"an Interesting Case"

[philospher77]

Not words you want to hear from your vet!

 

Here's the situation: Katie woke me up around 1 am on Saturday, dry heaving, panting, restless, unable to settle, definitely showing signs of distress. That lasted about 10 minutes, just about long enough to get me worried about bloat, so I got us all ready to go to the emergency vet. By the time I got dressed, got her to the car, and got to the vet, she seemed back to normal. However, given the symptoms and the amount of discomfort she had been in, I went ahead and had x-rays done to check for bloat. That came back clean... BUT (get used to this word, it's going to show up a lot) there was a suspicious "tissue opacity" in the x-ray, that looked like an enlarged spleen. Recommendation: follow-up with ultrasound to get a better view and see what's going on with that.

 

So, today I had the ultrasound done. That confirmed that the spleen is, in fact, enlarged, but otherwise looks healthy (which is a relief, since hemangiosarcoma had been firmly pushed to the back of my mind while I waited for the results). BUT... the ultrasound also detected fluid in the abdomen (a small amount, not even enough, apparently, to be able to get a sample), distention of the hepatic blood vessels, and possible fluid in the pericardium, although that was not definitive because the ultrasound was not being specifically done of the heart. Recommendation: have the cardiologist take a look at the heart and see if there are any issues with that. So, the echocardiogram came back that the heart structure and function appear to be normal.

 

So, right now I have a bunch of very diffuse symptoms, that all point to "something" being wrong, but no real clear ideas of what the "something" is. The current working hypotheses are:

• a tick-born illness (most likely ehrlichiosis) in the chronic stage that is presenting in an anomalous fashion (the vet's words: Could I force a connection between the symptoms and the disease medically? Yes, but it's a stretch. However, we are testing for antibodies to see if there is any sign of it.)
• vasculitis (which is a condition, not a diagnosis. There's still the question of "what's causing the inflammation")
• And finally, Budd-Chiari-like syndrome, which is a really rare condition in which an obstruction of the caudal vena cava causes an increase in pressure in the hepatic vessels, allowing fluid and proteins to leak out the hepatic sinusoids into the surrounding tissues. And that's about all I can find on it on-line, since it's apparently rare enough that all google finds are references to articles on "here's a case I had in this dog" and a very short wiki. And, to make things more fun, the spot where the blockage would be is apparently really hard to image, so the best diagnostic tool for that is a CT scan. Also, not all of the symptoms are there for it, although if it were really early in the syndrome, they might not be yet (hepatomegaly and abdominal distention wouldn't show up, I believe, until the blockage had been there for a while). And, of course, that raises the question of "what's causing the blockage?"

Not entirely sure why I am posting this, since there's not much I can do until I get the lab tests back. Assuming that there is no evidence for the ehrlichiosis, would you pursue the CT scan? It is a very rare condition, but that doesn't mean it's not possible. On the other hand, I am not sure what I would do with that information. The entire treatment section of the wiki is: Surgery is indicated for some cases, but is very risky. Medical treatment to provide supportive therapy. And the prognosis section is: Excellent with an experienced surgeon, but poor if only medical therapy is used. Which is not at all reassuring!

 

Or, does anyone have any other ideas of what these symptoms could point to?

 

Thanks!

[Remolacha]

No idea, but for a good outcome

[tbhounds]

Well-I'm going to be bias because I work in a veterinary imaging center-I can tell you that you will receive a very complete/diagnostic report and ct scans are super/duper quick. In our clinic ct's take all of 10 minutes.

[philospher77]

Well-I'm going to be bias because I work in a veterinary imaging center-I can tell you that you will receive a very complete/diagnostic report and ct scans are super/duper quick. In our clinic ct's take all of 10 minutes.

 

Does the dog need to be sedated? Or otherwise drugged? Or is this a relatively low-risk procedure?

[racindog]

Goldie had an enlarged spleen and a greatly enlarged abdomen that developed over the course of a few months. The vet (board certified and a good diagnostician imo) did test after test after test and could never identify what it was. All the results were always in a nebulous zone and nothing definitive could be ascertained from them. His condition continued to deteriorate until he was unable apparently to properly digest his food despite having a huge appetite and I had to allow him to cross over.

[tbhounds]

Pets need to be under general anesthesia for ct's however, most often they are under light anesthesia and as I mentioned it's a very quick procedure and are awakened in 10 minutes.

99% of our patients walk out of the clinic under a 1/2 hour.

[EllenEveBaz]

How's Katie doing?

[philospher77]

The tick panel came back clean. The tentative diagnosis seems to be either Budd-Chiara-like syndrome or constrictive pericarditis. My vet is talking to the specialists to see what the next steps are, but I will probably go ahead and do the CT scan, just to get a better idea of what's going on in her insides.

 

This is also one of those cases where, if I hadn't done the tests, I wouldn't really think there is anything wrong with her, but now that I have, I go "is this possibly a symptom? or this?" we had a photoshoot on Sunday, and I will post up some of the photos in another thread.