An eight-month-old, male, neutered, domestic short hair cat was presented for further investigation of white granuloma-like lesions on the tongue and recent onset regurgitation. The owner reported that the cat had an ‘unusual’ gait. Moderate increases in alanine aminotransferase, aspartate aminostransferase and markedly elevated creatine kinase were present. Thoracic radiographs revealed moderate-to-severe oesophageal impaction, cardiomegaly and an irregular appearance of the diaphragm. Endoscopy revealed a distended oesophagus with accumulation of ingesta. Difficulties were encountered when passing the endoscope through the cardia. Histology of the white granuloma-like lesions were pathognomonic of calcinosis circumscripta. These features raised the suspicion of feline muscular dystrophy. Muscle biopsies and electromyography were declined, and the patient was euthanased. Postmortem examination, histopathology and immunohistochemistry were suggestive of dystrophin-deficient muscular dystrophy (DDMD). This case emphasises the importance of including DDMD as a differential diagnosis for regurgitation and lingual calcinosis circumscripta in cats.
Sagittal T2-weighted sequences (T2-SAG) are the foundation of spinal protocols when screening for the presence of intervertebral disc extrusion. We often utilize sagittal short-tau inversion recovery sequences (STIR-SAG) as an adjunctive screening series, and experience suggests that this combined approach provides superior detection rates. We hypothesized that STIR-SAG would provide higher sensitivity than T2-SAG in the identification and localization of intervertebral disc extrusion. We further hypothesized that the parallel evaluation of paired T2-SAG and STIR-SAG series would provide a higher sensitivity than could be achieved with either independent sagittal series when viewed in isolation. This retrospective diagnostic accuracy study blindly reviewed T2-SAG and STIR-SAG sequences from dogs (n = 110) with surgically confirmed intervertebral disc extrusion. A consensus between two radiologists found no significant difference in sensitivity between T2-SAG and STIR-SAG during the identification of intervertebral disc extrusion (T2-SAG: 92.7%, STIR-SAG: 94.5%, P = 0.752). Nevertheless, STIR-SAG accurately identified intervertebral disc extrusion in 66.7% of cases where the evaluation of T2-SAG in isolation had provided a false negative diagnosis. Additionally, one radiologist found that the parallel evaluation of paired T2-SAG and STIR-SAG series provided a significantly higher sensitivity than T2-SAG in isolation, during the identification of intervertebral disc extrusion (T2-SAG: 78.2%, paired T2-SAG, and STIR-SAG: 90.9%, P = 0.017). A similar nonsignificant trend was observed when the consensus of both radiologists was taken into consideration (T2-SAG: 92.7%, paired T2-SAG, and STIR-SAG = 97.3%, P = 0.392). We therefore conclude that STIR-SAG is capable of identifying intervertebral disc extrusion that is inconspicuous in T2-SAG, and that STIR-SAG should be considered a useful adjunctive sequence during preliminary sagittal screening for intervertebral disc extrusion in low-field magnetic resonance.
Case summaryA male neutered Ragdoll cat aged 11 years and 9 months presented with a 6 month history of weight loss and a 1 month history of lethargy and adipsia. A thorough clinical investigation confirmed a diagnosis of primary adipsia and hypernatraemia secondary to a non-secretory neuroendocrine pituitary macroadenoma.Relevance and novel informationPrimary adipsia is a very rare clinical entity. This report is the first to describe primary adipsia secondary to a non-secretory pituitary macroadenoma in the cat. The veterinary literature available in this field is very limited and this report adds a new differential diagnosis for cats presenting with primary hypodipsia.
A 2-year-old crossbreed dog was presented for evaluation of a 6-week history of progressive paraparesis. Magnetic resonance imaging and computed tomography angiography of the thoracic and lumbar spinal cord disclosed multifocal, anomalous, small, vascular structures, distributed throughout the subarachnoid space of the included section of the spinal cord. An additional focal intramedullary lesion was identified extending from T9 to T10 to T12. Histopathological examination confirmed the presence of an intramedullary arteriovenous malformation affecting the thoracic spinal cord and leading to diffuse congestion and focal hemorrhages into the affected spinal cord.
An earlier article discussed the diagnosis of canine insulinoma (Housley and Tappin (2014) 19(3): 138–42). This second article examines the treatment options available and the associated prognosis for these patients. In the acute situation, hypoglycaemic signs should be managed with the administration of glucose, either orally or by cautious intravenous injection. Medical management with frequent feeding of complex carbohydrates, prednisolone and diazoxide will control clinical signs in most patients. Surgery should be considered in all patients, even those with metastatic disease, as long-term prognosis is better after debulking surgery. Most patients will have a mass identified at surgery; if not, careful palpation, intra-operative ultrasound or new methylene blue administration may highlight the lesion. If a mass cannot be found, speculative hemipancreatectomy can be performed with little risk of either endocrine of exocrine insufficiency. Long-term prognosis depends on the presence or absence of metastasis, but disease-free intervals of more than two years have been reported, with survival times longer than this if medical management is commenced when signs recur.
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