One of the most common causes of documented persistent estrus in bitches are follicular ovarian cysts. Follicular ovarian cysts originate due to failure to ovulate and should be differentiated from other cysts developing from or within the ovaries or the ductal remnants adjacent to them such as cystic rete ovarii, paraovarian cysts, and subsurface epithelial structures and from ovarian neoplasia (granulosa cell tumor). The follicles are thin walled, fluid filled, and > 8 mm in their widest dimension.
Persistent estrus has been defined as physical and behavioral signs of proestrus and estrus, and presence of cornified vaginal epithelium confirmed on vaginal cytologic evaluation, for at least 6 weeks. This can be difficult to diagnose in queens due to the nature of their estrous cycle.
Clinical Signs of Follicular Cysts in Small Animals
Clinical signs of follicular cysts in small animals include:
vulvar swelling
serosanguineous discharge
alopecia along the neck, trunk, and perineum with chronic exposure to high estrogen
Skin may appear hyperpigmented with hyperkeratosis. Many are found incidentally and have no clinical signs associated with them.
Diagnosis of Follicular Cysts in Small Animals
Diagnostic tests that are useful in follicular cysts in small animals include vaginal cytologic evaluation, hormone assays, and ultrasonography.
Courtesy of Dr. Autumn P. Davidson.
Vaginal cytologic findings include predominately cornified epithelial cells in response to estrogen, but RBCs, polymorphonuclear cells, and bacteria may also be present.
Estrogen concentration is elevated.
Follicular cysts are usually visible on ultrasonography as anechoic structures with thin walls.
Treatment of Follicular Cysts in Small Animals
Ovulation may be induced with gonadotropin-releasing hormone (50 mcg/dog, IM, once) or human chorionic gonadotropin (1000 U, half IV, half IM; or 22 U/kg, IM, every 24 hours for 3 days).
Ovariohysterectomy is the preferred treatment because dogs induced to ovulate after persistent estrogen exposure may be predisposed to cystic endometrial hyperplasia or pyometra.
