Case Study

15_00048 Sonny C Mitral insufficiency, suspect left atrial tear

A 6-year-old MN Yorkshire terrier with history of elevated ALP activity and current therapy with Denosyl, was initially presented for evaluation of a slight but persistent cough, PU/PD, and diarrhea for one week duration. Abnormalities on physical examination were a pot-bellied abdomen and pyrexia (103.2В°). CBC and blood chemistry showed mildly elevated MCHC, hypoglycemia, elevated BUN and elevated ALP activity, and hyperglobulinemia. Eight months later he was presented for coughing 3-4 times a day and increased PU/PD. On physical examination a gallop rhythm was present on auscultation.

A 6-year-old MN Yorkshire terrier with history of elevated ALP activity and current therapy with Denosyl, was initially presented for evaluation of a slight but persistent cough, PU/PD, and diarrhea for one week duration. Abnormalities on physical examination were a pot-bellied abdomen and pyrexia (103.2В°). CBC and blood chemistry showed mildly elevated MCHC, hypoglycemia, elevated BUN and elevated ALP activity, and hyperglobulinemia. Eight months later he was presented for coughing 3-4 times a day and increased PU/PD. On physical examination a gallop rhythm was present on auscultation. Survey thoracic radiographs showed an enlarged cardiac silhouette and hepatomegaly.

DX

Mitral insufficiency. Moderate to severe left atrial enlargement, suspect left atrial tear.

Sonographic Differential Diagnosis

Mitral insufficiency. Moderate to severe left atrial enlargement, suspect left atrial tear. Moderate pericardial effusion. Poor long term prognosis.

Image Interpretation

A slight amount of anechoic ascites was noted in this patient. The liver presented dilated hepatic veins and severe dilation of the caudal vena cava. The liver was swollen in contour likely due to passive congestion. The cardiac presentation in this patient presented a moderate amount of pericardial effusion measuring 2.5cm with severe left atrial enlargement and severe mitral insufficiency. Left ventricular overload was also present. The right auricle was mobile in the pericardial effusion yet no cardiac masses were noted. A left atrial tear is of high suspicion with equilibrium maintained by the pressures from the pericardial fluid against the left atrium. However underlying cardiac neoplasia could be playing a role. This is causing passive congestion into the caudal vena cava, hepatic veins and causing a minor amount of ascites.

Outcome

The patient was humanely euthanized due to grave prognosis.

Clinical Differential Diagnosis

Cough – collapsing trachea, bronchitis, pneumonia (infectious, allergic, inhaled chemicals), neoplasia, cardiac disease, edema. Pyrexia – infectious, neoplasia, immune-mediated. PUPD – renal, liver, metabolic, electrolyte anomalies. Liver disease – metabolic, infectious, neoplasia, nodular regeneration. Gallop rhythm – cardiomyopathy, pulmonary hypertension.