Buddy is an 11 year old overweight Cocker Spaniel that weighs 52 pounds.
I saw Buddy first in July and heard a 2-3/6 systolic murmur. I had the owners discontinue the heart medications and put him on dexamethasone and doxycycline.
2 weeks later the owner told me the cough got worse when off heart medications and so they started them up again. Dog improved somewhat but not normal.
I put he dog on Amoxicillin and Hycodan and suggested radiographs…the owners continued the enalapril and furosemide…
Buddy is an 11 year old overweight Cocker Spaniel that weighs 52 pounds.
I saw Buddy first in July and heard a 2-3/6 systolic murmur. I had the owners discontinue the heart medications and put him on dexamethasone and doxycycline.
2 weeks later the owner told me the cough got worse when off heart medications and so they started them up again. Dog improved somewhat but not normal.
I put he dog on Amoxicillin and Hycodan and suggested radiographs…the owners continued the enalapril and furosemide…
Radiographs taken on 9/2018 reveled an enlarged heart w/ a VBS of 11, an increased interstitial lung pattern…but a small “bulge”/nodule at 1:00 on the right lateral in the area of the LA??? I’m not sure if this is a nodule or associated w/ the LA?Radiographs from the first veterinarian dated 9/2017 didn’t show this nodule.
Did U/S and subjectively I felt like there is eccentric hypertrophy of the LV with the LVIDd being increased and not a lot of systolic movement…but when I plug the numbers into the VIN calculator for a 50# dog the measurements are in the normal range…I’d say this dog is at least 10 pounds overweight and that puts the LVIDd closer to abnormal. That with an LA:Ao of 2.0 and a decent MR jet makes me suspicious of an emerging cardiomyopathy.But I’m still concerned about the “nodule” on the radiograph.
Currently the dog is on enalapril, furosemide and hycodan…I’ve discussed a trans-tracheal wash but I’m polling the crowd to see if I’m missing anything. The owner feels the dog is getting worse w/ time.
Thanks in advance,
Sam
Comments
Here are the m-mode and LA:Ao
Here are the m-mode and LA:Ao ratio stills.
Nodule may be incidental but
Nodule may be incidental but in that area would be putting pressure on the mainstem bronchi and stimulating the cough receptors. Is there a DV or VD view of the thorax?, as it could give a better indication of the postion of the nodule.
Here’s the VD
Here’s the VD
On y9our second video 4
On y9our second video 4 chamber right ps long axis or “The Brick” SDEP echo view. Go by the atrial septum as its flattened when the LA is normal and deviated toward the RA when enlarged… unless the RA is big too which will push it back a bit. This is non cardiac for me… LA has to be big to have cardiac based clinical respiratory signs in dogs or cats.
I think that nodule dorsal to the heart base or lung or bronchus as its too high to be the LA.
Your heart based still image is too ventral and no AV valves so if they arent in view your LA will be artifically big. Slide dorsally to get the mercedes benz sign clean then check the la/ao ratio which I bet wikll be < 1.6 when it looks 2.0 or so in your view.
Let me see if Nele can plug in on the lung nodule.
Looks like the nodule is
Looks like the nodule is sitting within the mediastinum – and with the chronic cough would think within the bronchus. Consider bronchoscophy and if negative then CT.
Thanks for the help
Sam
Thanks for the help
Sam