Cardiac lymphoma and pericardial effusion in dogs: 12 cases (1994-2004)

OBJECTIVE: To determine clinical characteristics and clinicopathologic findings, including results of pericardial fluid analysis, and determine the outcome associated with pericardial effusion caused by cardiac lymphoma in dogs. DESIGN: Retrospective case series. ANIMALS: 12 dogs. PROCEDURE: Medical records of affected dogs were reviewed for echocardiographic findings, radiographic findings, results of pericardial fluid analysis, clinicopathologic findings, treatment protocols, and outcomes. RESULTS: Pericardial effusion was detected by echocardiography in all 12 dogs, and lymphoma was detected by cytologic examination of the effusion (11/12 dogs) or histologic examination of pericardium (3/12). Large-breed dogs were overrepresented; median weight was 40.5 kg (89.1 lb). Most hematologic and biochemical changes were mild and non-specific. Survival time for dogs treated with combination chemotherapeutic agents was 157 days and for dogs that did not receive chemotherapy survival time was 22 days. This difference was not significant, but several dogs had long-term survival. CONCLUSIONS AND CLINICAL RELEVANCE: Cardiac lymphoma is an uncommon cause of pericardial effusion, and results suggest that cardiac lymphoma does not always warrant the poor prognosis of other stage V, substage b lymphomas.     

Alteration of ventricular function on echocardiography associated with intra-pericardial disorder in dogs

Two dogs with severe exercise intolerance (Cases 1 and 2) and another dog with cardiac dilation (Case 3) were referred to the Nihon University Animal Medical Center (ANMEC). Case 1 was diagnosed as pericardial effusion (PE), Case 2 as pericardial hemorrhage, and Case 3 as pericardiophrenic hernia. When these causative disorders were removed, the heart expanded, and clinical symptoms markedly improved in these three dogs. In particular, the cardiac chamber diameters and left ventricle fractional shortening (LVFS) was normalized in all 3 dogs postoperatively. There is only one case report that compares before effusion extractions in the pericardial sac with the after echocardiography findings. In this paper, echocardiography was conducted on the three endocardial disease cases, comparing before removing these causative disorders with the findings after echocardiography.     

Echocardiographic evaluation of cardiac tamponade in dogs before and after pericardiocentesis: four cases (1984-1986)

The echocardiographic (M-mode and 2-dimensional) features (before and after pericardiocentesis) of 4 dogs with pericardial effusion and clinical evidence of cardiac tamponade were reviewed. M-Mode echocardiography revealed pericardial effusion, with exaggerated swinging motion of the heart and abnormal septal motion in all 4 dogs. In each case, 2-dimensional echocardiography demonstrated right ventricular diastolic free-wall collapse. Three dogs had right atrial diastolic collapse as well. Clinical signs improved, and right ventricular and right atrial diastolic collapse subsided after pericardiocentesis. Two-dimensional echocardiographic features of right atrial and ventricular collapse were used as indicators for determining the presence of cardiac tamponade.     

Idiopathic hemorrhagic pericardial effusion with organized thrombi in a dog

A dog was examined because of cardiac tamponade secondary to pericardial effusion. Masses adjacent to the right atrial and ventricular walls were revealed by echocardiography. Pericardectomy and biopsies of the masses established the diagnosis of idiopathic hemorrhagic pericardial effusion with organized thrombi. The dog was healthy 3 months after surgery. These organized thrombi mimicked cardiac neoplasia echocardiographically, and such a possibility should be included in the list of differential diagnoses of cardiac masses.     

Presumptive primary cardiac lymphoma in a cat causing pericardial effusion

We report a case of primary cardiac lymphoma in a cat, causing pericardial effusion. A 13-year-old castrated male Himalayan cat was evaluated for chronic weight loss and radiographic finding of cardiomegaly. Pericardial effusion and a heart mass were detected via echocardiography. Pericardiocentesis and ultrasound-guided fine needle aspirate of the heart mass were performed under sedation. Antemortem diagnosis of cardiac lymphoma was made based on cytology of pericardial fluid. Based on physical examination, laboratory tests and abdominal radiographs, primary cardiac lymphoma was established as the presumptive clinical diagnosis. Treatment with chemotherapeutic agents was initiated.     

DETECTION OF CARDIAC MASSES IN DOGS BY TWO-DIMENSIONAL ECHOCARDIOGRAPHY

From a two-year review of diagnostic two-dimensional real-time echocardiographic studies, a diagnosis of cardiac mass lesion was made in 18 dogs. Thirteen of 18 also had pericardial effusion. Three types of lesions were identified: (1) right atrial masses (7 dogs; 5 confirmed as hemangiosarcoma) originating from the wall of the right atrium of right auricle and projecting into the atrial lumen, pericardial space, or both; (2) large cavitary pericardial masses (2 dogs; both confirmed as abscesses) located over the right ventricle; (3) heartbase masses (9 dogs; 6 confirmed as neoplasms) attached to the ascending aorta, with varying degrees of infiltration of heartbase structures. Although extrapericardial portions of the masses were not outlined as well as intrapericardial portions, surgical accessibility was correctly predicted in most dogs. It was concluded that two-dimensional echocardiography (2DE), performed systematically using multiple imaging planes, allowed accurate detection and localization of cardiac and pericardial masses in dogs and was useful in predicting surgical accessibility of these lesions.     

Pericardial effusion in a dog with rhabdomyosarcoma in the right ventricular wall

A seven-year-old male labrador retriever presented in right heart failure with weak femoral pulses, and pleural, abdominal and mild pericardial effusion. No diagnosis could be established initially. Two days later, the dog developed severe pericardial effusion causing cardiac tamponade. A tumour in the right ventricular wall was visualised on ultrasonographic examination. An exploratory thoracotomy was performed and biopsies of the mass submitted for histopathological examination. A diagnosis of rhabdomyosarcoma arising from the myocardium was established. Cardiac rhabdomyosarcoma has been reported in only two dogs. Neither report was associated with pericardial effusion.     

Echocardiographic results and clinical considerations in dogs with right atrial/auricular masses

The case records of 26 dogs with pericardial effusion were examined. Sixteen dogs with confirmed right atrial/auricular masses were found. Eighteen masses were identified, of which 16 were confirmed as hemangiosarcomas. Eleven dogs had an abnormal mass detected during the echocardiographic examination, and tumor location was correctly predicted in nine of the 11 dogs. Six of seven tumors, which were not detected during the echocardiogram, were located in the right auricle. Pericardial effusion was apparently not necessary for the echocardiographic detection of a right atrial/auricular mass. Of ten dogs with pericardial effusion due to causes other than a cardiac mass, one abnormal mass-like lesion was seen during echocardiographic examination.     

Idiopathic aseptic pericardial effusion with cardiac tamponade in a horse

This report describes the successful treatment of pericardial effusion and cardiac tamponade in a 10‐year‐old Hanoverian gelding. Pericarditis and pericardial effusion are uncommon conditions in horses. Although many potential causes for the effusion have been described most cases are classified as idiopathic. The most valuable diagnostic procedure for the detection of pericardial effusion is echocardiography. Pericardiocentesis and drainage of the fluid were carried out in this case. At one year follow‐up there were no clinical signs of recurrence and the horse has returned to his previous level of athletic performance.     

Long-term survival of 23 dogs with pericardial effusions

Twenty-three dogs with pericardial effusions were identified from case records made between 1992 and 2000. Fourteen of the 23 were diagnosed with idiopathic pericardial effusions, and three of these were treated successfully by one pericardiocentesis. In the remaining 11 cases the pericardial effusion recurred; six cases were managed long-term by either two (three cases), three (two cases), or 11 repeated pericardiocenteses, and the remaining five were treated by pericardiectomy. The median survival time of the six dogs treated by repeated pericardiocentesis was five years and nine days.     

Cardiac troponins I and T in dogs with pericardial effusion

Cardiac troponin I (cTnI) and cardiac troponin T (cTnT) are sensitive and specific markers for myocardial ischemia and necrosis. Dogs with pericardial effusion frequently have myocardial ischemia and necrosis, and these changes are more severe in dogs with hemangiosarcoma (HSA). We investigated the utility of using serum cTnI and cTnT concentrations to identify the idiopathic pericardial effusion from that associated with HSA. Blood samples for measurement of cTnI and cTnT concentrations were collected before pericardiocentesis in 37 dogs with pericardial effusion. Eighteen dogs had a mass consistent with HSA, 6 dogs had idiopathic pericardial effusion, 1 dog had mesothelioma, and 1 dog had a heart base tumor. No final diagnosis was achieved for 11 dogs. Dogs with pericardial effusion had significantly higher serum concentrations of cTnI (P < .001) but not cTnT (P = .16) than did normal dogs. Dogs with HSA had significantly higher concentrations of cTnI (2.77 ng/dL; range: 0.09-47.18 ng/dL) than did dogs with idiopathic pericardial effusion (0.05 ng/dL; range: 0.03-0.09 ng/dL) (P < .001). There was no difference in the concentration of cTnT between dogs with HSA and those with idiopathic pericardial effusion (P = .08). Measurement of cTnI may be useful in helping to distinguish between idiopathic pericardial effusion and pericardial effusion caused by HSA.     

兔病毒性出血症自然感染病例的解剖病理学观察

为了给兽医临床诊断兔瘟病提供病理学快速诊断依据,对一起非典型兔瘟(慢性兔瘟)病例的发病情况和解剖病理变化进行了详细观察和拍照,并通过对流行病学调查、临床症状、剖检病理变化、实验室微生物学检查和血清学检测等综合分析,确诊为兔瘟。观察到兔瘟病主要病理变化表现为心脏充血、心耳充血明显,心包积液,心内外膜有散在针尖大小出血点;喉头和气管黏膜充血和出血,气管内有泡沫状液体;肺脏水肿、出血;胸腺严重水肿、出血,有的肿大3～5倍,外观大理石样;肝脏稍肿大、土黄色、质地脆弱;脾脏肿大,呈紫黑色,边缘有锯齿状坏死;胃壁变薄,黏膜易脱落;结肠充气鼓胀,浆膜有出血点或出血斑;肠系膜淋巴结肿大、点状出血;肾脏水肿、土黄色、有出血点或出血斑;膀胱积尿、有出血点;母兔子宫水肿、出血等。本试验为兽医临床快速诊断兔瘟病提供参考资料。     

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.     

Thoracoscopic partial pericardiectomy in 13 dogs

Thirteen dogs with cardiac tamponade resulting from pericardial effusion were prospectively evaluated to determine feasibility and outcome of thoracoscopic partial pericardiectomy. A lateral thoracoscopic approach allowed adequate exposure to remove a 4- to 5-cm-diameter section of pericardium in all dogs. Complete resolution of cardiac tamponade occurred in all dogs for which there was follow-up (11 dogs). Ten of 13 dogs (76.9%) had neoplastic pericardial effusion. One of these dogs remains alive at 220 days postoperatively and is asymptomatic. The mean survival of the remaining 9 patents with neoplastic effusion was 128 days (range, 14-544 days; median, 38 days). Three of 13 patients (23.1%) had idiopathic pericardial effusion. Two of these dogs remain alive at 585 and 1,250 days postoperatively. One dog with idiopathic pericardial effusion developed cardiomyopathy and was euthanized 18 days after the procedure. Results indicate that the procedure was technically successful in all dogs. No anesthetic complications occurred. Procedural complications included phrenic nerve transection (1 dog), lung laceration (1 dog), and moderate intraoperative bleeding (1 dog). No adverse clinical manifestations of the complications were apparent. We conclude that thoracoscopic partial pericardiectomy is technically feasible and offers several advantages over conventional open thoracic surgical pericardiectomy.     

Partial pericardial defect with left auricular herniation in a dog with syncope

Pericardial defects are rare in both people and dogs. They may be congenital or acquired in origin, and partial or total in extent. Commonly, pericardial defects are incidental findings at autopsy; however, diagnostic methods such as thoracic radiography and echocardiography can be useful in the ante mortem diagnosis of pericardial defects. This report describes the first case of a dog with syncope, supraventricular tachycardia, and a partial left pericardial defect with herniation of the left auricle for which extensive ante mortem diagnostic information was available. Partial absence of the pericardium should be considered in dogs with disproportionate enlargement of cardiac chambers for which other congenital and acquired heart diseases are ruled out.     

Pericardial free patch grafting as a rescue technique in surgical management of right atrial HSA

A 7 yr old, neutered female vizsla underwent an exploratory thoracotomy after diagnosis of recurrent hemorrhagic pericardial effusion and a right auricular mass. Staging tests were negative for metastasis. The patient underwent a right, fourth intercostal thoracotomy, subtotal pericardectomy, right auricular mass excision, and pericardial free patch graft. The patient experienced blood loss during surgery, which required a packed red blood cell transfusion. The patient experienced transient arrhythmias postoperatively, but was discharged from the hospital 48 hr later. Histopathologic diagnosis of the mass was hemangiosarcoma. The patient was treated with carboplatin single-agent chemotherapy and palliative radiation therapy. The patient died at home, presumably from metastatic disease 260 days postoperatively. Surgical mass removal or debulking along with pericardial free patch grafting may be considered as palliative treatment options for dogs diagnosed with right auricular masses. In this case report, other techniques failed to repair the defect in the heart and a free patch graft offered a good rescue procedure with a favorable outcome without the need for inflow and outflow occlusion when used in conjunction with adjunctive therapies.     

Disease association and clinical assessment of feline pericardial effusion

Records were reviewed from 83 cases to determine the main causes and clinical significance of feline pericardial effusion. The most common causes included hypertrophic cardiomyopathy with congestive heart failure, neoplasia, and systemic infection. Most cases had concurrent or secondary pleural effusion or pulmonary edema, with clinical signs of respiratory disease. However, several cases appeared to be affected solely by pericardial effusion rather than pulmonary pathology. Feline pericardial effusion remains an infrequent diagnosis, but its clinical relevance and association with severe cardiac and extracardiac disease warrant diagnostic evaluation.     

Acquired cardiac diseases in the dog: a retrospective analysis

To document the frequency of the different acquired cardiac diseases in the referring area of the University of Zurich, records of 474 dogs were retrospectively analysed. Most common were valvular diseases, predominantly atrioventricular valve endocardiosis (49.4%), myocardial diseases, predominantly dilated cardiomyopathy (21.1%), pericardial effusion (12.4%), mainly due to neoplasia or idiopathic pericarditis, and cardiac neoplasia without pericardial effusion (7.0%). Rare to very rare diagnoses were dirofilariosis (2.5%), endocarditis (1.1%, only 2 of these valvular), hypertrophic cardiomyopathy (0.6%) and infectious pericarditis (0.4%). Arrhythmias were found in 145 dogs, mainly tachyarrhythmias, and most commonly associated with dilated cardiomyopathy. Relevant concomitant diseases were tracheobronchial collapse and hyperadrenocorticism in dogs with mitral endocardiosis. Knowing prevalence and causes of the various cardiac and the complicating non-cardiac diseases with clinical similarities is important for formulating diagnosis and differential diagnosis.     

Pericardial effusion and pericardiocentesis in a guinea pig (Cavia porcellus)

A three-year-old, female guinea pig (Cavia porcellus) presented for acute dyspnea and weakness. Radiographs and echocardiography were consistent with a diagnosis of pericardial effusion and heart failure secondary to cardiac tamponade. Ultrasound-guided pericardiocentesis was performed, and clinical signs rapidly improved. Serial echocardiography and radiographs demonstrated normalization of cardiac function over the subsequent six months.