Heart failure

Case contributed by Allison L Zwingenberger
Diagnosis certain

Presentation

One episode of acute onset collapse. Inability to support himself on the hind limbs and disorientation.

Patient Data

Age: 11 years
Gender: Castrated male
Category: Domestic dog
Organism: Cavalier King Charles spaniel

Thorax

x-ray

There is severe generalized cardiomegaly with dorsal deviation of the trachea on the lateral projection. The cardiac enlargement and mild rotational position on the d/v has caused the cardiac apex to shift to the right. There is a severe alveolar pattern present within the right caudal lung lobe, as well as air bronchograms indicating a milder alveolar pattern in the left cranial and left caudal lung lobes. The pulmonary vasculature is difficult to assess due to overlying alveolar infiltrates. Within the viewable abdomen, there is a small amount of foreign material within the stomach.

Case Discussion

Left heart failure with asymmetric pulmonary edema. The severe generalized cardiomegaly is the main imaging sign. Differentials for this finding should include severe valvular disease or dilated cardiomyopathy. Alveolar pulmonary infiltrates are attributed to cardiogenic edema. Echocardiogram is recommended for further evaluation if clinically indicated.

Eccentric jets in dogs with mitral valve disease may cause asymmetric pulmonary edema in approximately 1/3 of cases, usually worse on the right side.

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