4.5 month old German Shepherd

Comments

1. Charlierak says

   July 4, 2015 at 2:15 am

   The included abdominal has poor serosal detail with several loops of SI with gas. The pleural space cranial to the cranial lung lobes has increased inwardig soft tissue opacities and on DV view there is increased tissue opacity between the left and right cranial lung lobe. There is a increased pleural opacities with lung lobe retraction in the cranial thorax. There is a bulge on the cranial cardiac silhouette around the base of the heart as well as the large caudal vena cava confirmed on both views. The esohpahgus is filled with fluid. On the DV view, the aortic arch seems enlarged. The right cranial lung lobe has a doughnut sign, consistent with brochial pattern. The cranial and right caudal pulmonary artery dilated without change of shape. The right cardiac silhouette is increased.

   Findings
   Cardiomegaly with enlarged caudal vena cava, pulmonary arteries and enlarged aortic arch or MPA along with Heart murmur/ young age.
   Increased pleural space without any interpleural fissures.
   No pulmonary patterns except bronchial pattern at the right cranial lung lobe, seemingly incidental findings irrelevant with clinical symptoms.
   Decreased serosal detail – Pleural effussion or young age due to lack of fat tissue in the abdomen.

   DDX
   right side heart enlargement with pulmonic stenosis/aortic stenosis or PDA/
   Ultrasound should be done.

   Question – From the interpretation, I only formulated congenital anomaly and thought most likely DX would be a pulmonic stenosis with other possiblities. Are there any other clues that makes you think cor triatriatum dexter in this case or is it just common DDX for right side enlargement. Thanks again. This is really interesting.

   • Charlierak says

     July 4, 2015 at 4:40 am

     I know this is a rare case but just wonder how you can bring out that condition first in DDX list. That’s all hah.

2. Allison Zwingenberger says

   July 4, 2015 at 9:01 pm

   This one is unusual in that there were multiple congenital anomalies causing an enlarged heart. The classic appearance of cor triatriatum dexter is a normal sized heart, a murmur, and right heart failure with ascites. Those findings together would put it at the top of my differential list.

   • Charlierak says

     July 4, 2015 at 11:01 pm

     Thanks for your answer and sorry for bothering your sweet weekend!