Case Of the Month

Before and After Plavix

That dreadful swollen belly, life before and after Plavix, and a sneaky portal vein thrombus. Ever wonder how to resolve the mystery of that swollen abdomen in a 10-year-old hypercoagulable AIHA Maltese? Put a probe on it and see what’s really going on inside that belly. Working through the ascites case with the probe, Lindquist & a little help from his friends.

Case managed by Drs. Joe Powel and Paul Sedlacek & staff at Animal Clinic of Morris Plains, Morris Plains, New jersey, USA. Imaging by Dr. Eric Lindquist of SonoPath.com & New Jersey Mobile Associates.

Sonogram (Abdomen, 11/8/10, 3/4/11): “Prince”

History: A 10-year-old MN Maltese with recent history of profound anemia that had been diagnosed as primary autoimmune hemolytic anemia and had been treated with a blood transfusion, p rednisone and Atopica, was presented a few weeks later for anorexia, weight loss, and depression. Physical examination found the patient with generalized muscle wasting and a pot-bellied appearance. Abnormalities on CBC were mild anemia and leukocytosis. Doxycycline was added to the treatment to cover for infectious anemia pending an abdominal ultrasound.

Outcome

The patient was treated with Plavix and a plasma transfusion after the first sonogram was performed. At a recheck examination several weeks later, the patient was found to be doing very well on current therapies. CBC and blood chemistry were both within normal limits. The patient was recommended to continue with the current protocol of Plavix, Prednisone, and Atopica

Comments

Special thanks to Drs. Joe Powel and Paul Sedleck and staff at Animal Clinic of Morris Plains for their excellent and successful management of this complicated case.

Clinical Differential Diagnosis

(Lobetti):

Drug effects – iatrogenic Cushing’s disease, gastric ulceration, steroid hepatopathy, infectious disease from immune suppression, pancreatitis
Thrombo-embolic disease
Pre-existing causes for IMHA – neoplasia, bacterial/fungal infections, abscess, granuloma

Sonographic Differential Diagnosis

(Lindquist DMV, DABVP): Portal vein thrombus with secondary portal hypertension and ascites. Splenic thrombosis. Renal infarctions.