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Case 12
Primary clinician: Mark D. Kittleson, DVM,
PhD, DipACVIM
(Cardiology)
Signalment
 | 10-year-old FS German shepherd cross weighing 17 kg
("Lucky") |
Presenting Complaints
| Fluid in the Chest/Possible Tumor |
Pertinent History
| Lucky was adopted at the age of 6 months by the owner. She has lived all her life in
Fresno, CA and every summer goes to Fish Camp near Yosemite (alt=5000'). She also
occasionally spends time in the foot hills, but is mostly inside there. This summer she
did not go to Fish Camp because the owner was advised not to by the referring DVM.
|
| Approximately, 6 months ago, the owner began to notice that she was not eating as well as
she usually does, was becoming lethargic, and was panting more frequently. She is fed ProPlan kibble, boiled chicken, zucchini, and rice. Three weeks ago, Lucky began refusing
to eat the kibble. |
| Nine days ago she was taken to the emergency hospital in Fresno because the owner
noticed that she was making "gurgling" sounds. Radiographs were taken which
revealed severe pleural effusion and possibly pulmonary edema as well as some loss of
serosal detail in the abdomen. The ECG showed a tachycardia (HR=270bpm).
1500ml of serosanguinous fluid was drained from her chest. She also had a fever (105.0)
and was mildly dehydrated. The S.G. of the fluid was 1.015 and the protein was 1.0g/dl.
This cytology is most consistent with a transudate although the presence of RBCs and
neutrophils may indicate a modified transudate. Lucky was sent home on Lasix 12.5mg
tablets (1 1/2 tablets SID), enalapril 20mg tablets (1/4 tablet every 12 hours), and
digoxin 0.125mg (1 1/2 tablets SID). |
| Yesterday she returned to the same emergency hospital for "gurgling" sounds
with respiration. 1500ml of clear-straw colored fluid was removed from her thorax. She was
found to be 5% dehydrated at this time. The emergency veterinarian wanted to take repeat
radiographs and the owner declined opting for a referral to UC Davis (he went to school
here). Her digoxin dose was reduced to 1 tablet SID (0.125mg). The owner spoke with a
resident here last night and was advised not to give her any digoxin this morning. |
Physical Examination
| T=101.5, HR=240, RR=52 |
| QAR, Mild dehydration, emaciated. |
| Integ: Full, dry and coarse coat. No alopecia.
Two ticks were seen and removed. Lucky tends to chew on her skin. |
| Eyes: Clear corneas and
anterior chambers. Small amount of clear-greenish discharge OU. Ears: Clean with no odor
or discharge. |
| Nose: Moist with no discharge. No sneezing. Mouth: 4+ tartar with moderate
gingivitis. |
| MS: Emaciated with general muscular atrophy. No gait abnormalities.
|
| GI:
Palpated a 2cm, soft, mass in the ventral abdomen (may be fat or intestine). No vomiting
or diarrhea. Hepatomegaly, small spleen. |
| GU: No vaginal discharge, empty bladder. Nervous:
Not evaluated. L.N.: All within normal limits. |
| CV: Tachycardia which fluctuates in rate and rhythm. No murmur ausculted. MM=pink,
CRT=2sec. Weak to fair pulses. Pulse deficits were noted. The hepatojugular reflux test
was
positive. |
| Resp: Dyspnea (panting and increased chest movements). She prefers to
remain standing or sternal (orthopnea). |
Problems
| Dyspnea with historical pleural effusion |
| Positive hepatojugular reflux test |
| Emaciation |
| Tachycardia/Arrhythmia |
Laboratory Work
| Difil test for microfilariae - negative |
| Heartworm antigen test - negative |
|
