Case Study

RADS – Cardiogenic Pulmonary Edema with Mitral Insufficiency in a 10 year old MN Lhasa Apso dog

History of chronic valvular disease, congestive heart failure, and previous episode of aspiration pneumonia. The patient continues to have a positional cough that has not become more frequent, but has increased in its level of severity. Currently on enalapril 3.75 mg in the AM, 2.5 mg in the PM; Furosemide q8-25mg/18.75mg/25mg; Pimobendan 2.5mg q8, and spironolactone 6.25mg am, 12.5mg pm.

Physical Exam: Crackles, murmur, currently in 0xygen cage-responding to Lasix. CBC WNL; chemistry elevated BUN.

Image Interpretation

Rads of right lateral, left lateral and VD thorax – Osseous structures: Mild degenerative changes were associated with the axial
skeleton.
Extrathoracic soft tissue structures: There was moderate aerophagia.
Intrathoracic structures: The trachea was elevated. The cardiac silhouette was
obscured by the pulmonary pattern but as far as visible significantly
enlarged in height and width. The left main stem bronchus was elevated. Split main
stem bronchi were evident on VD. The pulmonary vessels were mildly enlarged (with
patient on diuretics).
There was a moderate generalized alveolar pattern. Severe alveolar infiltrate with
distinct air bronchograms was evident within the right cranial and caudal lung lobe.
A moderate underlying vascular pattern was also evident.

DX

The findings are compatible with severe cardiogenic pulmonary edema. The lack of pronounced venous congestion is likely owing to the fact that the patient is under diuretic treatment. The right caudal lobar infiltrate is common in mitral valve insufficiency with eccentric regurgitant jets. Note that the generalized distribution and the right cranial lobar infiltrate are not typical in cardiogenic edema. Remnants of the aspiration pneumonia, as well as noncardiogenic edema/ARDS have to be considered. A neoplastic infiltrate or hemorrhage appears to be very low for potential with the current history.

Outcome

Control radiographs after 24-48 hours are recommended.
There was moderate aerophagia likely as a function of the dyspnea.

Comments

Radiographs were submitted in jpeg format – DICOM would be the preferred format for unlimited postprocessing.

The degree of inspiration was moderate

Patient Information

Patient Name : Monk Hinckley, Critical Vet Care

Gender : Male, Neutered

Species : Canine

Type of Imaging : Ultrasound

Status : Complete

Clinical Signs

Dyspnea

History

Congestive heart failure
Enalapril therapy
Pimobendan therapy

Exam Finding

Heart Murmur
Pulmonary crackles

Images

Blood Chemistry

BUN high

Clinical Signs

Dyspnea