Renal Tumour in a Chameleon: A Case Study.

A one year old male Panther Chameleon presented to the clinic following a one week history of progressive hind limb weakness, loss of motor function, swelling of the left knee and sleeping with his back legs dangling from his branch. He was still eating although his appetite was reduced. His owner was very knowledgeable and experienced in keeping reptiles, and his husbandry and captive care sounded excellent when taking a full clinical history and appraisal. There had been no changes to his routine or care, and no known history of trauma. His left knee joint however was visibly enlarged and swollen compared with the right hand side.

Hind limb paresis unilateral swollen stifle

On clinical examination, the joint was swollen but didn’t appear painful on palpation. However he was demonstrating bilateral hind limb paresis, or loss of motor function. Gripping was much reduced in the back feet compared to the front, and he appeared much weaker on the pelvic limbs also. Similarly he was reluctant to bear weight on the left hind compared with the right. Sensory function was intact and present in all limbs. This examination allowed me to form a reasonable diagnosis of a neurological problem, most likely a spinal lesion in the lumbar region or an intra-abdominal mass placing pressure therefore impinging on the nerves in this area resulting in compression and subsequent loss of motor function. I should mention here that I had seen a photo of this chameleon on a forum I am a member of the previous day when the owner asked for advice. From a photo alone it would have been impossible for me to pinpoint the problem or give a reasoned diagnosis as I could when the animal was in the clinic and I could perform a full neurological examination. For this reason I would always warn owners to beware accepting an online diagnosis based on a photo alone. If in doubt, a vet visit with a reputable reptile vet is really worthwhile.

Hind limb paresis perching

I explained to the owner that based on the issues I was seeing, I suspected an abdominal mass was the worst case but highly likely scenario, so we decided an X-ray was the next step. I took a dorso-ventral view after giving the chameleon some anaesthetic gas to allow me to tape both legs in position so I could get the best image possible to compare the knee joints in the same position. The X-ray however showed a very serious and obvious problem quite apart from the swollen joint. The entire abdomen of the lizard was full of air and the internal organs were all compressed. Air on an X-ray is black, and in normal chameleons the lung shadows demarcated by free gas extend a little over halfway down the length of the abdomen. Chameleons are fairly unique in that they also have finger like extensions or air sacs extending very far back towards the tail end of the body which are lined with a very thin transparent tissue almost like cling film. Therefore this is very prone to rupture from trauma, infection or damage during surgery for example.

DV view

I took a lateral view to confirm the organs were compressed ventrally (towards the bottom or belly of the abdomen), which highlighted that in fact a lung or both lungs were ruptured and air had leaked into the free space within the abdomen. I was also curious to gain another view of the very dense whitish-grey mass in the caudal or tail end of the abdomen just before the pelvis, which was occupying the entire width of this section of the abdomen. Unfortunately, on the lateral view this corresponded to the site of the kidneys and confirmed my worst fear that a kidney mass of some description was responsible for the nerve impingement and neurological signs on presentation. The kidney mass may have been an abscess or a congenital problem such as hydronephrosis present from birth which was gradually causing a growth in size over time. Similarly it may have been a tumour but it was difficult to tell from X-rays alone. The swelling of the joint in the left knee could have been explained by trauma associated with reduced motor function, the assumption being that he injured it in the preceding days whilst dragging it behind him.

Lateral view

The prognosis based on a renal or kidney mass of that size no matter what the underlying cause was unfortunately quite grim, not to mention the issue of air within the abdomen causing breathing problems and compression of other vital organs. After lengthy discussion with an upset owner, it was decided that it would be fairest and most humane to put the chameleon to sleep and prevent further suffering. Any treatment or further diagnostics would have had to be very invasive and highly unlikely to bring a resolution to the problem. In order to bring a resolution to the case and for the sake of education, the owner kindly allowed me to open the abdomen following euthanasia in a post mortem examination to confirm my diagnosis of a renal or kidney mass, and ascertain the nature of the lesion. Sadly my suspicion of a renal tumour was confirmed; quite a surprising diagnosis in such a young animal you might say. However renal lymphoma, which is one of the more common cancers in reptiles, is unfortunately not exclusive to older animals as in many other cancers. Several other cancers are also reported in reptiles. In this case, the classification of the tumour would not affect the outcome of the case so I did not send any tissue samples for pathological classification. A very sad case, but the positives if any can be taken from it were that I and hopefully other veterinarians can learn from this little chameleon’s death. I’m therefore very appreciative to the owner for allowing me to write this up and share the case study.


WARNING: THE FOLLOWING PICTURE IS GRAPHIC IN NATURE, SHOWING THE POST MORTEM FINDINGS. PLEASE DO NOT VIEW IF YOU ARE SQUEAMISH OR EASILY OFFENDED. I INCLUDE IT HERE FOR EDUCATIONAL PURPOSES ONLY SO THAT SIMILAR CASES MAY BE DIAGNOSED EARLIER IN FUTURE WITH THE EXPRESS PERMISSION OF THE OWNER OF THE ANIMAL IN QUESTION.

PM findings labelled

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Frog Enucleation: Eye Removal Surgery

Eye surgery

Eye surgery

Splat the albino horned frog (sometimes called Pacman frogs because of their large mouth and appetite!) somehow injured his eye, presumably by jumping into one of the furnishings in his vivarium. Unfortunately, the eyeball itself was ruptured and could not be saved so it had to be removed, or enucleated. Here he is in an anaesthetic bath containing dissolved anaesthetic drugs that he is absorbing through his skin.

2 Once anaesthetised, I also injected some local anaesthetic around the eye socket and behind the eye itself. He had earlier been given pain relief and antibiotic injections to ensure he was comfortable and to prevent infection. I carefully dissected out the eye from the underlying ocular muscles lining the eye socket. 3

Once the eye had been removed, I placed collagen implant into the socket and packed it well to prevent bleeding and allow the remaining space to fill in with new tissue as it heals. At this point we started to rinse Splat in order to start the process of recovery from his anaesthetic.

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Here he is after the surgery having closed the eyelids with dissolvable suture material. Now it was time to recover him and wake him from his operation.

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We placed him in clean, de-chlorinated water and irrigated him regularly whilst keeping him warm in order to dilute the anaesthetic residue in his skin and keep him maximally hydrated so that he could recover and wake from anaesthesia. He recovered well, and went home the next day having been given another pain relief injection and oral antibiotic drops for the owner to administer. Here’s hoping he will be fighting fit in no time!

The snake that became unstuck!

Crystal the Royal python got in a rather sticky situation, when she managed to tangle herself in some loose duct tape that was being used temporarily in her vivarium when her owners were installing new lights. Unfortunately in her bid to untangle herself she managed to rip the delicate thin skin on her neck and caused a full thickness laceration exposing the underlying muscle. Her owners were panicked and rushed her down to see me, travelling nearly 3 hours in traffic to get to the surgery. Luckily it was my turn to work the Saturday clinic that day and my afternoon wasn’t as busy as usual so we managed to see her quickly and fix her up before more damage was done.

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Snakes and sticky tape do not mix

Here she is being given some anaesthetic gas and oxygen, after initially being given sedative drugs via intramuscular injection. At this point we couldn’t see the true extent of her injury, but knew it was bad. I was confident however that we would stitch her up and have her reasonably back to normal in no time. I took the opportunity while she was going under anaesthetic to administer pain relief and antibiotic injections to make her comfortable and prevent infection setting in.

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Snake laceration wound

Once she was fully anaesthetised I used surgical spirit to dilute the solvent on the tape and peel it off bit by bit, taking great care not to allow any spirit to contact her delicate tissues underlying her scales or to cause further tears. After removing the tape the area was cleaned and disinfected and prepped for surgery, reducing contamination and minimising the risks of post-operative infection. She was kept on a warm heat pad throughout the procedure to enable her cold-blooded body to maintain it’s metabolism and process the anaesthetic and other drugs effectively. Reptile patients are unique in that all bodily functions rely on external heat from immune function, to heart rate and even breathing rate. Therefore it is vital that they are warmed throughout surgery and maintained in thermostatically controlled conditions whilst hospitalised and in recovery.

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Suturing snake wound

I carefully sutured her skin back together taking care not to cause too much tension and not to invert the scale edges so that the wound could knit back together efficiently and heal quickly. Good surgical technique at this stage was critical to obtain a cosmetic and functional wound that would repair over the coming weeks without causing future problems with shedding skin for example.

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A vet’s work is never done, even on a Saturday evening

Here I am hard at work on a Saturday afternoon whilst all my colleagues (apart from my nurse Sharon assisting on anaesthetic duties) were out in the back car park starting our end of summer barbecue, beers and wine in hand. Now there’s dedication, eh?!

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Python in recovery hospital cage

After she was stitched back together I reversed her sedative drugs with another injection and set her up in a warm hospital cage on a heat pad to recover from her ordeal. By this point her meds ensured she would awake pain free within a couple of hours. Things are definitely slower in my reptilian patients compared with dogs and cats.

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Snake wound sutured post-op

This was the finished handiwork post-operatively. I am happy to say she went home very alert and happy on the Monday morning to her relieved owners and will come back to visit me to remove her sutures in 4-6 weeks.