Signalment: 8.5 years, Spayed female, Cocker-Poodle Cross
Presenting Complaint: Abdominal distention
Presenting History

Lateral view

Lateral view

Lateral View:
	Evidence of Chamber Enlargement learn more
		Left Ventricle: Yes    The heart is too tall.
		Right Ventricle: Yes    The heart is slightly greater than 4 intercostal spaces wide.
		Left Atrium: No
		Right Atrium: Indeterminate    This projection is not ideal to assess the right atrium for enlargement.
		Left Auricle: Indeterminate    This projection is not ideal to assess the left auricle for enlargement.
		Right Auricle: No    There is no loss of the cranial waist.
	Abnormalities of Great Vessels learn more
		Aortic Dilation: No    There is no loss of the cranial waist.
		Main Pulmonary Artery Dilation: No    There is no loss of the cranial waist.
		Caudal Vena Caval Enlargement: Yes    It is considerably larger than the aorta.
	Pulmonary Venous Distention learn more: No
	Airway Changes learn more
		Peribronchial Pattern: No
	Alveolar Changes learn more
		Air Bronchograms: No
		Cotton-like Densities: No
		Lobar Sign: No
	Pleural Effusion learn more
		Fissure Lines: No
		Leafing of Lung Lobes: No
	Pulmonary Edema learn more: No
	Evidence of Heartworm Disease learn more: No
	Other Findings
		None
	Radiographic Diagnosis
		Generalized cardiomegaly
	Description
		This is another example of an moderate to severely enlarged heart - the theme of the past several chest x-rays. Causes for generalized cardiac enlargement can include dilated cardiomyopathy, severe mitral valve insufficiency, pericardial effusion, peritoneal pericardial diaphragmatic hernia, congenital heart disease like PDA. There is no evidence of pulmonary edema.

Lateral View:
	Evidence of Chamber Enlargement learn more
		Left Ventricle: No
		Right Ventricle: Yes    The right ventricle appears generous.
		Left Atrium: Indeterminate    This projection is not ideal to assess the left auricle for enlargement.
		Right Atrium: Yes    The region of the right atrium is generous.
		Left Auricle: No
		Right Auricle: Indeterminate    This projection is not ideal to assess the right auricle for enlargement.
	Abnormalities of Great Vessels learn more
		Aortic Dilation: No
		Main Pulmonary Artery Dilation: No
		Caudal Vena Caval Enlargement: Indeterminate    The borders of the caudal cava are not visible.
	Pulmonary Venous Distention learn more: No
	Airway Changes learn more
		Peribronchial Pattern: No
	Alveolar Changes learn more
		Air Bronchograms: No
		Cotton-like Densities: No
		Lobar Sign: No
	Pleural Effusion learn more
		Fissure Lines: No
		Leafing of Lung Lobes: No
	Pulmonary Edema learn more: No
	Evidence of Heartworm Disease learn more: No
	Other Findings
		None
	Radiographic Diagnosis
		Cardiomegaly with right heart enlargement.
	Description
		As for the lateral projection we observe a moderate to severely enlarged heart - the theme of the past several chest x-rays. Causes for generalized cardiac enlargement can include dilated cardiomyopathy, severe mitral valve insufficiency, pericardial effusion, peritoneal pericardial diaphragmatic hernia, congenital heart disease like PDA. There is no evidence of pulmonary edema.

Clinical Diagnosis   Right ventricular and right atrial eccentric hypertrophy (dilation)

Comment   When considering causes for generalized cardiac enlargement the absence of left atrial enlargement rules out dilated cardiomyopathy and mitral valve insufficiency (the case of March 2010). The border of the diaphragm is not lost on the DV projection which strongly suggests that a peritoneal pericardial diaphragmatic hernia is not likely. The heart is not particularly globose to support a pericardial effusion (the case of Feb 2010). We are therefore left with some congenital and or right heart disorder.

Echocardiography demonstrated severe right ventricular and right atrial enlargement with marked tricuspid valve insufficiency. As the tricuspid valve appeared to be morphologically normal we are investigating some form of pulmonary artery to coronary artery shunt. There was no evidence of pulmonary artery hypertension.