Small Animal Radiology and Ultrasound: A Diagnostic Atlas and Text

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Chapter Two The Thorax 151 Radiographic findings include right atrial dilation, which is radiographically apparent only if massive, and right ventricular enlargement (see Fig. 2-101). Hepatomegaly and pleural or abdominal effusion and persistent caudal vena caval dilation may be present if right heart failure occurs. Combinations of the above findings may be noted if both conditions coexist (Fig. 2-126). Echocardiographic findings of mitral insufficiency include marked left atrial dilation, left ventricular dilation, and mild left ventricular hypertrophy. Malformations may include displaced papillary muscles, abnormal chordae tendineae, and shortened and thickened valve leaflets. Prolapse of the valve leaflets (i.e., displacement of one or more valve leaflets into the atrium) may be seen. Fractional shortening is typically normal or increased but may be decreased late in the course of disease. 350,351 Carefully performed Doppler studies will confirm a diagnosis of mitral regurgitation. Because the regurgitant flow may be narrow or directed angularly into the left atrium, the study may require Doppler mapping (i.e., sampling at multiple locations throughout the atrium) unless color-flow studies are used to define the site of maximal regurgitation. The use of color Doppler readily confirms the diagnosis and requires a great deal less time to perform. 352 Further, the degree of regurgitation may be estimated with the color-flow study. Echocardiographic findings of tricuspid insufficiency include severe right atrial dilation and right ventricular enlargement. Abnormal papillary muscles, chordae tendineae, and valvular prolapse may be seen (Figs. 2-127 and 2-128). Positioning of the valves low in the ventricle away from the annulus may be seen in Ebstein’s anomaly. Doppler findings will be similar to those seen with mitral regurgitation. M I T R A L S T E N O S I S A N D T R I C U S P I D S T E N O S I S Stenosis of atrioventricular valves has been reported in the dog and cat but involvement of the tricuspid valve is very uncommon. 353-356 Radiographic abnormalities noted may include left atrial enlargement and possibly pulmonary venous congestion and pulmonary edema. Two-dimensional echocardiography may reveal incomplete diastolic leaflet separation, lack of leaflet closure in middiastole, and doming of the mitral valve. 356 Doppler studies will reveal an increased velocity of flow across the mitral valve with associated turbulence. Mitral insufficiency may be demonstrated also. P R I M A RY E N D O C A R D I A L F I B R O E L A S T O S I S Endocardial fibroelastosis has been reported in dogs, has also been reported in Siamese cats, and has been documented as a congenital anomaly in Burmese cats. 357-359 Radiographically, left heart enlargement or generalized cardiomegaly may be seen. Expected echocardiographic findings would include hyperechoic endocardium, dilation of the left atrium and ventricle, and decreased fractional shortening and possibly thickening of the mitral valve leaflets. C O M B I N E D A N D M I S C E L L A N E O U S C O N G E N I TA L D E F E C T S There have been several reports of animals with multiple congenital cardiac anomalies. 360-368 Their radiographic and echocardiographic appearance will reflect both the anatomical defects as well as their alterations in hemodynamics. ACQUIRED CARDIAC DISEASE AC Q U I R E D AT R I O V E N T R I C U L A R VA LV U L A R I N S U F F I C I E N C Y Insufficiency of the mitral or the tricuspid valve or both is seen frequently in older, mostly small-breed dogs and is usually the result of endocardiosis. An inherited predisposition to endocardiosis and mitral valve prolapse is present in Cavalier King Charles Spaniels. 369-372 Endocardiosis, also sometimes termed mucoid valvular degeneration and myxomatous transformation of the AV valves, is a degenerative process that results in thickened, shortened, nodular, and distorted valve leaflets. 373 Although it may affect any heart valve, the mitral and tricuspid valves are involved most commonly. A less common cause of valvular insufficiency is trauma to the heart resulting in disruption of part or all of the valve. 374,375
152 Small Animal Radiolo g y and Ultrasono graphy Fig. 2-126 A 3-month-old female mixed breed dog with an acute onset of respiratory distress. A grade 4/6 systolic murmur was detected on physical examination. The cardiac silhouette is markedly enlarged. A, On the lateral radiograph the caudal cardiac margin is straightened. The trachea is elevated. There is increased sternal contact and bulging of the cranial margin of the cardiac silhouette. B, On the ventrodorsal radiograph the cardiac silhouette is enlarged and the apex is rounded. The cardiac silhouette appears elongated. There is an alveolar pulmonary infiltrate in the right caudal lung lobe. The radiographic findings are indicative of congenital heart disease with left heart failure. Diagnosis: Congenital mitral and tricuspid insufficiency. A B
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SAUNDERS An Imprint of Elsevier Sci
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C H A P T E R O N E Introduction GE
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Chapter One Introduction 3 Fig. 1-1
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metal. Soft tissues or organs surro
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Chapter One Introduction 19 Fig. 1-
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26 Small Animal Radiolo g y and Ult
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A B C Fig. 2-63 A 10-year-old male
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202 Small Animal Radiolo g y and Ul
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Fig. 3-234 A 7-year-old female Brit
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Fig. 4-59 A 9-year-old female Russi
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Fig. 4-73 A 2-year-old female Saint
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Fig. 4-97 A 10-year-old male mixed
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Fig. 4-107 A 4-year-old male Chow C
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I N D E X A Abdomen, abnormal prese
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Index 729 Bone, cysts of, 525-527,
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Index 731 Ear, abscess of—cont’
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Index 733 Hydrocephalus—cont’d
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Index 735 Lungs. See also Pulmonary
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Index 737 Pregnancy, determination
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Index 739 S-shaped aortic deformity
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Small Animal Radiology and Ultrasound: A Diagnostic Atlas and Text

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