Buddy
Labrador Retriever
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Radiographic Report
Radiographic interpretation: There is a reverse ‘D’ sign on the VD projection (right ventricular enlargement with main pulmonary artery enlargement) the apex of the heart is elevated on the lateral projection, and there is an increased width to the cardiac silhouette; these findings support right ventricular enlargement. The pulmonary arteries are grossly enlarged with dilation in the area of the pulmonary trunk at the 1 o’clock to 2 o’clock position on the ventrodorsal radiograph. A diffuse bronchointerstitial pattern is seen in the lungs, worst in the caudodorsal lung fields. The trachea is dorsally deviated within the thorax on the lateral views. No distinct mediastinal or pleural abnormalities are identified. No obvious abnormalities are seen in the cranial abdomen. The extrathoracic structures are otherwise unremarkable.
Radiographic diagnosis: The right-sided heart enlargement and dilated pulmonary arteries are compatible with advanced heartworm infection.
Clinical interpretation/additional case information: The parenchymal changes in the lungs support a diagnosis of heartworm-induced pneumonitis and likely explain the cough. The GI signs were believed to be a consequence of decreased GI perfusion and an anaphylactic response to acute worm death 10 days after adulticide. The dog was hospitalized and received supportive care for the pneumonitis (prednisone) as well as GI protectants. He was discharged on strict cage rest with continuation of the above therapies. He returned one month later and was hospitalized for the additional melarsomine injections, both of which were given after premedication with diphenhydramine and methadone.
Clinical History
Signalment: 4 year old M Labrador
Clinical history: Patient was presented with a complaint of cough. He came from a rescue organization in Texas and upon rescue was diagnosed as heartworm antigen positive. Two months previously he had been prescribed heartworm preventative (ivermectin) and a one month course of doxycycline. Ten days ago he received his first dose of melarsomine as adulticide therapy. Yesterday he developed diarrhea and vomiting and worsening cough was noted.
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