This week we have an avian case contributed by Dr. Leila Marcucci of the Bay Area Bird Hospital in San Francisco. It’s a 21-year-old female Scarlet Macaw who presented for increased water intake, watery droppings, and decreased appetite. Have a look and post your comments below.
5/31/08 – The lateral radiograph demonstrated a 4.5 cm diameter, well-circumscribed, soft tissue opacity in the central abdominal area. It extended from the caudal hepatic border to the caudal pelvic region. Its dorsal margin was relatively distinct and did not silhouette with the kidneys. Evidence of calcification was not identified. Increased endosteal opacity was present in the pelvic extremities. The remainder of the study was unremarkable except for mild decreased liver size.
- Soft tissue opacity mass – retained egg (within the reproductive tract vs. free in the coelom), less likely splenic mass.
- Endosteal opacity – indicates reproductive activity.
5/31/08 – Conservative medical management was selected for the retained egg. Treatment consisted of calcium lactate/clacium glycerpohospate (Calphosan, l5 mg/ml, 1 cc IM) IM Injection and a gavage of a commercial avian diet. The bird was discharged for home care.
6/2/08 – Represented the following Monday (June 2). In an attempt to medically address the retained egg, the bird was hopsitalized and given fluids (LRS-W 35 cc SQ), IM calcium (Calphosan, l5 mg/ml, 1 cc IM) and butorphanol (10 mg/ml 0.32 cc IM). Bloodwork taken on 5/31 showed elevations in GGT (9 U/L), amylase (1024 U/L), glucose (379 mg/dl), uric acid (15.3 g/dl) and WBC (43,000). WBC morphology was within normal limits although there was an increased percentage of heterophils and a decreased percentage of lympocytes. A salpingitis or coelomitis was suspected and the bird was started on injectable antibiotics (Cefotaxime 200 mg/ml 0.5 cc IM). While hospitalized, the bird’s appetite was decreased, so she was gavaged twice daily.
6/3/08 – A recheck lateral radiographic study made on 6/3/08 and demonstrated persistence of the mass effect. Its margination was somewhat less distinct than on the previous studies, but individual intestinal segments could be identified indicating a large amount of free coelomic fluid was not present. No evidence of pulmonary consolidative disease or cardiac enlargement was identified.
Coelomic ultrasound was performed. A 3 cm rounded hypoechoic homogeneous mass effect occupied the caudal coelom.It had a thin uniform wall. There was no evidence of free coelomic fluid. It was concluded that the the rounded mass was a non viable egg, free within the coelomic cavity.
The following day (June 4) the bird was taken to surgery for egg removal. Coelomic exploration revealed extremely thickened peritoneal membranes and a soft-shelled egg free in the coelom. The egg was easily removed and a salpingohysterectomy performed. The bird awoke from the surgery without incident. The following day she was vocal, active and eating well on her own.
The soft-shelled egg was filled with a foul smelling liquid. Histopathology revealed inflammatory cells present on the surface including multinucleate giant cells, lymphocytes and plasma cells. Although the oviduct appeared to have a stricture in the submucosa on gross inspection, no lesions were noted on histopathology.
The initial radiographs were unusual because of the distinct margination of the egg in the coelom. Reproductive masses and free coelomic eggs are often poorly marginated, either by being surrounded by reproductive tissues or fluid from yolk coelomitis.
One week post surgery the white cell count was back in the normal range (12,000). By July 2008, the bird appeared normal, the incision was fully healed and her weight had returned to a more normal range (1115 gm)