https://doi.org/10.52973/rcfcv-e34306
Received: 19/08/2023 Accepted: 16/10/2023 Published: 01/01/2024
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Revista Científica, FCV-LUZ / Vol. XXXIV, rcfcv-e34306
ABSTRACT
A newborn German Shepherd breed male puppy was presented with
the complaint that some organs were formed outside the chest and
abdomen. The rhythmic movements of the swelling under the chest
pointed out the heart and the swelling under the abdomen was covered
with a membrane. On the lateral radiograph of body, sternal agenesis,
extra–thoracic location of the heart, and normal diaphragmatic border
were seen, while the swelling in the abdomen was thought to be
liver. During the diagnostic steps, the puppy died, and necropsy was
performed. At necropsy, it was observed that the heart wrapped with
the pericardium was placed extra–thoracically (thoracic ectopia
cordis) due to sternal agenesis, and the liver was partially located
abnormality in the other intrathoracic and intraabdominal organs.
Here, it is aimed to report thoracic ectopia cordis, sternal agenesis,
e anomaly.
Key words:
RESUMEN
A un cachorro macho recién nacido de raza pastor alemán se le
presentó la novedad de que algunos órganos se habían formado fuera
del pecho y el abdomen Los movimientos rítmicos de la tumefacción
debajo del pecho señalaban el corazón y la tumefacción debajo del
abdomen estaba cubierta con una membrana. En la radiografía lateral
del cuerpo se observó agenesia del esternón, ubicación extratorácica
del corazón y borde diafragmático normal, mientras que se pensó
que la la tumefacciónen el abdomen era hepática. Durante los pasos
de diagnósticos, el cachorro falleció y se le realizó la necropsia En
la necropsia se observó que el corazón envuelto con el pericardio
estaba ubicado extratorácicamente (ectopia cordis torácica) debido
a la agenesia del esternón, y el hígado estaba parcialmente localizado
que estaba rodeada por el peritoneo. Tanto los hallazgos radiológicos
como los de necropsia revelaron que no había estructura costal
después de las articulaciones costocondrales. Un árbitro señala que
el diafragma no presentaba alteraciones, al igual que el resto de los
órganos intratoraxico e intraabdominales. El presente trabajo tuvo
como objetivo reportar ectopia cordis torácica, agenesia esternal,
hallazgos radiológicos y de necropsiade la anomalía.
Palabras clave:
Thoracic ectopia cordis, sternal agenesis, partial ectopia hepatica
linical case
Emsal Sinem Özdemir–Salci
1
* , Koray Yildirim
2
1
Uludag University, Faculty of Veterinary Medicine, Department of Obstetrics and Gynecology. Nilufer, Bursa, Türkiye.
2
Military Veterinary School, Training Center Command. Gemlik, Bursa, Türkiye.
*Corresponding author: ssalci@uludag.edu.tr
FIGURE 1. Clinical view of the case, extra–thoracic located heart (H) and partial
extra–abdominal located liver (L)
Multiple congenital anomalies in German Shepherd puppy / Ozdemir-Salci and Yildirim_____________________________________________
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Multiple congenital anomalies are less common in domestic animals.
Although the etiology of some congenital anomalies is not known, it is
considered that anomalies are caused by genetic factors, mutations,
chromosomal anomalies, infectious and environmental factors [1].
in another part of the body or in another organ or tissue [2].
Ectopia cordis is the presence of the heart partially or totally outside
the thoracic cavity [3, 4]. Similarly, ectopia hepatica is an anomaly
characterized by different location of the hepatic parenchyma [5].
cervical, cervicothoracic, thoracic, thoracoabdominal and abdominal
[3, 4]. In cases of ectopia hepatica, a small liver tissue may be attached
to the gallbladder, intraabdominal organs and ligaments separately, or
a small accessory liver lobe may be seen in different localization [5].
The reported sternum anomalies include branched xiphoid process,
shaped or asymmetric sternum, sternum gallinaceum and sternal
foramen [6]. Fissura abdominalis is a defect caused by the absence
of complete fusion of the abdominal wall in the median line [7].
Ectopia cordis have been reported in cattle (Bos taurus), goat (Capra
hircus), horses (Equus caballus) [3, 4] and human neonates [8, 9]; and
ectopia hepatica is seen in cattle, dogs (Canis lupus familiaris) and
cats (Felis catus) [5]. Although defects of the thorax are reported,
sternal agenesis has not been reported together with the other
congenital anomalies [3
may be encountered in dogs with other anomalies [7].
humans and includes thoracoabdominal wall, sternal, diaphragmatic,
pericardial and intracardiac defects [8, 10, 11, 12]. Depending on the
defects, which named as complete pentalogy and classified as
class I; an probable/incomplete pentalogy includes four defects
a milder incomplete pentalogy includes any combination of given
8, 10, 11, 13].
Although some cases can be treated in human medicine, the majority
lity [10].
Taking these literatures into consideration, here, it is aimed to
anomaly (thoracic ectopia cordis, sternal agenesis, ectopia hepatica
and fissura abdominalis) with a milder incomplete pentalogy of
erd puppy.
MATHERIALS AND METHODS
Case history
A German Shepherd breed male puppy was presented with the
complaint of abnormal thoracic and abdominal swellings. In the
the unrelated mother and father, and born with two different swellings
that moved in the chest area and were motionless in the abdomen.
One of the born puppies was normal, one was dead and the presented
puppy had anomaly, as well. The mother was 4 years old and gave
the same mother and father born in the previous parturitions. The
reference values. Due to the rhythmic movements of the swelling
under the chest, it was thought to be the heart and the membrane
around the heart could be a pericardium. The basis of the heart and
the large vessels were in the thoracic cavity. A different swelling
covered with a membrane was observed under the abdomen, which
was directed about 1 cm in front of the umbilical cord towards the
swelling in the chest. It was thought that this swelling might be a
during palpation (FIG. 1).
During radiological examination (Ajex Meditech Ltd., Ajex160H,
Korea), spontaneous death occurred in the puppy. A necropsy was
performed to detail the anomaly. However, advanced diagnostic
diagnostic aids were not performed considering the general condition
of the puppy, technical reasons and the fact that they provide better
information about cardiovascular system evaluations when the
animal is alive.
of thoracic ectopia cordis, sternal agenesis, ectopia hepatica and
the puppy.
RESULTS AND DISCUSSION
there was no sternum, the heart was positioned extra–thoracically,
and the swelling on the abdomen was at liver localization (FIG. 2).
The diaphragmatic border was evident, and normal air radiolucent
appearance was present in the trachea and lung area. Apart from these
was found.
pathology, but general anesthesia is required to ensure patient
immobility while applying these imaging methods [14]. In the
presented case, considering the general condition of the patient,
FIGURE 2. Lateral radiograph of the dog shows the absence of the sternum, and the heart (H) and liver (L) are partially located outside to body
FIGURE 3. At necropsy, the appearance of the heart (H), pericardium (Pr), liver
(L) and peritoneum (Pt)
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the extent of the pathology and the technical conditions advanced
these imaging diagnostic methods are also used in postmortem
examinations, but especially in postmortem cardiovascular system
evaluations the methods have limitations [15].
At necropsy a longitudinal incision was made along the chest
and abdominal median line, starting from the swelling under the
chest to the abdominal swelling and caudal abdominal. Thoracic and
abdominal cavities were exposed with the cutting procedure. First,
the thorax was examined and the membrane on the extra–thoracic
in vascular and internal structures of the heart. The ventilation and
the peritoneal space. The diaphragm border was normal, but there was
no sternum. Also, the parts of the ribs after the costochondral joints
were absent (FIG. 4). The reason for the non–closure of the thoracic
cavity was sternal agenesis. The cranial abdominal muscles were not
be partially located in the abdominal swelling. The membrane covered
the other organs was detected in the examination of thoracic and
abdominal cavities.
Ectopias can be seen in one organ or may be observed with other
multiple anomalies [2]. These abnormalities affect an organ, system,
or even some systems (cardiovascular or gastrointestinal) [4]. The
prevalence of thoracic ectopia cordis varies among species [3] and
there are a few case reports of ectopic liver in Veterinary Medicine
a rare syndrome of human neonates, defined as a collection of
FIGURE 4. In the examination of the thoracic and abdominal cavities, absence
of the sternum and partial parts of the ribs after the costochondral joints
(arrows), the appearance of the heart (H), diaphragm (D) and liver (L)
Multiple congenital anomalies in German Shepherd puppy / Ozdemir-Salci and Yildirim_____________________________________________
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by thoracoabdominal wall, sternal, diaphragmatic, pericardial defect
the number of included pathologies as complete or incomplete [10,
11, 13
literature reporting thoracic ectopia cordis, sternal agenesis, ectopia
milder incomplete pentalogy of
Ectopia cordis results from incomplete fusion of the body
cavity, especially in the abdominal wall, during development of the
fetus [3, 9]. In ectopia cordis cases, the heart appears partially or
completely outside the thoracic cavity and may be complicated with
other malformations either cardiac or non–cardiac. It is possible to
encounter ectopia cordis especially with abdominal wall, sternum,
diaphragm, pericardium and heart defects [4, 8, 9]. The thoracic
ectopia cordis anomaly encountered in the presented case was
together with ectopia hepatica, sternal agenesis and fissura
abdominalis anomalies. The sternum has different variations and
anomalies [6], and some sternal pathologies such as a shortened
and widened manubrium, sternal cleft, sternal foramen, xyphoid
cartilage hypoplasia, double appearance sternebrae and presence of
multiple sternebrae can be seen in cases with cervical ectopia cordis
[1, 4, 6]. In this German Shepherd puppy, radiological and necropsy
rib structure after the costochondral joints.
As reported in the literature, diagnostic imaging techniques
present details in ectopia cases [3, 4, 5
the cases with ectopia cordis is not so much affected due to a fast
sternal connections, if there is [3]. In the presented case, premortem
radiological examination helped the diagnosis of sternal agenesis.
On the lateral radiograph, the heart was outside, the diaphragmatic
border was normal and the swelling on the abdomen was in the
localization of the liver.
In an ectopia cordis, surgically, after the heart is placed in the
chest cavity, death may occur in the early postoperative period and
the survival time of the cases varies from 3 minutes to several years.
In addition, neonatal death usually occurs if the heart is displaced
through the sternum or rib [4]. On the other hand, surgical intervention
has been reported to be successful in patients with ectopia hepatica
[2]. This means that patients with ectopia hepatica have a better
chance of life than ectopia cordis. However, as in this presented case,
death was inevitable due to ectopia cordis and ectopia hepatica, the
case was died following to the radiological examination.
As it is understood from the literature [1, 3, 6], necropsies performed
in cases with anomalies provide information about the organs and
diagnosis of the pathology. Ectopia cases can be noticed immediately
after birth. While death is inevitable in ectopias related to the heart,
lung, and chest wall, the patient can survive in other ectopia, which
are not observed from the outside, but where organs and tissues enter
another organ or tissue. These ectopias can mostly be determined in
post mortem necropsies [2
diagnosis of the anomaly. With the necropsy, it was observed that
ectopia cordis was formed due to sternal agenesis, and ectopia
previously [3], ectopia cordis in this case raised the suspicion that
there may be any other intracardiac pathologies, but no pathology
was found in the anatomical structures of the heart. Differently
from other reported cases [10, 11], which reported as incomplete
excluded, in our case we had to chance to perform a cardiac evaluation
no cardiac and diaphragmatic anomalies, but on the numbers of
included pathologies combination of sternal and thoracoabdominal
pentalogy.
CONCLUSION
In conclusion, developmental anomalies such as thoracic ectopia
have a chance to be treated, but it should be known that when these
anomalies are seen together in the same case (as in the presented
case), death is inevitable in the early postnatal period.
interest.
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