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

Severe Bilateral Sialadenitis of the Mandibular and Parotid Salivary Glands with Severe Panniculitis in a 2-Year-old Standard Poodle

A 2-year-old male neutered Standard Poodle weighing 17.9 kg was presented to their primary care veterinarian for enlarged bilateral submandibular swellings following an interdog altercation sustained in the previous weeks. Cytology performed following fine-needle aspirates of the regions of swelling was inconclusive, and the patient was treated empirically with Clavaseptin. Despite treatment, the submandibular swellings continued to enlarge, and right-sided intermittent epistaxis was reported. On biochemical profile, there was mild hypercalcemia and mild hyperglobulinemia. The computed tomography (CT) findings were indicative of severe multifocal sialadenitis with severe regional cellulitis and inflammatory lymphadenopathy. Histopathology and cytology results described mixed inflammation of the salivary gland. Methenamine silver staining and Fite's acid-fast staining were negative. Aerobic and anaerobic cultures were negative. Targeted, next-generation DNA sequencing detected no known fungi or bacterial pathogens. These findings were consistent with the diagnosis of severe bilateral mandibular sialadenitis, panniculitis, and lymphadenopathy. The patient was prescribed enrofloxacin, clindamycin, phenobarbital, and prednisolone for 1 month. One week after initiating treatment, the patient had a significant reduction in size of the salivary glands. CT imaging was helpful in the diagnosis of this patient and allowed the clinician to identify which submandibular anatomical structures were abnormal, guiding subsequent diagnostic decisions to provide medical management to resolve the condition.

Case report: Chronic disseminated intravascular coagulopathy with concurrent paraneoplastic secondary hyperfibrinolysis in a dog with metastatic nasal adenocarcinoma

In human medicine, hemostatic disorders such as thrombocytopenia, hyperfibrinolysis, and disseminated intravascular coagulopathy (DIC) have been associated with many cancers. Acute hemorrhage secondary to hyperfibrinolysis has been predominantly reported with prostatic adenocarcinoma in human patients. To the author's knowledge, severe bleeding due to paraneoplastic hyperfibrinolysis has not yet been reported in veterinary medicine. The case involves an 8-year-old neutered male Border Collie who was evaluated for progressive and recurrent epistaxis, having a history of 1 year of treatment for metastatic nasal adenocarcinoma. A progressive and severe coagulopathy thought to be related to the known cancer was diagnosed. Advanced coagulation testing was consistent with a chronic DIC and secondary hyperfibrinolysis. Throughout 1 week of hospitalization, the dog was treated with multiple blood products, vitamin K1, and anti-fibrinolytic medications. While the dog was initially discharged home, the dog re-presented the following day and was humanely euthanized due to a perceived poor quality of life. Post-mortem analysis revealed a histopathologic diagnosis of disseminated adenocarcinoma. In dogs with disseminated nasal adenocarcinoma that are experiencing severe bleeding, paraneoplastic secondary hyperfibrinolysis should be considered as a differential. Knowing this association could help guide treatment recommendations for optimal patient management.

Diagnostic benefits of platelet-to-lymphocyte, neutrophil-to-lymphocyte, and albumin-to-globulin ratios in dogs with nasal cavity diseases

BACKGROUND

A multimodal approach for diagnostic tests under anesthesia is required to diagnose nasal cavity pathology (NP) reliably in dogs. Blood test results may provide clues to the suspected NP.

METHODS

This prospective blinded study assessed 72 dogs with chronic nasal discharge due to NPs, and 10 healthy dogs as the control group (CG). NPs were diagnosed using whole-body computed tomography (CT), upper airway endoscopy, examination of nasal mucosal swabs by bacterial and fungal culture, and histopathological examination of nasal mucosa biopsies. The exclusion criteria were the presence of any additional diseases or corticosteroid pre-treatment. In consideration of these exclusion criteria, 55 dogs entered the study. Dogs were classified into benign (benign tumors, idiopathic rhinitis (IR), and others) and malignant (carcinomas and sarcomas) NP groups. Blood count and blood chemistry tests were performed. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and albumin-to-globulin ratio (AGR) were calculated and compared.

RESULTS

25 dogs with malignant NP (13 and 12 with carcinomas and sarcomas, respectively) and 30 dogs with benign NP (seven with benign tumors,13 with IR, and 10 others) were included. In general, in dogs with NP there were only slight abnormalities in complete blood count. However, PLR was significantly higher in dogs with malignant NP (carcinoma and sarcoma) than in those with benign NP and in the CG. Compared with the CG, the NLR was significantly increased in all dogs with NP, and the AGR was mild but significantly lower, except in dogs with sarcomas and benign tumors.

CONCLUSIONS

In dogs with nasal disease alone, there are usually no marked abnormalities in blood count. However, while mildly increased NLR and decreased AGR can be observed in almost all NPs, an increased PLR may indicate a malignant NP and can be used as an additional screening tool in dogs with nasal discharge due to nasal cavity pathology.

Construction of diagnostic prediction model for canine nasal diseases using less invasive examinations without anesthesia

Advanced imaging techniques under general anesthesia are frequently employed to achieve a definitive diagnosis of canine nasal diseases. However, these examinations may not be performed immediately in all cases. This study aimed to construct prediction models for canine nasal diseases using less-invasive examinations such as clinical signs and radiography. Dogs diagnosed with nasal disease between 2010 and 2020 were retrospectively investigated to construct a prediction model (Group M; GM), and dogs diagnosed between 2020 and 2021 were prospectively investigated to validate the efficacy (Group V; GV). Prediction models were created using two methods: manual (Model 1) and LASSO logistic regression analysis (Model 2). In total, 103 and 86 dogs were included in GM and GV, respectively. In Model 1, the sensitivity and specificity of neoplasia (NP) and sino-nasal aspergillosis (SNA) were 0.88 and 0.81 in GM and 0.92 and 0.78 in GV, respectively. Those of non-infectious rhinitis (NIR) and rhinitis secondary to dental disease (DD) were 0.78 and 0.88 in GM and 0.64 and 0.80 in GV, respectively. In Model 2, the sensitivity and specificity of NP and SNA were 0.93 and 1 in GM and 0.93 and 0.75 in GV, respectively. Those of NIR and DD were 0.96 and 0.89 in GM and 0.80 and 0.79 in GV, respectively. This study suggest that it is possible to create a prediction model using less-invasive examinations. Utilizing these predictive models may lead to appropriate general anesthesia examinations and treatment referrals.

Knowledge, Attitude, and Practice of First Aid for Epistaxis Among the General Population in the Jazan Region of Saudi Arabia

Background Epistaxis, or nosebleeds, is a widespread medical condition that can be effectively managed with appropriate first aid. Understanding the general public's knowledge and practices about this is crucial. Objectives This study sought to evaluate the awareness and practice regarding first aid for epistaxis within the general population of the Jazan region in Saudi Arabia. Methods A cross-sectional survey was administered from April through June 2023, using a questionnaire that covered sociodemographic factors, knowledge of epistaxis, first aid practices for epistaxis, and any previous training received. Statistical analysis was performed using SPSS (IBM Corp., Armonk, NY), with chi-square tests to evaluate the variables' associations. Results The questionnaire was completed by 622 participants, predominantly females, Saudis, and individuals from the age group of 18 to 25 years. It was found that 60% of the participants had experienced epistaxis, but only 52% had received prior first aid training. Although the majority (91.8%) accurately defined epistaxis, a mere 40.8% correctly identified all the steps for first aid management of epistaxis. There was a notable insufficiency in understanding the causes, risk factors, and appropriate first aid steps. Participants' knowledge was evenly split, with approximately half exhibiting low knowledge (49.70%) and the remainder showing high knowledge (50.30%). Certain sociodemographic factors such as older age (p=0.028), Saudi nationality (p=0.045), and higher education (p=0.001) were linked with more experiences of epistaxis. Conversely, younger age (p=0.002), female gender (p=0.036), single status (p=0.001), prior experience with epistaxis (p=0.001), and higher overall knowledge (p=0.001) were associated with a higher likelihood of having received first aid training. Conclusions The study reveals significant gaps in the knowledge and practices of first aid for epistaxis among the general population in the Jazan region. Public awareness campaigns and educational programs are urgently needed, particularly for specific groups. Enhancing first aid knowledge could help alleviate the impacts of epistaxis. Further research is required to develop effective educational interventions.

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.

Canine Nasal Disease: An Update

Nasal disease in dogs is common and is often accompanied by chronic nasal discharge with or without other clinical signs. A thorough history and physical examination often guide the most appropriate choice of diagnostic testing to provide the best chance of attaining a diagnosis as to cause, and therefore, the most appropriate treatment. The purpose of this article is to guide the practitioner through a logical approach to the evaluation of dogs that are presented with signs of nasal disease.

AORTIC ANEURYSM, DISSECTION, AND RUPTURE IN SIX BILE-FARMED BEARS

Across China and Southeast Asia, over 17,000 bears are currently farmed for bile, predominantly for traditional Chinese medicines. Bears on farms in China are cage confined and undergo repeated daily bile extraction facilitated by surgically implanted catheters or gallbladder fistulas. Numerous health problems have been reported in bile-farmed bears including peritonitis, abdominal hernias, and extraction site abscessation. Between 2009 and 2014, five Asiatic black bears ( Ursus thibetanus) and one Asiatic black/Eurasian brown bear ( Ursus arctos arctos) hybrid, rescued from the bear bile industry in China, died from ruptured and/or dissecting aortic aneurysm. Medical records were reviewed and two bears exhibited no clinical signs prior to death. In four bears, clinical findings varied and included increased stereotypic behavior prior to death, epistaxis, retinal lesions, dysphagia, weight loss, and acute onset of hyporexia. On postmortem examination, hemopericardium with dissection and/or rupture of the ascending aorta and left ventricular wall hypertrophy were present in all cases. No evidence of infectious disease, connective tissue disorders, or congenital cardiac disease was identified. Based on these observations screening thoracic radiography was performed on all bears at the rescue center and aortic dilation was identified in 73 of 134 (54.5%) bile-extracted bears. To the authors' knowledge, aortic aneurysm, rupture, and/or dissection have not been previously reported in any bear species and the high prevalence in this population of bears suggests an association with bile-farming practices. Future studies are needed to investigate the etiopathogenesis of this condition to aid in early diagnosis and improved management of bears being rescued from bile farms across Asia.

ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats

An update to the 2007 American College of Veterinary Internal Medicine (ACVIM) consensus statement on the identification, evaluation, and management of systemic hypertension in dogs and cats was presented at the 2017 ACVIM Forum in National Harbor, MD. The updated consensus statement is presented here. The consensus statement aims to provide guidance on appropriate diagnosis and treatment of hypertension in dogs and cats.

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.

Erosive rhinitis resembling granulomatosis with polyangiitis (Wegener's granulomatosis) in an Anatolian shepherd dog

Granulomatosis with polyangiitis (Wegener's granulomatosis) is one of the idiopathic immune-mediated small-vessel vasculitides described in humans which are characterised by the presence of circulating antineutrophil cytoplasmic antibodies. It most commonly involves capillaries, venules and arterioles of the ear, nose and throat, lungs and glomeruli. A case of destructive haemopurulent rhinitis associated with relapsing periods of pyrexia, lethargy and stiffness as well as generalised pulmonary infiltrates in a young Anatolian shepherd dog is presented that closely resembles granulomatosis with polyangiitis (GPA) as reported in humans. Perinuclear antineutrophil cytoplasmic antibodies (pANCA) were detected in the dog's serum. Signs resolved promptly and completely once immunosuppressive doses of prednisone were administered, and have not recurred. This is the first report on the use of pANCA to investigate rhinitis in dogs. It is also, to the authors’ knowledge, the first description of a relapsing haemopurulent lytic rhinitis in this species. The concurrent manifestations of erosive haemopurulent rhinitis, ground-glass opacities on pulmonary computed tomography, pyrexia and listlessness resemble GPA as described in humans.

Characteristics of canine nasal discharge related to intranasal diseases: a retrospective study of 105 cases

OBJECTIVES

To compare characteristics of nasal discharge caused by different intranasal aetiologies in dogs.

METHODS

Medical records of 105 dogs with nasal discharge due to intranasal disease were retrospectively reviewed with special focus on composition, severity, duration and localisation of discharge. On the basis of diagnostic findings, cases were classified into different disease groups and characteristics of discharge were compared between groups.

RESULTS

Cases were classified as having non-specific rhinitis (n=42), nasal neoplasia (n=23), foreign bodies (n=21), nasal mycosis (n=7) and miscellaneous disorders (n=13). Dogs with foreign bodies or nasal mycosis were significantly younger. Mucous components of discharge occurred more often in non-specific rhinitis and nasal neoplasia, although haemorrhagic components predominated in nasal neoplasia when discharge lasted ê14 days. Pure or mixed haemorrhagic discharge was significantly more common with nasal neoplasia, foreign bodies and nasal mycosis. Purulent components were associated with longer duration of discharge and predominantly seen in non-specific rhinitis and foreign bodies. Dogs with foreign bodies were presented earlier and sneezing was more frequent. Nasal stridor was significantly more often observed in dogs with nasal neoplasia.

CLINICAL SIGNIFICANCE

Characteristics of nasal discharge and associated clinical signs might aid in planning the diagnostic approach, but a combination of diagnostic techniques is still required to confirm a diagnosis.

Canine nasal disease

Nasal disease often manifests as nasal discharge with or without other nasal signs. Attention to signalment, history, and physical examination findings often facilitates a differential diagnosis. Imaging techniques and tissue sampling for microscopic examination are usually necessary for diagnosis. Advanced imaging offers important advantages over traditional skull radiographs but is less widely available and more costly. Bacterial culture is seldom beneficial, and fungal culture is reserved for cases likely to have fungal rhinitis. Nasal biopsy is required to confirm a specific diagnosis and is always required for diagnosis of specific tumor type or for inflammatory rhinitis.

Epistaxis: some aspects of laterality in 326 patients

Lateralization of primary epistaxis was prospectively studied in 326 patients at Radebeul Elblandklinikum. The male-female-ratio was 1.3:1. A slight dominance of the right side (45% right vs. 39% left) was found in all patients. Further analyzed were the relationship to the localization of bleeding (anterior or posterior), the age and possible causes or risk factors. Nose bleeding from the posterior nasal portion appears to be statistically significantly higher than on both sides of anterior epistaxis. No statistically significant age dependence of laterality of epistaxis was observed in the age groups which we selected. However, nosebleed appears more frequently in women under the age of 50 years in both nostrils. With identified risk factors, idiopathic epistaxis occurs more frequently on the right side than does nosebleed. Mechanical trauma (intranasal sprays or nose picking) is a possible factor explaining the dominance of epistaxis on the right side, especially in idiopathic cases.