Case Study

US and RAD – Stage B1 valvular disease with mild non-cariogenic pulmonary edema in a 10 year old MN Maltese dog

This 10 year old MN Maltese dog has a 10 day history of syncopal episodes and coughing

DX

Echo: Mitral valve prolapse. Moderate insufficiency. Stage B1 Valvular disease. Rads- mild non-cardiogenic pulmonary edema, such as neurogenic.

Image Interpretation

Cardiac ultrasound- Mitral insufficiency was noted in this patient – compensated; velocity 6.49 m/sec. Prolapse of the anterior mitral valve leaflet was noted. The left ventricle presented thicknesses with linear contour and was not dilated nor restricted

Rads of the thorax, 2 sets provided 10 days apart – Intrathoracic structures: There is a pleural fissure line demarcating the right caudal lung lobe seen on the ventrodorsal view. Lung lobes reveal a moderate mixed unstructured interstitial-alveolar pattern emphasizing the caudodorsal and central aspect as well as the right side. The volume of the right lung lobe is rather small.
Intraabdominal structures:
Moderate aerophagia is seen on both sets of rads.

Outcome

Recommend assessment of blood pressures in this patient for potential systemic hypertension given the elevated MR velocity. There is some anesthesia risk in this patient. If anesthesia is to be performed, Torbutrol premed, Propofol induction, isoflurane maintenance is recommended with avoidance of excessive tachycardia given the fragility of the mitral valve apparatus. . The patient should not have clinical signs owing to cardiac disease in this moment given that no volume overload is noted in the left atrium or left ventricle. Recheck echocardiogram in 3-6 months or sooner if clinical signs initiate; evaluate metabolic or neurologic disease with further diagnostic imaging such as MRI or CT and screen for hypoglycemia as cause of the syncope.