An intact male mixed breed dog of unknown age was presented for evaluation of 4-5 days of progressive abdominal distension. Abnormalities on laboratory work included anemia and a positive heartworm test. Survey radiographs showed cardiomegaly and a possible abdominal mass.
An intact male mixed breed dog of unknown age was presented for evaluation of 4-5 days of progressive abdominal distension. Abnormalities on laboratory work included anemia and a positive heartworm test. Survey radiographs showed cardiomegaly and a possible abdominal mass.
Case Study
Right sided heart failure in a heartworm-positive MI mixed breed dog with abdominal distension
Sonographic Differential Diagnosis
Right sided heart failure. A large number of heartworms was noted in the main branch of the pulmonary artery. Pulmonary hypertension was noted.
Image Interpretation
The echocardiogram revealed an enlarged right heart with right atrial enlargement and significant tricuspid regurgitation. Tricuspid insufficiency was noted at a velocity of 3.87 m/sec. The main branch of the pulmonary artery was enlarged, and a large amount of heartworms was noted. Smoke was evident in the right atrium. The mitral valve was also insufficient with a velocity of 5.56 m/sec, however the left atrium was of normal size.
DX
Heartworms, pulmonary hypertension
Outcome
No further outcome.
Comments
Ideally, it would be prudent to perform a blood pressure and ECG in this patient. Given the changes seen on echocardiographic examination this patient would be an ideal candidate for basket retrieval of heartworms. Until this procedure is performed the patient should be treated with aspirin at 1 mg/kg every other day, Pimobendan at 0.25-0.3 mg/kg b.i.d. and Sildenafil at 1 mg/kg b.i.d. The Sildenafil dose can be increased to 1.5 mg/kg b.i.d. over 10 days. Lasix should be instituted at 1-2 mg s.i.d. Given the significant amount of heartworms noted in the pulmonary artery coupled with the patient’s clinical signs the patient’s prognosis is guarded at this time.
Clinical Differential Diagnosis
Cardiac – right heart failure secondary to heartworm, pericardial effusion, cardiomyopathy. Abdominal mass – neoplasia, granuloma, abscess or cyst of the spleen, liver, or kidney.
Sampling
FNA of the liver were obtained and submitted for cytologic evaluation.
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Patient Information
Patient Name :
Charlie Bone E
Gender :
Male, Intact
Species :
Canine
Type of Imaging : Ultrasound
Book :
yes
Status :
Complete
Liz Wuz Here :
Yes
Code :
15_00132
Clinical Signs
- Abdominal Distension
Exam Finding
- Abdominal Distension
Images
CBC
- RBC, Low
Clinical Signs
- Abdominal Distension
Special Testing
- Heartworm Antigen Positive