution of all gas inclusions. While hospitalized, the dog developed severe hematemesis, and abdominal ultrasound revealed severe gastric wall thickening. Subsequent endoscopy confirmed severe gastric mucosal necrosis without evidence of deeper ulceration and relatively mild petechiation of the esophagus. The dog was ultimately discharged after 5 days of hospitalization and continued to do well at home. Recheck ultrasound 5 weeks postdischarge showed normal gastric wall appearance.

NEW OR UNIQUE INFORMATION PROVIDED

To the authors' knowledge, this is the first reported case of pneumoperitoneum secondary to hydrogen peroxide toxicity and the first description of the clinical course of severe toxicity in dogs.

Bezoar as a cause of portal vein pneumatosis: a case report

Pneumatosis of the portal vein is considered a rare imaging sign rather than a disease. It usually occurs in patients with digestive tract diseases such as intestinal obstructive diseases, mesenteric vascular diseases, closed abdominal trauma, and liver transplantation. Because of its high mortality rate, it is also termed the "sign of death." Hawthorn contains tannic acid, and seafood is rich in calcium, iron, carbon, iodine, and other minerals and proteins. Thus, consuming both hawthorn and seafood together can result in the formation of an indigestible complex in the body, acting as the main pathogenic factor in patients with intestinal obstruction. We herein describe a patient with duodenal obstruction caused by hawthorn who developed the hepatic portal venous gas sign and was cured by nonsurgical treatment.

Medical management of feline emphysematous hepatitis-A case report

Case report summary: A 9-year-old male castrated domestic shorthair feline was presented to the emergency department with a chief complaint of constipation of 3-day duration, decreased urination of 1-day duration, vomiting, and hind limb weakness. Physical examination abnormalities included hypothermia, dehydration, and generalized paresis with inability to stand for a prolonged period of time. Abdominal ultrasonography showed pinpoint hyperechoic foci throughout the hepatic parenchyma, small gas foci circulating within the portal vasculature consistent with emphysematous hepatitis, and mild volume of ascites. Cytology of the ascites was consistent with inflammatory effusion. Hepatic cytology was consistent with mixed inflammation/hepatitis with no apparent cause for inflammation noted. Urine culture yielded a negative result. Surgical liver biopsy and culture were declined by the patient's family. Ultrasound changes were presumed to be most likely secondary to an ascending infection.

Multi-phase MULTIDETECTOR-row computed tomographic features and laboratory findings in dogs with gallbladder rupture

Gallbladder rupture is a life-treating condition in dogs. In human medicine, multidetector-row computed tomography (MDCT) is considered the best modality for the diagnosis of gallbladder rupture. The aims of the study were to describe MDCT features of gallbladder rupture in dogs and to determine the CT findings and laboratory data that differ between dogs with ruptured biliary tree and dogs with biliary disease with no rupture. For this single-center, cross-sectional study were considered for inclusion dogs presented from May 2010 to September 2020, with surgical diagnosis of gallbladder rupture or integrity, who underwent MDCT examination and with CBC and biochemistry results available for review. Forty-seven dogs with different diseases of the biliary tract were included. Seventeen dogs with confirmed gallbladder rupture and 30 dogs with intact gallbladder were included. Multiple MDCT findings showed statistical significance in distinguish dogs with gallbladder rupture: irregular contours of the gallbladder (p < 0.0001), discontinuation of the gallbladder wall (p = 0.0005), adhesions with adjacent organs (p = 0.005), heterogeneous enhancement of the gallbladder wall (p = 0.01), pericholecystic effusion (p = 0.001) and pericholecystic peritonitis (p = 0.001). The presence of three or more of these findings was highly indicative for gallbladder rupture (AUC = 0.921). In this study, MDCT proved to be useful in differentiating dogs with gallbladder rupture from dogs with biliary disease without rupture.

Pathological features of hepatic portal venous gas in a cat

An 8-year 8-month-old castrated male Munchkin presented with vomiting, anorexia and hypoactivity. Computed tomography revealed excessive gas accumulation within the intestinal lumen and gas bubbles in the liver, spleen, and portal venous system, indicating hepatic portal venous gas. The cat died without any significant improvement, and mild splenomegaly was found at necropsy. Histologically, multiple gas vacuoles were diffusely observed in the liver and spleen. In the stomach, multiple gas vacuoles and scattered focal ulcers were detected within the mucosa. Multifocal hemorrhage was noted in the small and large intestines, whereas gas vacuoles were not present. Based on these findings, a gastric ulcer under high gas pressure may have provided an entry point for gas into the portal venous system.

Reference values and repeatability of pulsed-wave Doppler flowmetry of portal vein in healthy dromedary she-camels

OBJECTIVE

This study was conducted to establish the normal values and repeatability of pulsed-wave (PW) Doppler ultrasonographic parameters of the hepatic portal circulation in healthy dromedary she-camels.

MATERIALS AND METHODS

According to the American Society of Veterinary Clinical Pathology guidelines, the sample size and statistical analysis were followed. Ten healthy, non-pregnant, non-lactating she-camels were selected after physical, hematological, and ultrasonographic examinations. All hepatic ultrasonographic measurements were obtained from unsedated standing she-camels at the 11th right intercostal space using B-mode and PW Doppler.

RESULTS

The ultrasonographic measurements were portal vein (PV) diameter 1.76 ± 0.37 cm; portal velocity 12.3 ± 3.2 cm/sec; portal area 2.05 ± 0.57 (cm)2; portal congestion index 0.16 ± 0.04 cms; and portal blood flow volume 0.02 ± 0.05 ml/sec/kg. The intra-assay coefficient of variations (CV)% of the above-mentioned variables were 5.84 ± 4.32, 12.3 ± 7.1, 10.5 ± 5.8, 14.7 ± 7.1, and 15.8 ± 12, respectively. However, the inter-assay CV% were 13.2 ± 5.9, 18.5 ± 8.4, 19.7 ± 7.6, 17.3 ± 8.8, and 31.9 ± 15, respectively.

CONCLUSION

This study provides data that may be used as reference values for Doppler measurements of the PV in she-camels, which may help diagnose some hepatic disorders in camels.

Extensive hepatic portal venous gas and gastric pneumatosis in a cat

A 15-year-old female neutered Domestic Long Hair cat was presented for acute hematemesis. Initial diagnostic workup, including serum biochemistry panel, complete blood count and coagulation profile, was unremarkable. Abdominal ultrasound showed gastric mural thickening and non-obstructive gastric foreign material. Endoscopy was performed to remove the foreign matter and obtain biopsies. Significant abnormalities of the upper gastrointestinal (GI) tract were not noted endoscopically. Overnight, the patient required a packed red blood cell transfusion following two episodes of severe hematemesis, hypotension and collapse. Serial radiographs and ultrasound revealed hepatic portal venous gas (HPVG). Computed tomography (CT) scan confirmed massive gas accumulation within the liver and emphysematous gastritis. The patient became increasingly unstable and, given her rapid decline, humane euthanasia was elected. Gastric and duodenal histopathology showed inflammatory changes, spirochetosis and mucosal epithelial degeneration. HPVG is a rarely described finding and prognosis varies drastically depending on aetiology. To the best of our knowledge, this is the first description of portal vein gas documented on multiple imaging modalities, including CT, in a cat. The patient in this report had several potential risk factors including prior endoscopy, compromise of the intestinal barrier and evidence of gastric mural bacterial invasion.