Presentation
Two-week history of progressive exercise intolerance and a four day history of cough.
Patient Data
There is mild generalized cardiomegaly with severe left atrial enlargement. The left atrium appears as a round soft tissue opacity superimposed on the cardiac silhouette on the d/v projection. There is a diffuse, dense interstitial to alveolar pattern that is worse cranioventrally. The cranial lobar vein is larger than the artery on the left lateral projection. There are multiple fissure lines visible that are not widened. This is consistent with dilated cardiomyopathy and left heart failure.
Case Discussion
Left heart failure due to dilated cardiomyopathy was diagnosed on echocardiogram. Doberman Pinschers have a predisposition to DCM, making it the primary differential diagnosis. The Doberman heart shape is somewhat rectangular, and tends to get taller with DCM.
There is a cranioventral distribution to the pulmonary edema which can occur in long-standing cases where the fluid settles to the ventral portions of the lungs. The nodular opacities are caused by enlarged vessels and areas of interstitial to alveolar pattern.
The fissure lines are not widened making pleural effusion less likely. The lung lobe borders may be more visible than normal because of the increased density of the lungs.
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