Signalment: 10.5 years, female spayed, Doberman Pinscher
Presenting Complaint: Physical exam revealed a Grade 4/6 left apex holosystolic heart murmur, and a Grade 3/6 right mid heart murmur, numerous premature beats were ausculted, and an intermittant S3 gallop rhythm. Femoral pulses were mildly weak. Lungs ausculted normally.
Presenting History

Lateral view

DV view

Lateral View:
	Evidence of Chamber Enlargement learn more
		Left Ventricle: Yes    The heart is too tall.
		Right Ventricle: Yes    The heart is 3 intercostal spaces wide. Deep chested dogs should not be wider than 2.5 intercostal spaces.
		Left Atrium: Yes    Loss of the caudal waist.
		Right Atrium: No    If the right atrium was enlarged the right auricle would be enlarged as well however there is no evidence of right auricular enlargement.
		Left Auricle: Indeterminate    This projection is not ideal to assess left auricular enlargement.
		Right Auricle: No    No loss of the cranial waist.
	Abnormalities of Great Vessels learn more
		Aortic Dilation: No
		Main Pulmonary Artery Dilation: No
		Caudal Vena Caval Enlargement: Yes    Mild
	Pulmonary Venous Distention learn more: Yes
	Airway Changes learn more
		Peribronchial Pattern: Yes    Profound and diffuse
	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: Yes
	Evidence of Heartworm Disease learn more: No
	Other Findings
		None
	Radiographic Diagnosis
		Congestive heart failure
	Description
		These radiographs were selected to illustrate marked peribronchial changes. Tram lines and donuts are noted throughtout.

DV View:
	Evidence of Chamber Enlargement learn more
		Heart too Wide: No    I measure it at the high end of normal
		Left Ventricle: No    But this projection is inferior to the other projection for this determination.
		Right Ventricle: No
		Left Atrium: Yes    Although this projection is inferior to the other projection for this determination, the left atrium is so big is extends caudal to the cardiac silhouette in this case.
		Right Atrium: No
		Left Auricle: No
		Right Auricle: Indeterminate    This projection is inferior to the other projection for this determination.
	Abnormalities of Great Vessels learn more
		Aortic Dilation: No
		Main Pulmonary Artery Dilation: No
		Caudal Vena Caval Enlargement: Indeterminate    It frequently is not visualized in this projection. The VD projection is better for this determination.
	Pulmonary Venous Distention learn more: Yes
	Airway Changes learn more
		Peribronchial Pattern: Yes    Not as prominent as noted on the lateral projection but nevertheless excessive.
	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: Yes
	Evidence of Heartworm Disease learn more: No
	Other Findings
		None
	Radiographic Diagnosis
		Congestive heart failure
	Description
		The peribronchial changes, while very prominent, are not as prominent as noted on the lateral projection.

Clinical Diagnosis   Dilated cardiomyopathy with congestive heart failure

Comment   A marked peribronchial pattern can occur with airway disease or pulmonary edema. The differentiation is made based on substantive evidence of a process that promotes pulmonary edema. Thus for pulmonary edema of cardiac etiology to be present we need conditions that disturb Starlings Forces causing an elevation in capillary hydrostatic pressure with promoting the flux of fluid from the capillary compartment to the intestitium. For this to be the case we need evidence of pulmonary venous distention and left atrial enlargement. Both are evident in this case.