Case of the week 7.6.20
Publication Date: 2020-07-06
4 images
Diagnosis
There is markedly increased height of the cardiac silhouette on the lateral views, resulting in dorsal displacement of the caudal intrathoracic trachea. There is marked widening of the cardiac waist on the lateral views. On the VD and DV views there is marked generalized rounded enlargement of the cardiac silhouette, so that it occupies the entire width of the thoracic cavity.
The pulmonary vessels are considered normal. The caudal vena cava is slightly enlarged. There is dorsal deviation and narrowing of the caudal mainstem bronchi. There is a mild bronchial pattern more so affecting the caudal lung lobes. There is diffuse mild gas dilation of the esophagus.
The liver is diffusely mildly enlarged. There is an incidental finding of fractured osteophyte versus incomplete center of ossification of what of the shoulders.
Discussion
Severe generalized cardiomegaly is indicative of heart disease, such as hypertrophic cardiomyopathy or dilated cardiomyopathy (given the severe generalized enlargement). The severe cardiomegaly is resulting in compression/partial collapse of the mainstem bronchi which could be contributing to the patient’s cough. The pulmonary pattern is considered likely due to chronic lower airway inflammatory disease, however, peribronchial cuffing from early left-sided heart failure cannot be ruled out. The increased size of the caudal vena cava with concurrent hepatomegaly may represent incidental normal variant or benign etiologies, however, early right sided cardiac decompensation with congestion cannot be ruled out. An echocardiogram is recommended for further evaluation.
Notes
On echocardiography the patient was diagnosed with end-stage hyperetrophic cardiomyopathy.
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