-Middle age female spayed dog
-Presented for vague, non-specific signs including abdominal enlargment
-Very small focal amounts of free fluid located in abdomen, no masses noted aside from focal enlargement of the caudal pole of one adrenal gland.
-Hepatic vasculature and CVC appear prominent to me but I would like to see others’ opinions. I’m including a clip of the pylorus in which you can compare the vessels.
-The mesentery appears “clumpy” to me but I don’t see distinct nodules.
-Middle age female spayed dog
-Presented for vague, non-specific signs including abdominal enlargment
-Very small focal amounts of free fluid located in abdomen, no masses noted aside from focal enlargement of the caudal pole of one adrenal gland.
-Hepatic vasculature and CVC appear prominent to me but I would like to see others’ opinions. I’m including a clip of the pylorus in which you can compare the vessels.
-The mesentery appears “clumpy” to me but I don’t see distinct nodules.
-Brief view of heart appeared ok, no pericardial effusion, full echo not done.
-Trying to figure out whether to concentrate on abdomen or thorax for cause of clinical signs.
Thanks!
***As I’m reviewing my post, at times I see the wrong still image (from one I posted a long time ago) but I did select the correct image mutliple times. You should be seeing a view of an adrenal gland (not a hyperechoic lymph node). Not sure what’s happening but clearly a small techinical glitch.
Comments
Hepatic vein dilation would
Hepatic vein dilation would suggest passive congestion…. unless sedated dex-dom which I doubt because the heart is beating well. The right heart looks subjectively fine in this view but need TR doppler to rule out PHT and emerging right chf. If thats not the issue then think something obstructing the CVC in caudal mediastinum like tumor or cvc thrombus. Tap the ascites and ensure its just transudate.
Ok, thanks for the advice! I
Ok, thanks for the advice! I tried to find the concise way to approach ascites but wound up getting out my notes from one of your lectures. Is it available here?
Thanks again!
Suzanne
I am not sure I see hepatic
I am not sure I see hepatic vein congestion.
You might try a trick that Dr. Sonya Gordon taught me in trying to decide if there is increased RH pressure refered back to through the CVC. Look for CVC collapse with each breath at the level of the liver. This is best seen in the right transverse intercostal view of the liver in sagittal. If you see the CVC collapsing with breathing then the right heart pressure is likely normal. If the CVC does not collapse then it is likely increased above normal and makes right heart failure more suspect as a rule out. And as the pressure in the CVC increases, you of course will see hepatic vein congestion and GB wall edema with emerging ascites. Just a thought.
That makes sense but of
That makes sense but of course I didn’t think about it when I was acquiring the images! I was hoping you could tell from comparing the hepatic vessels to the liver and the Ao/CVC/portal comparison. The main reason I posted was because I wasn’t sure if the liver was truly congested. I guess I am still not sure.
I advised them that the cause of the ascites may not be in the abdomen (I belive they were considering an exploratory) and that a sample of fluid would help further narrow down the potential ddx.
I’ll try to remember that for next time – thanks!
Suzanne
I would get a solid TR jet
I would get a solid TR jet first before exploratory or they risk exploring a right heart failure patient. Not at right chf patients have big RA but the TR jet will be at least > 3.5 m/sec typically… or there could be somethign in the thoracic cvc impinging or a thrombus occluding.