- 5 yr old German Shepherd presented for not acting herself, lethargic, hesitant to walk up/down stairs
- PE showed splenomegaly
- Abdominal, pelvic, and thoracic rads read by radiologist show no abnormalities.
- Blood work s hows HCT=37.6%, Hgb 13.3g/dl, 4 nRBC per 100 WBC,PLT=77K/mcl however clumping observed
- 5 yr old German Shepherd presented for not acting herself, lethargic, hesitant to walk up/down stairs
- PE showed splenomegaly
- Abdominal, pelvic, and thoracic rads read by radiologist show no abnormalities.
- Blood work s hows HCT=37.6%, Hgb 13.3g/dl, 4 nRBC per 100 WBC,PLT=77K/mcl however clumping observed
- Abdominal US shows moderate splenomegaly with the spleen extending caudally to the bladder. Splenic parenchyma and echogenicity are wnl. Some vascular congestion seen. Normal blood flow on CF Doppler.
- Echocardiogram shows eccentric right ventricular enlargement. RA and MPA also appear subjectively enlarged. There is an echogenic focal wall thickening on the RV side of the IV septal wall but I suspect this is just trabecular muscle. Concurrent ECG shows what looks like inverted QRS waves. The patient was sedated with butorphanol-midazolam for both ultrasound studies (initially was just going to be abdominal US).
- Differential diagnoses for the splenomegaly include sedation, RCHF, benign hyperplasia, and infiltrative disease.
- Do you agree there is RV enlargement here? Could this be an arrhythmogenic cardiomyopathy? I believe the focal wall thickening I am seeing is just trabecular m. but am also wondering about small tumor.
Comments
RA and RV are overloaded and
RA and RV are overloaded and ventricular septum is flattened. The TV looks dysplastic maybe TV dysplasia? Are the hepatic veins and cvc dilated? If so emerging right CHF especially if the lethargy is exercise intollerance. If Hv and CVC are normal then its compensated and the cause of the clinical signs may be from something else.
I agree the septum is
I agree the septum is flattening out. The spleen was enlarged with obvious congestion. The liver was normal to slightly decreased in in size with no hepatic vein enlargement. No obvious abnormalities at the portal hilus, however, image quality was fair, even with paracostal imaging, in this large deep chested German Shepherd. I performed CF and PW Doppler on the TV on multiple views and only picked up a small 1.0m/s TVI with pulse wave Doppler only on 4 chamber left apical views. Wouldn’t I be seeing a high velocity TVI jet if this right side enlargement was due to tricuspid dysplasia? Also no murmur ausculted. Could butorphanol midazolam cause a RCHF appearance (RA/RV enlargement and splenomegaly)? I will also double check and make sure there was no dexmedetomidine.