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

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(Created page with "[[|centre|500px]] <br /> '''A four-year-old cat is diagnosed with hypertrophic cardiomyopathy.''' <br /> <FlashCard questions="4"> |q1=What is a common vascular complication ...")
 
 
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'''A four-year-old cat is diagnosed with hypertrophic cardiomyopathy.'''
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'''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.'''
  
 
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<FlashCard questions="4">
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<FlashCard questions="3">
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|q1=What is a common vascular complication associated with this disease process?
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|q1=What is the most likely diagnosis?
 
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Aortic thromboembolism. Thromboemboli commonly lodge at the aortic trifurcation and extended into the branches.
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Periprostatic cyst. <br>
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The size of the cyst and the absence of communication with the prostate make this the most probable diagnosis.  
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Peripheral thromboemboli may originate from cardiac thrombi which dislodge and pass into the aorta.
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|l1=Prostatic and Paraprostatic Cysts
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|q2=What anatomic structure is thought to be involved in this process?
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Occasionally, cardiac thrombi are detected using ultrasound.
 
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|q2=What are three commonly noted clinical or physical examination findings associated with this condition?
 
 
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Common abnormalities include paraparesis, pain, hypothermia and ischemia of the hindlimbs; and auscultation of a murmur, gallop sound or arrhythmia.  
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Periprostatic cysts are thought to arise from the uterus masculinus, a remnant of the Müllerian duct system. <br><br>
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Serosal cysts and hemorrhage can also result in periprostatic cyst formation.
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Absent or weak femoral pulses indicate presence of a thrombus.
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|l2=Prostatic and Paraprostatic Cysts
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|q3=What are the surgical treatments for this abnormality, and what are the advantages and disadvantages of each?
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Dyspnea and tachypnea may also be observed.
 
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|q3=Is surgery useful for treatment?
 
 
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Treatment includes supportive therapy with fluids and diuretics, use of a vasodilator such as acepromazine, and an anticoagulant such as heparin, aspirin, or warfarin.
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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>
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*Marsupialization provides continuous drainage, and prostatic manipulation is minimized reducing the likelihood of damage to the prostatic neurovascular supply.  
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Heparin is generally used in the acute phase, and warfarin for long-term anticoagulant therapy.  
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*The cyst is anchored to the paramedian rectus abdominus muscle.  
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*The cyst membrane is incised and the fluid drained and cultured.  
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Clot dissolution has been achieved using streptokinase and urokinase.  
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*The cyst wall is then sutured to the skin to form a semi-permanent stoma. <br><br>
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Disadvantages include difficulty in mobilizing the cyst to reach the abdominal wall and prolonged drainage. <br><br>
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Surgical removal of aortic thromboemboli has not been rewarding. It is best performed within four hours of embolization.  
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*Resection is required if the cyst cannot be mobilized sufficiently.  
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*The stoma usually closes spontaneously by eight weeks postoperatively.  
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Amputation of the left atrial appendage has also been suggested to eliminate the nidus for thrombus formation.  
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*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.
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|l3=Prostatic and Paraprostatic Cysts#Treatment
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In most cases, surgery is not rewarding and medical management is preferred.
 
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|q4=What is the prognosis?
 
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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.  
 
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Reembolization was common.  
 
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Prognosis varies with the severity of the embolic event, degree of ischemia, evidence of abdominal organ infarction and severity of the underlying cardiac disease.
 
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Latest revision as of 12:10, 19 October 2011


Mansonlogo This question was provided by Manson Publishing as part of the OVAL Project. See more Small Animal Soft Tissue Surgery Q&A.





SmAn ST Sx 03.jpg


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? Link to Article
What anatomic structure is thought to be involved in this process? Link to Article
What are the surgical treatments for this abnormality, and what are the advantages and disadvantages of each? Link to Article


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