Title : Bicavitary haemorrhagic effusion in a dog with a liver lobe torsion
Abstract:
Aim of this case report:
Liver lobe torsion is an uncommon condition in dogs. The goal of this report was to describe an uncommon presentation of this pathology where bicavitary haemorrhagic effusion and abcessation were diagnosed.
Case presentation:
A 4-year-old male neutered Greyhound presented to a referral center in the United Kingdom in 2021 for investigation of vomiting, diarrhoea, abdominal pain and pyrexia. A haematology was unremarkable.Biochemistry revealed mild hypoalbuminemia (21 g/l RI 25-38), mild elevation of the ALT (238 IU/L RI 30-180) and ALP (157 IU/L RI 19-120) and markedly increased C-reactive protein (215 mg/L RI <10). Point of
care ultrasound of the thorax and abdomen revealed marked bilateral pleural effusion and moderateabdominal effusion. Cytology of the abdominal and pleural fluid was consistent with an exudate with marked neutrophilic inflammation (non-degenerate neutrophils) and evidence of haemorrhage. The haematocrit of the pleural and abdominal effusion was 0.11 L/L and 0.08 L/L respectively. Coagulation times (APTT and PT) were within normal limits and Angiostrongylus vasorum rapid immunoassay was negative. The patient developed tachypnea, requiring thoracocentesis and one liter of pleural effusion was drained. An abdominal ultrasound revealed a cranial abdominal lesion containing gas, compatible with an abscess. Small volume of pneumoperitoneum and severe cranial abdominal peritonitis were also identified. Computed tomography confirmed an emphysematous lesion in the cranial abdomen,suspected arising from the liver and highly suggestive of a liver lobe torsion, most likely of the papillary process of the caudate lobe, with concurrent abscessation of the lobe. No evidence of primary pulmonary
pathology was identified.
Treatment and follow up:
The dog underwent exploratory laparotomy and liver lobectomy. Histopathology of the papillary process revealed acute, diffuse and severe coagulative necrosis and haemorrhage. The pleural effusion was monitored over the course of 6 days and progressively resolved after the abdominal surgery. The underlying cause of the patient’s liver torsion remained unknown. The dog was reported to be well one month after surgery.
Discussion:
To the authors’ knowledge, bicavitary effusion with liver lobe torsion has been rarely reported in veterinary small animal medicine, accounting for two dogs, one of them presenting with haemothorax and haemoabdomen. The pathophysiology for this is not well understood. The current case widens the literature about this possible manifestation of liver torsion and has an impact in veterinary small animal medicine as highlights the importance of considering it as a differential diagnosis for bicavitary haemorrhagic effusion, despite normal coagulation times, normal platelet count and mildly increased liver enzymes.
Audience Take Away:
- Case presentation of a dog with liver lobe torsion which is relatively rare in dogs
- The importance of considering liver lobe torsion as a differential diagnosis in dogs presenting with bicavitary haemorrhagic effusion, despite normal coagulation times and platelet counts.
- Discussion of the proposed pathophysiology for the bicavitary haemorrhagic effusion in liver lobe torsion
