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- Pyometra and uterine torsion
Lauren Bynum, Andra Voges, Kristin Repyak
Background
This case report describes an 8-year-old female domestic shorthair cat diagnosed with pyometra and unilateral uterine torsion. The cat presented with a history of lethargy, hyporexia, and abdominal distension without pyrexia or vaginal discharge. Uterine torsion is rare in non-gravid cats and is typically associated with conditions like pyometra or mucometra. This study provides a novel description of the ultrasonographic "whirl sign" in diagnosing uterine torsion.
Methods
The cat underwent physical examination, complete blood count (CBC), radiographic imaging, and abdominal ultrasound. The imaging included lateral and ventrodorsal radiographs and Doppler ultrasound using a linear transducer. An emergency ovariohysterectomy was performed following the diagnosis. Histopathological examination confirmed pyometra and uterine torsion.
Results
-Imaging: Radiographs revealed an enlarged soft tissue structure causing displacement of abdominal viscera. Ultrasound identified a fluid-filled uterus, a "whirl sign" (indicative of torsion), and inspissated debris.
]Surgical Findings: A 360° torsion of the left uterine horn was confirmed. The right horn was fluid-filled but not torsed.
-Histopathology: Multifocal acute suppurative endometritis with ulceration confirmed pyometra. No bacterial growth was identified in the uterine fluid.
-The cat recovered uneventfully post-surgery.
Limitations
The study is a single case report, and the diagnostic utility of the "whirl sign" in veterinary patients is not yet validated by broader research. Additionally, no bacterial culture results were obtained, limiting the etiological understanding of the pyometra.
Conclusions
This is the first documented case of pyometra with unilateral uterine torsion in a cat diagnosed preoperatively using the "whirl sign" via ultrasound. The findings emphasize considering uterine torsion as a differential diagnosis for acute abdominal symptoms in cats and highlight the utility of Doppler ultrasound in such cases.
Right and left lateral (A, B) and ventrodorsal (C) radiographs reveal a large, ovoid, soft tissue opaque structure in the caudal abdomen that displaced the small intestines and adjacent viscera cranially, dorsally, and left. A tortuous, tubular soft tissue opaque structure summates with the ovoid mass and the urinary bladder in (A) and (B) and is identified on the right side of the caudal abdomen in (C) (white arrows). Images (A–C) were acquired with a Canon Digital Radiography System (Canon CXDI control processing software NE).
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