Case Study

Right -sided heart failure with ventricular thrombus and passive liver congestion pattern in a 4 year old MN ferret

This 4 year old MN ferret presented with weight loss, vomiting, diarrhea and concern for diaphragmatic hernia. Initial rads soft tissue opacity between heart and diaphragm on lateral. Repeat rads revealed caudal aspect of heart touching diaphragm, no obvious soft tissue opacity there. Cardiac silhouette abnormal on all films.

Sonographic Differential Diagnosis

Right sided heart failure with right ventricular thrombus, passive congestion liver pattern.
Minor gastrointestinal thickening and fluid accumulation, likely owing to hypoxia.
Nodular hepatic changes, undefined.

Image Interpretation

Rapid view of the heart revealed right atrial enlargement. A large thrombus was noted in the right ventricle. Paradoxical septal motion, severe tricuspid insufficiency and tachyarrhythmia were all noted. Right atrium measured 1.5 cm and left atrial size was 0.4 cm. Minimal volume was noted in the left ventricle. Variable gastrointestinal thickening and mild dilation was noted. Reactive mesentery was noted in the cranial abdomen. The liver presented dilated hepatic veins with passive congestion pattern. Isoechoic, nodular hepatic changes were noted. Slight hepatic lymphadenopathy was noted, which his a common finding in ferrets.

DX

Right sided heart failure with right ventricular thrombus

Outcome

Recommend treatment for right sided heart failure in this patient. Off label Plavix and off label Sildenafil can be considered. Low dose Lasix is also possible. Passive congestion liver pattern is owing to right sided heart failure. The thrombus is likely a secondary issue and is non obstructive at this time, but could become obstructed in the pulmonary outflow tract at any time.