There's no better way to continue to expand your knowledge of cardiology then to spend time with talented cardiologists. This week I am thrilled to spend time with the cardiology team at NC State College of Veterinary Medicine. NC state has an impressive cardiology program, with 6 board-certified cardiologists, 3 residents, and a talented support staff of technicians and research assistants. Their cardiology department is renown for their innovation in interventional cardiology and genetics of heart disease. This week I've been able to participate in rounds and case workups, watch numerous echocardiograms, and observe special procedures such as balloon dilation of congenital pulmonary valvular stenosis. Meeting adorable patients and spending time on the beautiful campus have been the icing on the cake of my visit!
The video is from a geriatric female mixed-breed dog. She has multiple gallstones and one has migrated into the common bile duct (CBD). The CBD is s distended. Interestingly enough, this patient had normal liver values and was asymptomatic for gallstones or extrahepatic bile duct obstruction.
This 8 year/old pekingese presented with loss of appetite and ascites. Historically she had been diagnosed with a heart murmur. Lab work showed decreased sodium and globulins and thoracic x-rays showed a tall heart with an increased vertebral heart score of 11.5 and distention/loss of detail in her abdomen from fluid accumulation. Her lung sounds were normal. Abdominal ultrasound revealed ascites with venous congestion. No compression of the caudal vena cava at the diaphragm was noticed during the respiratory cycle and the rest of the abdomen appeared normal. An echocardiogram was performed and diagnosed moderate pulmonary arterial hypertension, severe tricuspid regurgitation, moderate pulmonic insufficiency, right atrial enlargement and right ventricular hypertrophy. The left atria was enlarged and moderate mitral valve regurgitation was present. The left ventricle had increased fractional shortening and was well compensated. An abdominocentesis was performed, removing 500 mls of pink-tinged serous fluid, and recommendations were made to initiate treatment with pimobendan, enalapril, furoseomide, spironolactone and sildenafil. With a good initial response and proper treatment for pulmonary hypertension and right-sided congestive heart failure, this patient's average life expectancy is 200 days. Without treatment we would expect this to decrease to days to just a few weeks.
Severe pancreatitis in a geriatric cat with abdominal pain, fever, mildly elevated bilirubin and a degenerative left shift. The pancreatic duct can be seen traversing the center of the left limb of the pancreas dorsal to the duodenum. The common bile duct was traced from the cystic duct to the major duodenal papilla and was normal for a geriatric feline. Choleliths were also found within the gall bladder but were not noted in the CBD. This patient had an equivocal pancreatic PSL test (Antech, 80% sensitivity) but ultrasound allowed a diagnosis to be attained.
Small intestine from a geriatric cat with weight loss. This section of bowel shows segmental wall thickening and loss of normal wall layering. Multiple enlarged mesenteric and colic lymph nodes were also noted during the ultrasound. A fine needle aspirate was obtained from one of the abnormal lymph nodes and a diagnosis of lymphoma was made.