Mark Patteson's Groups Activities

X-rays , pleural effusion , tumor ?

Stigen — Mon, 24 Feb 2025 14:11:10 GMT

8 year old cocker spaniel. Has lost 3,5kg since Octobre 2024 (in 4 months), last 4-6 weeks been eating less and less , and increased breathing efforts, at time abdominal breathing. At times coughing. Today did bloods - full biochemical profile + crp + hematology - all normal. X-rays lateral and Dv shows increased opacity of lung field, and mediastinum. Hr - 90 , but no murmurs audible. RR 35 and some degree of abdominal efforts. Dog is normally active on walks.

quick ultrasound to check for any free fluids, but could not see any(but my machine is quite bad, and I am not too experienced on thoracic imaging by US).
VHS is 11,7 - so heart is enlarged.

I wonder if there could be a mediastinal mass, and wheter the increased opacity is intrapulmonary or extrapulmonary. I will probably refer to echocardiogram, but just wanted to hear your opinions first.

Do you follow referral centre recommendations?

David Mills — Wed, 28 Aug 2024 21:59:19 GMT

You send an animal for referral

Animal comes back to you and with instructions for ongoing care but you on some level disagree with the treatment.

e.g.

Ortho case that comes back with instructions for 4 WEEKS of an important abx for superficial wounds that were cultured (nowhere near fracture or surgery site)

e.g.

Medical case on preds and azathioprene. Bloods normal last 2 times, but referral wants every 6w whilst on months of therapy.

What do you do?

Does anyone want to do anything about the state of the profession?

Arlo Guthrie — Mon, 25 Mar 2024 12:15:43 GMT

Was thinking over the weekend, after getting a couple of supportive responses to my letter in VT ...

Seems to me that quite a few people are unhappy with the direction the profession has taken, which has culminated in the CMA review.

I wonder whether it is time to actually try and DO something about the factors which have led to above-inflation increases in the cost of veterinary care, recruitment and retention problems, job satisfaction and so on and so on ....

Some ideas running through my mind ...

Set up a campaigning / membership group called (working title): The Pragmatic Vet, which might, amongst other things:

create evidence-based pragmatic guidelines
encourage more selective referral culture
encourage less defensive medicine
lobby for more practical cpd that encourages a more selective referral culture
lobby for regulatory changes to help lower the cost of veterinary care

and so on ...

Would anyone be interested in getting involved in something like this?

I mentioned in the other thread that I think a working party is needed. Likewise this membership / lobbying group would have to be led by a group of general practitioners.

I could offer practical support.

How are you diagnosing pulmonary hypertension in GP practice?

Richard Carter — Sat, 12 Aug 2023 09:25:17 GMT

How are people diagnosing pulmonary hypertension in gp practice? Have 12-13 y.o. FN jrt with coughing after rest, 4-5/6 murmur but crt <2 sec, good femoral pulses, no syncope, no exercise intolerance so suspect mitral valve disease with related atrial dilation but want to know if should be trying to look for pulmonary hypertension and how to do it?

8 month old 4.5kg cross breed dog with arrhythmia

hilary warner — Sun, 19 Dec 2021 18:31:24 GMT

Seeking some help, even if I am told I need to refer to a specialist.

This patient has no outward clinical signs and the arrhythmia was picked up in a routine check, pre GA.

The rhythm appears to be bigeminal VPC, and I believe the VPCs are from the same focus. There does appear to be one second degree sinus block on the ecg recorded.

There is no murmur and a heart scan does not show any apparent chamber enlargement, there may be a hyperechoic area at the top of the interventricular septum near the aortic valve but no apparent subaortic stenosis. Bloods are unremarkable for age, there was nothing obviously abnormal on an abdominal scan. I have not attempted to load the scan pictures but can if they might be of use.

I would be grateful of any suggestions for what to do next and have primed the owner for referral, but I am mindful that the referral centres are busy at present and do not wish to send something to them that should be sorted in a first opinion practice.

Would a Holter bring any more information of benefit?

Thank you

Aortic Aneurysms?? Dogs or otherwise?

Julian Earl — Fri, 03 Dec 2021 19:46:43 GMT

Hello All

Having just had an ECG and US scan to monitor a hereditary aortic aneurysm. I was wondering if anyone had seen this in a domestic animal, specifically in dog? I have not nor can I even recall ever reading about it occurring? In humans there is a National monitoring System which includes yours truly because my Dad had replacement surgery in his seventies. Hence I was added to the list. I do not suffer any clinical signs and my last scan a year or so ago took a reading of 4.3cm. Today, the lady would not tell me saying I have towait for the report from the cardiologist. Fair enough..., I id ask what is the danger-measurement so to speak? Amazingly I thought, it is 9-10cm!! WOW!! At that degree of dilation the walls mustbe like tissue paper? hen any strenuous exertion can cause it to rupture she said! Well, yes I can see that! My full report of today is as follows...:

I have been to Castle Hill hospital near Hull for my annual and routine ECG on my heart and ultrasound scan to check for an aneurysm. My Dad's Aneurysm was hereditary so I am included on the National monitoring list. following Dad's history with the condition. They use ultrasound to visualise the aorta and measure its diameter. The lady could not access my last measurement but we think it was 4.3cm compared to the normal 2-3cm, so stretched a bit but not to a dangerous degree. I asked the lady at what size does it become dangerous. She said 9-10cm, ie 4 inches! That is huge for this blood vessel when the vessel walls must be like tissue-paper thin and she said that then any severe exertion could then cause it to burst! asked her what my measurement as today but she said he is not allowed to say! \she did admit that if it was9-10cm I would not be going home but be kept in for emergency surgical repair! Exertion?/ What about my cycle-racing I asked? No problem she said, that should be safe!! I said that you do know it involves extreme exertion don't you, at heart rates up to 175, 176... but she just smiled and said that I had better ask the cardiologist when he passes on today's results to me! Being very used to studying ultrasound images in dogs, cats, cattle I could see that my aorta today was about 3-4cm wide, not dangerous at all. I'm afraid I said to her that if the cardiologist tells me to stop racing I shall have to ignore him! After all, what is the worst that could happen?/

A miserable life with no cycle-racing being the answer!! After this we visited a vet-friend Heidi at Howden nearby, who coincidentally was just about t scan her sheep-flock for pregnancy! If I had known I could have scanned my own aorta and avoided he long queue at Castle Hill. That will teach us to arrive 20minutes early for my appointment though!

One morbidly amusing aspect to this hospital visit was that after crossing the Humber Bridge and following all the Hospital Signs to Castle Hill, the hospital signs were displayed adjacent to another sign saying "Crenmatorium!" Are they trying to tell us something?

Normal LVIDd but increased LA:Ao ratio - to treat or not?

Anthony Dennison — Tue, 22 Dec 2020 13:06:47 GMT

12 year old Yorkie with tracheal collapse that has had a worsening cough over last month or so grade 3/6 systolic murmur, PMI over left apex. Had a positive tracheal pinch, seems to cough more when getting up from rest or when excited.

Colleague asked me to check echo to see if treatment required - her notes say there was some crackles on thoracic ausc but I can't hear anything.

LVIDd on M mode is 2.28cm which is right on the normal measurement when considering allometric scaling, slightly underneath actually. I use the table in the Cornell et al (2004) paper from JVIM to check the scaling.

LA:Ao is 1.98.

I have tried measuring mitral valve E and A velocity but this is right at the limit of my skills (doing it every time to practice and not sure it's accurate). I have an E:A ratio of 1.24, which from what I can see is normal? I think IVRT is 39.93ms.

The heart generally doesn't look globoid or enlarged on the scan so I was surprised to see the elevate LA:Ao ratio. I suspect this is worsening of the tracheal collapse rather than CHF, and this dog is still stage B1 but will need close monitoring. Am I wrong?

What is your approach to treatment of pericardial effusion secondary to atrial tear?

Glen McIntosh — Tue, 20 Oct 2020 10:34:07 GMT

For example, previously well 14 yo Pomeranian coughing for a few weeks, intermittent panting for a few days then sudden onset weakness and pallor a few hours prior to presentation. Rads show huge heart, mild alveolar pattern. FAST u/s shows moderate pericardial effusion (0.7 - 1.2 cm) with equivocal tamponade. LA is huge (LA:Ao > 2). Cranial lung fields appear a bit wet esp RHS. Marked ascites AFS = 4/4. No obvious masses seen. Abdominocentesis produces serosanguinous fluid - PCV <1%, TS 38, cytology predominantly rbcs, occ wbcs, no bacteria seen. Dog dull but ambulatory. Doppler BP on presentation 68mmhg. Bloods show moderate elevation BUN otherwise fairly unremarkable. HR 140 on presentation, grade 5 heart murmur.

I have a high index of suspicion for atrial tear in this case.

A couple of questions:

What would your approach to treatment of this type of case be?

The volume large volume of free abdominal fluid seems to have developed very rapidly if it was secondary to the pericardial effusion (assuming the onset of pericardial effusion coincided with the sudden change in the dogs symptoms a few hours prior to presentation), can this happen? My experience is that ascites from recent onset pericardial effusions tend not to be so high in volume, so was thinking there could be some other issue - eg right sided chf, neoplasia etc?

Thanks very much in advance for your thoughts.

Dog fainting during or post exercise

Dinu Catilina — Wed, 24 Jun 2020 22:05:05 GMT

I have a client with an 11 months old Miniature Bull Terrier with a history of fainting during or post exercise. First time happened at around 8-9 months of age, nothing for a while and then 3 times in a week. I don't have a video of the episode but the owner doesn't describe it as a seizure. The dog seems to just drop down and be back up in about 1 minute or so.

Clinical examination was unremarkable except for a sistolic heart murmur, grade 3/6 possibly louder towards base but I can not be certain, the dog was very excited. Normal rhythm and femoral pulse.

Blood biochem was unremarkable.

Communication is a small issue. Referral was discussed and offered but was declined ( I am not sure if money related or something else). The dog is not insured.

To me it was suspicious of aortic/subaortic stenosis. I did a scan but my cardiac scans are basic at best. I saved a few videos. Any advice regarding the scans or case are very welcomed and appreciated. I have consent from owner to share the images and ask for a second opinion.

www.vetsurgeon.org/.../5417.20200608_5F00_173502_5F00_0.avi www.vetsurgeon.org/.../0131.20200608_5F00_173927_5F00_1.avi www.vetsurgeon.org/.../0131.20200608_5F00_174751_5F00_8.avi www.vetsurgeon.org/.../3755.20200608_5F00_174218_5F00_3.avi

Hunting dog coughing up blood

Fable — Tue, 19 May 2020 01:55:12 GMT

Would really appreciate some help with this interesting case.

The patient is a pig hunting dog, who in the past 2 weeks has had episodes of coughing up small amounts foamy blood. This only occurs when he is out hunting and therefore exercising strenuously. The rest of the time according to his owner he seems normal. He has had no recent episodes of trauma and no access to rat bait or other toxins. The cough has persisted since the last episode 4 days ago.

On CE: mm pink and moist, crt<2s, HR fast but regular rhythm and no murmurs, RR normal but slightly increased lung sounds especially caudally, NAD abd palp, T 38.3

I sedated him to take the images attached to this post. He has right sided heart enlargement with enlarged lobar pulmonary arteries suggesting pulmonary hypertension. This could explain the bloody foam he is coughing up.

I have also run full CBC/biochem which came back with only very mild increases in urea and glucose and low normal K+.

In an ideal world I would refer this dog for echocardiography, but if that is not an option in this case what further diagnostics would you recommend that I do with this patient? Is there any benefit to a treatment trial - something like sildenafil or pimobendan? Clinically he is normal most of the time so could we elect for benign neglect or should I act now to slow the progression of disease? Obviously his career as a hunting dog is going to be limited.

Any advice would be gratefully received. Many thanks!

Atrial Wall Tumours

Anthony Dennison — Sat, 09 May 2020 12:29:22 GMT

As mentioned in a previous thread, last weekend I saw a dog with a pericardial effusion caused by a mass within the right atrium, which seemed to be originating from by the pulmonary vein inflow (see video clip).

Is there anything that can be done treatment-wise for these, or is it always a hopeless prognosis?

www.vetsurgeon.org/.../1667.VID_5F00_20200504_5F00_173808.mp4

How useful are troponin and cardiac pro-BNP in diagnosing heart disease?

Sonia Wilson — Thu, 09 Apr 2020 17:39:57 GMT

How useful are Pro BNP and cardiac troponin in diagnosis of cardiac disease?

VetSurgeon.org

Tue, 28 Apr 2009 05:55:54 GMT