Pulmonary Hypertension

7 January, 2021

Case example


An 8-year-old female, intact mixed breed dog from Romania was diagnosed and treated for lungworm infections. She now presents for increased respiratory effort.

Radiographic findings

  • Thin, linear gas opacities along the contours of the hilar vessels characterize a mild pneumomediastinum.
  • A focal convexity is at the 1-2 o`clock position of the cardiac silhouette in the region of the main pulmonary artery.
  • The lobar arteries are moderately dilated and tortuous. The pulmonary veins are within normal limits.
  • The cardiac silouette shows an increase in its craniocaudal dimension and the sternal contact is increased.


  • Mild to moderate right cardiac enlargement with moderate to severe enlargement of the main pulmonary artery and pulmonary arteries can be consistent with a heart worm infection (Dirofilaria immitis).
  • Mild, secondary pneumomediastinum.

Take Home Message

  • Enlarged, tortuous and blunted pulmonary arteries ARE a common radiographic feature of manifested heart worm disease (dirofilariosis).
  • The severity of radiographic findings correlates with the severity of an infection and normal radiographs do not exclude an active dirofilariosis.
  • Additional radiographic findings include an unstructured interstitial pulmonary pattern and to the majority peripheral alveolar infiltrates
  • A pneumomediastinum can occur in patients with dyspnea and cough.
  • CT- angiography can aid in the depiction of pulmonary arterial and perivascular pulmonary changes in the earlier state of infection and can highlight the arterial wurm burden with or without thromboembolisms.