30
10
2008
3 month old Toy Poodle with lethargy
Posted by: Allison Zwingenberger, in Case of the DayToday’s case is a 3 month old Toy Poodle with lethargy. Have a look at the images and post your interpretation in the comments section! Answers will be available on Monday.
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October 30th, 2008 at 5:14 am
On both views the pulmonary vasculature is prominent. On the lateral view there is loss of the cranial waist of the heart which can indicate enlargement of the MPA or aorta, and the left atrium is enlarged.
On the VD view the MPA is prominent,, the right ventricle is rounded as well. The ascending aorta might be prominent as well, and the area of the L auricle is slightly rounded. On that view the pulmonary arteries are larger than the veins. PDA? or possibly reverse PDA?
October 30th, 2008 at 5:46 am
Enlarged pulmonary lobar arteries and veins, dilation of aorta, dilation of main pulmonary artery. Also appears to be mixed generalised lung change (if had to classify would call mixed alveolar/interstitial). These changes are characteristic of PDA, especially having enlargement of both the aorta and MPA.
It is a patent ductus arteriosus until proven otherwise. If it was a reverse PDA you would not have enlarged pulmonary vasculature.
November 2nd, 2008 at 1:58 pm
Generalised cardiomegaly with prominent proximal d. AO and PA. Big deviation of main stem-bronchi due to enlarged LA and auricle. Broncho-interstitial lung pattern due possible to pulmonary hypertension. Increased size of P. art and veins. Looks like PDA (not reversed)- also fits with the continoous murmur and breed predisposition. Prominent thymus on DV view (or DV?). Could be VSD but less likely?
November 2nd, 2008 at 7:17 pm
I have similar comments…
Enlarged pulmonary arteries and veins with the veins mildly greater in size than their corresponding arteries. Resulting in diffuse vascular pulmonary pattern. Enlarged cardiac silhouette. Left atrial (indicated by straightening of the caudal margin of the cardiac silhouette and bulge at 1-2 o’clock position on lateral projection and splaying of the mainstem bronchi on the DV view) and left ventricular enlargement. Dilated proximal aorta and MPA. Thymic sail sign on DV projection and decreased abdominal serosal detail, both consistent with young age of patient.
Rad Dx: Left to right shunt with pulmonary overcirculation, due to congenital cardiac defect. PDA most likely. No evidence of heart failure (cardiogenic pulmonary edema).
November 3rd, 2008 at 1:24 pm
Right. The key features in this case are the enlarged arteries and veins, enlarged left atrium and enlarged aorta/main pulmonary artery. Reverse PDA was mentioned as a possibility, but you are all correct that the vasculature would be small. In that case, the fetal high pressure arteries never transform into low pressure vessels, so the blood has to overcome very high pressure to enter the pulmonary arteries. This low blood volume makes both the arteries and veins look small.