Signalment: 13 year old, female spayed, Welsh Corgi
Presenting Complaint: Respiratory distress.
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 too wide, however this appears to be mostly due to a soft tissue opacity in the cranial thorax that partially silhouettes with the cranial cardiac silhouette.
		Left Atrium: Yes    There is loss of the caudal cardiac waist.
		Right Atrium: Indeterminate    This projection is not ideal to assess the right atrium.
		Left Auricle: Indeterminate    This projection is not ideal to assess the left auricle.
		Right Auricle: Yes    There appears to be a bulge in the region of the cranial cardiac waist which is comprised of the right auricle, ascending aorta, and main pulmonary artery.
	Abnormalities of Great Vessels learn more
		Aortic Dilation: Yes    There appears to be a bulge in the region of the cranial cardiac waist which is comprised of the right auricle, ascending aorta, and main pulmonary artery.
		Main Pulmonary Artery Dilation: Yes    There appears to be a bulge in the region of the cranial cardiac waist which is comprised of the right auricle, ascending aorta, and main pulmonary artery.
		Caudal Vena Caval Enlargement: No
	Pulmonary Venous Distention learn more: Indeterminate    The pulmonary vasculature is being partially obscured, therefore border delineation is tough.
	Airway Changes learn more
		Peribronchial Pattern: No
	Alveolar Changes learn more
		Air Bronchograms: No
		Cotton-like Densities: No
		Lobar Sign: No
	Pleural Effusion learn more
		Fissure Lines: Yes    In the cranial thorax.
		Leafing of Lung Lobes: Yes
	Pulmonary Edema learn more: No
	Evidence of Heartworm Disease learn more: No
	Other Findings
		In the pleural space, there is a soft tissue opacity that partially silhouettes with the cranial cardiac silhouette and causes retraction of the lungs from the body wall. In the first intercostal space, there is a well delineated soft tissue nodule.
	Radiographic Diagnosis
		Generalized cardiomegaly, pleural effusion, pulmonary nodule
	Description
		This radiograph was immediately intriguing, as there is an obvious large abnormality in the cranial thorax. Potentially due to the pleural effusion, it is difficult to tell exactly the cause of the increased opacity. Is this a distinct bulge in the cranial cardiac silhouette, or is this a mass effect that is partially silhouetting with the cranial cardiac waist? A heart base mass was high on the list of differentials.

DV View:
	Evidence of Chamber Enlargement learn more
		Heart too Wide: Yes
		Left Ventricle: Yes
		Right Ventricle: No    The right side of the cardiac silhouette is obscured and therefore difficult to accurately assess, however subjectively looks normal.
		Left Atrium: Indeterminate    This projection is not ideal to assess this structure.
		Right Atrium: Indeterminate    The cardiac silhouette is too obscured in this region to assess the right atrium.
		Left Auricle: No
		Right Auricle: No
	Abnormalities of Great Vessels learn more
		Aortic Dilation: No
		Main Pulmonary Artery Dilation: No
		Caudal Vena Caval Enlargement: No
	Pulmonary Venous Distention learn more: No    The pulmonary artery and vein branches are clearly visible in this projection and are normal.
	Airway Changes learn more
		Peribronchial Pattern: No
	Alveolar Changes learn more
		Air Bronchograms: No
		Cotton-like Densities: No
		Lobar Sign: No
	Pleural Effusion learn more
		Fissure Lines: Yes
		Leafing of Lung Lobes: Yes    Minimal leafing on the right thorax
	Pulmonary Edema learn more: No
	Evidence of Heartworm Disease learn more: No
	Other Findings
		None
	Radiographic Diagnosis
		Cardiomegaly, pleural effusion
	Description
		This projection does not display the cranial thoracic abnormality quite as well, however the cardiac silhouette is enlarged. The mass may therefore be be within the pericardium. The differential diagnosis for the enlarged cardiac silhouette should include pericardial fluid, severe cardiomegaly, or heart base mass.

Clinical Diagnosis   Heart base mass, pleural effusion, pulmonary nodule

Comment   Upon assessment of the above radiographs, a brief focused ultrasound was performed of the chest and revealed moderate pleural effusion and pericardial effusion resulting in tamponade. A pericardiocentesis and thoracocentesis were therefore performed. Maggie responded well to these therapies, resulting in stabilization of her condition. A subsequent echocardiogram was performed and discovered a very large heart base mass as well as chronic valvular degeneration. This substantial mass was determined to be the soft tissue opacity in the cranial thorax seen on the above radiographs.