Radiology Packet 5

1. Radiology Packet 5 Heart Failure

2. 8 year Schipperke “Robbie” • Hx: Has a history of coughing and lethargy. A very loud systolic murmur is present, loudest over the apex of the heart on the left.

4. 8 year Schipperke “Robbie” • RF • Heart is too tall and too wide. • Straightening of the caudal cardiac waist, lateral deviation of the right caudal mainstem bronchus on the DV view and increased opacity of the hilar region on DV. • Enlarged right cranial lobar pulmonary vein relative to the artery. • Consolidating infiltrates are present in the right and left caudal lungs centrally, while the periphery (caudal dorsal) is an interstitial infiltrate. Air bronchograms are noted in consolidated regions (Alveolar pattern). • RD • Cardiogenic pulmonary edema • Chronic left heart failure secondary to mitral valve insufficiency

5. 6-year old MN DSH“Fatty Lumpkin” • Hx: Presented for evaluation of lethargy and increased respiratory rate

7. 6-year old MN DSH“Fatty Lumpkin” • RF • Cardiac silhouette is partially obscured by increased opacity within the thoracic cavity. • The atrial region of the heart appears wide. • The trachea is elevated. • Retraction of the lung lobes from the thoracic wall. • Mild pulmonary vascular congestion is present as well as free pleural fluid (hard to see). • RD • Hypertrophic cardiomyopathy • Congestive heart failure

8. 14-year old domestic long hair cat“Monty” • Hx: Presented with dyspnea and lethargy.

10. 14-year old domestic long hair cat“Monty” • RF • Greatly enlarged cardiac silhouette. • Increased craniocaudal dimension • Elevated trachea • Increased sternal and diaphragmatic contact • Increased width on the DV view • Upward deviation of the caudal vena cava toward the heart • Markedly enlarged pulmonary vessels. • Mild loss of vascular margin clarity. • RD • Cardiomegaly and pulmonary congestion, mild pulmonary edema • R/O • Hypertrophic and dilatative cardiomyopathy • Pericardial effusion • Next: Cardiac ultrasound

11. 2-year old MN Angora feline“Trooper” • Hx: Presented for evaluation of tachypnea and dyspnea.

13. 2-year old MN Angora feline“Trooper” • RF • Cardiac silhouette reveals a somewhat “square” appearance to the cranial cardiac margin. • In the VD view the atrial region of the heart appears very wide, the ventricular region is obscured by superimposed opacity. • Pulmonary vessels are at the upper limits of normal. • Interstitial to alveolar lung pattern distributed in the perihilar region and ventral lung fields. • In the VD views the pulmonary changes appear to be present in the caudal lung lobes. • RD • Hypertrophic cardiomyopathy • Cardiogenic pulmonary edema • R/O • Left-sided congestive heart failure

14. 10-year old male miniature poodle • Pre-treatment • Post-treatment

15. Pre-treatment Post-treatment

16. 2-year old MN Angora feline“Trooper” • RF • Cardiac silhouette is too tall and too wide, with increased contact and elevation of the trachea. • Left atrial enlargement, noted as loss of the caudal cardiac waist and increased soft tissue opacity. • A heavy interstitial to alveolar pulmonary infiltrate is present, with the cranial lobes less affected. Thin pleural fissure lines are noted on the DV film, indicating subpleural fluid accumulation. • The cranial lobar vessels on the lateral radiograph are prominent. • RD • Congestive heart failure with severe pulmonary edema • Next: Immediate therapy with a diuretic to lessen the pulmonary edema.

17. 6-year old Doberman “Sarge” • Hx: is easily stressed and has trouble breathing

19. 6-year old Doberman “Sarge” • RF • Elevated trachea. • Heart at upper limits for craniocaudal width. Too wide. • Increased cardiophrenic and cardiosternal contact. • Partial loss of visualization of the pulmonary vessels (interstitial infiltrate). • Accentuation of some of the bronchi/bronchioles due to interstitial infiltrate. • Thin pleural fissure line over the heart, large caudal vena cava • Lobar border noted between the right middle and caudal lung lobe. • RD • Cardiomegaly and cardiogenic pulmonary edema • Next: Echocardiogram

20. 16-year old dog “Peter” • Hx: Presented for lethargy. Has a severe systolic heart murmur.

22. 16-year old dog “Peter” • RF • Tracheal elevation • Increased cardiophrenic and cardiosternal contact • Loss of the caudal cardiac waist • Increased soft tissue opacity between the mainstem bronchi on the DV film. • Large caudal vena cava. • Distended abdomen. • Incidental is a mild sternal anomaly (S7-8). • RD • Marked generalized cardiomegaly • Large CVC and impression of abdominal fluid suggest right heart failure • R/O • Right heart failure • Severe RAV and LAV endocardiosis and insufficiency. • Infectious vegetative valvular disease.

23. 7-year old MN Golden Retriever“Bud” • Hx: Presented for evaluation of lethargy, abdominal distension and increased respiratory rate.

25. 7-year old MN Golden Retriever“Bud” • RF • Increased opacity throughout the thoracic cavity obscures evaluation of the heart and diaphragm. • In the VD view the lung lobes are separated from the internal surface of the thoracic wall by a band of soft tissue opacity. • The lungs are retracted from the ventral thoracic cavity in the lateral view. • There is an overall increase in opacity of the lung fields due to superimposition of the free pleural fluid. • An air bronchogram is visible in the region of the right middle lung lobe. • Increased size of the liver +/- the presence of free abdominal fluid is suspected. • RD • Large volume of free pleural fluid • R/O • Cardiovascular disease • Mediastinal mass • Other neoplastic disease of the thoracic cavity • Hepatic disease • Next: Echocardiogram, Thoracic ultrasound