Veterinary Ultrasound Society

11-week-old Shih Tzu

Progressive vomiting, diarrhea, anorexia, and lethargy for the past 36 hours

  • Purchased from a pet shop 5 days prior to presentation.
  • Owners are reporting progressive vomiting, diarrhea, anorexia, and lethargy for the past 36 hours.
  • The dog is up-to-date on vaccines and has received Panacur (fenbendazole).
  • On physical examination the dog was severely dehydrated and hypotensive.
  • The dog was also hypoglycemic, hypochloremic, hyponatremic and had a temperature of 99.9°F.


Abdominal ultrasound was pursued in order to evaluate for an intussusception.

Multiple loops of small intestine are moderately fluid filled. Echoes within the fluid often settle to the dependent wall of the small intestines, consistent with hypomotility. Some segments of small intestine are corrugated. Many small intestinal walls have thin mucosa layers but prominent/thick submucosal layers. A few lymph nodes around the small intestines are rounded and perhaps mildly hypoechoic.

Moderate to severe diffuse enteropathy. The differential diagnosis includes infectious and toxic enteritis with functional ileus. Based on the history and the appearance of the small intestinal walls, mucosal sloughing and submucosal edema secondary to parvovirus enteritis must be considered.

The dog tested strongly positive for parvovirus on snap test. The puppy was hospitalized for 4 days. Despite some initial improvements in appetite and energy, the puppy deteriorated and was euthanized because of refractory hypoglycemia and refractory hypotension (concern for sepsis).

Mucosal sloughing and submucosal edema is seen in parvovirus enteritis as well as other severe toxic or infectious enteritis. Lymphadenomegaly is minimal to none and this is thought to be related to severe cortical depletion of lymphocytes. The lymph nodes in this patient could be normal for the young age of the dog.

Gladwin, NE, Penninck, DG, Webster, CRL. Ultrasonographic evaluation of the thickness of the wall layers in the intestinal tract of dogs. Am J Vet Res 2014;75:349–353.