Signalment: 3 year, Male neutered, Pit Bull cross
Presenting Complaint: Presented for substantial coughing and exercise intolerance.
Presenting History

Lateral view

DV view

Lateral View:
	Evidence of Chamber Enlargement learn more
		Left Ventricle: Indeterminate
		Right Ventricle: Indeterminate
		Left Atrium: Indeterminate
		Right Atrium: No
		Left Auricle: No
		Right Auricle: No
	Abnormalities of Great Vessels learn more
		Aortic Dilation: Indeterminate    The ascending aorta is difficult to visualize against the pathology in the lung.
		Main Pulmonary Artery Dilation: Indeterminate    The main pulmonary artery is difficult to visualize against the pathology in the lung.
		Caudal Vena Caval Enlargement: No
	Pulmonary Venous Distention learn more: No
	Airway Changes learn more
		Peribronchial Pattern: Yes
	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: Indeterminate
	Other Findings
		The pulmonary arteries are dilated.
	Radiographic Diagnosis
	Description

DV View:
	Evidence of Chamber Enlargement learn more
		Heart too Wide: Yes    The heart is greater than 2/3 the width of the thorax.
		Left Ventricle: No
		Right Ventricle: Yes    The reverse "D" sign indicates right ventricular enlargement.
		Left Atrium: No
		Right Atrium: No
		Left Auricle: No
		Right Auricle: No
	Abnormalities of Great Vessels learn more
		Aortic Dilation: No
		Main Pulmonary Artery Dilation: Yes    There is a bulge in the region of the main pulmonary artery.
		Caudal Vena Caval Enlargement: Indeterminate
	Pulmonary Venous Distention learn more: Indeterminate
	Airway Changes learn more
		Peribronchial Pattern: Yes    There is delineation of several small airways, track lines and donut holes are present.
	Alveolar Changes learn more
		Air Bronchograms: No
		Cotton-like Densities: No
		Lobar Sign: No
	Pleural Effusion learn more
		Fissure Lines: Yes    There are several faint fissure lines.
		Leafing of Lung Lobes: No
	Pulmonary Edema learn more: Yes    Diffuse increase in opacity of the lungs indicates pulmonary edema.
	Evidence of Heartworm Disease learn more: Yes    Right ventricular enlargement and severe pulmonary artery enlargement support the diagnosis of heartworm disease.
	Other Findings
		The pulmonary arteries are severely dilated and many are tortuous. In this radiograph, the red arrows show the arteries, and the green arrows show fissure lines.
	Radiographic Diagnosis
		Heartworm disease and pulmonary edema.
	Description

Clinical Diagnosis   Heartworm disease with eosinophilic pneumonitis.

Comment   The dog tested heartworm positive in June 2010 (he was coughing substantially with exercise intolerance) and subsequently received melarsomine therapy (2 injections 24 hours apart) by his primary care veterinarian. He presented to the cardiology service in October because he was still coughing, although not as severely as he had been prior to treatment. Based on these radiographs, he likely has pneumonitis, and since it is 4 months after therapy, he is likely still heartworm positive. No microfilaricide was prescribed with the adulticide at the time of the diagnosis, so possibly there were some adult worms who have now matured.

The dog was treated with a short tapering course of prednisone over 10 days for pneumonitis, and he was started on Heartguard preventative. We recommend a repeat antigen test in a month, with adulticide therapy (3 treatment protocol) if he is still positive.