Dyspnea, pulmonary infiltrates, and adrenal gland tumor in a 10yr MN ShihTzuh


This dog presented for vomiting 2 days ago and was diagnosed with pancreatitis based upon a positive cPLI and hazy abdominal radiographs.  The WBC ct was elevated as was AST and ALT.  The dog was treated in part with SQ fluids.  Last night, the dog went to the emergency clinic for dyspnea.  The radiology report stated LV enlargement, pleural effusion, and pulmonary infiltrates most likely secondary to CHF and mitral valve disease.  HR at initial ER presentation was 130bpm.  Hmmm….The dog returned to the primary vet where Lasix and oxygen therapy were continued.

This dog presented for vomiting 2 days ago and was diagnosed with pancreatitis based upon a positive cPLI and hazy abdominal radiographs.  The WBC ct was elevated as was AST and ALT.  The dog was treated in part with SQ fluids.  Last night, the dog went to the emergency clinic for dyspnea.  The radiology report stated LV enlargement, pleural effusion, and pulmonary infiltrates most likely secondary to CHF and mitral valve disease.  HR at initial ER presentation was 130bpm.  Hmmm….The dog returned to the primary vet where Lasix and oxygen therapy were continued.  A cardiac murmur was never ausculted.  Echo done today shows a normal LA and LA:AO ratio, decreased LVIDd  and decreased FS (presumably due to hypovolemia) and a heart rate of 130bpm.  There are no visible pleural or pericardial effusions or cardiac masses.  Cardiac measurements are as follows:  IVSd=8.6mm, LIVDd=18.7mm, LVPWd=9.3mm, IVSs=9.7mm, LVIDs=14.0mm, and LVPWs=10.6mm.  FS=25%.  An abdominal US shows a left adrenal gland mass with adjacent echogenic reactive fat.  No local vascular invasion is seen.  The dog’s dyspnea persists with a RR=50rpm on flow by oxygen and increased respiratory effort.

I am trying to figure out what put this dog into respiratory distress and whether or not the adrenal mass is related.  There is no significant mitral valve insufficiency so that cannot be the cause of the pulmonary infiltrates.  My rule outs for the respiratory distress are as follows:  aspiration pneumonia, fluid overload from SQ fluids (seems unlikely), hypertensive crisis secondary to pheochromocytoma, Addisonian crisis, pulmonary emboli secondary to hyperadrenocorticism.  Any other thoughts?  I have instructed the primary vet to wean off of furosemide and initiate antibiotic therapy for possible aspiration.  I will try to get ahold of the rads.


2 responses to “Dyspnea, pulmonary infiltrates, and adrenal gland tumor in a 10yr MN ShihTzuh”

  1. The heart isnt a player…

    The heart isnt a player… check systemic hypertension that will cause respiratory issues… pain as well and TED of course. Are you sure thats the left adrenal mass and not a blown our LN or pancreatic lesion? A met shower to the lungs can cause respiratory issues as well, Whatever that thing is it needs  25g needle I believe:)

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    Thank you.

  2. Thank you Eric.  The mass is

    • Thank you Eric.  The mass is located immediately medial to the left kidney and just caudal to the celiac artery and cranial mesenteric artery.  So, its a bit caudal on the left for pancreas although I suppose still possible.
    • Blood pressure measurements obtained at the primary clinic were normal.
    • I posted this case because I have had multiple recent cases of dyspenic little dogs that were treated aggressively with lasix for presumed congestive heart failure. As the mobile sonographer coming in to do the echo 24-48 hours after aggressive lasix therapy, it can be challening to determine what the inital insult was.  This case was a no-brainer because of the relatively normal HR and lack of any MVI.
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