- The initial history provided was that the dog was isolating himself and seeking cooler areas for the past month. Then, acutely, the dog developed an increased respiratory rate. PE findings demonstrated harsh lung sounds, however, it was difficult to discern between upper and lower respiratory disease.
- Radiographs were performed and there was concern for cardiomegaly, heart failure and a possible mass at the carina. The patient was placed on pimobendan and an echocardiogram was scheduled for the following week.
- The initial history provided was that the dog was isolating himself and seeking cooler areas for the past month. Then, acutely, the dog developed an increased respiratory rate. PE findings demonstrated harsh lung sounds, however, it was difficult to discern between upper and lower respiratory disease.
- Radiographs were performed and there was concern for cardiomegaly, heart failure and a possible mass at the carina. The patient was placed on pimobendan and an echocardiogram was scheduled for the following week.
- On the day of the echo, the doctor in charge was concerned more about diffuse pulmonary disease and possible lung nodules than cardiac disease. The dog had not improved on pimobendan.
- The echocardiogram showed evidence of hypovolemia (increased IVSd, LVPWd, and decreased LVIDd and LVIDs). The LA and LA/AO were wnl. No valve leaks were seen. The patient was anxious and did display stress induced dyspnea (tongue would turn blue when restrained) but this seemed more due to brachyocephalic/upper airway obstruction.
- LA=2.13cm, LA/AO=1.21, IVSd=1.14, LVIDd=2.45, LVPWd=1.38, IVSs=1.41, LVIDs=1.48, LVPWs=1.81, FS=40%, EF=72%, HR=99bpm.
- In summary, I did not identify any significant cardiac disease or any masses in the cardiac window. I also scanned both sides of the thorax (poured alcohol on the chest) and did not identify any near wall pulmonary or thoracic wall lesions. No B-lines or comet tails either.
- I persuaded them to perform bloodwork which later showed ALP=916 U/L, ALT=212 U/L, GGT=26 U/L, Glu=185mg/dL. In speaking with the owner on my way out of the clinic, I learned that the dog has had chronic weight loss and muscle wasting.
- The primary vet was very concerned about primary lung disease so I wanted to get your thoughts on the chest. Now, of course, knowing that there was more to the history, wish that I had scanned the abdomen.
- What are your thoughts on the rads?
Comments
Degree of tracheal deviation
Degree of tracheal deviation and mild enlargement of the cranial mediastimum – most likley incidental and from fat but do not discount it completely. Need to follow up abnormal liver enzymes with abdominal ultrasound.
Ok, thank you. There were no
Ok, thank you. There were no mediastinal masses.