Case Study

RADS and US – Nephritis, splenomegaly, hypovolemia and microcardia, possible Leptospirosis in a 5 year old MN Giant Schnauzer dog

This 5 year old MN Giant Schnauzer presented with acute onset lethargy and hematuria

Physical exam: slightly pale and icteric mucous membranes. Temp 103.1

CBC: HCT 21.7%, HGB- 7.2g/dl, platelets 30,000; coagulation panel Normal ( pT and ApTT) 4DX= Negative

Chem: Albumin- Normal at 4.0 g/dl, TBIL increased 3.8 mg/dl

This 5 year old MN Giant Schnauzer presented with acute onset lethargy and hematuria

Physical exam: slightly pale and icteric mucous membranes. Temp 103.1

CBC: HCT 21.7%, HGB- 7.2g/dl, platelets 30,000; coagulation panel Normal ( pT and ApTT) 4DX= Negative

Chem: Albumin- Normal at 4.0 g/dl, TBIL increased 3.8 mg/dl

DX

• acute nephritis pattern with renal and/or urinary bladder hemorrhagia • splenomegaly • hypovolemia with microcardia and underperfusion of the lung • mild bronchointerstitial lung pattern – likely to be age related

Image Interpretation

Rads of the thorax: The chest volume is within normal limits. A mild generalized fine linear
bronchointerstitial pattern is noted throughout the lung parenchyma. There is mild
under perfusion of the lung with a hypovascular pattern. The caudal vena cava is thin.
Mild microcardia is noted.
The heart, trachea and other mediastinal structures are within normal limits. There is
no evidence of mediastinal lymphadenomegaly.
Rads of the abdomen: A moderate generalized
splenomegaly is noted as well as mild central abdominal crowding which is associated
with a minor loss of serosal detail. The stomach contains a mild amount of linear
mineral opaque structures within the pyloric antrum. There is no evidence of a gastric
outflow obstruction. The small intestinal loops contain a moderate amount of gas but
are non-dilated and even in diameter throughout.

Ultrasound findings: A moderate amount of non-shadowing echogenic debris is seen precipitating within the
urinary bladder. Both kidneys present an overall swelling with increased cortical echogenicity & cortex
medulla ration as well as a mild loss of the corticomedullary definition. There is no
pyelectasia. Moderate generalized splenomegaly with maintained parenchymal echoarchitecture
and echogenicity is noted. The
gallbladder is moderately distended with a moderate amount of non-shadowing sludge.

Outcome

Consider infectious disease such as Leptospirosis, tick-borne and other immune
mediated causes (IMHA, Evan’s syndrome, recent vaccination, other…).
Theoretically round cell neoplasia and amyloidosis are possible differential diagnoses,
but considered low for potential here. The splenomegaly is more likely to be a function
of an activated immune response.
Consider ultrasound-guided sampling of the spleen, liver and kidney(s) for further
definition and to rule out round cell neoplasia. Urinalysis including sediment and
culture should be obtained as well.
Running a coagulation panel is strongly recommended before considering any kind of
sampling procedure.