Computed tomography diagnosis of a caval-azygos communication in a dog with cor triatriatum dexter

An 18-month-old Springer Spaniel was presented for investigation of ascites, exercise intolerance and suspected cor triatriatum dexter. Division of the right atrium into two separate chambers by an anomalous perforated membrane consistent with cor triatriatum dexter was confirmed during echocardiography. However, a routine agitated saline contrast (bubble) study yielded results that could not be explained by the congenital heart defect alone. Computed tomography angiography was performed and revealed a dilated ventral internal vertebral venous plexus and a short, dilated vessel in the midlumbar region redirecting blood flow away from the caudal vena cava and into the azygos vein. Balloon dilatation of the orifice within the cor triatriatum dexter membrane successfully reduced pressure within the caudal chamber of the right atrium and enhanced return via the caudal vena cava with subsequent resolution of clinical signs. This case report highlights the use of cross-sectional imaging in dogs with cor triatriatum dexter and unexpected contrast study results, as a means by which concurrent vascular anomalies may be identified.