Objective: To determine whether a balloon for resuscitative endovascular balloon occlusion of the aorta (REBOA) could be accurately placed in the descending aorta between the left subclavian and celiac arteries (zone I) by using external anatomic landmarks in dogs. Study design: Cadaver study. Sample population: Fifteen canine cadavers of 3 weight categories (10-20, 20-30, and ≥ 30 kg). Methods: Percutaneous catheterization of the femoral artery was attempted under ultrasonographic guidance; when unsuccessful, an arterial cutdown was performed to place an introducer sheath. Distance was measured between the introducer sheath and the target region, located ventral to the epaxial muscles at the level of the 12th thoracic vertebra. The balloon was advanced the measured distance, and placement was confirmed with fluoroscopy. The volume of iohexol solution required to inflate balloons was recorded. Histopathology was performed on the aortas of the first 5 dogs. Results: Three catheters were placed under ultrasonographic guidance. Balloons were successfully placed into zone I in 15 of 15 cadavers. Balloons were inflated with a median 0.4 mL/kg (range, 0.21-0.67) of iohexol solution. Minor changes were identified in 2 of 5 dogs examined with histopathology (linear defects in 1 dog, small focal dissection in the other). Conclusion: A balloon for REBOA was consistently placed in the target zone I without fluoroscopic guidance. Clinical significance: Fluoroscopy may not be required for zone I REBOA in dogs. Additional studies are warranted to evaluate the feasibility of REBOA in clinical dogs with hemoperitoneum.
Thymoma‐associated nephropathies have been reported in people but not in dogs. In this report, we describe a dog with thymoma and concurrent renal amyloidosis. A 7‐year‐old castrated male Weimaraner was presented for progressive anorexia, lethargy, and tachypnea. The dog was diagnosed with azotemia, marked proteinuria, and a thymoma that was surgically removed. Postoperatively, the dog developed a large left ventricular thrombus and was euthanized. Necropsy confirmed the presence of a left ventricular thrombus and histopathology revealed renal amyloidosis. We speculate that the renal amyloidosis occurred secondary to the thymoma, with amyloidosis in turn leading to nephrotic syndrome, hypercoagulability, and ventricular thrombosis. This case illustrates the potential for thymoma‐associated nephropathies to occur in dogs and that dogs suspected to have thymoma should have a urinalysis and urine protein creatinine ratio performed as part of the pre‐surgical database.
Background Increased airway resistance due to upper airway obstruction is a common cause of respiratory distress. An upper airway exam is an inexpensive and quick diagnostic procedure that can serve to localize a disease process, confirm a definitive diagnosis, and offer therapeutic benefits. DescriptionThe upper airway examination consists of an external evaluation of the head and neck as well as a sedated examination of the oral cavity, the pharyngeal cavity, larynx, and nasal passages.
Background Respiratory distress is a common reason for animals to present to the emergency room. An understanding of respiratory physiology is helpful to facilitate accurate localization of the patient's source of respiratory distress. This knowledge will aid implementation of more appropriate therapies. Physiology/pathophysiology summary Respiratory distress can occur secondary to lesions at any location of the respiratory system. Diseases affecting different portions of the respiratory track (eg, upper airway, lower airways, parenchymal, or the pleural space) lead to distinguishing clinical signs as the patient's respiratory physiology is affected differently. Clinical importance Respiratory distress can be life‐threatening if it is not recognized and addressed in a timely matter. Prompt recognition of unique clinical signs may aid the clinician's ability to localize the disease process and implement targeted therapies. Key Points Diseases affecting different portions of the respiratory track (eg, upper airway, lower airways, parenchymal, or the pleural space) lead to distinguishing clinical signs as the patient's respiratory physiology is affected differently. Recognition of respiratory patterns allows clinicians to correlate clinical signs to the most likely affected region of the respiratory tract. Ideally, alveolar gas (ventilation) and blood flow (perfusion) are equally matched. However, even a normal lung does not have ideal ventilation/perfusion (V/Q) matching. There are a variety of conditions that lead to decreased lung compliance, from pathology of the pulmonary parenchyma (eg, pulmonary edema, alveolar infiltrates such as pneumonia or contusions, or pulmonary fibrosis), pleural space disease (eg, pneumothorax or pleural effusion), abdominal distension, or the inability to expand the rib cage (eg, pain, thoracic wall injury, constricting thoracic bandages). The five classic causes of hypoxemia include low FiO2, diffusion impairment, hypoventilation, shunt, and V/Q mismatch. Being prepared to rapidly induce anesthesia and intubate dyspneic animals with upper airway obstruction may be required alleviate the risk of respiratory arrest.
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