case_images: PMC11024378_01
case_images: Case timeline where Day 0 marks the day rivaroxaban was started. Day - 30 marks the patient's initial cardiology appointment. Day 15 marks the initial ER visit when rivaroxaban was discontinued. Days 20-27 mark the patient's hospital stay. The subsequent recheck examinations are marked by Days 39, 71, and 112. RIV, Rivaroxaban.
case_images: fvets-11-1364677-g001.jpg
case_images: PMC11024378_01_fvets-11-1364677-g001.jpg
case_images: fig1
case_images: An estimated 6-year-old spayed female mixed breed dog (weight: 21 kg) presented to the North Carolina State Veterinary Hospital Cardiology Service for evaluation of a new-onset heart murmur and generalized radiographic cardiomegaly (Day - 30; Figure 1). The dog was administered the first dose (0.5 mg/kg PO q12 h) of rivaroxaban 30 days after her initial presentation to the cardiology service and 7 days after her final dose of clopidogrel (Day 0; Figure 1). The dog was re-presented through the North Carolina State Veterinary Hospital Small Animal Emergency Service 10 days after the cardiology recheck visit for progressive hyporexia and lethargy (Day 15; Figure 1). North Carolina State Veterinary Hospital Small Animal Emergency Service 5 days after the previous emergency visit (Day 20; Figure 1). No additional clinical signs were reported. Repeat labwork with her primary care veterinarian the week after discharge showed static to mildly improved values (Day 39; Figure 1; Table 1). Hospital Cardiology Service on Day 71 for a recheck echocardiogram (Figure 1). Her appetite had significantly improved, and she was otherwise doing well. Labwork performed on Day 112 revealed that the liver values had returned to baseline (Figure 1; Table 1).
case_images: (A) Echocardiogram image (right parasternal short axis view at the level of the pulmonary artery) and (B) computed tomography images (transverse view) identifying a large thrombus within the right branch pulmonary artery. RA, Right atrium; RV, Right ventricle; MPA, Main pulmonary artery; AO, Aorta; LPA, Left branch pulmonary artery; *large thrombus in the right branch pulmonary artery.
case_images: fvets-11-1364677-g002.jpg
case_images: PMC11024378_01_fvets-11-1364677-g002.jpg
case_images: fig2
case_images: The most significant finding was an approximately 1.5 cm by 5.5 cm hyperechoic structure within the distal main pulmonary artery and right branch pulmonary artery (Figure 2A). On CT, an extensive, mineralized right pulmonary arterial thrombus and partially occlusive thrombi within the right middle, right caudal, and left caudal lobar arteries were noted (Figure 2B).