2011 Radiology Exam - Ultrasound Case 1

HISTORY: 9 year old mixed breed dog with IV/VI heart murmur. Dental prophylaxis is scheduled for next week.

OBSERVATION:

1. Correctly identifying the anatomy (left atrium, left ventricle, mitral valve, left ventricular outflow tract, aorta on the short axis, right ventricular outflow tract on the short axis).
2. Irregular shape and thickening of the mitral valve and aortic valve
3. Moderate turbulent flow in the atrium during systole due to mitral insufficiency.
4. Mild turbulent flow from the aortic valve during diastole.
5. Mild enlargement of the left atrium and ventricle secondary to eccentric hypertrophy.

SYNTHESIS: 

1. Moderate mitral valve insufficiency, likely due to myxomatous degeneration. A vegetative endocarditis cannot be completely ruled out but is less likely because of the appearance of the valves and because the patient is otherwise healthy.
2. Minimal aortic valve insufficiency, also likely due to myxomatous degeneration.
3. Mild secondary left-sided cardiomegaly.

PLAN:

1. Thoracic radiographs to further assess cardiomegaly and potential for cardiogenic pulmonary edema.
2. If the patient is not in heart failure, a dental could be performed without complication. Judicious use of fluids may be recommended.

Successful candidates managed to indicate the correct valves and chambers involved. Some candidates suspected that the shape of the valves was too irregular to simply be due to degeneration. “Good” and “fair” candidates prioritized endocarditis over degeneration. “Fair” to “poor” candidates either completely failed to consider degeneration or failed to correctly identify anatomic regions (most commonly, the LVOT was incorrectly identified). “Poor” candidates only considered endocarditis (giving the patient a GRAVE prognosis) or did not correctly identify ANY normal anatomy (LVOT as a ventricular septal defect and the mitral valve labeled as a tricuspid valve).