Today’s case is a 6-year-old Doberman with a cough. See what you think and write your interpretation in the comments section.
6 year old Doberman
Teaching and learning about veterinary diagnostic imaging.
Teaching and learning about veterinary diagnostic imaging.
Today’s case is a 6-year-old Doberman with a cough. See what you think and write your interpretation in the comments section.
I’m on the large animal medicine rotation. It doesn’t seem like large animal people like me to open small animal radiographs in the large animal hospital..(:
Rad findings
1. Mixed pattern in the lung field (Alveolar pattern & interstitial pattern)
2. interlobar fissures on image #2 and #3
3. LA and LV enlargement
Rad Dx
1. Lung diseases with alveolar and interstitial patten
2. Pleural effusion
3. Left sided cardiomegaly
DDx
1. lung pattern
-infectious lung disease
-pulmonary edema
-neoplasia, hemorrhage -> lower possibility because of history, age and etc.
2. Cardiomegaly
-DCM (tentative)
-Mitral valvular insufficiency
This case may be easily thought as a cardiogenic pulmonary edema, but distribution of lung pattern is not typical for cardiogenic pulmonary edema (rather peripheral), so other lung diseases (infectious lung diseases, hemorrhage, neoplasia…) should be considered.
Dobbies have genetic predisposition for DCM, and the age of patient is kind of younger for MV insufficiency.
Need CBC, echocardiography, TTW or BAL.
There is a diffuse mixed interstitial-alveolar pattern.
On the right lateral view the LV+LA seem to be mildly enlagrged. On the VD view the LV seens to be a bit rounded, but in general the heart is in normal size.
On the lateral views there is an increased opacity cranial o the heart, might be associated with sternal lymphadenopathy.
The pulmonary vasculature is difficult to asses due to increased overall lung opacity, but it seems to be normal.
On the LL and the VD view there are fissure lines, which are probably associated with pleuritis.
Differential diagnoses include- pneumonia- viral, bacterial, fungal, allergic pneumonitis, diffuse pulmonary lymphosarcoma, hemmorhage.
A BAL or TTW with culture can aid in diagnosis.
CBC/chem and fungal serology
I agree with “an increased opacity cranial to the heart, might be associated with sternal lymphadenopathy” by vet74.
I would have only one differential – this looks like a typical DCM with left sided congestive cardiac failure.
– There is massive dilation of the left atrium with a prominent double density sign on the VD, while the rest of the heart is not very enlarged as is typically seen in these Doberman type DCMs (they sometimes present with atrial fibrillation instead of congestive heart failure because of this).
There is also evidence of:
– pulmonary venous congestion,
– diffuse increase interstitial pulmonary pattern,
– multifocal patchy alveolar pattern
– and peri-bronchial cuffing.
Even though the distribution is not the one described in textbooks for cardiogenic pulmonary edema, it is still commonly seen with these cases of slowly progressive cardiac failure in these DCM. The edema tends to involve also the ventral parts of the lungs and have a multifocal distribution, kind of what is seen in cats. Also note that on the VD, the pulmonary pattern is more severe on the right side: for some unknown reasons, it seems that when cardiogenic pulmonary edema is asymmetrical, it always is worse on the right side. There are also a few pleural fissure lines which are consistent with scant pleural effusion or pleural thickening.
CONCLUSION: DCM with mostly LA enlargement and cardiogenic alveolar/peribronchial pulmonary edema
Recommend Echocardiogram to assess severity, EKG to rule out FA and treat it, Lasix therapy.
Excellent reports! I agree, the pulmonary edema is atypically distributed and almost nodular in patern. I’ve seen this in long-standing cases or those that are resolving with treatment.
The pulmonary edema is also often more severe, or seen first, on the right side on the d/v projection. It may have to do with the venous pressure of the pulmonary veins as they reach the heart.
The answers to the case are now available for viewing.