Radiology Packet 5

Heart Failure

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.

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

6-year old MN DSH“Fatty Lumpkin”

• Hx: Presented for evaluation of lethargy and increased respiratory rate

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

14-year old domestic long hair cat“Monty”

• Hx: Presented with dyspnea and lethargy.

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

2-year old MN Angora feline“Trooper”

• Hx: Presented for evaluation of tachypnea and dyspnea.

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

10-year old male miniature poodle

• Pre-treatment • Post-treatment

Post-treatmentPre-treatment

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.

6-year old Doberman “Sarge”

• Hx: is easily stressed and has trouble breathing

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

16-year old dog “Peter”

• Hx: Presented for lethargy. Has a severe systolic heart murmur.

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.

7-year old MN Golden Retriever“Bud”

• Hx: Presented for evaluation of lethargy, abdominal distension and increased respiratory rate.

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