Ultrasonographic diagnosis of simultaneous pyometra with gestation in a bitch: A Diagnostic challenge

A 1-year-old German Shepherd cross-bred bitch was diagnosed with cystic endometrial hyperplasia - pyometra complex and commenced treatment without detection of gestational sacs using ultrasound, until the bitch aborted two stillbirths and one live preterm puppies 12 hours after ultrasonographic examination and 36 hours after commencement of treatment. Gestation should not be ruled out immediately after ultrasonographic diagnosis of pyometra in bitches.