Case Study

Stage B1 Valvular Disease Trivial Mitral and Tricuspid Insufficiency in a 5 year old FS Pomeranian Dog

A 5-year-old SFis a canine Pomeranian was presented for evaluation of , SF, 5 years. Dog losing weight loss and Iris stage 2 renal disease. A slight left sided murmur was audible on physical examination. Abnormalities on blood work were azotemia, , increased urea and creatinineelevated Iris stage 2, Spec cPL, and very elevated increased, very high ProBNP No murmur.

Sonographic Differential Diagnosis

Compensated mitral insufficiency.
No left atrial enlargement.
Minor tricuspid insufficiency – compensated
Minor pulmonic insufficiency.

Stage B1 Valvular Disease

Image Interpretation

The echocardiogram for this patient presented a left atrium of normal size with anechoic content. No evidence of “smoke” or thrombotic activity was noted. The atrial septum was straight without evidence of dilation or contraction. The LA/AO ratio was within normal limits. The cranial and caudal mitral valve leaflets demonstrated mildly vegetative contour. Trivial mitral insufficiency was moderate on color flow Doppler. The left ventricle demonstrated normal volume, septal and free wall diastolic thicknesses, and papillary integrity without evidence of significant dilation or contraction. Ventricular function was deemed adequate expressed by the fractional shortening measurement listed below. The aortic outflow tract revealed direct laminar flow along the ventricular septum with normal outflow velocity through linear valve leaflets with adequate extension, closure and uninterrupted motion. No evidence was found regarding valvular insufficiency or post stenotic dilation. Periaortic tissue was uniform and of normal echogenicity. No inconsistencies were revealed regarding the presence of an aortic body tumor or chemodectoma. The right atrium was subjectively assessed and found to be uniformly smaller than the left atrium without evidence of dilation or contraction. No neoplastic evidence was visualized. The tricuspid valve was found to be linear with proper extension, length and closure btu minor insifficiency was noted on CF Doppler. The right ventricle demonstrated normal size (1/3 diameter of the left ventricle), morphology, and kinetic activity. No evidence of heartworm or infiltrative disease was noted. Mild pulmonic insufficiency was noted and measured 1.5 m/sec. The myocardium throughout the heart was uniformly echogenic without evidence of significant fibrosis, infiltrative disease (lymphoma, hemangiosarcoma) or ischemic events (infarcts). Endo, epi, pericardial and pleural tissue was uniformly hyperechoic to the myocardium without the presence of effusions. The diaphragm was visualized as uniform without interruption.

Comments

This is essentially a normal echocardiogram with minor vegetative mitral lesions and minor MI TI. At times when systemic disease is present and volume contraction a murmuir may be heard that mnay not have been heard before.

Clinical Differential Diagnosis

Renal disease – chronic kidney disease, pyelonephritis, renoliths
Pancreas – chronic pancreatitis
GIT – IBD, dietary hypersensitivity, neoplasia
Cardiac – myocarditis, pericardial effusion, early endocardiosis