Presentation
Intermittent cough since adopted from shelter. Coughing more frequent with production of foamy material/small amount of blood.
Patient Data
There is moderate right sided heart enlargement with a prominent pulmonary artery bulge visible on the DV projection. There is moderate pulmonary arterial enlargement with the right caudal pulmonary artery being grossly enlarged and blunted. A patchy interstitial to alveolar pattern is present throughout all lung fields, primarily peribronchial in distribution. It is worse in the right caudodorsal lung fields. Incidentally there is a metallic BB within the soft tissues of the right dorsal thorax. These findings are consistent with heartworm disease and pneumonitis.
The right ventricle is enlarged, occupying 3/4 of the cardiac silhouette on the lateral (image 1)
The main pulmonary artery is enlarged on the v/d (image 2)
Pulmonary arteries are enlarged compared to veins on both views (images 3 and 4)
Case Discussion
Echocardiography showed right ventricle hypertrophy and dilation, mild pulmonic insufficiency, and worms in the main pulmonary artery and right pulmonary artery branch. A blood sample showed severe microfilaremia. All findings were consistent with active heartworm disease.
Heartworm disease causes obstruction in the outflow tract to the pulmonary arteries, resulting in concentric hypertrophy of the right ventricle. The pulmonary arteries are affected by thrombosis from the worm antigen, causing enlargement and inflammation in the surrounding lung tissue. Both heart and pulmonary changes can be seen.
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