RADIOGRAPHIC EVALUATION OF CANINE HEARTWORM DISEASE COEXISTING WITH RIGHT HEART FAILURE

Thoracic radiographs of 28 dogs with heartworm disease and right heart failure were evaluated subjectively and objectively. Radiographs of all dogs were abnormal. Abnormalities were consistent with those previously reported for heartworm disease but were more severe than those identified in another group of heartworm dogs that did not have right heart failure. The right ventricle and right caudal labor pulmonary artery were enlarged in every dog. The main pulmonary artery, right cranial lobar pulmonary artery, and caudal vena cava were enlarged in 24, 25, and 17 dogs, respectively. Radiographically apparent pathologic pulmonary conditions were present in 25 dogs. Pleural effusion was not identified.     

THORACIC RADIOGRAPHIC ABNORMALITIES IN 200 DOGS WITH SPONTANEOUS HEARTWORM INFESTATION

Thoracic radiographs of 200 dogs with spontaneously occurring heartworm disease were reviewed. Radiographs of 28 dogs (14%) were normal. In the remaining 172 dogs various combinations of cardiopulmonary abnormalties were found. The most frequently observed combination, noted in 61 of 200 dogs, was right ventricular, main pulmonary, and right cranial lobar pulmonary artery enlargemetn. Dogs with severe increse of one parameter generally had severe increase of the other two parameters also. One hundred five of the 200 dogs had a right cranial lobar pulmonary artery of normal size. Thus, right cranial lobar pulmonary artery size, when normal, is not a sensitive indicator of the absence of heartworm disease. There was a statistically significant positive relation between the size of the caudal vena cava and that of the right ventricle.     

Heartworm disease in dogs: unusual clinical cases

Two unusual cases of heartworm infection are described, including one of spontaneous rupture of cardiac chambers, most likely due to the progressive increase in pressure within the right ventricle caused by Dirofilaria immitis infection. Another case report describes persistent left cranial vena cava, which interfered with the surgical removal of heartworm via the left jugular vein.     

Chylothorax associated with dirofilariasis in a cat

A 4-year-old castrated domestic shorthair cat was referred for treatment of chylothorax. Thoracic duct lymphangiography revealed partial obstruction of the cranial vena cava, as evidenced by filling of mediastinal lymphatics with dye instead of all of the dye entering the vena cava. The thoracic duct was ligated via left 10th intercostal space thoracotomy. Immediate postligation lymphangiography revealed successful duct ligation. Results of a serum ELISA for adult heartworm antigen that was performed before surgery were positive. Drug treatment for the heartworm disease was not recommended, because the pleural effusion had ceased (as determined by radiographic examination 3.5 and 9 months after surgery) and the cat was doing well clinically. Sixteen months after surgery, the owner reported that the cat was doing well and did not have signs of respiratory problems.     

Management of cor triatriatum dexter by balloon dilatation in three dogs

Two dogs, one immature and one adult, were presented with a history of progressive ascites. In a third, immature dog, increasing exercise intolerance had been noted. Echocardiography demonstrated a partition in the right atrium (cor triatriatum dexter) and echocontrast studies documented normal flow from the cranial vena cava into the right atrium and ventricle. A saphenous vein contrast study demonstrated flow from the caudal vena cava into an accessory right atrial chamber (sinus venarum). The sinus venarum communicated with the true right atrium via a small defect in the atrial membrane in one dog, and additionally with the left atrium via a right-to-left shunting foramen ovale in the other dogs. All defects were visualised on angiographic studies by selective catheterisation of the caudal vena cava via the femoral vein. Balloon dilatation of the defect was then performed using a small followed by a larger balloon angioplasty catheter to enlarge the defect in the atrial membrane. Clinical signs improved within days and were sustained in the long-term in all cases.     

Cor triatriatum dexter of unusual morphology in a miniature schnauzer

A five-year-nine-month-old, male entire, miniature schnauzer presented for further investigation of pleural effusion. Echocardiography revealed a perforated membrane dividing the right atrium into two chambers: the true right atrium (a small, lower-pressure, cranioventral chamber communicating with the tricuspid valve and right ventricle) and the accessory right atrium (a larger, higher-pressure, caudodorsal chamber), consistent with a cor triatriatum dexter. This was confirmed using computed tomography angiography. Imaging studies revealed that both the cranial and caudal vena cava entered the higher-pressure accessory right atrium and the coronary sinus entered both the accessory and true right atrial chambers. This differed from the more usual canine cor triatriatum dexter presentation with the cranial vena cava entering the lower-pressure cranial chamber and the caudal vena cava entering the higher-pressure caudal chamber. Balloon membranostomy was successful in reducing the pressure gradient between the two right atrial chambers with subsequent resolution of the clinical signs. The patient continues to do well after three-years of follow-up.     

Catheter-guided percutaneous heartworm removal using a nitinol basket in dogs with caval syndrome

Carval syndrome is a severe heartworm infection where the worms have migrated to the right atrium and vena cava; this condition is associated with a myriad of clinical signs. Several non-surgical and interventional methods are currently used for mechanical worm removal. However, the success rate and complications related to these methods are heavily dependent on methodology and retrieval devices used. In this study, we developed a catheter-guided heartworm removal method using a retrieval basket that can easily access pulmonary arteries and increase the number of worms removed per procedure. With this technique, we successfully treated four dogs with caval syndrome.     

Atrial Septal Defect in a Ferret (Mustela putorius furo)

A 2-year-old, male castrated ferret (Mustela putorius furo) was presented with progressive abdominal distention and loss of muscle mass despite normal appetite. Physical examination findings included pale mucous membranes, a prolonged capillary refill time, a pulse rate greater than 300 beats/min, and severe abdominal distention. Abdominal ultrasound showed free abdominal fluid and an enlarged liver with distended hepatic veins and caudal vena cava. During the echocardiographic examination, abnormalities observed included a 2-mm-diameter left-to-right shunting atrial septal defect (ASD) with concurrent severe dilatation of the right atrium and eccentric hypertrophy of the right ventricle with mild pulmonary hypertension. All other echocardiographic measurements were within normal limits. The owner declined treatment, and the ferret was euthanized. Postmortem examination confirmed the ultrasonographic findings. The free abdominal fluid (200 mL) was a non-septic fibropurulent exudate. Decompensated right-sided heart failure due to ASD and exudative peritonitis of undetermined origin were the final diagnoses. To our knowledge, this is the first report of an ASD in a ferret.     

Complex cardiac congenital defects in an adult dog: An ultrasonographic and magnetic resonance imaging study

This article describes a complex and not previously reported combination of congenital cardiac defects. Echocardiography showed dilation of right and left chambers, accompanied with patent ductus arteriosus, persistence of the left cranial vena cava, atrial septal defect (ASD), subaortic stenosis, and tricuspid dysplasia. The interatrial wall was examined and the diameter of the ASD was measured by magnetic resonance imaging (MRI).     

Multiple cardiac anomalies in a cat.

A 7-week-old domestic shorthair cat was examined because of congestive heart failure. Echocardiography and angiography were used to identify multiple cardiac anomalies. Because of the uncorrectable nature of the defects, the cat was euthanatized. Necropsy revealed persistent left vena cava, patent foramen ovale, and a right atrial/left ventricular canal. The right atrioventricular valve was replaced by a small ostium, and no chordae tendinae or papillary muscles were observed around the ostium. The pulmonary trunk originated from the right atrium. The right ventricular free wall was approximately 1 mm thick.     

Pulmonary artery dissection causing haemothorax in a cat: potential role of Dirofilaria immitis infection and literature review

A 7-year-old male castrated domestic short-haired cat suddenly died. Gross examination revealed severe right-sided haemothorax with blood clots, four adult filarial nematodes in the blood clots and the caudal vena cava and haemorrhage dissecting into the tunica media of the right pulmonary artery. Histopathological investigation showed fibrosis of the tunica intima and disorganization/fragmentation of the elastic fibres accompanied by fibrous tissue deposition in the tunica media of both branches of pulmonary artery. Degenerative vasculopathy (intimal fibromuscular hyperplasia and medial hypertrophy/hyperplasia) involving pulmonary arteries was also observed. The polymerase chain reaction amplification and sequencing confirmed the identification of the parasite as Dirofilaria immitis. A diagnosis of pulmonary artery dissection with haemothorax and concomitant heartworm disease was formulated. Degenerative processes of the tunica media have been reported to cause pulmonary artery dissection in both humans and animals. Pulmonary artery remodelling induced by heartworms may be considered the underlying cause in the first case of feline pulmonary artery dissection, herein described.     

Double-outlet right ventricle with an intact interventricular septum and concurrent hypoplastic left ventricle in a calf

A 3-day-old Hereford heifer calf presented for evaluation of lethargy and dyspnea, with persistent hypoxia despite supplemental oxygen therapy. A grade III/VI right apical systolic murmur was noted during cardiac auscultation. Echocardiography revealed a double-outlet right ventricle with an intact interventricular septum and concurrent hypoplastic left ventricle and tricuspid valve dysplasia. Post-mortem examination revealed additional congenital anomalies of ductus arteriosus, patent foramen ovale, and persistent left cranial vena cava. This report illustrates the use of echocardiographic images to diagnose a double-outlet right ventricle with an intact interventricular septum and a hypoplastic left ventricle in a calf.     

An investigation of the role of immunologic factors in anemia associated with canine heartworm disease

Direct Coombs' antiglobulin tests were performed on 80 dogs with patent Dirofilaria immitis infection and 170 dogs negative for microfilaria of D. immitis. Presence or absence of anemia was determined by hematocrit in 55 of the heartworm negative dogs and 68 of the dogs with heartworm disease. Heartworm infected dogs showed a higher incidence (37%) of anemia than noninfected dogs (14.5%). Anemia was most prevalent in two groups of dogs with heartworm infection, one group showing vena caval syndrome (91%) and the other occult dirofilariasis (62.5%). These latter two groups of dogs also showed a significantly higher number of positive Coombs' reactions at 37 degrees C than other dogs with heartworm disease and the noninfected dogs. The number of positive Coombs' reactions at 4 degrees C among the total of 80 dogs with heartworm infection was significantly higher than that for dogs without heartworm disease. However, there was no positive correlation between anemia and the outcome of the Coombs' test at either temperature. These findings do not suggest that immunologic factors play a major role in the pathogenesis of anemia in dogs with heartworm disease.     

49-month survival following caval venectomy without nephrectomy in a dog with a pheochromocytoma

An 11 yr old spayed female Labrador retriever was diagnosed with a right adrenal tumor. At surgery, adhesions to the right kidney were dissected, allowing the right kidney to be preserved. The tumor showed extensive invasion into the suprarenal vena cava. It was felt that thrombus removal via venotomy could not be performed. Instead, the vena cava was ligated caudal to the liver and cranial to the right renal vein. The neoplastic gland was then excised en bloc together with the portion of the invaded caudal vena cava. Hind limb edema had developed preoperatively and increased transiently in the first days postoperatively. The animal was discharged 6 days postoperatively with no other clinical disorders, and hind limb edema resolved over time. Histopathology identified a pheochromocytoma. The dog died 49 mo later. A neoplastic thrombus of the vena cava may require venotomy to allow thrombus removal. Occasionally, removal of the thrombus by venotomy may prove impossible. In such a situation, en bloc removal of the concerned portion of the vena cava may be performed with a good long-term outcome provided that gradual occlusion of the vena cava by the thrombus has allowed time for collateral circulation to develop.     

Partial anomalous pulmonary venous connection in a dog

A 2-year-old male intact Belgian Malinois was presented for exercise intolerance. A grade III/VI left basilar systolic murmur was detected. Echocardiography revealed moderate right atrial and ventricular dilation and increased pulmonic outflow velocity. Thoracic radiographs showed right heart enlargement and a dilated caudal vena cava. In addition, on the left lateral projection, an enlarged aberrant right cranial pulmonary lobar vein was suspected to be diverging ventrally from the course of the right cranial lobar bronchus and inserting more ventrally than normal in the region of the right atrium. A left-to-right pulmonary vascular shunt was suspected, and the patient underwent further diagnostics under general anesthesia. An agitated saline study was positive, suggestive of a concurrent right to left shunt. A right heart catheterization was performed. Angiography was inconclusive. Oximetry testing revealed an increase in oxygen saturation within the right atrium at the level of the caudal cava supportive of a left-to-right shunt in this region. Computed tomography angiography revealed a large single pulmonary vein that anomalously entered into the caudolateral aspect of the right atrium (left-to-right shunt) and was suspicious for a small arteriovenous malformation between the right caudal pulmonary artery and the right pulmonary vein returning to the left atrium (right to left shunt). The patient was diagnosed with a partial anomalous pulmonary venous connection and a possible arteriovenous malformation.     

Ultrasonographic measurement of caudal vena cava to aorta ratios for determination of volume depletion in normal beagle dogs

A noninvasive method for quantifying hydration status would be helpful for clinical management and for research applications in dogs. This prospective, experimental, pilot study aimed to assess the feasibility of ultrasonographic measurement of the caudal vena cava to aorta ratio as a method for quantifying volume depletion in dogs. In 12 normal beagle dogs, furosemide was administered intravenously at a dose of 1 mg/kg, every 2 h, for 8 h, to induce consecutive volume depletion. Every 30 min after administration, ultrasonographic images of the caudal vena cava and aorta, and physical and biological parameters related to dehydration were acquired. On transverse and longitudinal planes of caudal vena cava and aorta images, the height and area of the caudal vena cava and aorta were measured to calculate the caudal vena cava/aorta ratios. All images were acquired by approaching from the right intercostal space with the dogs in left lateral recumbency. A negative correlation was present between the percentage of weight loss in dogs and all four investigated caudal vena cava/aorta ratios (transverse plane width of the caudal vena cava [TW]/aorta; transverse plane height of caudal vena cava [TH]/aorta; longitudinal plane area of the caudal vena cava [TA]/aorta; and longitudinal plane maximal height of the caudal vena cava [L]/aorta). Significant differences (P < 0.001) were seen between dogs with and without clinical signs of dehydration for all caudal vena cava/aorta ratios. Findings indicated that ultrasonographic caudal vena cava/aorta ratios are feasible methods for quantifying volume depletion and for use as an adjunct to standard subjective methods for estimating hydration status in dogs.     

Caudal vena cava kinking in dogs with ascites

A 9-year-old dog with spontaneous ascites was found to have hepatic vein distension and a tortuous vena cava on abdominal ultrasound. In right lateral recumbency, the caudal vena cava crossed the diaphragm and became kinked before entering into the right atrium. Following this observation, we performed an experimental study in a normal dog to determine whether kinking of the caudal vena cava could be the result and not the cause of ascites. Ascites was induced using warm saline injected through a needle inserted into the abdominal cavity. Venograms were collected from different body positions, under four conditions: before and after a total of one, two and 3 liters of saline had been injected. Caudal vena cava kinking was observed in the experimental dog after 2 liters of fluid had been injected. Vena cava obstruction may cause ascites, but we found that sometimes caudal vena cava kinking can be the result and not the cause of the peritoneal effusion.     

ADRENAL NEOPLASIA IN SEVEN FERRETS

Medical records from 7 ferrets presented to the VMTH with histologically confirmed adrenal neoplasia were reviewed. Three neutered female ferrets had adrenal cortical adenoma; four ferrets (2 neutered females, 2 neutered males) had adrenal cortical carcinoma. Ultrasound identified unilateral enlargement or abnormal shape of the adrenal gland in all ferrets. Only 1 ferret had adrenomegaly on abdominal radiographs. Adrenomegaly was identified in 1 ferret by magnetic resonance imaging (MRI). All ferrets were treated by adrenalectomy followed by a tapered dose of prednisone. Surgical complications were limited to fatal hemorrhage from the caudal vena cava in 1 ferret. Remission of clinical signs occurred in all 6 ferrets which survived surgery. The time of follow up varied from 3 to 16 months. The 3 ferrets with adrenal adenomas were still alive 3 to 7 months after surgery. AH 3 ferrets with adrenal carcinoma developed metastasis and were euthanized from 2 to 16 months after surgery.     

Diagnosis by ultrasonography of congestion of the caudal vena cava secondary to thrombosis in 12 cows

This paper describes the clinical, ultrasonographic, radiographic and postmortem findings in 12 cows with thrombosis of the caudal vena cava. The principal clinical signs were chronic bronchopneumonia and fever in 11 cows; one cow had epistaxis and one cow bled from the mouth; eight cows had anaemia and leucocytosis, and the clotting time for the glutaraldehyde test was markedly decreased in all the cows; in nine of the cows the activity of gamma-glutamyltransferase was high, suggesting chronic hepatic congestion. The most important ultrasonographic finding was congestion of the caudal vena cava attributable to thrombosis of the vein. In all the cows the caudal vena cava was round to oval on cross-section, rather than the normal triangular shape. The hepatic, splenic and portal veins were dilated in five, three and one cow, respectively. The results of radiography and endoscopy supported a diagnosis of bronchopneumonia, but there were radiographic changes in the diaphragmatic lung lobes that supported a diagnosis of vena caval disease in only four cows. Postmortem there was a thrombosis of the caudal vena cava in all the cows, and the thrombi were located in the thoracic, subphrenic and abdominal part of the caudal vena cava at the level of the liver in four, one and seven cows, respectively. In three cows, the thrombus was situated where a hepatic abscess had broken into the caudal vena cava, and in one cow it was at the site of a diaphragmatic abscess. In another cow, there was a fistula between the major bronchus of the right diaphragmatic lung lobe and the caudal vena cava where the thrombus was situated. Three cows had liver abscesses that had not broken into the caudal vena cava. There was severe bronchopneumonia in 11 of the cows, some of which also had multiple pulmonary abscesses.     

RADIOGRAPHIC AND ANGIOGRAPHIC EVALUATIONS OF FERRETS EXPERIMENTALLY INFECTED WITH DIROFILARIA IMMITIS

Five ferrets of each sex were each inoculated with 15 third-stage infective larvae of Dirofilaria immitis to study radiographic and angiographic changes in the cardiopulmonary system following heartworm infection; 5 additional ferrets of each sex served as noninfected controls. Prior to inoculation and every 8 weeks thereafter until 40 weeks, the infected and noninfected ferrets were radiographed; angiographic examinations were done prior to necropsy. At necropsy, the worms in the heart, lungs, and associated vessels were counted, and lung histosections were prepared and examined for changes. Radiographic changes were seen in the right side of the heart and associated vessels of infected ferrets as compared with the noninfected ferrets, but changes were less prominent than those seen in heartworm-infected dogs and cats. The changes were primarily an increase in the size of the right side of the heart, especially the right atrium. Radiographically, no changes could be visualized in the pulmonary vascular system. Worms in the enlarged cranial vena cava, azygous vein, and left caudal lobar pulmonary artery of infected animals were delineated by angiography. Histologically, no changes were seen in the pulmonary vascular tissues.