"Not Doing Right"

A 9-month-old intact male Mastiff mixed breed with history of being underweight presented at a referral facility for echocardiogram due to heart murmur.

Decreased appetite. Current meds: Metronidazole, Denamarin, Mirtazapine. ALT 393, T. bili 5.7, Mag 2.7, Chol 307, Amyl 1891, PSL 50, Lymphs 9, Mono 8, Neuts 11,680, Mono 1280,Eos. 1600, USG 1.048.

Patient was presented for ataxia, icterus, lethargy, and vomiting. History of atypical vaccine reaction after first DHLPP-ADR, enlarged peripheral LN. The patient has not been 100% since. Blood chemistry and CBC revealed BUN 3, TP 4.3, Alb 1.9, ALT 457, ALKP 869, GGT 20, Tbili 5.1, chol 84, amylase 216 and HCT 31%.

The patient presented for ADR and hiding which was worsening over time. Blood chemistry, CBC, and urinalysis were both unremarkable. The caudal lumbar area of the patient was uncomfortable upon palpation. Radiographs revealed fused tail vertebrae, enlarged heart, and a mass effect in the chest. A double cavity ultrasound was performed and findings confirmed fused kidneys (which had previously been diagnosed) and a pericardial diaphragmatic hernia was noted. Falciform fat was in the pericardial space. The heart did not appear to be dysfunctional owing to this congenital defect. Due to splenic enlargement FNA of the spleen was recommended.
A few weeks later the patient's clinical signs worsened again. Despite treatment with pain medication, cortisone and antibiotics the patient presented again with dull mentation and not wanting to walk. Upon examination no ataxia or nystagmus was noted but the patient was squinting; there was concern for CNS disease. A CT study was performed at Blairstown Animal Hospital.

The patient was presented for annual exam with a 1-2 month history of decreased appetite. Blood chemistry and CBC found a potassium low at 3.2, chloride low 113, AST high 70, monocytes high 684, and T4/fPL both normal. Repeat bloodwork a month later showed potassium even lower at 2.6. The patient was started on Renacare potassium supplement and abdominal ultrasound was scheduled.  The day of the ultrasound, potassium was rechecked and still low at 2.7; Renacare dose was increased and a month later the potassium level was normal. Post-ultrasound Aldosterone baseline level was high at 1194 (194-388). Prior to surgery she had a normal appetite and energy level, and CBC and chem were normal other than a mildly elevated ALT.

A 3-year-old, MN, Catahoula Leopard Dog was presented for a 4 month history of ADR, diarrhea, and vomiting which had acutely worsened within the last 48 hours. Physical examination found the patient with a body score of 2/9 with a 14 lb weight loss, temperature of 102.9, QAR, and mildly dehydrated. CBC/Chem, cPLI, and fecal were all WNL with the exception of an increase in monocytes (11%) with a normal WBC of 14,650. A full abdominal ultrasound was performed.

Hx of TTA performed on both knees. The patient was presented for a mass seen on the right knee. Owner reported the patient seemed more tired and not motivated for walks; limping on right hind limb. Examination of the right leg found a 15 cm invasive mass at the knee. The patient was placed on NSAIDS and scheduled for further diagnostics. CBC/Chem was WNL. 

A 7-year-old FS Bullmastiff was presented for acute diarrhea and decreased appetite.

Sonographic summary: The initial ultrasound findings were: Part of the small intestine presents a 1:1 muscularis/mucosa ratio with decreased motility, mildly obscured wall layering and mild accumulation of chyme. Focal circumferential wall thickening of up to 7 mm with transmural loss of layering is seen in the ileocecal region and is associated with an incomplete obstructive pattern with segmental dilation of the intestine with chyme. The central abdominal mesentery presents a generalized increase in echogenicity with loss of the regular echoarchitecture emphasizing the lymph node and intestinal wall changes. Severe mesenteric lymphadenomegaly of up to 8 cm is noted. The lymph nodes are rounded with a pathologic increase of their short-to-long-axis ratio beyond 0.5. A significant mass effect on the intestine resulting in an incomplete obstructive pattern is noted. The margin to the intestinal wall is obscured. Scant anechoic peritoneal effusion is noted. Ultrasound guided fine needle aspirations were performed for further definition and confirmed a large cell lymphoma. The patient underwent chemotherapy and presented two months later due to extreme ADR since finishing the 2nd round of chemo (Adriamycin), anorexia with the exception of treats, and PU/PD. Subcutaneous lymphoma of a single mass had been detected via FNA 1 week prior, therafter multiple SQ masses developed.

The progression of pre-chemo, post chemo, and escape from remission sonographic images are sequenced below.

A 2-year-old FS Beagle mixed breed. Clinical findings: 2 chest nodules. Fever of unknown origin. Vomiting/diarrhea. Altered CBC/Chem/UA values: WBC 20,000. TP 8.3. BUN subnormal at 5. Globulins sl. Elevated. Coag-wnl. HWT-neg.

The patient was presented for straining to defecate x 5 days, a poor appetite, recent vomiting, and possible hematuria. During physical exam a recal stricture was palpated. Blood was noted in the vulva. The patient was treated with Baytril, Cerenia, and IV fluids pending sonographic evaluation.

The patient was presented for evaluation due to severe vomiting. The vomiting stopped but the patient was now anorexic. The patient was quiet with a thin body condition. CBC found a low WBC of 3.7. Blood chemistry found albumin 3.7, total protein 7.0, ALKP 43, BUN 43, and cholesterol 79.

A 6-year FS Havanese with history of vomiting (mostly at night and in morning) for a few weeks; no diarrhea. Recent bloodwork found ALB 16, TP 40, GLOB 24 with other parmaters WNL. A fecal was negative. Urine SG 1.035, no protein on chemstrip and urine pro:crea ratio was pending.