Kidney-Sparing Surgery for Renal Subcapsular Abscess Caused by Staphylococcus pseudintermedius in a Dog

ABSTRACT An 11 yr old male Drahthaar dog was presented for dysuria, pollakiuria, and history of uroliths. Abdominal ultrasound revealed a subcapsular fluid-filled lesion of the left kidney, suspected cholecystitis, and a splenic infarct. The renal lesion was fully drained and cytology of the renal subcapsular and perirenal fluids revealed septic exudate. Bacterial culture of the urine, bile, and perirenal and subcapsular fluids were all positive for Staphylococcus pseudintermedius. Antimicrobial therapy was instituted based on culture sensitivity. After 7 days the dog re-presented for vomiting and abdominal pain, and a focal intestinal injury was suspected based on abdominal ultrasound. Enterectomy of an ischemic jejunal loop, a partial splenectomy, and excision of the left renal subcapsular abscess were performed. The renal parenchyma was left intact. Histopathology confirmed the diagnosis of a renal subcapsular abscess, intestinal infarction, and focal pyogranulomatous splenitis. Cholecystitis was confirmed by bile cytology and culture. No major complications and no recurrences were encountered at 1 yr follow-up. This is the first report of a renal subcapsular abscess in the dog, with septic complications, and treated with a kidney-sparing surgery.

The Concordance between Cytological and Histological Specimens of Bile Duct and Malignancy Rates of Cytological Specimens: A Study in a Single Institution

Background: Cytological evaluation of biliary tract specimens, especially from the common bile duct, is a procedure to identify potential malignant lesions that is less invasive than resection. Staffs of cytological service examined cytological specimens from the bile duct. Following this, tissue biopsy or resection was conducted and the diagnostic discrepancies between the two procedures were analyzed. Objective: To investigate the diagnostic concordance rates from the histological and the cytological examination of bile duct specimens and to evaluate the malignancy rate according to the bile duct cytological diagnostic category. Materials and Methods: Seventy-eight cytological bile duct specimens were collected between January 2011 and September 2017. In addition, 44 histological biopsied or resected specimens were retrospectively included in the present study. The Kappa coefficient was calculated and used to determine the concordance rate between the two procedures. The sensitivity and positive predictive value of cytology were calculated and compared to histological biopsied or resected specimens. The malignancy rates among the cytological diagnostic categories were identified. Results: There was moderate concordance between the cytology and the biopsy or resected specimens (K=0.52, p=0.001), the sensitivity and specificity of which were 75% (95% CI 47.62 to 92.73) and 79% (95% CI 59.05 to 91.70), respectively. The positive predictive value was 67 (95% CI 48.24 to 81.10), and negative predictive value was 85% (95% CI 69.73 to 92.92). The malignancy rate in the negative for malignancy group was 18%. Conclusion: The diagnostic concordance rate between the cytological results of bile duct specimens and the results of biopsy or resection was 77% (95% CI 62 to 88), with a moderate concordance rate (K=0.52, p=0.001). Keywords: Bile cytology, Bile duct, Cytology, Histology, Concordance rate, Bile duct cancer

Toxoplasma gondii-associated cholecystitis in a cat receiving immunosuppressive treatment

A 9-year-old female neutered domestic shorthair cat diagnosed with immune-mediated thrombocytopenia that was treated with prednisolone and cyclosporine, was presented for anorexia, vomiting, increased liver enzymes, and hyperbilirubinemia. Abdominal ultrasound revealed a markedly thickened gallbladder and common bile duct wall. Bile cytology detected severe neutrophilic inflammation and protozoal zoites. Suspected Toxoplasma gondii infection was confirmed by real-time PCR of bile. The cat was treated with clindamycin and ursodeoxycholic acid for 6 weeks, recovered and remained stable for 2 years despite ongoing immunosuppressive treatment. Thereafter, the cat was presented with suspicion of intestinal lymphoma, and recurrence of toxoplasmosis was diagnosed. Following treatment with clindamycin and prednisolone over 4 weeks the cat was euthanized. This is the first report of Toxoplasma gondii zoites detected in bile fluid from a cat with cholecystitis. Pathogenesis of toxoplasmosis in cats is still not fully understood. Although immunosuppression can represent a relevant predisposing factor, other factors, such as virulence of the parasite and genetic polymorphism of the host, can also play an important role. Toxoplasmosis should be included as a differential diagnosis in cats developing clinical signs of an inflammatory disease while receiving immunosuppressive treatment.

Percutaneous cholecystocentesis in cats with suspected hepatobiliary disease

Objectives The objective was to evaluate the safety and diagnostic utility of percutaneous ultrasound-guided cholecystocentesis (PUC) in cats with suspected hepatobiliary disease. Methods Medical records of 83 cats with suspected hepatobiliary disease that underwent PUC were retrospectively reviewed. Results At the time of PUC, at least one additional procedure was performed in 79/83 cats, including hepatic aspiration and/or biopsy (n = 75) and splenic aspiration (n = 18). Complications were noted in 14/83 cases, including increased abdominal fluid (n = 11), needle-tip occlusion (n = 1), failed first attempt to penetrate the gall bladder wall (n = 1) and pneumoperitoneum (n = 1). There were no reports of gall bladder rupture, bile peritonitis or hypotension necessitating treatment with vasopressor medication. Blood products were administered to 7/83 (8%) cats. Seventy-two cats (87%) survived to discharge. Of the cats that were euthanized (9/83) or died (2/83), none were reported as a definitive consequence of PUC. Bacteria were identified cytologically in 10/71 samples (14%); all 10 had a positive aerobic bacterial culture. Bile culture was positive in 11/80 samples (14%). Of the cases with a positive bile culture, cytological description of bacteria corresponded to the organism cultured in fewer than 50% of cases. The most common cytologic diagnosis was hepatic lipidosis (49/66). The most common histopathologic diagnosis was cholangitis (10/21). Conclusions and relevance PUC was safe in this group of cats with suspected hepatobiliary disease. Complications were likely associated with ancillary procedures performed at the time of PUC. Bile analysis yielded an abnormal result in nearly one-third of cats with suspected hepatobiliary disease. Complete agreement between bile cytology and culture was lacking. Further evaluation of the correlation between bile cytology and bile culture is warranted.