Case Study

Endocarditis, Ruptured Chordae, Mitral prolapse, and Aortic Aneurism with Thrombus and Suspected PTE in a Large Breed Dog undergoing Chemotherapy

A middle aged mixed breed FS dog was presented for evaluation of poor appetite, lethargy, polypnea, and recent onset heart murmur. Additional history is that the patient has had chemotherapy for neoplasia and is currently on prednisone therapy. Abnormalities on physical examination were hind limb deficits and weight loss. CBC revealed leuokocytosis. Serum chemistry was unremarkable. Cardiomegaly and an interstitial lung pattern were evident on survey radiographs.

A middle aged mixed breed FS dog was presented for evaluation of poor appetite, lethargy, polypnea, and recent onset heart murmur. Additional history is that the patient has had chemotherapy for neoplasia and is currently on prednisone therapy. Abnormalities on physical examination were hind limb deficits and weight loss. CBC revealed leuokocytosis. Serum chemistry was unremarkable. Cardiomegaly and an interstitial lung pattern were evident on survey radiographs.

Sonographic Differential Diagnosis

Arteritis and thrombus formation in abdominal aorta and right renal artery. Endocarditis type presentation. Blood cultures would be warranted. Lasix and ace inhibitor therapy would be warranted as well as blood pressure measurements. Very guarded prognosis. IV fluid support and IV and IM antibiotics are essential. A recheck sonogram in 4 days prior to discharge. Very guarded prognosis.

Image Interpretation

The cardiac presentation in this patient presented moderate left atrial dilation with a mitral valve prolapse and ruptured chordae tendinae with severe insufficiency. Some myocardial remodeling was noted as well as dilated left ventricle with hypercontractile left ventricular septum and free wall. The left ventricular outflow velocity revealed a mildly thickened aortic valve with moderate to severe insufficiency at 4.98 m/sec. The left ventricular outflow velocity was normal. Minor tricuspid insufficiency was noted with normal left atrial and right ventricular size. Pulmonary outflow was unremarkable. However, some minor, pulmonic insufficiency was noted. Pulmonic insufficiency velocity 1.02 m/sec. Aortic insufficiency velocity 4.98 m/sec. Mitral insufficiency velocity 5.98 m/sec. Tricuspid insufficiency velocity 2.3 m/sec.

DX

Endocarditis

Outcome

The patient was started on medications for left sided heart failure and endocarditis but was lost to followup

Clinical Differential Diagnosis

Vegetative endocarditis, endocardiosis with chordae tendina rupture, myocarditis, pericardial effusion, cardiomyopathy Aortic thrombo-embolism

Sampling

None