An 8-year-old NM DLH was presented for evaluation of intermittent vomiting, anorexia, and lethargy. Urinalysis, CBC, and abdominal radiographs were unremarkable. Abnormalities Altered on serum biochemistry were elevated CK (3262) and azotemia. Survey thoracic radiographs showed mild increase in the cardiac silhouette and a mild diffuse broncho-interstitial pattern.
An 8-year-old NM DLH was presented for evaluation of intermittent vomiting, anorexia, and lethargy. Urinalysis, CBC, and abdominal radiographs were unremarkable. Abnormalities Altered on serum biochemistry were elevated CK (3262) and azotemia. Survey thoracic radiographs showed mild increase in the cardiac silhouette and a mild diffuse broncho-interstitial pattern.
15-00147 Roux M Unclassified cardiomyopathy, MI, TI—NO IMAGES–
History
Clinical Differential Diagnosis
Pre-renal azotemia – dehydration, cardiac disease GIT – non-specific enteritis (viral/bacterial/helminths/protozoal/dietary indiscretion, toxins), foreign body, dietary hypersensitivity, IBD, neoplasia Pancreas – pancreatitis, neoplasia Heart – cardiomyopathy (dilated/hypertrophic/restrictive) Hyperthyroidism
DX
Unclassified cardiomyopathy w/ mitral and tricuspid insufficiency. Moderate left atrial enlargement.
Sampling
None
Sonographic Differential Diagnosis
Unclassified cardiomyopathy with mitral and tricuspid insufficiency. Moderate left atrial enlargement. It is recommended to primarily treat the heart. Ace inhibitor therapy should be considered as well as low dose Lasix at 6.25 mg s.i.d., ace inhibitor at 0.25-0.5 mg/kg. A recheck echocardiogram is recommended in one month. The gastrointestinal presentation is likely owing to low grade inflammatory bowel. Past history of pancreatitis may be an issue; however, it does not appear to be the primary issue at this time. Given the excessive gallbladder debris Ursodiol therapy can be considered. Blood pressure should be monitored.
Image Interpretation
The left atrium was moderately enlarged. The mitral valve was mildly thickened. Mitral valve insufficiency was noted with turbulence at the left ventricular outflow tract and aortic valve. Mitral insufficiency was noted on color flow Doppler. The left ventricle presented normal free wall and septal thicknesses with some areas of hyperechoic remodeling. The myocardium presented normal echogenicity without evidence of significant fibrotic or ischemic disease. Contractility of the ventricular walls was adequate and in normal range for this patient evidenced by the fractional shortening measurement. Subjective assessment of the right atrium and auricle revealed normal size, structure and content. No evidence of masses was noted. Tricuspid valve revealed insufficiency. The right ventricle was of normal size (1/3 diameter of LV), chordae structure, myocardial echogenicity and thickness. No evidence of dilation nor restriction was noted. Minor pulmonic insufficiency was also noted even though the structure appeared unremarkable. No visible pericardial or free pleura fluid was noted. No echographically detectable evidence of infiltrative disease was visible. The mediastinum was free of masses in the visible window. The diaphragm was visualized without interruption. Mitral insufficiency 5.0 m/sec. Aortic insufficiency 6.0 m/sec. Tricuspid insufficiency 2.0 m/sec.
Outcome
No further outcome at this time.
Patient Information
Age : 8 Years
Gender : Male, Neutered
Species : Feline
Status : For Review
Blood Chemistry
- Azotemia
- CPK, High
Clinical Signs
- Anorexia
- Lethargy
- Vomiting