9-year-old female Mixed Breed
Presented for seizures. Was febrile at the time of admission.
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- Heartworm infection, or less likely pulmonary hypertension. Possible abdominal mass and/or peritoneal fluid and functional or mechanical ileus.
- Heartworm testing, echocardiogram with Doppler evaluation of the pulmonic and tricuspid valves to assess pulmonary artery pressure if heartworm testing was negative. Abdominal radiographs +/- abdominal US to further characterize the abdominal changes. (Final diagnosis via necropsy was heartworm infection, large uterine cyst, uterine leiomyoma, secondary moderate volume peritoneal effusion, seizure secondary to presumptive heat stroke)
- Candidates received points for: Describing enlargement of the main pulmonary artery segment on the vd view. Identifying enlarged peripheral pulmonary arteries and describing the tortuous appearance of the vessels with mild perivascular interstitial opacity evident on the lateral view in the caudal dorsal lung fields. Characterizing the cardiac silhouette as normal or showing evidence of mild right sided cardiac enlargement. Describing mildly dilated gas filled loops of bowel in the cranial abdomen, reduced serosal detail and abdominal distension.
- This was a discriminating question and some candidates did not recognize enlarged peripheral pulmonary arteries or the enlarged MPA, or described the enlarged MPA but concluding the prominence was secondary to positioning artifact. Candidates who performed poorly mistakenly concluded the large nipple shadows present overlaying the lung in this patient were pulmonary nodules secondary to neoplasia or granulomatous disease. Most candidates recognized and were concerned about possible significant abdominal changes and appropriately recommended abdominal radiographs.