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Recheck of 7 year old mn Siberian Husky diagnosed with arterial thromboembolism (ATE) at the U of MN Emergency clinic in November of 2013. He had presented with painful bilateral rear leg paresis, worst on the left side, which progressed to loss of femoral pulses and cold distal rear extremities.
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Dog improved on pain meds and Plavix. Now the dog is acting painful again (whining) but is still ambulatory. Femoral pulses continue to be difficult to palpate.
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Recheck of 7 year old mn Siberian Husky diagnosed with arterial thromboembolism (ATE) at the U of MN Emergency clinic in November of 2013. He had presented with painful bilateral rear leg paresis, worst on the left side, which progressed to loss of femoral pulses and cold distal rear extremities.
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Dog improved on pain meds and Plavix. Now the dog is acting painful again (whining) but is still ambulatory. Femoral pulses continue to be difficult to palpate.
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Labwork showed normal thyroid levels , no proteinuria, normal liver enzymes, normal urine cortisol to creatinine ratio and no clinical signs of Cushing’s disease (not PU/PD, normal BCS, etc.)
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Echo and abdominal ultrasound done in November showed a clot distal to the aortic bifurcation extending into the left external iliac artery. Please see November image below.
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Echo done today is still normal. No abdominal masses or new clots are seen. Chest radiographs are normal.
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Repeat ultrasound today shows persistence of the arterial clot in the left external iliac artery, but now it has a different morphology to it. Is this normal progression of clot reorganization or is this a sign that the dog’s disease is progressing?
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Is it common not to identify the cause for ATE?
Nov. 2013: Embolus in the left external iliac a. Blue CF
is either a collateral a. or the internal iliac a.
January 2014-same location
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Comments
yeh that oine has been
yeh that oine has been there a while if its mineralized. There is misconception out there that TED is a cardiac issue. This is often not the case and anythign that can conceptually cause Virchow’s triad (http://en.wikipedia.org/wiki/Virchow%27s_triad) can cause TED which is often a local disease…. Virchow island…infectious disease/arteritis, neoplasia, hyperthyroidism, diabetes, cushings, old age, wind blowing the wrong direction….idiopathic… I have seen it when only hypertension is the only pathology I could find. We haven’t paid attention enough to this in vet med. Elastography has been in development but its far from imperfect. I think ultrasound and powerdoppler of the pv, phrenic veins, splenic vein, iliacs…. is likely even more important to find hypercoagulable statse in patients but thats just me..:) I live by the probe. Plavix coupled wiht aspirin and gi protect works well so I would go wiht that and follow up monthly. I blast baytril/clindamycin on these guys for 4 weeks and look for tick borne and rickettsials..
Thanks Eric. Do you know,
Thanks Eric. Do you know, will the dog ever break down this clot or is it probably there to stay?
yeh that oine has been
yeh that oine has been there a while if its mineralized. There is misconception out there that TED is a cardiac issue. This is often not the case and anythign that can conceptually cause Virchow’s triad (http://en.wikipedia.org/wiki/Virchow%27s_triad) can cause TED which is often a local disease…. Virchow island…infectious disease/arteritis, neoplasia, hyperthyroidism, diabetes, cushings, old age, wind blowing the wrong direction….idiopathic… I have seen it when only hypertension is the only pathology I could find. We haven’t paid attention enough to this in vet med. Elastography has been in development but its far from imperfect. I think ultrasound and powerdoppler of the pv, phrenic veins, splenic vein, iliacs…. is likely even more important to find hypercoagulable statse in patients but thats just me..:) I live by the probe. Plavix coupled wiht aspirin and gi protect works well so I would go wiht that and follow up monthly. I blast baytril/clindamycin on these guys for 4 weeks and look for tick borne and rickettsials..
Thanks Eric. Do you know,
Thanks Eric. Do you know, will the dog ever break down this clot or is it probably there to stay?
Mineralized likely needs
Mineralized likely needs fluoro guided intervention…. anyone doing vacsular IT near you?
That is a good question.
That is a good question. I’ll check with the U of MN.
Mineralized likely needs
Mineralized likely needs fluoro guided intervention…. anyone doing vacsular IT near you?
That is a good question.
That is a good question. I’ll check with the U of MN.
This dog is getting a CT scan
This dog is getting a CT scan done at the U of MN today as he is doing worse. It does not sound like the U does routine flouro guided intervention. Do any of you Sonopath forum people know of any clinics/surgeons in the midwest that are experienced in this procedure? The owner is willing to travel with his dog.
This dog is getting a CT scan
This dog is getting a CT scan done at the U of MN today as he is doing worse. It does not sound like the U does routine flouro guided intervention. Do any of you Sonopath forum people know of any clinics/surgeons in the midwest that are experienced in this procedure? The owner is willing to travel with his dog.
The owner reported that a CT
The owner reported that a CT scan done today showed a femoral sarcoma with mets to the region of the external iliac thrombus. I am waiting for the official report from the U. Moral of the story is
1. When you have an unexplained distal ATE, radiograph the extremities.
2. Stick a needle in it!
3. Perform your own physical exams?
4. Other?
One of the disadvantages of being the mobile sonographer is that I don’t usually perform my own complete physical exams on the patients. Although, I can say that this dog was receiving physical therapy for the last 2 months from a boarded surgeon who performs very thorough exams.
The owner reported that a CT
The owner reported that a CT scan done today showed a femoral sarcoma with mets to the region of the external iliac thrombus. I am waiting for the official report from the U. Moral of the story is
1. When you have an unexplained distal ATE, radiograph the extremities.
2. Stick a needle in it!
3. Perform your own physical exams?
4. Other?
One of the disadvantages of being the mobile sonographer is that I don’t usually perform my own complete physical exams on the patients. Although, I can say that this dog was receiving physical therapy for the last 2 months from a boarded surgeon who performs very thorough exams.
The art of veterinary
The art of veterinary medicine……neoplasia is an unsung thromboemoblic stimulator… doesnt get talked about much but cancer loves Virchow. Thx for the follow-up!! great post bad outcome.
The art of veterinary
The art of veterinary medicine……neoplasia is an unsung thromboemoblic stimulator… doesnt get talked about much but cancer loves Virchow. Thx for the follow-up!! great post bad outcome.