Volume: 57 Issue: 2
Year: 2026, Page: 312-316, Doi: https://doi.org/10.51966/jvas.2026.57.2.312-316
Received: Feb. 7, 2026 Accepted: April 10, 2026 Published: June 30, 2026
This study evaluated the occurrence of cystic endometrial hyperplasia (CEH) and pseudoplacentational endometrial hyperplasia (PEH) in canine pyometra using ultrasonographic assessment of endometrial changes. Fifty bitches with clinical signs of pyometra were diagnosed based on clinical, haematological, and B-mode and Doppler ultrasonographic findings. Systemic inflammatory response syndrome was present in 47 cases. Ultrasonography revealed marked uterine distension (2.58 ± 0.19 cm), increased uterine wall thickness (3.97 ± 0.27 mm), and reduced uterine arterial resistance (RI 0.64 ± 0.01). Ultrasonographically, CEH was detected in 92 per cent of cases, while 8 per cent showed no evidence of CEH or PEH. CEH grading included 2 Grade A, 17 Grade B, 21 Grade C, and 6 Grade D cases, with variable echogenicity of uterine contents. No ultrasonographic features characteristic of PEH were identified in pyometra-affected bitches. These findings indicate that CEH was the predominant, ultrasonographically detectable endometrial lesion associated with canine pyometra, whereas PEH was not identified in pyometra affected patients using ultrasonographic criteria.
Keywords: Cystic endometrial hyperplasia; Canine; Pseudoplacentational endometrial hyperplasia; Pyometra
Batista, P. R., Gobello, C., Rube, A., Corrada, Y. A., Tortora, M., & Blanco, P. G. (2016). Uterine blood flow evaluation in bitches suffering from cystic endometrial hyperplasia (CEH) and CEH-pyometra complex. Theriogenology, 85(7), 1258–1261. https://doi.org/10.1016/j.theriogenology.2015.12.
Bigliardi, E., Parmigiani, E., Cavirani, S., Luppi, A., Bonati, L., & Corradi, A. (2004). Ultrasonography and cystic hyperplasia-pyometra complex in the bitch. Reproduction in Domestic Animals, 39(2), 136–140. https://doi.org/ 10.1111/j.1439-0531.2004.00489.x
De Bosschere, H., Ducatelle, R., Vermeirsch, H., Van Den Broeck, W., & Coryn, M. (2001). Cystic endometrial hyperplasia–pyometra complex in the bitch: Should the two entities be disconnected? Theriogenology, 55(7), 1509–1519. https:// doi.org/10.1016/S0093-691X(01)00498-8
Demeli, A., & Meyer, J. C. (2023). Assessment of haematologic and serum chemistry parameters in canine pyometra: A systematic review and meta-analysis. Journal of Small Animal Practice, 64(9), 543–551. https://doi.org/10.1111/jsap.13641
Dow, C. (1959b). The cystic hyperplasia–pyometra complex in the bitch. Journal of Comparative Pathology, 69, 237–251. https://doi.org/10.1016/S0368-1742(59)80023-0
Harshan, M. H., Krishnan, A., Jayakumar, C., & Aravind, A. (2022). Ultrasonographic grading of uterus in canine CEH-pyometra complex and its predictive potential for response to medical management. In Compendium: National Conference on Canine Practice and Symposium on Newer Concepts and Approaches in Small Animal Practice and Welfare (pp. 257).
Krishnan, A. S., Harshan, M. H., Jayakumar, C., Shibu, S., & Unny, M. N. (2023). Uterine haemodynamics and band neutrophils as recovery markers in medical management of canine pyometra. Journal of Veterinary and Animal Sciences, 54(2), 428–432. https://doi.org/10.51966/jvas.2023.54.2.428-432
Konjeti, A., Kavuri, S. R., Manda, S., Makkena, S., & Kamisetti, A. K. (2022). Doppler Velocimetry of Uterine Artery in Bitches with Cystic Endometrial Hyperplasia-Pyometra Complex. Indian Journal of Veterinary Sciences & Biotechnology, 18(5). https://doi.org/10.48165/ijvsbt.18.5.10
Ma, L. Y., Heng, H. G., Chia, M. Y., Cheng, F. P., Lin, C. C., & Chen, K. S. (2021). Ultrasonographic appearance of pseudo‐placentational endometrial hyperplasia in a dog. Veterinary Radiology & Ultrasound, 62(6), e58–e62. https://doi.org/10.1111/vru.12866
Nomura, K. (1994). Induction of a deciduoma in the dog. Journal of Veterinary Medical Science, 56(2), 365–369. https://doi.org/10.1292/jvms.56.365
Peixoto, A. J. R., Lima, V. C. T., Fernandes, M. E. D. S. L., Oliveira, L. C., Blanc, B. T., Barros, F. F. P. D. C., & Coelho, C. M. M. (2023). The impact of clinical presentation, presence of SIRS and organ dysfunction on mortality in bitches with pyometra. Ciência Rural, 54(1), e20220219. https://doi.org/10.1590/0103-8478cr20220219
Ram, R. S., Harshan, H. M., Jayakumar, C., Abhilash, R. S., & Anoopraj, R. (2024). Response to medical management in cystic endometrial hyperplasia–pyometra affected bitches graded ultrasonographically for uterine changes. Journal of Veterinary and Animal Sciences, 55(2), 388–393. https://doi.org/10.51966/jvas.2024.55.2.388-393
Santana, C. H., Santos, D. O., Trindade, L. M., Moreira, L. G., Paixão, T. A., & Santos, R. L. (2020). Association of pseudoplacentational endometrial hyperplasia and pyometra in dogs. Journal of Comparative Pathology, 180, 79–85. https://doi.org/10.1016/j.jcpa. 2020.09.002
Singh, L. K., Patra, M. K., Mishra, G. K., Saxena, A. C., De, U. K., Singh, S. K., Kumar, H., & Narayanan, K. (2020). Prospects of diagnostic and prognostic biomarkers of pyometra in canine. Asian Pacific Journal of Reproduction, 9(4), 166–173. https://doi.org/ 10.4103/2305-0500.288584
Unnikrishnan, M.P., Kurien, M.O., Jayakumar, C., Harshan, H. M, John Martin K.D. and Unny M. N. 2020. Haematological evaluation of medically treated cases of pyometra in dogs. J. Vet.Anim. Sci . 51(1): 1-7. https://doi.org/ 10.51966/jvas.2020.51.1.1-7
Veiga, G. A. L., Miziara, R. H., Angrimani, D. S. R., Papa, P. C., Cogliati, B., & Vannucchi, C. I. (2017). Cystic endometrial hyperplasia–pyometra syndrome in bitches: Identification of hemodynamic, inflammatory, and cell proliferation changes. Biology of Reproduction, 96(1), 58–69. https://doi.org/10.1095/ biolreprod.116.140780
Thilak, (2024). Systemic inflammatory response syndrome, renal and endometrial changes in bitches with different grades of pyometra [M.V.Sc. thesis, Kerala Veterinary and Animal Sciences University].
© 2026 Swapna et al. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Swapna S., Harshan, H. M., Jayakumar C., Aravind A., Anoopraj R. & Sankar S. (2026). Ultrasonographic detection of cystic endometrial hyperplasia and pseudoplacentational endometrial hyperplasia in pyometra-affected bitches. Journal of Veterinary and Animal Sciences, 57(2),312-316 https://doi.org/10.51966/jvas.2026.57.2.312-316