Journal of Veterinary Clinics (한국임상수의학회지)

The Korean Society of Veterinary Clinics (한국임상수의학회)
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Assessment of Systemic Arterial Thromboembolism with Multi-Slice Spiral CT in a Dog

개에서 다중나선형 CT촬영에 의한 동맥혈전색전증의 평가

  • Shin, Seung-Ho (College of Veterinary Medicine, ChonBuk National University) ;
  • Lee, Ki-Chang (College of Veterinary Medicine, ChonBuk National University)
  • 신승호 (전북대학교 수의과대학) ;
  • 이기창 (전북대학교 수의과대학)
  • Published : 2007.06.30
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Abstract

A 15 kg 6-year-old intact male Jindo dog with a history of a respiratory distress, hindlimb paralysis with necrosed skin of dorsal digit for three weeks was referred to Animal Medical Center, Chonbuk National University. Heartworm infection was identified by kit examination. In plain thoracic radiographs, dilated pulmonary arteries reverse D sign and focal interstitial pattern was compatible with heartworm infection and possible pulmonary thromboembolism. Abdominal radiographs showed poor serosal detail indicating fluid accumulation within peritoneal cavity. No evidence of musculoskeletal abnormalities was found. Ultrasonography presented focal wedge-shaped hyperechogenecity on the both poles of left kidney, weak or absent pulse on the distal to the external iliac artery as well as ascites and irregular liver margin. Multi-organ failure was strongly supposed by blood profile including leukocytosis, anemia, hemoglobinuria bililubinemia, hypoalbuminemia, imbalance of electrolytes, and increased hepatic and renal function values. Interestingly, the glucose level is remarkably lower in pelvic limb compared to thoracic limb. Suspected pulmonary thromboembolism, renal infarction and femoral arterial embolization causing hindlimb paralysis and dermatic necrosis were confirmed by 3D reconstructed CT imaging. Prior to taking a consideration of euthanasia, interventional radiology was experimentally attempted but failed due to not recovered from general anesthesia. Early and accurate diagnosis of thromboembolism is valuable and 3D reconstructed CT images might be very useful to show the correct way to treat effectively.

호흡곤란과 후지마비 및 발등부위의 괴사를 나타낸 수컷 진돗개가 전북대학교 동물의료센터에 내원하였다. 초기 검사에서 심장 사상충 감염이 확인되었다. 흉부방사선 외측상에서 폐동맥의 확장과 후엽의 간질패턴, 그리고 복배상에서 주 폐동맥의 뚜렷한 확장등이 관찰되어 심장사상충증을 뒷받침하였고, 복부 외측상 및 복배상에서 복부세부음영 소실이 관찰되어 복수를 의심하였다. 초음파상에서 복수와 불규칙한 간변연 그리고 신장양극의 피질에서 쐐기모양의 국소적 고에코상을 관찰하였으며 복부대동맥에서 분지하여 주행하는 바깥장골동맥의 3상형 동맥파형이 분지부 근위에서 관찰되었으나 이 후 대퇴동맥의 파형은 확인되지 않았다. 혈액화학검사에서 백혈구증다증, 빈혈, 혈색소 뇨, 고빌리루빈혈증, 저 알부민혈증, 전해질불균형, 그리고 간장 및 신장효소치의 상승등이 관찰되어 광범위한 장기의 손상이 의심되었다. 특히 글루코스는 정상적인 전지와 마비를 보이는 후지에서 비교한 결과 후지의 글루코스 수치가 현저하게 낮았다. 전산화단층촬영술 후 3차원으로 재구성한 영상을 이용하여 후지 마비의 원인으로 여겨지는 후지 동맥의 혈전색전증과 폐동맥혈전색전증 및 신장경색 등을 확인하였다. 예후불량으로 판단되었으며 실험적 중재적 방사선술을 시도하였으나 마취에서 깨어나지 못했다. 3차원 재구성 CT 영상은 색전증의 빠르고 정확한 진단에 유용하며 효과적인 치료 계획을 수립하는데도 큰 도움이 된다고 판단된다.

Keywords

References

  1. Allibone Gw. Renal infarction presenting as a mass. Diagnostic role of computed tomography and ultrasound. Urology1982; 19: 98-100 https://doi.org/10.1016/0090-4295(82)90062-0
  2. Bart Dolmatch, William J. Bavros, Thomas M. Grist. Diagnostic angiography. In: Peripheral Vascular Diseases,2nd ed. St Louis, CV Mosby 1996: 65
  3. Berliner L, Redmond P, DeBalsi J. Renal infarction in bacterial endocarditis diagnosed by computed tomography. Urol Radiol 1982; 4: 231-233 https://doi.org/10.1007/BF02924053
  4. Boswood A, Lamb CR, White RN. Aortic and iliac thrombosis in six dogs. J Small Anim Prac 2000; 41: 109-114 https://doi.org/10.1111/j.1748-5827.2000.tb03176.x
  5. Clare AC, Kraje BJ. Use of recombinant tissue-plasminogen activator for artoic thrombolysis in a hypoproeinemic dog. J Am Vet Med Assoc 1998; 212: 539-543
  6. Cook AK, Cowgill LD. Clinical and pathological features of protein-losing glomerular disease in the dog: a review of 137 cases (1985-1992). 1996; 32: 313-322
  7. Dibartola SP, Tarr MJ, Parker AT, Powers JD, Pultz JA. Clinicopathologic findings in dogs with renal amyloidosis: 59 cases (1976-1986). J Am Vet Med Assoc 1989; 195: 358-364
  8. Fox PR, Sisson DD, Moise NS. Feline myocardial diseases. In: Canine and Feline Cardiology. New York, Churchill Livingstone 1988; pp 454-459
  9. Frank JR, Nutter FB, Kyles AE, Atkins CE, Sellon RK. Systemic arterial dirofilariasis in five dogs. J Vet Intern Moo 1997; 11: 189-194 https://doi.org/10.1111/j.1939-1676.1997.tb00089.x
  10. Gareth W.L. Phillips, Review of Arterial Vascular Ultrasound, World Journal of Surgery 2000; 24: 232-240 https://doi.org/10.1007/s002689910037
  11. Glazer GM, Francis IR, Brady TM, Teng SS. Computed tomography of renal infarction: Clinical and experimental observation. AJR 1983; 140: 721-727 https://doi.org/10.2214/ajr.140.4.721
  12. Glazer GM, London SS. CT appearance of global renal infarction. J Comput Assist Tomogr 1981; 5: 847-850 https://doi.org/10.1097/00004728-198112000-00011
  13. Haaga JR. Morrison SC. Case report-CT appearance of renal infarct. J Comput Asssist Tomogr 1980; 4: 246-247 https://doi.org/10.1097/00004728-198004000-00024
  14. Harris RD, Dorros S. Computed tomographic diagnosis of renal infarction. Urologoy 1981; 17: 287-289 https://doi.org/10.1016/0090-4295(81)90058-3
  15. Hogan DF, Dhaliwal RS, Sisson DD, Kitchell BE. Paraneoplastic thrombocytosis-induced systemic thromboembolism in a cat. J Am Anim Hosp Assoc. 1999; 35: 483-486 https://doi.org/10.5326/15473317-35-6-483
  16. Johnson LR, Lappin MR, Baker DC: Pulmonary thromboembolism in 29 dogs: 1985-1995, J Vet Intern Med 1999; 13: 338-345
  17. Joseph RJ, Greenlee PG, Carrillo JM, Kay WJ. Canine cerebrovascular disease-clinical and pathologic findings in 17 cases. JAAHA 1987; 24: 569-576
  18. Killingworth CR, Eyster GE, Adams T, Bartlett PC, Bell TG Streptokinase treatment of cats with experimentally induced aortic thrombosis. Am J Vet Res. 1986; 47: 1351-1359
  19. Klein MK, Dow SW, Rosychuk RA, Pulmonary thromboembolism associated with immune-mediated hemolytic anemia in dogs. Ten cases (1982-1987). J Am Vet Med Assoc 1989; 195: 246-250
  20. Kweon JK, Song KJ, Lee KC, Lee HC and Choi MC. Computed Tomographic Charateristics of Nasal Squamous Cell Carcinoma in a Dog: J Vet Clin 2003; 20: 399-402
  21. LaRue MJ, Murtaugh RJ. Pulmonary thromboembolism In dogs: 47 cases (1986-1987). J Am Vet Med Assoc. 1990; 197: 1368-1372
  22. Laste NJ, Harpster NK. A retrospective study of 100 cases of feline distal aortic thromboembolism: 1977-1993. J Am Anim Hosp Assoc 1995; 31: 492-500
  23. Lee KC, Kweon JK, Song KJ and Choi MC. Three Dimensional ComputedTomography in the Assessment of Subtle Fracture in Dogs: J Vet Clin 2003; 20: 523-526
  24. Nichols R. Complications and concurrent disease associated with canine hyperadrenocorticism. Vet Clin North Am Small Anim Pract. 1997; 27: 309-320 https://doi.org/10.1016/S0195-5616(97)50034-9
  25. Norris CR, Griffey SM, Samii VF. Pulmonary thromboembolism in cats: 29 cases (1987-1997), J Am Vet Med Assoc 1999; 215: 1650-1654
  26. Polak JF. Peripheral arterial disease. Evaluation with color flow and duplex sonography. Radiol Clin North Am. 1995; 33: 71-90
  27. Prewitt RM, Hoy C, Kong A, Gu SA, Greenberg D, Cook R, Chan SM, Ducas J. Thrombolytic therapy in canine pulmonary embolism. Comparative effects of urokinase and recombinant tissue plasminogen activator, Am Rev Respir Dis 1990; 141: 290-295 https://doi.org/10.1164/ajrccm/141.2.290
  28. Ramsey CC, Burney DP, Macintire DK, Finn-Bodner S. Use of streptokinase in four dogs with thrombosis. J Am Vet Med Assoc 1996; 209: 780-785
  29. Rawlings CA: Pulmonary vascular response of dogs with heartworm disease, Can J Comp Med 1978; 42: 452-459
  30. Rees CR, Palmaz JC, Garcia O, Alvarado R, Siegle RL. The hemodynamic effects of the administration of ionic and nonionic contrast materials into the pulmonary arteries of a canine model of acute pulmonary hypertension, Invest Radiol 1998; 23:184-189 https://doi.org/10.1097/00004424-198803000-00005
  31. Ritt MG, Rogers KS, Tomas JS. Nephrotic syndrome resulting in thromboembolic disease and disseminated intravascular coagulation in a dog. J Am Anim Hosp Assoc. 1997; 33: 385-391 https://doi.org/10.5326/15473317-33-5-385
  32. Scott-Moncrieff JC, Treadwell NG, McCullough SM, Brooks MB. Hemostatic abnormalities in dogs with primary immune-mediated hemolytic anemia. J Am Anim Hosp Assoc 2001; 37: 220-227 https://doi.org/10.5326/15473317-37-3-220
  33. Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman HA, Thompson BT, Weg JG Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease, Chest 1991; 100: 598-603 https://doi.org/10.1378/chest.100.3.598
  34. Tater KC, Drellich S, Beck K. Management of femoral artery thrombosis in an immature dog. Journal of Veterinary Emergency and Critical Care 2005; 15: 52-59 https://doi.org/10.1111/j.1476-4431.2005.04008.x
  35. Van Winkle TJ, Hackner SG, Liu SM. Cinical and pathological features of aortic thrombolism in 36 dogs. J. Vet. Emerg Crit Care 1993; 30: 13-20