Incidence of chyloabdomen diagnosis in dogs and cats and corresponding clinical signs, clinicopathologic test results, and outcomes: 53 cases (1984-2014).
01 Oct 2018-Javma-journal of The American Veterinary Medical Association (American Veterinary Medical Association)-Vol. 253, Iss: 7, pp 886-892
TL;DR: There were multiple causes of chyloabdomen in dogs and cats of the study, and outcome depended on underlying cause, and a multicenter prospective study of disease progression, treatment response, and clinical outcome is needed.
Abstract: 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.
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TL;DR: In this article , point-of-care ultrasound (POCUS) was used to distinguish between nonhemorrhagic ascites (NHA) and noncardiac diseases (ncNHA).
Abstract: Abstract Background Nonhemorrhagic ascites (NHA) can be caused by cardiac diseases (cNHA) and noncardiac diseases (ncNHA). N‐terminal brain natriuretic peptide (NT‐proBNP), cardiac troponin‐I (cTnI), and point‐of‐care ultrasound (POCUS) may differentiate between cNHA and ncNHA. Hypothesis/Objectives We compared NT‐proBNP and cTnI concentrations as well as POCUS findings in dogs presented with cNHA and ncNHA. Animals Dogs (n = 60) were enrolled based on identification of NHA with an effusion packed cell volume < 10%. Methods Blood samples were collected and POCUS was performed on all dogs. Dogs were diagnosed with cNHA (n = 28) or ncNHA (n = 32) based on echocardiography. The cNHA group was subdivided into cardiac non‐pericardial disease (n = 17) and pericardial disease (n = 11). Results The NT‐proBNP concentration (median; range pmol/L) was significantly higher in the cNHA group (4510; 250‐10 000) compared to the ncNHA group (739.5; 250‐10 000; P = .01), with a sensitivity of 53.8% and specificity of 85.7% using a cut‐off of 4092 pmol/L. The NT‐proBNP concentrations were significantly higher in the cardiac non‐pericardial disease group (8339; 282‐10 000) compared with the pericardial disease group (692.5; 250‐4928; P = .002). A significant difference in cTnI concentration (median; range ng/L) between the cNHA group (300; 23‐112 612) and ncNHA group (181; 17‐37 549) was not detected (P = .41). A significantly higher number of dogs had hepatic venous and caudal vena cava distension in the cNHA group compared to the ncNHA group, respectively (18/28 vs 3/29, P < .0001 and 13/27 vs 2/29, P < .001). Gall bladder wall edema was not significantly different between groups (4/28 vs 3/29, P = .74). Conclusions and Clinical Importance NT‐proBNP concentration and POCUS help distinguish between cNHA and ncNHA.
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TL;DR: This is the first case report of chyloabdomen due to a foreign body granuloma, which showed that an excellent outcome can be achieved following the removal of the underlying cause.
Abstract: Abstract A 2‐year‐old female neutered crossbreed dog was referred for investigation of a 10‐day history of progressive abdominal distension. Diagnostic investigations included radiographs, abdominal ultrasound and computed tomography (CT) with lymphangiography. Fluid analysis was consistent with chylous effusion. CT revealed a metal object embedded in an ovoid homogenous soft tissue attenuating lesion, located ventral to the aorta and surrounding the roots of the celiac and cranial mesenteric arteries. At exploratory laparotomy the metallic object (projectile) was identified and retrieved under fluoroscopic guidance. Four weeks following the surgery, the abdominal distention resolved and the physical exam was unremarkable. Chyloabdomen is a rare presentation which usually carries a guarded prognosis. This is the first case report of chyloabdomen due to a foreign body granuloma, which showed that an excellent outcome can be achieved following the removal of the underlying cause.
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TL;DR: A case of fulminant disseminated cryptococosis with fungemia, peritonitis, and empyema in a patient with chronic chylothorax treated with an indwelling pleurovenous shunt was described in this article.
Abstract: Cryptococcus species are ubiquitous in the environment with a global distribution. While causing disease predominantly in immunocompromised hosts such as those with advanced HIV, HIV-uninfected patients are increasingly recognized as being affected. The most common forms of infection are cryptococcal pneumonia and meningitis. HIV-uninfected patients and extrapulmonary infections have worse outcomes, likely due to delayed diagnosis and treatment. Cryptococcus infections involving chylothorax or chyloabdomen have rarely been reported in humans. We describe a case of fulminant disseminated cryptococcosis with fungemia, peritonitis, and empyema in a patient with chronic chylothorax treated with an indwelling pleurovenous shunt. Key autopsy findings included cryptococcal organisms identified on calcified lymphadenopathy, pleural adhesions, and pericardium. We discuss the importance of identifying patients with nontraditional risks factors for cryptococcal disease, such as lymphopenia and hypogammaglobulinemia, and the potential implications of pleurovenous catheters in Cryptococcus dissemination.
TL;DR: In this article , the authors used Light's criteria (LC) (activity of enzyme lactate dehydrogenase [LDH] in the effusion, effusion/serum ratio of the enzymatic activity of lactate de-hydrogenase, total protein ratio, serum-effusion albumin gradient, acute phase proteins in serum and effusion) to distinguish exudates from transudates.
Abstract: Simple Summary Analysis and classification of effusions is helpful in guiding diagnostic tests to identify an underlying disease. The traditional veterinary classification of effusions does not adequately reflect the disease mechanism causing the effusion in cats and might not sufficiently inform diagnostic work-up. The aim of this study was to assess whether other parameters might aid classification. Sixty-five cats with body cavity effusions (within the abdomen, chest and pericardial sac) were included. Effusions were classified as transudates (e.g., heart failure [n = 18]) or exudates (e.g., inflammation, cancer [n = 47]) based on the disease mechanism causing the effusion, and using the traditional scheme. Several parameters (activity of enzyme lactate dehydrogenase in the effusion; effusion/serum ratio of the enzymatic activity of lactate dehydrogenase; effusion/serum total protein ratio; serum–effusion albumin gradient; acute phase proteins in serum and effusion) were analysed in their ability to differentiate exudates from transudates. All tested parameters performed better in classifying effusions in comparison to the traditional scheme. Acute phase proteins were helpful in classifying effusions based on their disease mechanism but could not separate effusion types when using the traditional scheme. This latter finding further supports the classification of effusions based on their disease mechanism. Better classification of effusions might improve disease diagnosis in the future. Abstract The traditional veterinary classification (TVC) of effusions based on cell count and total protein (TP) does not adequately reflect the aetiology. Light’s criteria (LC) (activity of lactate dehydrogenase [LDH] in the effusion [LDHef], effusion/serum LDH ratio [LDHr], effusion/serum TP ratio [TPr]), serum–effusion albumin gradient (ALBg), acute phase proteins (APPs) [serum amyloid A (SAA), α1-acid glycoprotein (AGP), haptoglobin] might aid classification. The aim was to evaluate the utility of these parameters except LDHr in differentiating exudates from transudates. Sixty-five cats with effusions (33 peritoneal, 31 pleural, 1 pericardial), with 18 transudates and 47 exudates based on aetiological classification (AC), were included. The sensitivity, specificity and accuracy of several parameters to identify exudates (based on AC) was assessed. APPs were compared between exudates and transudates based on AC and TVC, with receiver operating characteristics analysis identifying the best APP to recognise exudates. Simplified LC (LDHef, TPr) had an accuracy of 79% and TVC of 48%. ALBg had the highest sensitivity (98%) and LDHef the highest specificity (83%) in identifying exudates in cats. All APPs but effusion SAA could differentiate exudates from transudates based on AC (effusion AGP had the largest area under the curve 0.79) but not TVC. All parameters were better than TVC in identifying exudates. The conformity of APPs with AC but not TVC favours the use of AC to classify effusions.
TL;DR: The first report of chylous ascites resulting from peliosis hepatis in any species is reported, which is likely to have been due to lymphangiectasia and disrupted hepatic sinusoids.