52 Indian

Indian Journal
Journal of of Animal
Animal Reproduction
Reproduction 3232
(2)(3) : Dec
: Dec 2011
2011

ULTRASONOGRAPHIC DIAGNOSIS OF CYSTIC ENDOMETRIAL

HYPERPLASIA-PYOMETRA IN BITCHES
P.SRIDEVI, K.KULASEKAR, N.ARUNMOZHI, S.RANGASAMY, CECILIA JOSEPH AND
R.C.RAJASUNDARAM
Department of Animal Reproduction, Gynaecology and Obstetrics, Madras Veterinary College,Chennai-600 007.

Received : 14.09.2010 ABSTRACT Accepted : 02.05.2011

The use of transabdominal ultrasonography as a useful and reliable diagnostic method to diagnose Cystic
endometrial hyperplasia in bitches is reported.

Key words: Ultrasonography, Cystic endometrial hyperplasia,Pyometra,Bitches

Cystic endometrial hyperplasia (CEH)–pyometra
complex is the most frequently encountered endometrial
disorder in bitches (Bigliardi et al., 2004) and its exact
pathogenesis is still unknown. CEH is considered by
many authors to be an exaggerated response of the
uterus to chronic progestational stimulation during the
luteal phase of the estrous cycle, causing an abnormal
accumulation of fluid within the endometrial glands and
uterine lumen (De Bosschere et al. 2001). This paper
describes the usefulness of ultrasonography as a means
of diagnosing cystic endometrial hyperplasia-pyometra
in bitches.
A total of 527 bitches of different breeds aged
between 2-14 yrs referred to the small animal obstetrics
and gynaecology referral unit of Madras Veterinary
College Teaching Hospital for various reproductive
disorders, were studied.
All the bitches were subjected to transabdominal
ultrasound scanning (Aquilo® Pro,Esaote Piemedicals)
by using 5 to 7.5 MHz sector probe. The uterus was
examined to evaluate the integrity of the endometrium,
presence of exudates and cystic hyperplasia of the
endometrium.
Of the 527 dogs subjected to ultrasonography,
240 bitches were diagnosed positive for various uterine
diseases of which the percentage incidence of
pyometra, CEH, stump pyometra and uterine tumour
was 85.42, 12.92, 1.25 and 0.41 respectively.
In all the 31 cases of CEH, ultrasound examination
was able to clearly identify the variations in uterine wall
thickness, uterine distention due to fluid accumulation
and cystic dilation of endometrial glands. Five bitches
had mild thickening of the endometrium with very little
fluid accumulation, in six, the endometrium appeared
thick and irregular and within the thickened endometrium
were islets of anechoic foci representing dilated cystic
glands. There was hypertrophy of the endometrium with
irregular surface almost completely obliterating the
uterine lumen and large cysts throughout the surface
in 20 bitches. The anechoic/hypoechoic uterine contents
were suggestive of CEH associated with pyometra (Fig.).
Panovariohysterectomy was the treatment of
choice for CEH-Pyometra, regardless of cervical patency
(Bigliardi et al., 2004) and the same was performed in
all the 31 cases. In all the operated cases, gross
examinations of the uterus revealed thickened
endometrium containing distended cystic glands giving
a cobble stone appearance in extreme cases. The
uterine lumen contained varying quantities of either
malodourous or foul smelling mucopurulent exudate.
Hardy and Osborne (1994), De Bosschere et al.
(2001) and Bigliardi et al. (2004) in their studies on cystic
hyperplasia-pyometra complex in the bitch reported that
ultrasound examination was useful in detecting uterine
exudate. However, mild to moderate cases of CEH in
which the endometrial surface was normal with none or
few small cysts and anechoic uterine content was not

Indian Journal of Animal Reproduction 32 (2) : Dec 2011

Ultrasonographic diagnosis of cystic endometrial hyperplasia-pyometra in bitches 53

always diagnosable. More severe cases of CEH were

well identified by ultrasound because of extent of
changes in the uterine tissue and therefore, its early
diagnosis would help in deciding to choose
ovarihysterectomy as the only choice of treatment as
against medical therapy (Bigliardi et al., 2004). In the
present study, ultrasonography proved to be a useful
indicator of CEH-pyometra in bitches helping the
clinician to opt for surgery rather than medical therapy
using prostaglandins regardless of the age of the bitch.
REFERENCES
Bigliardi,E., Parmigiani, E., Cavirani, S.,Luppi, A.,
Bonati, L. and Corradi, A.(2004). Ultrasonography
and cyctic hyperplasi-pyometra complex in the
bitch. Reprod. Dom. Anim., 39: 136-140.
De Bosschere, H., Ducatelle, R., Vermeirsch, H., Van
Den Broeck, W., Coryn, M.(2001). Cystic
endometrial hyperplasia-pyometra complex in the
bitch: Theriogenology, 55: 1509-1519.

De Cook, H., Ducatelle,R.,Tilman,K., De Schepper,

J.(2002). Possible role of insuling like growth
factor–I in the pathogenesis of cystic endometrial
hyperplasia pyometra complex in the bitch.
Theriogenology, 57: 2271-2287.

Hardy, R.M. and Osborne, C.A. (1994). Canine

Figure. Ultrasound of the uterine horn with
endometrial hyperplasia. The endometrial surface shows
numerous endometrial cysts. Uterine lumen contains
anechoic fluid. Insert shows gross appearance of the
endometrium after ovariohysterectomy.
pyometra: pathophysiology, diagnosis and
treatment of uterine and extra-uterine lesions.
J.Am.Anim.Hosp.Ass., 10: 245-268.
Kooistra, H.S., Okkens, A.C., Mol,J.A.,Van Garderen,
E.,Kirpensteijn, J. and Runberk,A.(1997).
Proceedings of the 3rd International symposium
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ISSAR AWARD
R.D. SHARMA AWARD

 The award is for the best presentation in Obstetrics by a young life member of ISSAR
below 35 years of age.

 The application along with five copies of the article with certificate of proof of age may
be submitted to the General Secretary, ISSAR.

 He should also send the abstract and full text of the article to the Organizing Secretary
of the convention.

 Application form may be obtained from General Secretary, ISSAR.

Indian Journal of Animal Reproduction 32 (2) : Dec 2011