Case Study

Pulmonary hypertension in a 10 year old MN Boston Terrier

A 10-year-old neutered male Boston Terrier dog was presented for possible seizure activity. A grade II/VI heart murmur and left submandibular lymphadenomegaly were present on physical examination. Abnormalities on CBC and blood chemistry included neutrophilia, eosinopenia, thrombocytosis, elevated ALP activity, and elevated CK. T4 was within normal limits. The patient was treated with enalapril and clindamycin pending ultrasound.

Sonographic Differential Diagnosis

Persistent pulmonary hypertension. Rule out concurrent systemic hypertension. Mitral insufficiency, currently compensated.

Image Interpretation

The echocardiogram images showed a prominent right heart with mild right ventricular hypertrophy without clinically significant tricuspid regurgitation. The right atrial size was normal. The tricuspid insufficiency jet velocity measured 3.6 m/sec. The pulmonary artery was uniformly prominent with mildly depressed pulmonic velocity measured on PW Doppler. No overt heartworms were noted in the main or visible deep pulmonary arteries. (Theoretically heartworms could be present in the deep pulmonary vasculature out of visible sonographic range.) More likely, however, this prominent right heart is due to excessive intrathoracic pressures caused by chronic respiratory disease and/or excessive intrathoracic fat (Pickwickian syndrome.) The mitral valve presented vegetative contour and was visibly insufficient on PW and color flow Doppler. The mitral insufficiency velocity measured 5.1 m/sec. Left atrial dilation was not evident.

DX

Persistent pulmonary hypertension

Outcome

The patient was treated with sildenafil, low dose baby aspirin, and recommended for recheck ultrasound in 4-6 weeks. At last communication the patient was doing well on therapy.

Clinical Differential Diagnosis

Seizures – intracranial disease (neoplasia, cyst, meningitis, trauma, hydrocephalus), metabolic disease (renal, liver, electrolytes, cholesterol), toxins. Syncope – cardiac, pulmonary, metabolic. Lymph node – infection, neoplasia, reactive.