Thoracotomy in adult dairy cattle: 14 cases (1979-1991).

Fourteen cows were subjected to thoracotomy as an aid in the treatment of either septic pericarditis (n = 7) or unilateral pleuritis (fibrous or purulent; n = 7). Thoracic lesions were primary in 4 cows, secondary to traumatic reticuloperitonitis in 9 cows, and secondary to extension of a liver abscess in 1 cow. Thoracotomy was performed on 9 cows under local anesthesia. Surgery was performed on 5 cows under general anesthesia; 2 died during anesthesia, and 2 others were euthanatized. Of the 10 cows allowed to recover from surgery, 4 had pericarditis and 6 had pleuritis. Four cows with pleuritis had thoracic abscesses. All but 1 cow with pericarditis died or were euthanatized, and 5 of the 6 cows with pleuritis were discharged from the hospital. A year after surgery, 1 cow was culled because of infertility, and the other 5 cows were returned to production.     

Pericarditis and pleuritis caused by Corynebacterium pseudotuberculosis in a horse

A 13-year-old Oldenburg mare was evaluated for lethargy and signs of mild colic. Pericardial tamponade caused by fibrinoeffusive pericarditis was diagnosed. Cytologic and biochemical evaluation of pericardial fluid was consistent with a septic effusion. Corynebacterium pseudotuberculosis, the cause of pigeon fever, was identified by bacteriologic culture of pericardial fluid. Drainage and lavage of the pericardial sac, local (intrapericardial) and systemic antimicrobial treatment, and subsequent corticosteroid treatment resulted in a successful outcome in this horse. To the authors' knowledge, this is the first report of pericarditis associated with C pseudotuberculosis in a horse.     

Intraoperative echocardiography and surgical treatment of traumatic pericarditis in a pregnant cow

Traumatic pericarditis is one of the most significant bovine cardiac diseases. The authors describe the use of intraoperative echocardiography and successful surgical treatment of a case of traumatic pericarditis. A seven-year-old Hungarian Simmental dairy cow in late pregnancy showed severe oedema of the throat region and brisket, as well as jugular distension. Cardiac auscultation demonstrated tachycardia with a normal cardiac rhythm. The heart sounds were muffled, but no cardiac murmur or splashing sounds were heard. A large amount of echogenic fluid with some strands of fibrin was seen in the pericardial and right pleural cavities by ultrasonography. Ultrasound-guided pericardiocentesis demonstrated the presence of a thick, fetid and purulent exudate. Pericardiotomy was performed in standing position with sedation and local anaesthesia. After costal resection, intraoperative echocardiography was performed. It showed an echogenic tract between the caudal pericardium and diaphragm, but no foreign body was seen. Two weeks after the surgery, the cow delivered a healthy bull-calf. Intraoperative echocardiography - not reported earlier - can be applied to evaluate the entire bovine pericardial sac and heart. The report also demonstrates that surgical treatment of traumatic pericarditis can be successful in carefully selected cases.     

Septic fibrinous pericarditis in a cocker spaniel

A four-year-old cocker spaniel presented with cardiac tamponade due to a pericardial effusion, in addition to pyrexia and peripheral neutrophilia and a recent history of chest trauma. Cytological examination of the pericardial effusion revealed a predominant neutrophilia. The echocardiographic findings were of numerous hyperechoic densities in the pericardial space, due to fibrin, with concurrent thickening and distortion of the pericardium. Postmortem examination, including microbiology, revealed the presence of organising septic fibrinous pericarditis associated with a mixed infection of Streptococcus canis, Citrobacter species, Pseudomonas species and alpha-haemolytic streptococci.     

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.     

Constrictive pericarditis in a mare: attempted treatment by partial pericardiectomy.

Chronic constrictive pericarditis was diagnosed in a 6-year-old Thoroughbred mare based on the clinical findings of right congestive heart failure, hyperechoic pericardium without pericardial effusion, and a dip-and-plateau shape of the right ventricular pressure curve with equilibration of the diastolic pressures in all cardiac chambers. Treatment was attempted by partial pericardiectomy using a right lateral thoracotomy approach. Because of severe epicardial involvement recurrence of the constrictive pathology was noted 6 weeks after the surgical procedure. However, in selected cases in which the disease process is limited to the pericardium, partial pericardiectomy may offer a mode of therapy in horses suffering from constrictive pericarditis.     

Two-dimensional echocardiographically guided pericardiocentesis in a horse with traumatic pericarditis

Two-dimensional echocardiographic (2DE) examination was performed on a horse with clinical signs of pericardial effusion. Thickening of the pericardium, excess amount of pericardial fluid, elevation of the cardiac apex, and right ventricular compression, characteristic of cardiac tamponade, could be seen on 2DE recordings. Fibrinous pericarditis was suspected by observation of fibrinous strands in the pericardial fluid and epicardial fibrin deposits. Echocardiographically guided pericardiocentesis was performed, and 4 L of fluid was removed from the pericardial sac. Streptococcus zooepidemicus was isolated from the fluid. Pericardiocentesis was repeated for 3 days, and medication was administered. Despite temporary improvement in cardiac function, the horse's condition deteriorated gradually, and euthanasia was performed on the ninth day of hospitalization. Necropsy revealed chronic serofibrinous pericarditis of traumatic origin, attributable to an intercostal stab wound entering the pericardium and the apical portion of the myocardium.     

Idiopathic pericarditis in dogs: no evidence for an immune-mediated aetiology

OBJECTIVE: To ascertain whether specific immunological changes are associated with canine pericardial effusion due to idiopathic pericarditis. METHODS: In this prospective study, serum antinuclear antibody and serum and pericardial fluid immunoglobulin (Ig) G, Ig M and Ig A concentrations were measured in dogs with pericardial effusion due to idiopathic pericarditis or pericardial neoplasia. The secretory index relative to albumin concentration was calculated in order to distinguish between Ig actively secreted into the pericardial fluid and that derived from the blood accumulating within the pericardial sac. Statistical analysis was performed comparing the results obtained between the two groups of dogs. RESULTS: Only three dogs were antinuclear antibody positive; two of these dogs had idiopathic pericarditis and one had neoplasia. Mean serum Ig M and Ig A concentrations were lower than the reference values in both groups, and the secretory indices for Ig M and Ig A were greater than 1.0. However, there was no significant difference with respect to any Ig measurement between the two groups of dogs (P>0.1). CLINICAL SIGNIFICANCE: The results of the present study do not support the hypothesis that canine idiopathic pericarditis has a significant 'immune-mediated' aetiology or immunological features that distinguish it from the pericardial changes associated with local neoplastic disease.     

Subtotal pericardectomy and epicardial excision for treatment of coccidioidomycosis-induced effusive-constrictive pericarditis in dogs: 17 cases (1999-2003)

OBJECTIVE: To determine the history, clinicopathologic findings, and results of surgery for effusive-constrictive pericarditis associated with Coccidioides immitis infection in dogs. DESIGN: Retrospective study. ANIMALS: 17 client-owned dogs that underwent a subtotal pericardectomy and epicardial excision. PROCEDURE: Hospital records from May 1999 to June 2003 were reviewed. Data collected included history, clinicopathologic findings, treatments, and outcome. Follow-up information was obtained via recheck examination and by use of standardized telephone interviews with referring veterinarians and owners. RESULTS: All dogs were of large breeds, and most were male (mean age, 4.66 years). Ten dogs had no prior history of C. immitis infection, and 7 dogs had chronic infection with C. immitis. Having a chronic C. immitis infection reduced the odds of survival, compared with no previous infection. All dogs had clinical signs of right-sided heart failure. All dogs had serum titers (range, 1:8 to 1:256) for antibodies against C. immitis prior to surgery, and titers were not significantly associated with outcome. Predominant echocardiographic findings were thickened pericardium, reduced right ventricular filling, and pleural or pericardial effusion. All dogs underwent a subtotal pericardectomy and epicardial excision and had fibrosing pyogranulomatous pericarditis in biopsy specimens obtained during surgery. The perioperative mortality rate was 23.5%, and the 2-year postdischarge survival rate was 82%. CONCLUSIONS AND CLINICAL RELEVANCE: Surgical treatment via subtotal pericardectomy and epicardial excision is successful at relieving right-sided heart failure in dogs with effusive-constrictive pericarditis secondary to C. immitis infection, but long-term treatment with antifungal agents may still be required.     

DIAGNOSTIC PNEUMOPERICARDIOGRAPHY IN DOGS WITH SPONTANEOUS PERICARDIAL EFFUSION

To evaluate the diagnostic accuracy of pneumopericardiography, diagnostic pneumopericardiograms from 39 dogs with spontaneous pericardial effusion of various etiologies were reviewed. Diagnoses were confirmed by surgical biopsy, necropsy, or follow-up evaluation. Thirty-two of 39 studies (82%) were considered diagnostic. There were one false-positive and six false-negative studies. Fifteen of 16 studies (94%) in dogs with idiopathic sanguinous pericardial effusion were negative (i.e., similar to those in normal dogs). Seven of 12 right atrial hemangiosarcomas (58%), six of six heartbase neoplasms (100%), and two of two pericardial cysts (100%) were outlined. Studies in two cases of infective pericarditis revealed abnormal findings, while a negative study was obtained in one patient with pericardial mesothelioma. Lateral positions were most valuable in idiopathic effusions and for outlining heartbase neoplasms. The left lateral recumbent position was particularly important for outlining hemangiosarcomas. Pericardial cysts were profiled best in ventral or dorsal recumbent positions. This study documents the high diagnostic potential of technically adequate pneumopericardiograms in the etiologic diagnosis of pericardial effusion in the dog.     

Idiopathic, aseptic, effusive, fibrinous, nonconstrictive pericarditis with tamponade in a standardbred filly.

A Standardbred filly was admitted for evaluation of pleuritis and pneumonia. Heart rate was 80 to 120 beats/min, and the pulse was barely palpable. Thoracic and abdominal ultrasonography and echocardiography revealed substantial pericardial effusion with cardiac tamponade, fibrinous pericarditis, pleural effusion, and ascites. Initial electrocardiography revealed normal sinus rhythm with decreased amplitude of the QRS complexes consistent with pericardial effusion. Following thoracentesis, echocardiogram-guided pericardiocentesis was performed. Bacterial culture yielded no growth from any of the fluids, and bacteria were not seen on cytologic examination. Initial treatment included broad-spectrum antibiotic treatments, IV fluid therapy, and anti-inflammatory agent administration. On the basis of negative culture results, an immune-mediated cause was considered, and dexamethasone was instituted in a decreasing dosage regimen. Pericardial effusion, ventral edema, and ascites began to resolve within 3 days after beginning dexamethasone treatment. Thirty days following discharge, the filly was reexamined, and at that time, the prognosis for athletic performance was considered good so the horse was returned to race training. The final diagnosis in this case was idiopathic, effusive, nonconstrictive pericarditis with tamponade. Early identification, clinical understanding, and application of knowledge of the pathophysiologic mechanisms of pericarditis in horses, combined with use of diagnostic aids such as ultrasonography and aggressive therapy consisting of effusion drainage, pericardial lavage, antibiotics that penetrate the pericardium, and corticosteroids when indicated are critical for a successful outcome in horses with pericarditis.     

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.     

Pericarditis in horses: six cases (1982-1986)

Records of 6 horses with pericarditis were reviewed. Septic pericarditis was suspected in all horses, based on historic and clinical findings. In horses 1, 2, and 4, cytologic examination of the pericardial effusion revealed acute inflammation with severe neutrophil degeneration. In horses 3 and 5, cytologic examination of pericardial fluid revealed subacute inflammation with degenerated neutrophils, and in horse 6, chronic active inflammation, with well preserved neutrophils. In horses 1 and 3, bacteria were identified on cytologic examination of pericardial fluid. Results of microbiologic cultures of pericardial fluid were positive in horse 3. All horses were treated with broad-spectrum antibiotics. An indwelling pericardial catheter was used to lavage and directly administer antibiotics into the pericardial sac. Horses 1, 4, 5, and 6 survived, horse 2 died of unrelated causes, and horse 3 was euthanatized at the owner's request. Surviving horses returned to athletic performance.     

Electrophoretic studies on serum proteins in cows with traumatic pericarditis.

Diagnostic significance of electrophoretic findings of serum protein in cows with traumatic pericarditis was evaluated. Affected cows were classified into 3 groups according to autoptical findings: fibrinous, sero-fibrinous, and purulent types. Slight hypoprotenemia, moderate hypo-albuminemia, slight hyper-alpha globulinemia and tendency of hyper-beta globulinemia were commonly observed in the affected cows. The level of gamma globulin tended to be lower in the cows with fibrinous or sero-fibrinous, and higher in purulent pericarditis, than the level in healthy cows. In the serum protein electropherograms of the cows with fibrinous or sero-fibrinous pericarditis, there was pathognostic pattern composed of slender albumin, acute shape of alpha globulin with a broad rising accompanied by double peaks and with main peak migrating toward the albumin side, tendency of rising beta globulin fraction, and large indentation between beta and gamma fractions. These findings except for the slender albumin fraction, however, was not or poorly observed in purulent pericarditis. Electrophoretic findings were subacute inflammatory pattern with non-selective serum protein losing in fibrinous or sero-fibrinous, and chronic inflammatory pattern in purulent pericarditis.     

Evaluation of the presence of selected viral and bacterial nucleic acids in pericardial samples from dogs with or without idiopathic pericardial effusion

Many viruses have been identified in pericardial fluid and in tissue samples from humans with pericarditis by means of molecular diagnostics. In canine idiopathic pericardial effusion there is as yet no conclusive evidence to support the involvement of an infectious agent. This study was designed to investigate a possible relationship between idiopathic pericardial effusion in dogs and viruses most commonly encountered in humans affected with viral pericarditis. Coxsackievirus B3 RNA, influenza virus type A RNA, human adenovirus type 2 DNA, human cytomegalovirus DNA, and parvovirus B19 DNA were investigated using PCR on pericardial effusion samples and pericardial tissue specimens collected from 14 dogs with idiopathic pericardial effusion. PCR was also used to test for two bacteria, Borrelia burgdorferi and Chlamydia pneumoniae. The same microorganisms were also looked for in pericardial effusions or pericardial washes from 10 dogs with neoplastic pericardial effusion, and in samples collected from 10 dogs which died of a non-cardiac disease. One pericardial effusion sample from a dog with the idiopathic form of the disease tested positive for influenza virus type A and sequencing of the amplicon confirmed the PCR result. In another dog from the same group a cytomegalovirus was detected by PCR in the effusion, but sequencing showed this to be a false-positive result. The genomes of the microorganisms investigated were not detected in neoplastic effusions or pericardial washes. The results indicate that viral and bacterial DNA/RNA of relevance for human pericarditis is rare in pericardial samples from dogs with idiopathic pericardial effusion. The finding of influenza type A viral RNA in pericardial fluid from one dog with the idiopathic form of the disease warrants further investigation.     

Septic pericardial effusion associated with pulmonary and pericardial botryomycosis in a dog

The authors report a case of septic pericardial effusion resulting in cardiac tamponade associated with intrathoracic botryomycosis in a dog. Septic pericarditis and a pulmonary mass were diagnosed, and subtotal pericardiectomy and lobectomy of the affected pulmonary areas were carried out. Histopathology of the excised tissue showed changes supportive of botryomycosis--namely a pyogranulomatous inflammation with neutrophils centred around amorphous homogeneous eosinophilic material and club-like bodies containing Gram-positive bacterial cocci present in the centre. The patient recovered well following surgery and antibiotic therapy. To the authors' knowledge, this is the first report of pulmonary botryomycosis in the dog and the first report of this condition presented with pericardial involvement and cardiac tamponade in any species.     

Idiopathic effusive pericarditis with tamponade in the horse

Pericarditis and pericardial effusion are considered to occur rarely in the horse. The clinical and laboratory features of idiopathic pericarditis with effusion diagnosed in 10 horses over a seven-year period were reviewed. Consistent physical findings included tachycardia, ventral oedema, jugular venous distention and diminished heart sounds. Electrocardiographic features included diminished voltages and electrical alternans, and the effusion was identified by echocardiography in the six horses in which it was performed. Pericardiocentesis relieved clinical signs in nine horses. Laboratory analysis of pericardial fluid samples classified six cases as aseptic serofibrinous, three cases as eosinophilic, and one case as histiocytic. One horse died and three were destroyed. The remaining six horses recovered following pericardiocentesis (performed once or twice) with or without corticosteroid treatment, and were alive one month to seven years after diagnosis.     

Clinical findings in 28 cattle with traumatic pericarditis

Traumatic pericarditis was confirmed postmortem in 28 cattle that had shown signs of a heart rate of more than 100 bpm, distended jugular veins and muffled heart sounds or abnormal pericardial sounds. The heart rate was higher than normal in 24 of them, and in 18 of these it ranged from 100 to 130 bpm. Twenty of the cattle had muffled heart sounds and 10 had pericardial sounds, such as splashing, rubbing or squeaking sounds. Both jugular veins were distended in 24 of the cattle, and 15 had oedema of the throat region, brisket and ventral abdomen. The most important laboratory findings were a reduced clotting time in the glutaraldehyde test in 26 animals, leucocytosis in 22 and a higher than normal concentration of fibrinogen in 19. There was an increase in the activity of gamma-glutamyl transferase in 20, and of aspartate aminotransferase in 15, and in the concentration of bilirubin in 11 of the cattle, indicative of hepatic congestion. A definitive diagnosis of traumatic pericarditis was made on the basis of the clinical findings in 15 of the 28 animals, all of which had typical signs of the disease. In another eight animals, traumatic pericarditis was suspected, although one of the characteristic signs was absent. A tentative but incorrect diagnosis of valvular endocarditis was made in three animals, and a similarly incorrect diagnosis of traumatic reticuloperitonitis was made in the other two.     

Constrictive pericarditis secondary to Coccidioides immitis infection in a dog

A 4-year-old castrated male mixed-breed dog with a history of coccidioidomycosis was referred for evaluation of abdominal and pleural effusion. Results of radiography, ultrasonography, cytologic evaluation of thoracic fluid, and serologic testing supported a diagnosis of constrictive pericarditis secondary to infection with Coccidioides immitis. Aggressive treatment for presumptive coccidioidomycosis was begun, but the dog's condition continued to deteriorate, and the dog was euthanatized. At necropsy, the pericardium was thicker than normal and fibrotic and adhered to the epicardium. Microscopically, the pericardium and 1 section of epicardium contained lymphoplasmacytic infiltrates with a few macrophages and neutrophils. Coccidioides immitis was cultured from pericardial fluid. A search of records from the Arizona Veterinary Diagnostic Laboratory for 1988 through 1998 revealed that of 46 dogs in which a diagnosis of coccidioidomycosis was confirmed at necropsy, 13 had involvement of the heart or pericardium.     

Septic pericarditis and myocardial abscess in an English Springer spaniel

Septic pericarditis and myocardial abscess are rare conditions in dogs. They are usually caused by foreign bodies, penetrating wounds, systemic infections or extension of local infections such as endocarditis, pleuritis or pulmonary infections to the myocardial tissue. Here we report a septic pericardial effusion and myocardial abscess in a young English Springer spaniel presenting with a long history of pyrexia and lethargy. No cause could clearly be identified although a penetrating injury or dissolving foreign body was highly suspected. The patient was successfully treated with a surgical approach in combination with broad spectrum antibacterials resulting in resolution of clinical signs without recurrence of the infection.