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1.
Thoracic duct lymphangiography and ligation were done on 15 dogs with idiopathic chylothorax. Lymphangiography revealed thoracic lymphangiectasia in all dogs; none had a thoracic duct rupture. Lymphangiography immediately after ligation demonstrated missed branches of the thoracic duct in 4 of the 15 dogs. Eleven of the 15 dogs are alive and doing well. Eight of the 11 had no radiographic or clinical signs of pleural effusion (mean follow-up, 31.5 months; range, 4 to 75 months). The other 3 living dogs had persistent effusion; 2 were successfully managed with a pleuroperitoneal shunt (follow-up, 15 months) or pleurodesis (follow-up, 5 months), respectively, and 1 was not treated because the effusion was mild and the dog did not have clinical signs of disease (follow-up, 14 months). Four of the 15 dogs died or were euthanatized because of persistent effusion (mean follow-up, 11.5 months; range, 3 to 24 months). Considering the lack of treatment alternatives for dogs with idiopathic chylothorax, these results support thoracic duct ligation as a treatment method for dogs.  相似文献   

2.
Four years after successful implantation of a pleuroperitoneal shunt in a dog with persistent pleural effusion, signs of lethargy and dyspnea reappeared. Although the shunt was still functional, compartmentalization of the right pleural space eventually isolated a pocket of fluid, causing dyspnea. Symptomatic relief was achieved for at least 11 months by contralateral implantation of a second shunt.  相似文献   

3.
A 3-year-old spayed female Whippet was examined for cough and respiratory distress. Lung lobe torsion with pleural effusion was diagnosed, and lung lobectomy was performed. Pleural effusion recurred during the following 27 months; conventional bacteriologic cultures of pleural effusion did not result in bacterial growth. A second lung lobectomy, pleuroperitoneal shunt placement. and pericardectomy were subsequently performed. Mycobacterium kansasii was eventually isolated from pleural fluid and identified by polymerase chain reaction amplification and DNA sequencing. The dog was euthanatized before therapeutic response could be evaluated. To our knowledge, this is the first report of M. kansasii infection in a dog. Additionally, this is the first report of mycobacterial isolation from pleural fluid, and one of few reports of antemortem mycobacterial isolation from a body fluid, as opposed to identification in specimens during histologic examination. Routine bacteriologic culture methods are insufficient to isolate mycobacterial agents, and special methods are indicated in dogs with persistent pleural effusion.  相似文献   

4.
OBJECTIVES: To describe a novel technique for the surgical treatment of idiopathic chylothorax in a dog. ANIMALS: A 6-year-old, male Rhodesian Ridgeback, which presented with a history of reduced exercise tolerance and dyspnea. METHODS: Idiopathic chylothorax was diagnosed. Intermittent pleural drainage failed to resolve the problem. During surgery, extensive pleural fibrosis made it impossible to identify the thoracic duct. A dorsal omental pedicle was advanced through an incision in the diaphragm and into the cranial thoracic cavity to act as a physiological drain. RESULTS: The dog recovered well and has remained free from clinical signs of recurrence of the effusion (16 months at the time of writing). CONCLUSIONS: The disease-free interval achieved in this dog indicates that this novel technique is worthy of further consideration in the management of idiopathic chylothorax.  相似文献   

5.
Thirty-four dogs with chylothorax were studied retrospectively. In 24 dogs, chylothorax appeared to be idiopathic, with only 10 dogs having evidence of neoplasia or trauma. Rupture of the thoracic duct secondary to trauma appeared to be a much less common cause for the development of a chylous pleural effusion than that reported previously. The Afghan Hound was the breed most commonly affected, comprising 37.5% of the dogs in the idiopathic category and 26.5% of all dogs with chylothorax. A clear correlation between the cause of chylothorax and age was not apparent, and gender and neutering appeared to have no relationship to the development of chylothorax in the dog.  相似文献   

6.
Ligation of the cranial vena cava (CrVC) distal to the entrance of the azygous vein resulted in chylothorax in 7 of 10 dogs. Of the remaining 3 dogs, 1 developed a serosanguineous effusion that did not become chylous, and 2 dogs did not develop pleural effusion. In 2 of the 7 dogs developing chylothorax, the pleural effusion became serosanguineous within 2.5 weeks after CrVC ligation. Mesenteric lymphangiography was performed 2 to 6 weeks after ligation of the CrVC. Lymphangiectasia was seen in 4 dogs with chylothorax, but was not seen in the 3 dogs with serosanguineous effusions or the 2 dogs that did not develop effusions. One dog with chylothorax died prior to repeat lymphangiography. Less dye entered the thoracic duct, and alternate lymphaticovenous communications to the caudal vena cava were evident in the dogs without chylothorax. Ligation of the thoracic duct at the lymphaticovenous junction was performed in 3 dogs. These dogs did not develop pleural effusion. Lymphangiography was performed immediately after ligation and indicated filling of abdominal lymphatics but not of the thoracic duct. Lymphangiographic findings 6 weeks after ligation also indicated filling of intestinal lymphatics. Results of the present study indicated that ligation of the CrVC causes chylothorax, and that thoracic lymphangiectasia is a consistent finding in animals with experimental chylothorax. Obstruction of the thoracic duct did not induce lymphangiectasia or chylothorax. Impedence of thoracic duct flow into the CrVC may be a cause of clinical chylothorax in the dog.  相似文献   

7.
Neurological dysfunction is an uncommon complication following extrahepatic portosystemic shunt ligation. Three dogs and one cat are described that developed neurological signs within 21 to 42 hours of attenuation of intrahepatic portosystemic shunts. None of these cases had biochemical evidence of hepatic encephalopathy postoperatively. Two dogs died during management of status epilepticus following aspiration of food. One dog died six months postoperatively. The cat had persistent neurological dysfunction at discharge, but was alive and had recovered most of its neurological function at the time of writing, 37 months after surgery. This report demonstrates the potential for animals with intrahepatic portosystemic shunts to develop postoperative neurological signs and highlights the difficulty of managing such cases. Two dogs had both intrahepatic and extrahepatic portosystemic shunts. Large intestinal malrotation (partial situs inversus) may have been linked to the development of a portosystemic shunt in the remaining dog.  相似文献   

8.
OBJECTIVE: To identify breed disposition, postoperative complications, and outcome in dogs with lung lobe torsion. DESIGN: Retrospective study. ANIMALS: 22 client-owned dogs. PROCEDURE: Information on signalment; history; clinical findings; results of clinicopathologic testing, diagnostic imaging, and pleural fluid analysis; surgical treatment; intra- and postoperative complications; histologic findings; and outcome were obtained from medical records. RESULTS: All 22 dogs had pleural effusion; dyspnea was the most common reason for examination. Fifteen dogs were large deep-chested breeds; 5 were toy breeds. Afghan Hounds were overrepresented, compared with the hospital population. One dog was euthanatized without treatment; the remaining dogs underwent exploratory thoracotomy and lung lobectomy. Eleven dogs recovered from surgery without complications, but 3 of these later died of thoracic disease. Four dogs survived to discharge but had clinically important complications within 2 months, including chylothorax, mediastinal mesothelioma, gastric dilatation, and a second lung lobe torsion. Six dogs died or were euthanatized within 2 weeks after surgery because of acute respiratory distress syndrome, pneumonia, septic shock, pneumothorax, or chylothorax. Chylothorax was diagnosed in 8 of the 22 dogs, including 4 Afghan Hounds. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that lung lobe torsion is rare in dogs and develops most frequently in large deep-chested dogs, particularly Afghan Hounds. Other predisposing causes were not identified, but an association with chylothorax was evident, especially in Afghan Hounds. Prognosis for dogs with lung lobe torsion was fair to guarded.  相似文献   

9.
Objective: To report frequency and type of complications, and outcome in dogs with severe neurologic signs secondary to internal, suspected obstructive hydrocephalus treated by ventriculoperitoneal (VP) shunting. Study Design: Case series. Animals: Dogs (n=14). Methods: Medical records (2001–2006) was reviewed for dogs that had VP shunting. Inclusion criteria were complete medical record, progressive forebrain signs unresponsive to medical treatment, normal metabolic profile, negative antibody titers and/or cerebrospinal PCR for Toxoplasma gondii, Neospora caninum, and canine distemper virus, magnetic resonance images of the brain, confirmed diagnosis of VP shunting, and follow‐up information. Results: Hydrocephalus was idiopathic in 5 dogs and acquired (interventricular tumors, intraventricular hemorrhage, inflammatory disease) in 9 dogs. Four dogs developed complications 1 week to 18 months postoperatively, including ventricular catheter migration, infection, shunt under‐drainage, kinking of the peritoneal catheter, valve fracture, and abdominal skin necrosis. Three of these dogs had 1 or more successful revision surgeries and 1 dog was successfully treated with antibiotics. All, but 1 dog, were discharged within 1 week of surgery, and had substantial neurologic improvement. Median survival time for all dogs was 320 days (1–2340 days), for dogs with idiopathic hydrocephalus, 274 (60–420) days and for dogs with secondary hydrocephalus, 365 (1–2340) days. Conclusions: VP shunting was successful in relieving neurologic signs in most dogs and postoperative complications occurred in 29%, but were resolved medically or surgically.  相似文献   

10.
Percutaneous balloon pericardiotomy (PBP) has been performed in people and in a small number of dogs as a treatment for recurrent pericardial effusion with tamponade (PET). We performed this technique on 6 dogs with recurrent PET (5 with heart base tumors and 1 with no identifiable mass). Under general anesthesia and fluoroscopic guidance, a balloon-dilating catheter (diameters 14-20 mm) was introduced percutaneously at the 5th intercostal space through a sheath-introducing catheter, positioned across the parietal pericardium, and inflated 3 times. No dog experienced serious complications. The procedure was considered successful in 4 of 6 dogs. One dog is still alive without recurrence of PET 1 year after the procedure. Three dogs died of unrelated disease without recurrence of PET 5. 19, and 32 months after the procedure. The procedure was not beneficial in 1 dog that was euthanized 9 weeks later because of recurrence of pleural and abdominal effusion thought to be secondary to PET. One dog may have temporarily benefited but developed symptomatic PET 6 months after PBP. PBP appears to be a safe, economical, and potentially effective palliative treatment for recurrent PET and is a reasonable, less invasive alternative to surgery for dogs with recurrent PET, especially effusions caused by heart base tumors and possibly idiopathic pericardial effusion. Premature closure of the stoma is a potential cause for long-term failure and was thought to have been responsible for the recurrence of clinical signs in 2 dogs.  相似文献   

11.
Two dogs with simultaneous congenital and acquired portosystemic shunts are reported. The first dog was an eight-month-old, male Golden Retriever with a history of peritoneal effusion, polyuria/polydipsia, and stunted growth. The dog had a microcytic, hypochromic anemia, a mildly elevated AST, and a moderate to severely elevated preprandial and postprandial serum bile acids. Transcolonic portal scintigraphy confirmed the presence of a portosystemic shunt. An intraoperative mesenteric portogram was performed. Two conjoined congenital extrahepatic portosystemic shunts and multiple acquired extrahepatic portosystemic shunts were identified. The second dog was a five-month-old, mixed breed with two week history of peritoneal effusion. Abdominal ultrasound and transcolonic scintigraphy were used to diagnose a portosystemic shunt. A single extrahepatic portosystemic shunt, portal hypertension, and multiple acquired collateral shunts were identified at surgery. The histologic alterations observed in these dogs were consistent with a portosystemic shunt. In these dogs, the presence of congenital and acquired portosystemic shunts and histopathologic findings are considered to represent a combination of congenital portosystemic shunts and noncirrhotic portal hypertension or portal vein hypoplasia.  相似文献   

12.
CASE DESCRIPTION: A 7-year-old spayed female Labrador Retriever was evaluated because of pericardial effusion. CLINICAL FINDINGS: The dog had a history of decreased appetite and exercise intolerance of 3 days' duration. Thoracic radiography performed by the referring veterinarian revealed a large cardiac silhouette. Heart sounds were muffled. Echocardiographic findings were indicative of severe pericardial effusion with cardiac tamponade; no pleural effusion was identified. Pericardiocentesis yielded a considerable amount of chylous fluid. A diagnosis of chylopericardium in the absence of pleural effusion was made. TREATMENT AND OUTCOME: Conservative management was not effective, and subtotal pericardectomy and thoracic duct ligation were recommended. Surgery was postponed by the owners for 25 days, at which time the dog had both chylopericardium and chylothorax. The dog underwent subtotal pericardectomy and thoracic duct ligation; to delineate the thoracic duct, intraoperative lymphangiography was performed by injection of a radiopaque contrast agent directly into a mesenteric lymph node and subsequent injection of methylene blue solution into another mesenteric lymph node. Surgical treatment resulted in complete resolution of the clinical signs and pleural effusion. CLINICAL RELEVANCE: To the authors' knowledge, this is the first report of the development of chylopericardium prior to development of chylothorax in a dog. Treatment with thoracic duct ligation and pericardectomy resulted in complete resolution of the effusion and clinical signs.  相似文献   

13.
The aims of this study were to determine if accurate diagnosis of congenital portosystemic shunt was possible using two dimensional, grey-scale ultrasonography, duplex-Doppler, and color-flow Doppler ultrasonography in combination, and to determine if dogs with congenital portosystemic shunts have increased or variable mean portal blood flow velocity. Eighty-two dogs with clinical and/or clinicopathologic signs compatible with portosystemic shunting were examined prospectively. Diagnosis of congenital portosystemic shunt was subsequently confirmed in 38 of these dogs using operative mesenteric portography: 14(37%) dogs had an intrahepatic shunt and 24(63%) had an extrahepatic shunt. Ultrasonography had a sensitivity of 95%, specificity of 98%, and accuracy of 94%. Ultrasonographic signs in dogs with congenital portosystemic shunts included small liver, reduced visibility of intrahepatic portal vessels, and anomalous blood vessel draining into the caudal vena cava. Correct determination of intra - versus extrahepatic shunt was made ultrasonographically in 35/38 (92%) dogs. Increased and/or variable portal blood flow velocity was present in 21/30 (70%) dogs with congenital portosystemic shunts. In one dog with an intrahepatic shunt the ultrasonographic diagnosis was based partly on finding increased mean portal blood flow velocity because the shunting vessel was not visible. Detection of the shunting vessel and placement of duplex-Doppler sample volumes were facilitated by use of color-flow Doppler. Two-dimensional, grey-scale ultrasonography alone is sufficient to detect most intrahepatic and extrahepatic shunts; sensitivity is increased by additional use of duplex-Doppler and color-flow Doppler. Increased and/or variable portal blood flow velocity occurs in the majority of dogs with congenital portosystemic shunts.  相似文献   

14.
Three male Poodles (two Toy, one Miniature) were presented to their veterinarians for evaluation of urolithiasis and varying degrees of hepatic encephalopathy. All three dogs were diagnosed as having intrahepatic shunts and referred for surgical correction. In each case, shunts arose from the right branch of the portal vein and were amenable to perivascular dissection caudal to where the vessel entered the hepatic parenchyma and to placement of perivascular cellophane bands to achieve shunt attenuation. During the same period, a female Miniature Poodle also presented for treatment of a congenital portosystemic shunt discovered during evaluation for generalised motor seizures. This animal had an extrahepatic portoazygous shunt that was completely ligated. Congenital portosystemic shunts have not previously been identified in Toy and Miniature Poodles at the University Veterinary Centre, Sydney and the anatomical types of shunt seen in this breed have not previously been reported in a consecutive series of cases. The three male dogs are noteworthy for a number of reasons: all had intrahepatic shunts, despite being small breed dogs; all three presented in a similar fashion, and all had shunts of an anatomical type amenable to placement of cellophane bands. One male dog died within 12 hours of surgery, the remaining three dogs survived and their liver function was normal at follow-up between 2 and 3 months after surgery. Use of cellophane bands for successful attenuation of intrahepatic shunts has not been previously reported.  相似文献   

15.
Thirteen dogs with cardiac tamponade resulting from pericardial effusion were prospectively evaluated to determine feasibility and outcome of thoracoscopic partial pericardiectomy. A lateral thoracoscopic approach allowed adequate exposure to remove a 4- to 5-cm-diameter section of pericardium in all dogs. Complete resolution of cardiac tamponade occurred in all dogs for which there was follow-up (11 dogs). Ten of 13 dogs (76.9%) had neoplastic pericardial effusion. One of these dogs remains alive at 220 days postoperatively and is asymptomatic. The mean survival of the remaining 9 patents with neoplastic effusion was 128 days (range, 14-544 days; median, 38 days). Three of 13 patients (23.1%) had idiopathic pericardial effusion. Two of these dogs remain alive at 585 and 1,250 days postoperatively. One dog with idiopathic pericardial effusion developed cardiomyopathy and was euthanized 18 days after the procedure. Results indicate that the procedure was technically successful in all dogs. No anesthetic complications occurred. Procedural complications included phrenic nerve transection (1 dog), lung laceration (1 dog), and moderate intraoperative bleeding (1 dog). No adverse clinical manifestations of the complications were apparent. We conclude that thoracoscopic partial pericardiectomy is technically feasible and offers several advantages over conventional open thoracic surgical pericardiectomy.  相似文献   

16.
Chylothorax is a devastating disease, and the success rates from either medical or surgical management are less than satisfactory. In some animals with chylothorax, a thickening of the pericardium occurs that is associated with chronic irritation induced by chyle. We hypothesized that pericardial thickening would lead to increased right-sided venous pressures and that abnormal venous pressures would act to impede the drainage of chyle via lymphaticovenous communications after thoracic duct (TD) ligation. We also hypothesized that serosanguineous effusions that occurred after TD ligation could effectively be treated or prevented by pericardectomy in affected animals. TD ligation plus pericardectomy was performed in 17 animals, and pericardectomy alone was performed in an additional 3 animals that presented during a 5.5-year period to the Texas A&M University (College Station, TX). Nineteen animals presented for an evaluation of idiopathic chylothorax (9 dogs and 10 cats), and 1 dog presented for serosanguineous pleural fluid after TD ligation that had been performed elsewhere. Echocardiography was normal in all animals, except for a subjectively thickened pericardium in 7 cats and 6 dogs. Clinical signs of pleural fluid accumulation resolved in 10 of 10 dogs and in 8 of 10 cats after surgery. The overall success rate for the surgical treatment of chylothorax (ie, the resolution of pleural fluid accumulation) in this study was 90% (100% in dogs and 80% in cats). These data suggest that TD ligation in conjunction with pericardectomy has a favorable outcome in animals with idiopathic chylothorax.  相似文献   

17.
OBJECTIVE: To evaluate the use of a portocaval venograft without an ameroid constrictor in the surgical management of intrahepatic portosystemic shunts (PSS). STUDY DESIGN: Prospective clinical study. ANIMALS: Seven dogs with intrahepatic PSS. METHODS: Portal pressure was measured after temporary suture occlusion of the intrahepatic PSS. In dogs with an increase in portal pressure > or =8 mm Hg or signs of portal hypertension, a single extrahepatic portocaval shunt was created using a jugular vein. Clinical outcome and complications were recorded. RESULTS: The mean (+/-SD) portal pressure increased from 5.9+/-1.6 to 17.9+/-4.1 mm Hg with PSS occlusion. There were no intraoperative complications and, after creation of the portocaval shunt, the intrahepatic PSS could be completely ligated in all dogs. The final portal pressure was 9.6+/-1.9 mm Hg. Complications developed during postoperative hospitalization in 5 dogs and included incisional discharge (4 dogs), ascites (3), ventricular premature contractions (2), and melena, bloody diarrhea, neurologic signs, coagulopathy, and aspiration pneumonia (each in 1 dog). Six dogs died or were euthanatized with clinical signs related to depression, inappetance, abdominal pain, vomiting, melena, and abdominal distention, with a median survival of 82 days (range, 20-990 days). One dog was clinically normal at 33 months after surgery. CONCLUSIONS: Clinical signs observed in 6 dogs after surgery were consistent with portal hypertension. Use of a portocaval venograft without an ameroid constrictor may reduce the likelihood of hepatic vascular development, thereby increasing the risk of life-threatening portal hypertension should the venograft suddenly occlude. CLINICAL RELEVANCE: Use of a portocaval venograft without an ameroid constrictor to control portal hypertension after ligation of an intrahepatic PSS cannot be recommended.  相似文献   

18.
Persistent nonchylous pleural effusion followed thoracic duct ligation for chylothorax in a dog. Attempts at tetracycline pleurodesis twice failed to reduce the quantity of pleural effusion. Repeated thoracentesis caused malnutrition and hypoproteinemia. A modified Denver peritoneal-venous shunt was implanted to internally drain the pleural fluid into the peritoneal cavity. Normal body weight and plasma protein concentration were regained in 40 days. Digital compression of the pump chamber alleviated the signs of respiratory compromise, without complication. At 50 weeks post-installation, a proteinaceous clot obstructed the original efferent pump valve, necessitating shunt replacement. Eight weeks after replacement, the dog was asymptomatic.  相似文献   

19.
OBJECTIVE: To report use of combined cisterna chyli ablation (CCA) and thoracic duct ligation (TDL) for treatment of spontaneously occurring chylothorax in dogs. STUDY DESIGN: Retrospective study. ANIMALS: Eight dogs with chylothorax. METHODS: TDL was performed through a right caudal intercostal thoracotomy and CCA through a left flank paracostal approach or ventral median celiotomy. Long-term outcome (range, 2-48 months; median, 11.5 months) was evaluated by telephone communication with owners. RESULTS: Seven dogs were free of clinical signs related to chylothorax at last follow-up (range, 4-48 months; median, 15.5 months). One dog was euthanatized 2 months after surgery because of lack of improvement. No major complications occurred from CCA. CONCLUSION: CCA and TDL resolved chylothorax in most dogs (88%). CLINICAL RELEVANCE: CCA combined with TDL may improve the outcome of chylothorax in dogs.  相似文献   

20.
OBJECTIVES: To evaluate outcome in dogs with left divisional intrahepatic portosystemic shunts (PSS) treated by partial ligation (PL) or ameroid ring constrictor (ARC) placement on the left hepatic vein. DESIGN: Retrospective study. ANIMALS: Dogs (n=28) with left divisional intrahepatic PSS. METHODS: Retrieved data from medical records of dogs with left divisional intrahepatic PSS that had PL (n=17) or ARC (n=11) were signalment, history, clinical signs, preoperative blood work, portal pressure measurements, ARC size, complications and postoperative technetium scintigraphy. Outcome assessed by owner interview 6 months-10 years after surgery was classified as excellent, good or poor. Differences were tested by exact chi2 test. RESULTS: Major complications occurred in 3 dogs: coagulopathy (1 PL dog died), ascites (1 PL dog survived) and seizures (1 ARC dog died). Eight PL dogs had technetium portal scintigraphy; 1 dog was negative and 7 dogs positive for persistent shunting. Seven ARC dogs had scintigraphy; 4 dogs were negative and 3 positive for persistent shunting. In PL dogs, long-term clinical outcome was excellent (92%) or good (8%) whereas, in ARC dogs it was excellent (20%), good (50%) or poor (30%). This outcome difference between treatment groups was significant (P=.0012). CONCLUSION: Dogs treated by PL had significantly better long-term outcome compared with ARC treated dogs. CLINICAL RELEVANCE: Based on these data, ARC placement on the left hepatic vein in dogs with left-divisional intrahepatic PSS cannot be recommended.  相似文献   

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