Hypoattenuating periportal halo on CT in a patient population can occur in presence of a variety of diseases

Many pathologies can occur in the periportal space and manifest as fluid accumulation, visible in Computed tomography (CT) images as a circumferential region of low attenuation around the intrahepatic portal vessels, called periportal halo (PPH). This finding is associated with different types of hepatic and extra-hepatic disease in humans and remains a non-specific sign of unknown significance in veterinary literature. The aim of this study was to investigate the prevalence of PPH in a population of patients undergoing CT examination and to assess the presence of lesions related to hepatic and extra-hepatic disease in presence of PPH. CT studies including the cranial abdomen of dogs and cats performed over a 5-year period were retrospectively reviewed. The prevalence of PPH was 15% in dogs and 1% in cats. 143 animals were included and the halo was classified as mild, moderate and severe, respectively in 51%, 34% and 15% of animals. The halo distribution was generalized in 79 cases, localized along the second generation of portal branches in 63, and along the first generation only in one. Hepatic disease was present in 58/143 and extra-hepatic disease in 110/143 of the cases. Main cause of hepatic (36%) and extra-hepatic disease (68%) was neoplasia. Associations between halo grades and neoplasia revealed to be not statistically significant (p = 0.057). In 7% of animals the CT examination was otherwise unremarkable. PPH is a non-specific finding, occurring in presence of a variety of diseases in the examined patient population.

Contralateral sialadenitis after resection of a right cerebellar metastasis: illustrative case

BACKGROUND Acute postoperative sialadenitis is a rare and potentially morbid complication of cranial neurosurgery. This rapidly progressive, unilateral neck swelling often presents within hours of extubation. Diagnosis is made by imaging and exclusion of other causes of etiologies, such as neck hematoma, sialolithiasis, and dependent soft tissue edema. OBSERVATIONS The authors presented a case of acute postoperative sialadenitis after suboccipital resection of a right cerebellar metastasis. Shortly after extubation, extensive left-sided neck swelling was apparent in the postanesthesia care unit. No central lines were placed during the procedure. Imaging revealed submandibular gland edema and fluid accumulation in the surrounding tissue. The patient was managed conservatively with steroids, antibiotics, and warm compresses, with complete resolution of symptoms 2 weeks after the procedure. LESSONS This case emphasizes the broad differential of acute neck swelling after cranial surgery. Physical examination of the neck and airway protection should guide initial treatment. If a patient is stable, bedside ultrasound and computed tomography can be helpful with the differential diagnosis. Here the authors proposed an algorithm for diagnosis and treatment of acute neck swelling after cranial surgery.

A Window in the Heart Is Sometimes a Good Start: It’s Not Always Sepsis

Cardiac tamponade is a life-threatening compression of the heart caused by abnormal accumulation of pericardial fluid. Important elements affecting its disposition and treatment are the rate of fluid accumulation relative to pericardial stretch and the effectiveness of compensatory mechanisms before critical hemodynamic compromise occurs. It is a clinical diagnosis and waiting for the threshold of steep rise in cardiac transmural pressure to critical levels may lead to catastrophic outcomes which is why early drainage has to be strongly considered in suspected cases.

Huge subcutaneous extraperitoneal pseudocyst after migration of the ventriculoperitoneal shunt catheter

The formation of an intraperitoneal pseudocyst as a complication of ventriculoperitoneal shunts is well known. However, the formation of a pseudocyst at the subcutaneous extraperitoneal abdominal space is unusual and likely secondary to the migration of the peritoneal catheter. We present a 53-year-old male who had placement of a ventriculoperitoneal shunt for hydrocephalus secondary to a vestibular schwannoma. Five months later, he presented with an enormously distended abdomen. Investigations showed the peritoneal catheter in the extraperitoneal space within a large right lower quadrant abdominal wall pseudocyst. The patient was taken to the operating theatre, and the shunt was externalised at the original abdominal incision. Approximately 3 L of cerebrospinal fluid were aspirated from the distal peritoneal catheter. After negative cultures, a new peritoneal catheter was placed intraperitoneally at the contralateral lower abdominal quadrant. The contralateral quadrant was utilised to prevent fluid accumulation into the old extraperitoneal cavity.

Clinical and pathogenetic aspects of the complications after surgical treatment of hepatic echinococcosis

Aim. To identify factors influencing effectiveness of surgical approaches in hepatic echinococcosis, depending on the location, size and stage of development of the cyst.Material and methods. From 2015 to 2017 the experience of surgical treatment of 98 patients with liver echinococcosis who underwent percutaneous (PAIR – 23 and PEVAC – 29 patients) and laparoscopic (46 patients) interventions was considered.Results. After the PAIR, a complication was noted in 1 (16.7%) case of isolated use with a CE3 cyst. Various complications were noted in 3 (60%) cases with a cyst puncture of more than 4 cm, and in 2 of them with CE2 and CE3. The average time for evacuating the cysts contents when performing the PEVAC technique was 5 days. Hemorrhagic fluid in drainage was noted in 6.9% of cases, biliary fistula – in 13.8%. Accumulation of fluid and suppuration in the residual cavity were identified in 34.5%. Taking into account the size of the cysts, the complication rate after PEVAC was 9.1% for cysts ≤6 cm vs 50% for cysts >6 cm. Various difficulties with manipulations during laparoscopic echinococcectomy were noted more often with CE2–4. So, difficulties with aspiration or removal of cyst contents more often arose with CE4. The incidence of complications after drainage removal was 17.9%, of which fluid accumulation was in 14.3% and residual cavity suppuration in 3.6% of cases.Conclusion. The US criteria, main indications and tactical and technical aspects for performing PAIR and PEVAC methods, as well as for performing laparoscopic echinococcectomy, and criteria for assessing the required volume of percytectomy for an adequate abdominalization of fibrous capsule have been clarified.

Dilatated Cardiomyopathy In Two Month Old Puppy

Background: Canine dilated cardiomyopathy (DCM) is a disease that results in a decreased ability of the cardiac contraction to generate pressure to pump blood through the vascular system. DCM is characterized by dilation of the ventricles with ventricular wall thinning. Purpose: The DCM case in Indonesia is rarely reported; therefore, this paper contains information about dilatated cardiomyopathy in a 2-month-old puppy. Case Analyze: A two-month-old local dog arrived with a complaint about coughing, loss of appetite, fatigue, and swelling on extremities, also having a history of seizures and bloody diarrhea. Physical examination shows that the patient breathes using abdominal type and polypnea, tachycardia pulse, pale mucose, and dehydration. Electrocardiogram result shows tachycardia sinus and abnormality in the depression of ST-segment. Radiography examination shows heart dilation and liquid accumulation in the thoracic cavity and abdomen. Hematology routine examination shows microcytic hyperchromic anemia, leucocytosis, and eosinophilia. Feces examination resulted in negative. Pathology anatomy examination show dilatated cardio, pulmonum hepatization, fluid accumulation in the thoracic cavity and abdomen cavity. Result: According to anamnesis, clinical examination, laboratory examination, and anatomy pathology examination can be concluded that the dog, in this case, is diagnosed with dilatated cardiomyopathy.

Resolution of Optic Disc Pit Maculopathy Following Posterior Vitreous Detachment

Purpose: This work presents a case of significant improvement of optic pit disc maculopathy following an acute posterior vitreous detachment (PVD) and discusses the possible mechanisms of this phenomenon. Methods: A case report and review of the literature are presented. Results: A 56-year-old man presenting with progressive visual decline in his left eye was found to have an optic disc pit with optical coherence tomography (OCT) evidence of severe intraretinal edema and maculoschisis. His visual acuity and macular anatomy on OCT improved dramatically in the months following a PVD. Conclusions: This report presents an interesting case of spontaneous improvement of optic disc pit–related maculopathy following PVD. We discuss the cause of the retinal fluid accumulation in optic disc pit maculopathy and consider that the OCT findings in our case lend credence to the theory that this fluid originates from the vitreous humor.

A novel Vascular Leak Index identifies sepsis patients with a higher risk for in-hospital death and fluid accumulation

Purpose: Sepsis is a leading cause of morbidity and mortality worldwide and is characterized by vascular leak. Treatment for sepsis, specifically intravenous fluids, may worsen deterioration in the context of vascular leak. Methods: We performed a retrospective cohort study of sepsis patients in four ICU databases in North America, Europe, and Asia. We developed an intuitive vascular leak index (VLI) and explored the relationship between VLI and in-hospital death and fluid balance using generalized additive models (GAM). Results: Using GAM, we found that increased VLI is associated with an increased risk of in-hospital death. Patients with a VLI in the highest quartile (Q4), across the four datasets, had a 1.61-2.31 times increased odds of dying in the hospital compared to patients with a VLI in the lowest quartile (Q1). VLI Q2 and Q3 were also associated with increased odds of dying. The relationship between VLI, treated as a continuous variable, and in-hospital death and fluid balance were statistically significant in the three datasets with large sample sizes. Specifically, we observed that as VLI increased, there was increase in the risk for in-hospital death and 36h-84h fluid balance. Conclusions: Our VLI identifies groups of patients who may be at higher risk for in-hospital death or for fluid accumulation. This relationship persisted in models developed to control for severity of illness and chronic comorbidities.

Prevalence of some common bacterial diseases in commercial poultry farm

Bacterial disease of poultry is one of the major constraints to the expansion of poultry industry. The study was undertaken to investigate some common bacterial diseases in commercial poultry farm. A total of 100 sick and dead chickens (67 broilers, 26 layers and 7 sonali) were collected from different poultry farms which were subjected to postmortem examination for tentative diagnosis. After the post-mortem examination, out of 100 collected dead chickens, bacterial diseases were confirmed 58 %. Among them 52 % of the chickens were diagnosed tentatively to be the case of colibacillosis, 4 % salmonellosis, and 2 % of fowl cholera. In post-mortem examination, some pathological lesions like: omphalitis, fibrinopurulent fluid accumulation in peritoneal cavity, air sacculitis, pericarditis and perihepatitis, extreme congestion and septicemia in intestine for colibacillosis infection; unabsorbed yolk mass, bronze discoloration and friable liver, hemorrhages in spleen, misshaped ova for salmonellosis as well as swollen and hardening of comb, congestion of skin, multiple pin point pale color necrotic lesion on liver, pin point hemorrhage on fat muscle of heart were observed for fowl cholera infection. Hence, this study will definitely help to perceive the prevalence of common bacterial diseases like colibacillosis, salmonellosis and fowl cholera infection in commercial poultry farm.

Multimodal imaging of bilateral immunogammopathy maculopathy associated to Waldenström’s macroglobulinemia

Aim: Our aim is to report a case with bilateral Waldenström’s macroglobulinemia (WM) associated maculopathy, assessed with multimodal imaging including swept source optical coherence tomography (SS-OCT) and OCT-Angiography (OCT-A). Methods: Observational case report. Case presentation: A 61-year-old diabetic woman with history of treated WM currently in remission, presented with progressive bilateral visual loss. Best-corrected visual acuity was 20/100 in the right eye (RE) and 20/200 in the left eye (LE). Fundus examination showed bilateral microaneurysms and retinal punctuate hemorrhages and a large macular serous detachment in the LE. There was no retinal ischemia on FA nor macular dye leakage. SS-OCT showed a significant schisis-like intraretinal fluid accumulation in the RE and a large prominent macular detachment with significant subretinal fluid accumulation in the LE. Retinal and choriocapillaris vascular densities were normal on OCT-A. Conclusion: Our case illustrated characteristic multimodal imaging findings in WM associated maculopathy such as schisis-like intraretinal fluid accumulation and angiographically silent serous macular detachment. OCT-A could non-invasively analyze macular vascular densities layer-by-layer, without noticing any vascular anomaly.