What Is Your Diagnosis?

Hock Gan Heng Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907.

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 DVM, MVS, MS, DACVR
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Elissa Randall Departments of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48910.

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 DVM, MS, DACVR
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Kurt Williams Departments of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48910.

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 DVM, PhD, DACVP
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Cheri Johnson Departments of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48910.

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 DVM, MS, DACVIM

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History

A healthy 3-year-old female Briard-Beagle crossbred dog was admitted to the Michigan State University Veterinary Teaching Hospital for late pregnancy evaluation. The dog was 2 days past the estimated date of parturition and had no signs of labor during physical examination. The dog was part of a research breeding colony and had a history of 2 normal pregnancies that resulted in the birth of healthy puppies. During the ultrasonographic examination of the fetuses, 4 viable fetuses were detected, 1 of which had multiple abnormalities and a heartbeat that was slow and weak (approx 100 beats/min; Figure 1).

Figure 1—
Figure 1—

Parasagittal (A) and dorsal (B) ultrasonographic images of the thorax of a late-term fetus in a healthy 3-year-old female Briard-Beagle crossbred dog that was 2 days past the estimated date of parturition. The fetal heartbeat was considered slow and weak.

Citation: Journal of the American Veterinary Medical Association 239, 1; 10.2460/javma.239.1.51

Determine whether additional imaging studies are required, or make your diagnosis from Figure 1—then turn the page

Diagnostic Imaging Findings and Interpretations

A large amount of pleural effusion, a small amount of peritoneal effusion, and a substantial amount of subcutaneous edema (Figure 2) is evident in the fetus with the slow and weak heartbeat. This fetus appears large, compared with the size of the other fetuses, because of the subcutaneous edema. Lungs of the affected fetus are small. These ultrasonographic findings are consistent with hydrops fetalis, also known as fetal anasarca.

Figure 2—
Figure 2—

Same ultrasonographic images as in Figure 1. Notice that anechoic effusion is present in the pleural (arrowheads) and peritoneal cavities (thin arrows). Subcutaneous edema is present in the thoracic wall (double-headed arrows). H = Heart of the fetus. The small lungs can be identified easily on the dorsal image (thick arrows).

Citation: Journal of the American Veterinary Medical Association 239, 1; 10.2460/javma.239.1.51

Abdominal ultrasonography of the fetus revealed kidneys without any evidence of corticomedullary differentiation (Figure 3), potentially the result of hypoplasia. Ultrasonographic evaluation of the other 3 fetuses revealed that they had normal appearing structures.

Figure 3—
Figure 3—

Sagittal ultrasonographic images of 2 fetuses comparing the kidneys. The left image shows a normal fetal kidney (black arrowheads), and the right image shows a kidney of the same fetus as in Figure 1. Notice that there was loss of normal corticomedullary differentiation (white arrowheads) and that there was anechoic pleural (thin arrows) and peritoneal (thick arrows) effusion.

Citation: Journal of the American Veterinary Medical Association 239, 1; 10.2460/javma.239.1.51

Comments

A cesarean section was performed immediately, and 3 clinically normal puppies were born and survived. The abnormal fetus died immediately after delivery. It had severe subcutaneous edema and weighed twice the weight of the littermates. On necropsy, the abnormal fetus had approximately 50 mL of pleural effusion and atelectasis. Peritoneal effusion was not detected, possibly because of a small volume. Histologic evaluation revealed underdevelopment of renal medullae and lung alveoli. Pulmonary hypoplasia was interpreted as being due to excessive amounts of pleural effusion. Underdeveloped kidneys are not a consistent finding in hydrops fetalis, and the precise cause in this fetus could not be determined.

Hydrops fetalis is an end-stage process in a number of fetal diseases that results in failure of fetal fluid homeostasis. It is usually characterized by various degrees of generalized edema and effusions in multiple body cavities.1 In puppies, this condition has been reported to be caused by cardiovascular malformation2; however, in most cases, the etiology is undetermined.3

Hydrops fetalis can be diagnosed during routine prenatal ultrasonographic examination.1,3,4 In animals, the predominant ultrasonographic finding is the presence of subcutaneous edema. Detection of effusion in the body cavities is uncommon.3 A slow and weak heartbeat in this fetus was most likely the result of fetal distress as hydrops fetalis is not known to be associated with bradycardia. Another complication of hydrops fetalis is fetal pulmonary hypoplasia secondary to the pleural effusion, which leads to perinatal death, as seen in this fetus.

  • 1.

    Fleischer AC, Killam AP, and Boehm FH, et al. Hydrops fetalis: sonographic evaluation and clinical implications. Radiology 1981; 141:163168.

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  • 2.

    Padgett GA, Bell TD, and Patterson WR. Genetic disorders affecting reproduction and periparturient care. Vet Clin North Am Small Anim Pract 1986; 16:577586.

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  • 3.

    Hopper BJ, Richardson JL, and Lester NV. Spontaneous antenatal resolution of canine hydrops fetalis diagnosed by ultrasound. J Small Anim Pract 2004; 45:28.

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  • 4.

    Edward Allen W, and England GCW, et al. Hydrops fetalis diagnosed by real-time ultrasonography in a Bichon Frise bitch. J Small Anim Pract 1989; 30:465467.

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