A 10-year-old NM DSH was presented for evaluation of suspect pulmonary edema following a Depo-medrol injection. Tachypnea was present on physical examination.
A 10-year-old NM DSH was presented for evaluation of suspect pulmonary edema following a Depo-medrol injection. Tachypnea was present on physical examination.
Severe left atrial and left ventricular volume overload was noted in this patient. Contractility was subnormal. The right atrium was severely enlarged with a 2.0 cm thrombus formation. Arrhythmogenic activity was noted. A mild amount of pericardial effusion was also noted owing to right sided failure.
Triple therapy is warranted in this patient. Lasix at 2-3 mg/kg b.i.d., ace inhibitor, Pimobendan and Plavix would all be suggested. Very guarded prognosis. Heat support would be warranted. A recheck echocardiogram is recommended in 1 week. The patient is at right risk for sudden death. ECG and blood pressure measurements are recommended.
Followup echo 2/27/17 –
The cardiac presentation revealed volume overload of the left and right atrium as well as volume overload of the left ventricle with hypocontractility. Occasional arrhythmia was also noted. Minor pericardial effusion and slight pleural effusion was noted.
Unclassified cardiomyopathy with slight pericardial effusion and severe left atrial enlargement.
Recommend triple therapy in this patient with Lasix at 1-2 mg/kg b.i.d.,ace inhibitor at 0.5 mg/kg s.i.d. and Pimobendan off label at 0.25 mg/kg b.i.d. Plavix therapy should also be considered. A recheck echocardiogram is recommended in 10 days. Guarded prognosis.
Cardiac – cardiomyopathy (dilated, hypertrophic, restrictive)
Depo-medrol induced congestion – lung edema, pleural effusion
Pulmonary – pneumonia
Pleural effusion
