An 8 yr old castrated male Cavalier King Charles spaniel dog was presented for an acute onset of an abnormal mentation and ataxia. After vomiting a large volume of material containing paintball shells, the diagnosis of paintball intoxication was made. Despite mild hypernatremia (157 mmol/L) that was unchanged from presentation, the dog developed tonic-clonic seizures 4 hr after admission. Approximately 11 hr after admission, the patient's plasma sodium increased to 170 mmol/L; the dog became comatose and required endotracheal intubation. Gastric lavage was performed to remove a conglomerate of residual paintball material. The dog's free water deficit was corrected to safely reduce plasma sodium to baseline levels over 12 hr. The patient remained comatose for 7 hr following correction of the acute hypernatremia and developed a Cushing reflex that responded to hyperosmolar therapy. With continued intensive care, his neurological status made gradual improvements and he was successfully discharged after 68 hr with a normal neurological examination. Two weeks after discharge, the owners reported that the patient was bright and alert, with no persistent clinical signs and normal blood parameters on recheck blood work. This case report highlights successful treatment of a dog that developed severe neurological signs following "nontoxic" paintball ingestion both before and after the development of acute hypernatremia.

A 1 yr old female spayed dog presented for evaluation of lethargy, hyporexia, and left hind limb lameness. On presentation, she was tachycardic and febrile. Echocardiogram revealed pericardial effusion and evidence of pericarditis and myocarditis, and electrocardiogram showed underlying sinus rhythm with complex arrhythmias. Cardiac troponin-I level was markedly elevated. The dog was hospitalized for 6 days on IV fluid therapy and treated with ampicillin/sulbactam and enrofloxacin. She was discharged on amoxicillin-clavulanic acid and maropitant citrate. Within 24 hr, the dog returned because of progressive clinical signs. It was revealed that two of her littermates had tested positive for Brucella canis, so antimicrobial therapy was switched to enrofloxacin and doxycycline. Six days later, the dog developed worsening clinical signs and was euthanized. Postmortem examination was performed. Blood cultures and brucellosis testing were positive for B canis. Two other dogs and two humans in the household were ultimately diagnosed with brucellosis. To our knowledge, infection with B canis has not been reported in dogs diagnosed with myocarditis. However, myocarditis is a rare clinical manifestation of brucellosis in humans. Depending on patient history, clinical signs, and diagnostic findings, brucellosis is a zoonotic disease that may be a differential diagnosis in dogs with suspected myocarditis.

Boar attack-associated trauma (BAAT) in dogs was reviewed by assessing the injury type (blunt, penetrating, or combined), distribution, Animal Trauma Triage (ATT) score, and prognosis. We conducted a university teaching hospital retrospective study of the hospital medical records from December 2013 to January 2024 of all dogs presented for BAAT. Forty-two cases were identified: 36 (85.7%) had blunt trauma, 13 (30.9%) had penetrating trauma, and 7 (16.7%) had combined trauma. The mean ATT score (± standard deviation [SD]) was significantly higher in penetrating (4.3 ± 1.2) and combined trauma (5.0 ± 1.0) than in blunt (2.5 ± 1.3) trauma. Similarly, the mean ATT score was significantly higher in multiple (4.2 ± 1.4) than in single (2.5 ± 1.4) lesions. The mean ATT score was 3.0 (± 1.6) in survivors and 5.5 (± 0.71) in dogs that died naturally. The number of observations was too low to reach statistical significance. The survival rate was 100% (6/6) with only penetrating, 89.7% (26/29) with only blunt, and 85.7% (6/7) with combined lesions. ATT scores were higher in cases that suffered penetrating or combined and multiple injuries. Blunt trauma affecting a single region was more common than penetrating or multiple injuries. The overall survival rate was 90.5%.

Hyperechoic retroperitoneal fat was identified in a 3 yr old Sphynx cat with systemic coagulopathy. This ultrasonographic finding preceded the development of hematochezia and anemia, and pleural and peritoneal bleeding did not develop. Fine-needle aspirate cytology of the retroperitoneal space showed a predominance of erythrocytes, and rapid clinical recovery was noted following treatment with plasma, a whole blood transfusion, and vitamin K. Systemic coagulopathy should be considered a differential for hyperechoic retroperitoneal fat in cats, even in the absence of other clinical manifestations of hemorrhage.

The objective of this study was to determine if the time to any antimicrobial administration, as well as time to appropriate antimicrobial administration, impacted hospitalization time of dogs diagnosed with sepsis. Records from 175 dogs diagnosed with sepsis were included in this single-center retrospective study. Results found a significant, positive correlation between hospitalization time and time to appropriate antimicrobial administration (P = .004). A significant relationship was also found between survival rate and acute patient physiological and laboratory evaluation fast (APPLEfast) score (P = .03), survival rate and source control (P = .05), and source control and time to appropriate antimicrobial administration (P < .01). No significant relationship was found between hospitalization time and time to any antimicrobial administration (P = .11), time to any antimicrobial administration and source control (P = .77), time to any (P = .11) or appropriate (P = .37) antimicrobial administration and survival rate, or APPLEfast score (P = .07). These findings suggest the importance of appropriate antimicrobial choice upon recognition of sepsis in veterinary patients to decrease length of hospitalization. Additional research is required to further investigate the effect of time to antimicrobial administration on the survival rates of dogs with sepsis.

Dogs with hyperadrenocorticism (HAC) present to a referral dermatology practice with clinical signs that vary from the traditional HAC signs. This retrospective case series evaluates the presenting complaints, history findings, and physical examination findings in dogs diagnosed with HAC presenting to a referral dermatology practice. Medical records of 30 dogs diagnosed with HAC and evaluated at a private dermatology referral practice were retrospectively reviewed. A history of pruritus was the most prevalent history finding in 26/30 dogs (87%). On physical examination, a superficial bacterial pyoderma was diagnosed in 22/30 dogs (73%) with a supportive cytology followed by alopecia in 16/30 dogs (53%). Alkaline phosphatase was only elevated in 20/30 cases (67%). These results indicate that pruritus was the most commonly documented historic finding and pyoderma was the prevailing physical examination finding. Uncommonly reported findings included otitis externa and pododermatitis for patients with HAC presenting to a referral dermatology practice.

This case report describes partial pancreatectomy in a dog with insulinoma, emphasizing the role of pancreatic ductal anatomy on surgical planning and postoperative management. A 13 yr old castrated male poodle was evaluated for a pancreatic mass with signs indicative of insulinoma. Imaging showed the mass occupying most of the right pancreatic limb, with its cranial margin just adjacent to the minor duodenal papilla. Although intraoperative visualization was limited by duodenal adhesions, postoperative ultrasonography and histopathology supported anatomical preservation of the accessory pancreatic duct. Histopathologic and immunohistochemical analyses confirmed insulinoma with incomplete surgical margins, prompting adjuvant chemotherapy with imatinib. Initial follow-up revealed maintenance of normoglycemia despite development of pancreatitis. Over time, laboratory findings and clinical signs indicated progressive exocrine insufficiency, with diabetes mellitus diagnosed at 8 mo. The patient survived beyond 16 mo postoperatively without tumor recurrence. This case demonstrates that ductal preservation is anatomically feasible when tumor location permits, although functional preservation may not always follow. It highlights the complexity of balancing oncologic control with pancreatic function. Although surgical management of canine insulinoma is well described, few reports examine the impact of ductal anatomy on surgical decisions and long-term outcomes, underscoring the need for further investigation.

Veterinary medicine is centered on the animal patient, and similarly, human medicine is centered on the human patient. Yet animal health, human health, and the environment intersect in myriad ways. Despite this intersection, there are few resources that take a family-centered, collaborative approach to human, animal, and environmental health. To help address this gap, AAHA has brought together a task force of human and veterinary medical professionals with the goal of improving collaboration between professions to facilitate better outcomes for families with pets. These guidelines address common scenarios (e.g., zoonotic disease, disability, intimate partner violence) that intersect with human and animal health and provide strategies for greater communication and collaboration between the professions. The guidelines cover (1) terms and definitions to establish a common language between professions; (2) how to determine if a case requires a One Health approach; (3) how and when to reach out to other professionals for a case (e.g., social worker, physician, other medical professionals); and (4) how and when to follow up and close cases. These guidelines also offer case studies illustrating One Health scenarios that connect with human/family health, with supplemental materials available on the AAHA website at aaha.org/one-health.

In two castrated male dogs, entrapment of a nasogastric feeding tube, which had been used as an improvised urethral catheter, occurred during intermittent urethral catheterization. In both cases, multiple failed attempts to remove the catheter raised concerns about catheter entrapment, which was subsequently confirmed via abdominal radiography. To facilitate removal, both dogs were placed under deep sedation using IV butorphanol (0.3 mg/kg) and propofol titrated to effect. A retrograde over-the-needle catheter was inserted alongside the entrapped nasogastric tube, and the urethral orifice was manually narrowed as much as possible. While applying rectal compression of the urethra, saline was infused through the over-the-needle catheter to dilate the urethra, allowing for the gentle extraction of the entrapped tube. Following entrapped tube removal, no urethral trauma or adverse effects were observed. These cases highlight the risks associated with using nonstandard materials, such as nasogastric feeding tubes, for urethral catheterization and introduces a novel nonsurgical technique for managing urethral catheter entrapment in veterinary practice.

Carbapenemase-producing Enterobacterales (CPE) are an emerging public health threat in both human and veterinary medicine. As antibiotic resistance grows, there is increased importance in preventing the spread and transmission of these organisms by using appropriate infection prevention and biosecurity measures. The goal of this study was to test the efficacy of commonly used disinfectants in the veterinary setting against CPE strains. A total of 10 bacterial strains (9 CPE and 1 control strain) and 5 disinfectants were evaluated. Effective disinfection (at least a 3-log kill) was found at the manufacturer's contact time for all strains when paired with all products except for one strain (47422-21) of Enterobacter hormaechei, which only had a 2-log for the accelerated hydrogen peroxide product and a 1-log reduction for the quaternary ammonium compound product. When used according to manufacturer recommendations, the five surface disinfectants tested were effective in vitro against the majority of CPE of animal origin that were evaluated.

X-linked dystrophin-deficient muscular dystrophy is associated with a mutation of the DYS gene located on the X chromosome. To date, dystrophinopathy has been identified in 16 different dog breeds with 20 different variants confirmed. In this report, a 9 mo old male Australian cattle dog was evaluated for progressive generalized weakness and dysphagia beginning at 4 mo of age. A markedly elevated creatine kinase activity was noted on blood chemistry, and muscle biopsies confirmed a dystrophic phenotype. Dystrophin deficiency was identified by immunohistochemistry. In this report we identify dystrophin-deficient muscular dystrophy for the first time in a 9 mo old intact male Australian cattle dog. This finding expands the list of breeds confirmed with dystrophinopathy. Whole-genome sequencing is required to identify the causative mutation.

The objective of this study is to evaluate the relationship between protein content in commercially available dry food and behavioral scores collected via a validated behavior questionnaire. Health and lifestyle factors were obtained from owner-completed questionnaires for golden retrievers participating in a prospective canine health study, eating commercially available dry food as ≥80% of the daily intake. Diets were categorized as high (≥30%), medium (21-29%), or low (≤20%) protein levels. Ten behavioral outcomes from a validated survey were used as outcome measurements. The association of dietary protein level and behavior outcomes were estimated using logistic regression, adjusting for sex, reproductive status, and dog's primary lifestyle. Compared with dogs fed medium-protein diets, dogs fed high-protein diets were 1.3 times more likely to have dog rivalry (95% CI, 1.02-1.78). The dogs fed low-protein diets were 1.4 times more likely to have separation-related behavior (95% CI, 1.01-2.03). When assessing and treating aggression and separation related-behaviors, clinicians should evaluate and weigh the importance of several factors, including the diet being fed.

Radiographic signs of acute pancreatitis in dogs include widening of the pyloroduodenal angle and a cranial abdominal mass effect/decreased serosal detail. In some dogs with acute pancreatitis, it has been anecdotally noted that the right renal silhouette could be well visualized on the ventrodorsal abdominal radiograph. The purpose of this study was to see whether increased right renal conspicuity (i.e., renal "halo" sign) is associated with pancreatitis, other causes of a right cranial abdominal mass effect, decreased abdominal serosal detail as with the presence of peritoneal effusion, or perhaps representing a normal variation. The medical records of 100 dogs were retrospectively collected and divided into four groups, including control dogs (n = 30), right-sided hepatic mass effect (n = 16), peritoneal effusion (n = 15), and acute pancreatitis (n = 39). Ventrodorsal radiographs from each case were randomized for evaluation by a radiologist blinded to the final diagnosis. A right renal halo sign was identified in 13/39 (33%) of dogs with acute pancreatitis, 2/16 (12.5%) dogs with a right cranial abdominal mass effect, and 1/30 (3%) control dog. This study supports that the renal halo signs on ventrodorsal radiographs is most prevalent in dogs with acute pancreatitis and may help support a clinical diagnosis of this medical disorder.

A vertebral telangiectatic osteosarcoma was diagnosed in a 5 yr old female neutered Staffordshire bull terrier presenting with paraplegia with nociception in one limb and absent on the other. Computed tomography revealed a hypoattenuating, osteolytic lesion affecting the T9 vertebra. MRI revealed a well-demarcated dorsal extradural mass overlying the spinal cord along the T8-T10 vertebral bodies. A hemorrhaging, reddish mass dorsal to the spinal cord was removed surgically, and a diagnosis of telangiectatic osteosarcoma was confirmed through histopathological examination. The dog improved following surgery and chemotherapy but suffered acute deterioration 5 wk postoperatively and was euthanized. This is the first reported case of a vertebral telangiectatic osteosarcoma where computed tomography and MRI sequences were obtained, with surgical extraction and medical chemotherapy. This subtype of osteosarcoma is believed to have a negative prognosis in dogs, although this is the first report of attempted surgical treatment. Telangiectatic osteosarcoma should be considered as a differential in dogs, particularly when a mass is identified with associated intralesional hemorrhagic spaces, commonly seen in the telangiectatic subtype. Currently, there are no established treatment options for vertebral telangiectatic osteosarcomas and the prognosis appears to be poor.

Nasogastric tubes (NGTs) are used in critical care to provide early enteral nutrition to reduce mortality and morbidity. Compared with other feeding tubes, NGTs are inexpensive and easy to place without delaying provision of enteral nutrition. In addition, NGTs are used to monitor gastric motility and reduce the risk of aspiration pneumonia. Despite their versatility, there are complications associated with their use. This report presents three cases of isocalothorax in animals resulting from inadvertent placement of NGTs into the respiratory tract. Two dogs were treated surgically; one survived to discharge and one died. One cat survived to discharge with medical management. Few reports in veterinary literature describe complications of misplaced NGTs. To our knowledge, this is the first case report of successful medical management in a cat with isocalothorax. This report highlights complications of NGT misplacement and offers possible management strategies in cases of isocalothorax.

A 3 yr old intact male Doberman pinscher was referred with chronic diarrhea, severe polyuria-polydipsia, and behavioral changes for 2 wk. Biochemical abnormalities were consistent with central diabetes insipidus, hypothyroidism, and hypoadrenocorticism. Brain MRI and cerebrospinal fluid analysis raised suspicion for lymphocytic hypophysitis and meningitis, later confirmed histologically. Immunosuppressive steroid therapy and hormonal supplementation were implemented, resulting in a marked clinical improvement. Brain MRI at a 3 mo follow-up showed a resolution of inflammatory lesions along with pituitary atrophy. The patient was euthanized 4.5 mo following diagnosis because of uncontrolled aggressiveness. Lymphocytic hypophysitis (LHP) is a rare autoimmune condition in people and dogs, often accompanied by total or partial pituitary hormonal deficiency. This is the first case of histologically confirmed canine LHP with documented clinical and biochemical response to medical management. As described in people, LHP should be considered as a differential diagnosis for pituitary lesions. Although the overall prognosis of this disease remains guarded to poor, early diagnosis and adequate immunosuppressive treatment might improve the outcome.

A 10 wk old male shih tzu (1.9 kg) was presented for severe non-weight-bearing lameness of the right thoracic limb. Radiographs revealed luxation of the right humeroulnar joint (type II), with severe external rotation of the proximal ulna. The ulna was manually reduced to achieve articulation with the medial part of the humeral condyle under general anesthesia, which was maintained by two positive-profile threaded pins placed into the lateral part of the humeral condyle in a caudal to cranial direction ("stopper" antiluxation pins). The lameness improved at 5 days postoperatively. One pin appeared loose radiographically and both pins were removed at 30 days postoperatively. The dog showed no lameness with mildly limited range of motion with radiographic findings including the mild residual humeroulnar incongruity and degenerative joint disease at the final follow-up (6.8 yr postoperatively). We propose that this extra-articular method to prevent luxation is advantageous for its minimal adverse effect on elbow range of motion, as compared with the previously described methods including transarticular pinning and external fixators. This case report describes a novel treatment option for congenital humeroulnar luxation in very young dogs that maintains reduction and allows early return to function.

Recurrent pericardial effusion (PE) with cardiac tamponade due to a cardiac mass was identified in two dogs. Cytology of the masses was consistent with a malignant epithelial tumor with a neuroendocrine appearance in both cases. Given the location and description, an ectopic thyroid carcinoma was considered the most likely cytological diagnosis. Pericardiectomy and chemotherapy were proposed in both cases, but the owners declined to perform any invasive surgical treatment, and an alternative option was offered to palliate the symptoms associated with PE. Placement of a subcutaneous pleural access port in the pericardial cavity was achieved to drain the PE and avoid the need to perform serial percutaneous pericardiocentesis. The placement of a subcutaneous access port appeared to be safe and well tolerated in two patients for whom more invasive treatment was declined and may be considered for future similar cases.

A 1 yr old spayed female Scottish fold cat was referred for further investigation because of loss of appetite and markedly elevated liver enzyme activities. Significant biliary dilatation and positive bile culture were documented, raising suspicion for cholangitis. A strictured/stenotic duodenal papilla was noted on laparotomy, with retrograde cholangiopancreatography documenting the main pancreatic duct joined with the common bile duct outside the duodenal wall. In addition, pancreatic enzyme activity in the bile was high, suggesting that pancreatic juice was flowing back into the biliary tract. These findings are similar to those of pancreaticobiliary maljunction observed in humans. Duodenal papillotomy improved the excretion of bile and pancreatic juice, resolving both the bile duct dilatation and elevated liver enzyme activities. To our knowledge, this is the first report demonstrating the association of pancreaticobiliary maljunction with the development of cholangitis associated with biliary dilatation in cats. In clinical practice, when cholangitis with severe biliary dilatation is observed in a young cat, the association with pancreaticobiliary maljunction should be considered.

A 12 yr old, 6.11 kg, neutered male spitz dog was referred for acute hind limb paralysis. The dog had a history of inflammatory bowel disease and hyperadrenocorticism. Abdominal ultrasonography revealed a large thrombus at the aortic trifurcation, involving both iliac arteries. Therefore, the dog underwent mechanical thrombectomy using a stent-retriever thrombectomy device via the carotid artery. The procedure involved three cycles of thrombus retrieval, successfully capturing dark red thromboembolic material in the device. Successful recanalization of the aortic trifurcation and external iliac arteries was confirmed on the angiogram. After the procedure, the dog's neurological deficits resolved, and normal motor function in both hind limbs was maintained during follow-up. This case demonstrates that mechanical thrombectomy using a stent-retriever thrombectomy device is a viable and effective alternative to traditional treatments for dogs in the acute stage of aortic thromboembolism.

Across the many types of specialty practitioners and hospitals, the requirements for veterinary patient referrals vary from one-time consultations to long-term case oversight and management. These guidelines propose a structured and technology-based approach to optimize the referral process for patients, clients, and veterinary teams. They emphasize a family-centered health care approach that keeps the focus on patients and clients through consistent collaboration between primary and specialty care teams. Collaboration between primary care teams and specialty care teams requires detailed and timely communication and medical records sharing. Veterinary clients also need content-rich and supportive conversations as they navigate often stressful clinical situations with their pets, including the realities of referral care costs, prognoses, and possible ongoing treatments and/or management of chronic conditions. These guidelines establish the concepts, roles, client communication strategies, and timelines that will promote successful referral relationships. Later sections offer detailed insights into the key responsibilities for the primary and specialty care team, from the initial contact before referral, through the referral itself, and then back to primary care team oversight. The final sections consider strategies to increase access to care using team optimization and telehealth, as well as possible obstacles in the referral process and how to address or avoid them.