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Case report: Thromboembolic heartworm induced lower limb necrosis in a dog


Case Reports


doi: 10.3389/fvets.2022.868115.


eCollection 2022.

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Case Reports

Piyanan Taweethavonsawat et al.


Front Vet Sci.


.

Abstract

A 9-year-old spayed female boxer suffered from lameness in both hindlimbs with a perforated paw wound. Additionally, a linear, worm-like creature was penetrating out from the wound. On examination, the dog was emaciated and infected with heartworms, detected through a fresh blood smear, echocardiography, and transabdominal ultrasonography. Adult heartworms were detected at the right atrium (RA), right ventricle (RV), and pulmonary artery (PA), including the distal abdominal aorta, external iliac, and femoral arteries. During the surgery, adults heartworms were removed from both the heart (n = 8) and the femoral arteries (n = 5). Unfortunately, not all heartworms could be removed from these locations due to the extent of the heartworm infection. The opened, ischemic wounds in the distal limbs progressively expanded and the dog subsequently died, possibly due to caval syndrome complications and septicemia. The necropsy showed no evidence of an atrial septal defect, and a total of 25 adult heartworms were collected from the perforated paw, heart, pulmonary, and femoral arteries. All worms collected during the necropsy process were molecularly confirmed to be Dirofilaria immitis.


Keywords:

aberrant; dog; heartworm; ischemia; parasitic thrombosis.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures



Figure 1

Ultrasonographic images at the left external iliac artery (A), mid femoral artery (B), and echocardiographic images (C,D) revealed linear hyperechoic structures in the cardiovascular lumen which were subsequently molecularly confirmed to be Dirofilaria immitis.


Figure 2


Figure 2

The photographic images displayed the adult Dirofilaria immitis (red arrows) removal from the jugular vein (A) and the femoral artery (B). At the jugular vein, a modified, brush-like instrument (yellow arrow) was used to take off the cardiac heartworms.


Figure 3


Figure 3

A maximum-likelihood phylogenetic tree showing the genetic relation between Dirofilaria immitis from heart, femoral artery, and wound (red color) and other filarial species using cytochrome oxidase subunit I gene.


Figure 4


Figure 4

Pedal gangrenous necrosis was demonstrated in the metatarsal-phalangeal region of the hindlimb (A). Microscopically, occluding thrombus is demonstrated in the artery with the presence of a cross-section of the worm, ~100–250 μm in size (arrow) (B). Bar = 100 μm.

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