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VetOo, كامب شيزار - أمام كوبري الجامعة بجوار كافية, Alexandria (2026)

11/09/2026

🐱 Retrobulbar Nerve Block in Cats

Retrobulbar anesthesia is a valuable regional technique during feline ophthalmic procedures, especially enucleation.

Its role goes beyond analgesia—it may also help reduce the oculocardiac reflex (OCR).

🔬 Oculocardiac Reflex

Ocular manipulation → Trigeminal afferent stimulation → Brainstem → Vagal activation → Bradycardia ± arrhythmias

During enucleation, traction on extraocular muscles and orbital tissues can trigger this reflex.

💉 Why perform a retrobulbar block?

By reducing sensory input from the globe and orbit, the block can provide:

• Better perioperative analgesia
• Reduced nociceptive input
• Reduced anesthetic/opioid requirements
• Potential reduction in the severity of OCR

⚠️ Important

Retrobulbar injection requires a good knowledge of orbital anatomy. Complications can include intravascular injection, globe/optic nerve injury, hemorrhage, and local anesthetic toxicity.

Always calculate the local anesthetic dose in mg/kg, aspirate before injection, inject slowly, and never inject against significant resistance.

🫀 Remember: A nerve block does not eliminate the OCR completely.

Continuous ECG monitoring remains essential. If significant bradycardia occurs, stop the surgical stimulus and reassess anesthetic depth, oxygenation, ventilation, and cardiovascular status.

Regional anesthesia + multimodal analgesia + appropriate anesthetic management + continuous monitoring = safer ophthalmic anesthesia.

13/08/2026

From Severe Cranial Trauma to Recovery: Basbousa’s Case 🐾

Basbousa, a young cat, was presented to the Canadian Veterinary Hospital after a severe traumatic accident in which a heavy metal door struck and compressed her head and neck.

Immediately after the trauma, she lost consciousness and subsequently developed recurrent seizure-like episodes, severe ataxia, and anisocoria.

On presentation, she was in critical condition, showing marked tachypnea, tachycardia, hypothermia, and hypoglycemia, in addition to significant neurological abnormalities.

We performed A-FAST and T-FAST examinations, which showed no evidence of free fluid or active hemorrhage within the abdominal or thoracic cavities. Radiographs also showed no obvious cervical vertebral fractures.

However, some radiopaque changes within the cranial cavity raised concern for possible intracranial pathology, including hemorrhage. Unfortunately, CT and MRI were not immediately available, so our management was guided by the clinical presentation and neurological findings.

Our main differentials included:

• Traumatic Brain Injury (TBI)
• Spinal Cord Trauma
• Brainstem Injury
• Intracranial Hemorrhage
• Central Vestibular Dysfunction

Initial management focused on stabilization, seizure control, and prevention of secondary neurological injury.

Repeated doses of diazepam were administered, followed by propofol when the response was insufficient and the neurological episodes continued to recur. Despite these interventions, the response remained limited, and additional sedation with xylazine was required to achieve better control.

Considering the possibility of intracranial hemorrhage, tranexamic acid (Kapron) and etamsylate (Dicynone) were administered. Mannitol 10% IV was also used for several days as osmotic therapy to help reduce suspected cerebral edema and intracranial pressure.

Supportive fluid therapy, vitamin B12, and gabapentin for analgesia and neuropathic pain control were also incorporated into the treatment plan.

The improvement was not immediate. Basbousa continued to experience recurrent neurological episodes during the initial period despite sedation and anticonvulsant therapy. However, with continuous monitoring, supportive care, and management of the suspected intracranial complications, her neurological status gradually improved.

Today, Basbousa is walking, playing, and has regained a remarkable degree of normal neurological function. ❤️🐱

This case highlights an important principle in veterinary trauma: the absence of obvious fractures or extracavitary hemorrhage does not rule out significant intracranial or neurological injury.

Early stabilization, seizure control, management of suspected intracranial hypertension, prevention of secondary brain injury, and close neurological monitoring can be critical—especially when advanced imaging such as CT or MRI is not immediately available.

From severe neurological trauma… back to playing again. 🐾❤️

06/08/2026

When "Spondylosis" Isn't Just Spondylosis...

At first glance, both lesions may appear similar on spinal radiographs—but recognizing the difference can be lifesaving.

🔴 Red Arrow: Spondylosis Deformans

- Smooth, well-organized ventral osteophyte formation.
- Originates from adjacent vertebral endplates.
- Often progresses to form a complete bony bridge.
- Typical degenerative change, commonly incidental in older dogs.

🟡 Yellow Arrow: Periosteal Reaction Secondary to Prostatic Carcinoma

- Irregular, aggressive new bone formation.
- Asymmetrical with poorly organized margins.
- Does not follow the typical bridging pattern of spondylosis.
- Should raise suspicion for vertebral metastasis, particularly in older intact male dogs with lower urinary tract signs.

📌 Take-home message:
Not every ventral vertebral bone proliferation is spondylosis. When the new bone is irregular, asymmetric, or aggressive in appearance, always include prostatic carcinoma with skeletal metastasis in your differential diagnosis.

The radiograph may be your first clue to an underlying malignant disease.

03/08/2026

"Diffuse Pulmonary Nodules on Thoracic Radiographs: Metastatic Disease Until Proven Otherwise… or Is It?"

Thoracic radiography remains the first-line imaging modality for evaluating pulmonary disease in small animals. However, the identification of a diffuse pulmonary nodular pattern should never be considered synonymous with metastatic neoplasia.

A pulmonary nodular pattern is a radiographic descriptor, not a definitive diagnosis.

Differential Diagnoses
The current diagnostic approach should include the following major categories:
Metastatic neoplasia
Mammary carcinoma
Osteosarcoma
Hemangiosarcoma
Thyroid carcinoma
Transitional cell carcinoma
Histiocytic sarcoma
Primary pulmonary neoplasia
Pulmonary adenocarcinoma
Bronchoalveolar carcinoma
Granulomatous pulmonary disease
Fungal pneumonia
Mycobacterial infection
Nocardiosis
Actinomycosis
Sterile granulomatous inflammation

Parasitic disease
Aelurostrongylus abstrusus
Paragonimus spp.
Capillaria aerophila

Septic pulmonary embolism
Pulmonary abscessation

Beyond Pattern Recognition
Recent advances in veterinary thoracic imaging emphasize that diagnostic confidence depends on lesion characterization rather than simply identifying nodules.

Important imaging features include:
Nodule size
Distribution (random, peribronchial, peripheral, or diffuse)
Margin definition
Mineralization
Cavitation
Growth kinetics
Associated bronchial or interstitial changes
Mediastinal lymph node enlargement
Pleural abnormalities

No single radiographic characteristic is pathognomonic for metastatic disease.

Why Thoracic CT Has Become the New Standard
Modern veterinary oncology increasingly recommends thoracic computed tomography (CT) for patients with pulmonary nodules because CT provides:
Detection of significantly more pulmonary nodules than conventional radiography.
Improved evaluation of lesion morphology.
Accurate assessment of pulmonary lobe involvement.
Better pre-surgical staging.
Enhanced detection of mediastinal lymphadenopathy and pleural disease.
Consequently, thoracic CT has become the preferred imaging modality whenever metastatic disease is suspected.

Clinical Perspective
Diffuse pulmonary nodules should always be interpreted within the context of:
Clinical history
Signalment
Geographic exposure
Laboratory findings
Cytology or histopathology
Advanced imaging
Radiographic appearance alone should never dictate the final diagnosis or prognosis.
The image suggests a diagnosis. The patient confirms it.

Special thanks to our brilliant colleague, Dr. Salwa Hesham, for this fascinating thoracic radiographic case.

© All publication rights reserved to Canadian Veterinary Hospital – Alexandria.

25/07/2026

Adrenal Mineralization in Cats: An Incidental Finding or a Diagnostic Clue?

During a recent abdominal radiographic examination of a feline patient, a distinct mineral opacity was identified within the region of the adrenal gland.

Although adrenal mineralization is an uncommon radiographic finding in cats, its presence should prompt careful interpretation within the context of the patient's history, clinical signs, laboratory findings, and complementary imaging.

Differential diagnoses include:

- Age-related dystrophic mineralization (often incidental, particularly in older patients)
- Previous adrenal hemorrhage or chronic inflammation
- Adrenal neoplasia (e.g., adenoma, adenocarcinoma, or pheochromocytoma)
- Chronic adrenal degeneration
- Rare metabolic disorders associated with soft tissue mineralization

Why ultrasound is essential

Radiography can demonstrate mineralization but cannot adequately characterize adrenal morphology. Abdominal ultrasonography is recommended to assess:

- Adrenal size
- Shape and symmetry
- Echogenicity
- Vascular invasion
- Relationship to adjacent structures

When indicated, further investigation may include:

- CBC and serum biochemistry
- Blood pressure measurement
- Electrolyte profile
- Endocrine testing (based on clinical suspicion)
- CT imaging for surgical planning or staging

Clinical takeaway

Adrenal mineralization is a radiographic sign—not a diagnosis. While it may represent an incidental age-related change, it can also be the first clue to significant adrenal pathology. Interpretation should always integrate imaging findings with the patient's overall clinical picture.

Have you encountered adrenal mineralization in feline patients? What was the final diagnosis in your case?

22/07/2026

The Diagnostic Road: Evaluating Malignancy and Metastasis in Canine Mammary Tumors. Canine mammary gland tumors (CMTs) are among the most frequent neoplasms in intact female dogs, presenting a daily diagnostic challenge in veterinary pathology.When evaluating a fine-needle aspirate (FNA) from a mamm...

16/07/2026

🚨 One Cyst Is Never Just One Cyst!
When you diagnose Polycystic Kidney Disease… don't stop at the kidneys.
As veterinarians, it's easy to focus on the kidneys after identifying multiple renal cysts on ultrasound. However, Polycystic Kidney Disease (PKD) is a systemic ciliopathy, not simply a renal disorder. The kidneys are often only the beginning of the story.
Recently, I encountered a feline case where multiple renal cysts were identified along with hepatic cysts during the same ultrasound examination. This served as an important reminder that every diagnosis of PKD should prompt a thorough search for extra-renal manifestations.
🩺 What is PKD?
Polycystic Kidney Disease is an inherited disorder characterized by the progressive development of fluid-filled cysts originating from the renal tubules. Over time, these cysts enlarge, compress normal renal parenchyma, and gradually reduce functional nephron mass, eventually leading to Chronic Kidney Disease (CKD).
In cats, PKD is classically associated with Persian cats and related breeds, resulting from mutations in the PKD1 gene, although sporadic cases can occur in other breeds.
Don't stop scanning the kidneys!
Once PKD is diagnosed, the next question should be:
"Where else could cysts be hiding?"
🟢 Liver
The liver is the most common extra-renal organ affected.
Hepatic cysts may remain clinically silent for years, but occasionally they become large enough to:
Compress adjacent structures
Cause hepatomegaly
Produce abdominal discomfort
Rarely interfere with liver function
Finding liver cysts together with renal cysts strongly supports a systemic cystic disease rather than isolated renal pathology.
🟢 Pancreas
Although less common, pancreatic cysts have been reported in cats with PKD and may occasionally contribute to gastrointestinal signs or be discovered incidentally during abdominal ultrasound.
🟢 Spleen
Splenic cysts are uncommon but have been described as part of generalized cystic disease.
Clinical implications
Patients may initially appear completely healthy despite extensive cyst formation.
As functional renal tissue is progressively replaced by enlarging cysts, clinical signs eventually emerge:
Polyuria & polydipsia
Weight loss
Poor appetite
Vomiting
Hypertension
Progressive azotemia
Chronic kidney disease
Many cats remain asymptomatic until a significant proportion of renal function has already been lost.
The Take-Home Message
Whenever you identify multiple renal cysts, resist the temptation to finish the examination.
➡️ Scan the liver carefully. ➡️ Examine the pancreas. ➡️ Evaluate the spleen and the remaining abdominal organs. ➡️ Measure blood pressure. ➡️ Assess renal function and stage CKD appropriately.
Because PKD is rarely "just a kidney disease."
Sometimes, the kidneys reveal only part of the diagnosis.

17/02/2026

كل عام وأنتم بخير ❤️🌙

27/01/2026

Hyperlipidemia in Cushing’s Syndrome and Its Role in Thrombogenesis
Hyperlipidemia is a common but often underestimated metabolic consequence of Cushing’s syndrome, and it plays a direct role in the development of thromboembolic disease.
Pathophysiology
Chronic hypercortisolism induces dyslipidemia through multiple mechanisms:
Increased hepatic VLDL synthesis
Enhanced lipolysis with redistribution of free fatty acids
Reduced activity of lipoprotein lipase
Insulin resistance contributing to altered lipid metabolism
This typically results in:
Marked hypertriglyceridemia
Elevated total cholesterol
Lipemic or grossly turbid serum samples (as seen clinically)
Link Between Hyperlipidemia and Thrombosis
Hyperlipidemia contributes to thrombogenesis by:
Increasing blood viscosity
Promoting endothelial dysfunction
Enhancing platelet activation and aggregation
Reducing fibrinolytic activity via increased PAI-1
Upregulating procoagulant factors (Factors VIII, IX, XI)
These effects act synergistically with cortisol-induced:
Antithrombin III suppression
Decreased protein C and S activity
➡️ The result is a profound hypercoagulable state.
Clinical Implications
Patients with Cushing’s syndrome are predisposed to:
Venous thromboembolism (VTE)
Pulmonary thromboembolism
Microthrombi affecting renal, hepatic, and pulmonary perfusion
Hyperlipidemia should therefore be viewed as a pathologic contributor, not merely a biochemical abnormality.
Clinical Take-Home Messages
Lipemic serum in Cushing’s patients is a red flag
Routine lipid profiling should be part of endocrine case monitoring
Thrombotic risk assessment is essential, especially in severe or untreated cases
Early intervention may reduce morbidity and mortality

25/01/2026

🔬 How to Diagnose Ovarian Remnant Syndrome (ORS) in Cats
A practical, clinic-based approach
🐱 Background
Ovarian Remnant Syndrome occurs when functional ovarian tissue remains after ovariohysterectomy, leading to persistent or recurrent estrus signs in spayed queens.
📌 When to suspect ORS?
A spayed female cat presenting with:
• Vocalization and typical estrus behavior
• Lordosis and rolling
• Attracting male cats
• History of OVH (especially early age or difficult surgery)
⚠️ Estrus signs in a spayed cat = ORS until proven otherwise
🩺 Diagnostic Approach
1️⃣ Vaginal Cytology (Key Diagnostic Tool)
📍 Why?
Vaginal cytology confirms estrogen influence, which should NOT exist in a properly spayed queen.
🧪 Sampling technique:
• Use a sterile cotton swab
• Moisten with saline
• Insert gently into the vaginal canal (no speculum needed in cats)
• Rotate swab, withdraw, and roll onto a glass slide
• Air dry and stain (Diff-Quik / Giemsa)
🔍 Cytology findings suggestive of ORS:
✔️ High percentage of cornified superficial epithelial cells
✔️ Angular, anucleated or pyknotic nuclei
✔️ Minimal neutrophils
➡️ Indicates active estrogen secretion
2️⃣ Imaging (Supportive, not definitive)
• Ultrasound may show:
– Small hypoechoic ovarian tissue
– Cystic structures near ovarian pedicle
• Absence of findings does NOT exclude ORS
3️⃣ Hormonal Testing (If available)
• Serum estrogen ↑ during estrus
• Progesterone may rise after induced ovulation
• hCG or GnRH stimulation test can help confirm functional tissue
📍 Definitive Diagnosis
➡️ Estrus behavior + estrogenized vaginal cytology
➡️ ± imaging / hormonal confirmation
🛠️ Treatment of Choice
✔️ Exploratory laparotomy
✔️ Removal of remnant ovarian tissue
✔️ Surgery ideally performed during estrus (better visualization)
💡 Clinical Pearl
Vaginal cytology is a simple, low-cost, high-value tool that can differentiate behavioral problems from true ovarian activity in spayed cats.
🎯 Take-home message
If a spayed queen shows heat signs, do not ignore it.
A single vaginal smear can completely change your diagnosis and surgical plan.

VetOo

11/09/2026

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