Difference between revisions of "Small Animal Soft Tissue Surgery Q&A 03"

Revision as of 19:06, 1 October 2011

The figure shows an eight-year-old male dog at exploratory surgery. The mass adjacent to the bladder was thin walled and filled with clear yellow fluid. There were several adhesions to the prostate, but an anatomic communication with the gland was not identified.

Question	Answer	Article
What is the most likely diagnosis?	Periprostatic cyst. The size of the cyst and the absence of communication with the prostate make this the most probable diagnosis.	[[\|Link to Article]]
What anatomic structure is thought to be involved in this process?	Periprostatic cysts are thought to arise from the uterus masculinus, a remnant of the Müllerian duct system. Serosal cysts and hemorrhage can also result in periprostatic cyst formation.	[[\|Link to Article]]
What are the surgical treatments for this abnormality, and what are the advantages and disadvantages of each?	Cysts resection is curative if the origin is identified. Disadvantages include more extensive prostatic manipulation needed to identify the origin of the cyst and recurrence in the case of inadequate resection. A recent report described good success using omentalization of the cyst remnant after subtotal resection. Marsupialization provides continuous drainage, and prostatic manipulation is minimized reducing the likelihood of damage to the prostatic neurovascular supply. The cyst is anchored to the paramedian rectus abdominus muscle. The cyst membrane is incised and the fluid drained and cultured. The cyst wall is then sutured to the skin to form a semi-permanent stoma. Disadvantages include difficulty in mobilizing the cyst to reach the abdominal wall and prolonged drainage. Resection is required if the cyst cannot be mobilized sufficiently. The stoma usually closes spontaneously by eight weeks postoperatively. Biopsy of the prostate and cyst wall and castration are performed at the time of resection or marsupialization to identify neoplasia and prevent recurrence of prostatic disease by inducing involution.	[[\|Link to Article]]

@@ Line 1: / Line 1: @@
-[[|centre|500px]]
+[[File:SmAn ST Sx 03.jpg|centre|500px]]
 <br />
-'''A four-year-old cat is diagnosed with hypertrophic cardiomyopathy.'''
+'''The figure shows an eight-year-old male dog at exploratory surgery. The mass adjacent to the bladder was thin walled and filled with clear yellow fluid. There were several adhesions to the prostate, but an anatomic communication with the gland was not identified.'''
 <br />
-<FlashCard questions="4">
+<FlashCard questions="3">
-|q1=What is a common vascular complication associated with this disease process?
+|q1=What is the most likely diagnosis?
 |a1=
-Aortic thromboembolism. Thromboemboli commonly lodge at the aortic trifurcation and extended into the branches.
+Periprostatic cyst. <br>
+The size of the cyst and the absence of communication with the prostate make this the most probable diagnosis.
-Peripheral thromboemboli may originate from cardiac thrombi which dislodge and pass into the aorta.
-Occasionally, cardiac thrombi are detected using ultrasound.
 |l1=
-|q2=What are three commonly noted clinical or physical examination findings associated with this condition?
+|q2=What anatomic structure is thought to be involved in this process?
 |a2=
-Common abnormalities include paraparesis, pain, hypothermia and ischemia of the hindlimbs; and auscultation of a murmur, gallop sound or arrhythmia.
+Periprostatic cysts are thought to arise from the uterus masculinus, a remnant of the Müllerian duct system. <br><br>
+Serosal cysts and hemorrhage can also result in periprostatic cyst formation.
-Absent or weak femoral pulses indicate presence of a thrombus.
-Dyspnea and tachypnea may also be observed.
 |l2=
-|q3=Is surgery useful for treatment?
+|q3=What are the surgical treatments for this abnormality, and what are the advantages and disadvantages of each?
 |a3=
-Treatment includes supportive therapy with fluids and diuretics, use of a vasodilator such as acepromazine, and an anticoagulant such as heparin, aspirin, or warfarin.
+Cysts resection is curative if the origin is identified. Disadvantages include more extensive prostatic manipulation needed to identify the origin of the cyst and recurrence in the case of inadequate resection. A recent report described good success using omentalization of the cyst remnant after subtotal resection.<br><br>
+*Marsupialization provides continuous drainage, and prostatic manipulation is minimized reducing the likelihood of damage to the prostatic neurovascular supply.
-Heparin is generally used in the acute phase, and warfarin for long-term anticoagulant therapy.
+*The cyst is anchored to the paramedian rectus abdominus muscle.
+*The cyst membrane is incised and the fluid drained and cultured.
-Clot dissolution has been achieved using streptokinase and urokinase.
+*The cyst wall is then sutured to the skin to form a semi-permanent stoma. <br><br>
+Disadvantages include difficulty in mobilizing the cyst to reach the abdominal wall and prolonged drainage. <br><br>
-Surgical removal of aortic thromboemboli has not been rewarding. It is best performed within four hours of embolization.
+*Resection is required if the cyst cannot be mobilized sufficiently.
+*The stoma usually closes spontaneously by eight weeks postoperatively.
-Amputation of the left atrial appendage has also been suggested to eliminate the nidus for thrombus formation.
+*Biopsy of the prostate and cyst wall and castration are performed at the time of resection or marsupialization to identify neoplasia and prevent recurrence of prostatic disease by inducing involution.
-In most cases, surgery is not rewarding and medical management is preferred.
 |l3=
-|q4=What is the prognosis?
-|a4=
-A recent study showed that affected cats had a 34% chance of surviving the initial thromboembolic episode; those that did had an average survival of 11.5 months.
-Reembolization was common.
-Prognosis varies with the severity of the embolic event, degree of ischemia, evidence of abdominal organ infarction and severity of the underlying cardiac disease.
-|l4=
 </FlashCard>

Difference between revisions of "Small Animal Soft Tissue Surgery Q&A 03"

Revision as of 19:06, 1 October 2011

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