Presentation
Presented with decreased appetite and activity.
Patient Data
The heart is mildly enlarged. There is a diffuse interstitial pattern with a focal area of alveolar pattern in the right middle lung lobe. There is mild retraction of the lung lobes indicating pleural effusion.
Impression:
The diffuse pulmonary pattern may be due to vasculitis and/or pulmonary edema or fibrosis. The focal alveolar pattern may be inflammatory or left heart failure.
Case Discussion
The dog was diagnosed with IMHA and thrombocytopenia. Echocardiography showed mitral valve degeneration without left heart failure and pulmonary hypertension with mild right heart failure.
Respiratory distress worsened and euthanasia was performed. The severe non-responsive respiratory distress was caused by an acute bacterial shower from a tricuspid valve endocarditis. Within the lung, there were multiple foci containing degenerate neutrophils and small numbers of mixed bacteria, consistent with a hematogenous embolic pneumonia. Additionally, there were few microthrombi within pulmonary vessels that may have contributed to the respiratory disease. There were chronic changes in the tricuspid valve that likely set-up the bacterial colonization. There was hyperplasia of the endothelium and underlying stroma as well as neovascularization.
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