Therapeutic pericardiocentesis in the dog and cat

Pericardial effusion is a potentially life-threatening problem leading to a rise in the intrapericardial pressure resulting in varying degrees of hemodynamic compromise. Cardiac tamponade occurs when the intrapericardial pressure equals or exceeds right ventricular diastolic filling pressures leading to a decreased cardiac output. In dogs, the most common causes of pericardial effusion that require pericardiocentesis are cardiac neoplasia and idiopathic pericardial effusion (IPE). The incidence of cardiac neoplasia in dogs is low, and it is rare in cats. In dogs, hemangiosarcoma and chemodectoma are the two most common types of cardiac neoplasia. In cats, lymphosarcoma is the most common form of cardiac neoplasia, but they are more likely to develop pericardial effusion secondary to congestive heart failure or feline infectious peritonitis. Common histories include lethargy, dyspnea, anorexia, collapse, and abdominal distension. Pericardiocentesis is used to stabilize animals with life-threatening cardiac tamponade, relieve the pressure leading to right-sided heart failure, and obtain fluid samples for diagnostic evaluation. The fluid should be quantified and characterized. Serious complications associated with pericardiocentesis are rare. Complications include cardiac puncture, arrhythmias, and laceration of a tumor or coronary artery resulting in intrapericardial hemorrhage or sudden death.     

Chronic granulomatous pneumonia and lung rupture secondary to aspiration of activated charcoal in a French Bulldog

A 4‐year‐old, spayed female French Bulldog was presented for respiratory distress and suspected aspiration pneumonia after oral administration of activated charcoal for possible ingestion of a suspected toxic dose of trazodone. The patient had a moderate volume of pleural effusion, which contained free and intracellular black particulate matter consistent with charcoal. Due to presumed charcoal aspiration with subsequent lung rupture, the right middle and right caudal lung lobes were surgically removed. Histology revealed abundant black debris consistent with charcoal and severe granulomatous inflammation. Based on the clinical, gross, and histologic findings, a diagnosis of severe, chronic, locally extensive, aspiration pneumonia and lung rupture with secondary pleuritis and mediastinitis due to charcoal aspiration was made. Aspiration pneumonia is the main complication of activated charcoal administration, which can incite extensive, granulomatous inflammation in the respiratory tract. To the authors’ knowledge, this is the first report describing the cytologic and histologic findings associated with inadvertent charcoal aspiration in a veterinary species.     

Complex mammary carcinoma with metastases to lymph nodes,subcutaneous tissue,and multiple joints in a dog

An 8‐year‐old, intact female, mixed‐breed dog presented to the Oklahoma State University Boren Veterinary Medical Teaching Hospital for evaluation of progressive lameness and joint effusion of multiple joints. Physical examination revealed joint effusion of the elbow, hock, and stifle joints bilaterally, enlarged left axillary and right popliteal lymph nodes, a subcutaneous mass over the left elbow, and a subcutaneous mass involving the left second and third mammary glands. Cytologic examination of the mammary mass, enlarged lymph nodes, and joint fluid from most affected joints revealed a monomorphic population of loosely cohesive neoplastic epithelial cells. The patient was humanely euthanized, and subsequent necropsy with histopathologic examination revealed a complex mammary carcinoma with metastases to enlarged lymph nodes, subcutaneous tissue over the left elbow, and the synovium of multiple joints. Immunohistochemical stains were performed and showed diffusely positive pan cytokeratin, CK8/18, and CK19 staining in the neoplastic luminal epithelial cells of the mammary carcinoma, synovium, and lymph nodes, and showed diffusely positive vimentin staining of the myoepithelial cells. Myoepithelial calponin positivity was diffuse in the mammary mass and lymph nodes but minimal in the synovium. Only the mammary mass showed p63 positivity. Metastatic mammary neoplasia is relatively common in dogs; however, metastasis to the synovium has only been reported once previously in the literature. This is the first case utilizing immunohistochemistry for confirmation and characterization of metastases.     

Successful Treatment of Pericarditis in a Pregnant Llama

Objective: To describe the diagnosis and treatment of a pregnanat llama with perticardlts.
Summary: A 2-year-old female llama presented for lethargy of several days' duration. Partinent physical examination findings included tachycardia. muffled heart sounds, tachpnea and lethargy. Electrocardiography revealed tachycardia, second-degree AV block and electrical alternans. Echocardiography confirmed the presence of pericardial effusion and cardiac compromise. Thoracic sonogram revealed pleural effusion. Treatment included intravenous fluids, systemic antimicrobials, systemic anti-inflammatories, thoracocentesis and eventual pericardiocentesis with daily drainage and lavage. No etiological agent was identified. The llama reponded well to therapy well to therapy and a 3.5-month and 2-year follow-up revealed no cardiac problems.
New information provided: This is the first case report of pericarditis in a llama with treatment and a favorable outcome.     

What is your diagnosis? Muculent pleural effusion from a dog

Pleural effusion was examined from a 5-year-old, female Brittany Spaniel with a 7-day history of dyspnea, anorexia, and diarrhea. The fluid was yellow, cloudy, and slightly gelatinous, and had a total protein concentration of 2.8 g/dL, a total nucleated cell concentration of 1.1 x 10(3)/muL, and a triglyceride concentration of 177 mg/dL. A cytocentrifuged preparation contained a mixed inflammatory cell population with a predominance of small lymphocytes and abundant mucinous material in the background. The dog died 3 days later and a mass was found within the lumen and wall of the right auricle of the heart at necropsy. Histopathologic sections of the mass contained a population of anaplastic spindle cells diffusely suspended in a pale basophilic matrix, consistent with myxosarcoma. The cells were positive for vimentin and negative for cytokeratin, desmin, and von Willebrand factor VIII-related antigen. A myxoid matrix was confirmed by positive staining with Alcian blue. Myxosarcoma is a rare cardiac tumor in dogs that should be considered, along with mucus-producing carcinomas and bile, as a cause of muculent effusion.     

Serum Cardiac Troponin I Concentrations in Cattle with Cardiac and Noncardiac Disorders

Background: Making a clinical diagnosis of pericarditis in cattle is difficult and additional diagnostic tests are needed to evaluate cattle with suspected pericarditis. Serum cardiac troponin I (cTnI) concentrations are increased in cattle with pericarditis, but the utility of measuring serum cTnI concentrations in cattle with suspected pericarditis in cattle remains unclear.
Objectives: To determine if serum cTnI concentrations in cattle can be used to differentiate pericarditis from other cardiac disorders and noncardiac thoracic diseases.
Animals: Seventy-seven clinically diseased cattle and 19 healthy control cattle.
Methods: Serum cTnI concentrations were measured using an Immunlite Troponin I immunometric chemiluminescent assay in consecutive cases of postmortem-confirmed pericarditis (n = 18), endocarditis (n = 15), chronic suppurative pneumonia (n = 13), congenital heart disease (n = 10), reticulitis (n = 3), mediastinal abscess (n = 7), thymic lymphoma (n = 6), and caudal vena cava thrombosis (n = 5). Serum cTnI concentrations were measured in 19 healthy cattle.
Results: Although serum cTnI concentrations were significantly higher in cattle with pericarditis compared with healthy cattle, they were not significantly different from concentrations in cattle with endocarditis, congenital cardiac disease, mediastinal abscess, reticulitis, caudal vena cava thrombosis, or chronic suppurative pneumonia.
Conclusions: Serum cTnI cannot be used to distinguish cattle with pericarditis from cattle with other primary cardiac diseases. In addition, serum cTnI concentrations cannot distinguish between cattle with primary cardiac diseases and those with other noncardiac, intrathoracic disorders.     

CT features of pleural masses and nodules

Pleural space masses and nodules are rarely described on computed tomography (CT) in veterinary medicine and have only been described in patients with neoplasia. Our purpose was to describe the CT findings and diagnoses in seven patients with pleural masses and nodules. Two patients had broad-based, plaque-like pleural masses, both of which were due to neoplasia (primary pleural carcinoma, metastatic thymoma). Two patients had well-defined pleural nodules and nodular pleural thickening, one of which had mesothelial hypertrophy, and another of which had metastatic hemangiosarcoma. Three patients had ill-defined pleural nodules to nodular pleural thickening, one of which had metastatic pulmonary carcinoma, while the other two had bacterial infection with mesothelial proliferation (n = 2), fibrinous pleuritis (n = 1), and severe mediastinal pleuritis/mediastinitis (n = 2). Five of the seven patients had focal, multifocal or diffuse smooth, and/or irregular pleural thickening. Five of seven patients had pleural effusion, and postcontrast CT was useful in several patients for delineating the pleural lesions from the effusion. All patients except one had additional lesions identified on CT besides those in the pleural space. CT is useful in identifying and characterizing pleural space lesions and could be used to guide further diagnostic procedures such as thoracoscopy or exploratory thoracotomy. Both neoplastic and nonneoplastic diseases should be considered in the differential diagnoses for pleural space masses and nodules found on CT.     

Plasma N-terminal pro-brain natriuretic peptide concentrations before and after pericardiocentesis in dogs with cardiac tamponade secondary to spontaneous pericardial effusion

Objective

To determine if concentrations of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) are increased in dogs with cardiac tamponade and if there is a significant increase in plasma NT-proBNP after pericardiocentesis.

Left atrial rupture in dogs: 14 cases (1990–2005)

Objective: To describe the clinical parameters, treatment, and prognosis of dogs with left atrial rupture secondary to chronic mitral valve insufficiency. Design: Retrospective study. Setting: University referral hospital. Animals: 14 dogs with left atrial rupture. Interventions: None. Measurements and main results: Mixed breed dogs (n=6, 43%) and Shetland Sheepdogs (n=3, 21%) were most commonly affected. The median age was 12 years (range 5.8–18 y). The median weight was 11 kg (range 4–30 kg). Eight dogs had been previously diagnosed with chronic valvular disease. The most common presenting complaints included collapse (13/14), cough (9/14), and dyspnea (8/14). Four dogs were presented in either respiratory or cardiac arrest. Pericardial effusion was present in 13 dogs. The median left atrium:aortic outflow ratio was 2.66 (range 1.66:1–5.52:1). Pericardiocentesis was performed to alleviate tamponade in 3 dogs. Five dogs were discharged from the hospital, 3 of which were euthanized within 35 days of initial diagnosis for recurrence of clinical signs (n=2) and for hematochezia and lethargy (n=1). Five dogs were euthanized while in the hospital for a variety of reasons including DIC, progressive azotemia, collapse and recurrence of pericardial effusion, or possible seizure episode. Conclusions: Although rare, left atrial rupture resulting in pericardial effusion should be considered in older small‐ to medium‐sized dogs presenting with collapse, cough, and dyspnea. The overall prognosis appears poor.     

DETECTION OF PNEUMOTHORAX AND PLEURAL EFFUSION WITH HORIZONTAL BEAM RADIOGRAPHY

Forty‐seven patients with a known history of thoracic trauma or clinical suspicion of pneumothorax were selected for thoracic imaging. The patient population was composed of 42 dogs and five cats. Standard vertical beam (VB) left and right lateral and ventrodorsal/dorsoventral (VD/DV) projections were obtained for each patient, and at least one horizontal beam (HB) projection (VD projection made in lateral recumbency). A total of 240 images were reviewed. Subjective assessment for the presence and degree of pneumothorax and pleural effusion was made more confidently with HB projections. Pneumothorax was identified in at least one projection in 26 patients (26 dogs) and pleural effusion in 21 patients (19 dogs and two cats). Pneumothorax and pleural effusion were present concurrently in 17 dogs. Pneumothorax and pleural effusion were graded for each image as absent, mild, moderate, or severe. Right (P<0.001) and left (P<0.05) lateral HB VD projections and the standard VB left lateral projection (P<0.05) were significantly more likely to detect and grade pneumothorax severely than the VB VD/DV views. The right lateral HB projection had the highest rate of detection and gradation of severity for pneumothorax compared with other views. VD/DV projections had the lowest sensitivity for detection of the pneumothorax and gradation of severity for pneumothorax and pleural effusion. No significant difference in diagnosis (P=0.9149) and grade (P=0.7757) of pleural effusion were seen between views, although the left lateral HB had both the highest rate of detection and grade of severity.     

ULTRASONOGRAPHIC DIAGNOSIS OF DIAPHRAGMATIC RUPTURE IN A HORSE

Real–time ultrasonography was used to confirm diaphragmatic rupture in a horse that developed pleural effusion following a traumatic event. Pleural effusion, a cranially displaced crus, and a cranially positioned sacculated loop of bowel were seen radiographically. The presence of gas–filled intestine cranial and dorsal to the diaphragm was detected by ultrasound imaging. The use of ultrasound and radiography in the diagnosis of diaphragmatic rupture is discussed.     

Non-coagulopathic spontaneous hemothorax in dogs

Objective: To determine the history, clinicopathologic findings, underlying causes, and outcomes for dogs with non‐coagulopathic spontaneous hemothorax. Design: Retrospective case series. Setting: University referral hospital. Animals: Sixteen client‐owned dogs. Interventions: The medical records database was searched for dogs with hemothorax. Dogs with trauma, secondary coagulopathy, recent thoracic surgery, or pericardial intervention were excluded. For the remaining dogs, signalment, clinical signs, clinicopathologic findings, radiographic findings, histopathologic findings, interventions, and outcome were recorded. Measurements and main results: The most common presenting signs were tachypnea (n=9) and lethargy (n=5), typically of <1‐week duration. The most common cause of non‐coagulopathic spontaneous hemothorax in dogs was neoplasia, which was diagnosed in 14 patients (88%). Identified malignancies included hemangiosarcoma (n=1), malignant mesothelioma (n=1), metastatic ovarian carcinoma (n=1), osteosarcoma (n=2), and pulmonary carcinoma (n=2). An intrathoracic mass was visualized in 7 other dogs; however, histopathology was not obtained. Pancreatitis and lung lobe torsion were each diagnosed in 1 dog, and survival was prolonged with both surviving at least 1 year post discharge. Only 6 of 14 dogs that were diagnosed with neoplasia were discharged from the hospital. For the 4 dogs with cancer with available outcome data, median survival time was 16 days (range 1–70 days). Two dogs were lost to follow‐up and had unknown survival times. Conclusions: The development of non‐coagulopathic spontaneous hemothorax warrants a high‐index suspicion for neoplasia, in particular thoracic wall neoplasia.     

Septic pericarditis in a Yorkshire Terrier

Objective: To describe a novel case management strategy for a small breed dog diagnosed with septic pericarditis. Case summary: An 8‐year‐old spayed female Yorkshire Terrier presented for evaluation of pericardial effusion and persistent hypoglycemia. The dog had been hospitalized at a primary care facility for acute onset of vomiting, lethargy, inappetance, and painful abdominal distension. Pericardial effusion was detected and upon referral, cytologic examination revealed a suppurative exudate with Gram‐positive and Gram‐negative bacteria. The dog was treated with pericardiocentesis and placement of an indwelling pericardial catheter. Subtotal pericardiectomy was performed and a thoracotomy tube was utilized postoperatively. A penicillin‐susceptible Bacteroides species was cultured from the pericardial fluid and was treated with a 6‐week course of antibiotics. The dog was discharged from the hospital and clinical signs have not recurred in over 2 years. New or unique information provided: Septic pericarditis, an uncommon cause of canine pericardial effusion, has been described primarily in large breed dogs and in association with bacterial infection secondary to Hordeum grass (foxtail) awn migration. This case was unique in that the dog was a small breed with no evidence of foreign body penetration or other precipitating cause for the pericarditis. In a novel management plan, an indwelling pericardial catheter was employed to stabilize the dog before subtotal pericardiectomy.