title: Pulmonary hypertension and right-sided heart failure in an adult llama with hepatic disease.
abstract: METHODS
  A 13-year-old llama was examined because of lethargy, inappetence, and syncope.
  
  
  RESULTS
  Physical examination revealed muffled heart and lung sounds and peripheral edema. Clinicopathologic abnormalities included lymphopenia, hyperglycemia, prerenal azotemia, mild hyponatremia, mild hypoalbuminemia, and high gamma-glutamyltransferase and creatine kinase activities. On ultrasonography, the liver appeared hyperechoic and ascites and pleural effusion were seen. Echocardiography revealed severe dilatation of the right atrium, right ventricle, and pulmonary artery; severe tricuspid regurgitation; and high right ventricular systolic pressure consistent with right-sided heart failure secondary to pulmonary hypertension.
  
  
  RESULTS
  Treatment with furosemide was attempted, but because of failing health, the llama was euthanized 4 weeks later. Macronodular cirrhosis of the liver, glomerulonephritis, and intimal fibrosis and medial hypertrophy of muscular pulmonary arteries were seen on histologic examination of postmortem specimens.
  
  
  CONCLUSIONS
  Findings in this case were similar to those reported for human patients with portopulmonary hypertension secondary to hepatic cirrhosis. Pulmonary hypertension secondary to hepatic disease should be considered in the differential diagnosis of right-sided heart failure.
authors.affiliation: Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Middleton
authors.forename: Munashe
authors.initials: M
authors.lastname: Chigerwe
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Fine
authors.forename: James R
authors.initials: JR
authors.lastname: Turk
authors.forename: Jimmy C
authors.initials: JC
authors.lastname: Lattimer
mesh_terms: D000818:Animals; D002161:Camelids, New World; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000662:veterinary; D017809:Fatal Outcome; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000662:veterinary*; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology / Q000662:veterinary*; D008107:Liver Diseases / Q000150:complications / Q000175:diagnosis / Q000662:veterinary*