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.     

Marked pleural effusion causing right atrial collapse simulating cardiac tamponade in a dog

A 16-month-old, female German shepherd dog was presented with severe bicavitary effusions. A diaphragmatic hernia was diagnosed by thoracic radiography. An echocardiogram performed prior to surgical repair of the hernia revealed signs of cardiac tamponade, with right atrial collapse, in the absence of pericardial effusion. Right atrial collapse was presumed to be secondary to severe pleural effusion. At surgery, no pericardial disease was identified. Surgical correction of the diaphragmatic hernia resulted in resolution of the pleural and peritoneal effusions. Follow-up echocardiography demonstrated resolution of the signs of cardiac tamponade.     

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.     

Pheochromocytoma Presenting as Acute Retroperitoneal Hemorrhage in a Dog

Objective: This report describes the perioperative management of a dog with a right adrenal pheochromocytoma that presented with acute retroperitoneal hemorrhage, cardiac arrhythmia and hypertension. Additionally, a summary of pheochromocytoma and the idiosyncrasies of perioperative management of a pheochromocytoma are provided.
Summary: A 7-year old male, neutered, Dalmation was presented for acute collapse, abdominal pain and tachycardia. Physical examination findings were consistent with hypoperfusion concurrent with multiple cardiac arrhythmias and hypertension. Abdominal ultrasound revealed retroperitoneal effusion and a right adrenal mass intimately associated with the caudal vena cava. Incomplete right adrenalectomy was performed. Histopathology confirmed a pheochromocytoma.
Unique information provided: To the authors' knowledge, this is the first definitive report of acute retroperitoneal hemorrhage as the initial clinical manifestation of histologically confirmed adrenal pheochromocytoma in the dog. ( J. Vet Emerg Crit Care 2001; 11(3): 221–227 )     

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.     

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.     

Septic pericarditis, aortic endarteritis, and osteomyelitis in a dog

A 7-year-old, female spayed rottweiler was referred with a history of an acute onset of collapse attributable to cardiac tamponade. Thoracic radiographs revealed an enlarged cardiac silhouette compatible with pericardial effusion, sternal osteomyelitis, and an unusual mineralized lesion determined later to be within the aortic wall. The pericardial effusion was a septic exudate secondary to infection with Staphylococcus species and hemorrhage into the pericardium through a mineralized aortic lesion. The case demonstrates the importance of complete evaluation of thoracic radiographs in a patient with cardiac disease and the potential value of cytopathological evaluation of pericardial fluid.     

Successful Management of Traumatic Right Atrial Rupture

A 2 year old male mixed breed dog presented with clinical signs of acute cardiac tamponade after being hit by a car. Echocardiography confirmed the presence of pericardial effusion. Pericardiocentesis revealed venous blood that clotted normally, suggestive of an acute lesion involving the right side of the heart. An emergency thoracotomy was performed, and a laceration of the right atrium was identified and repaired. Postoperatively, the dog developed traumatic myocarditis that improved with time and medical management. Six months after surgery, the dog was healthy with no adverse effects of the trauma. The importance of early recognition and the necessity for expeditious surgical management of traumatic right atrial rupture in the dog is illustrated in this report.     

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.     

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.     

Idiopathic primary chylopericardium in a dog

CASE DESCRIPTION: A 7-year-old spayed female Labrador Retriever was evaluated because of pericardial effusion. CLINICAL FINDINGS: The dog had a history of decreased appetite and exercise intolerance of 3 days' duration. Thoracic radiography performed by the referring veterinarian revealed a large cardiac silhouette. Heart sounds were muffled. Echocardiographic findings were indicative of severe pericardial effusion with cardiac tamponade; no pleural effusion was identified. Pericardiocentesis yielded a considerable amount of chylous fluid. A diagnosis of chylopericardium in the absence of pleural effusion was made. TREATMENT AND OUTCOME: Conservative management was not effective, and subtotal pericardectomy and thoracic duct ligation were recommended. Surgery was postponed by the owners for 25 days, at which time the dog had both chylopericardium and chylothorax. The dog underwent subtotal pericardectomy and thoracic duct ligation; to delineate the thoracic duct, intraoperative lymphangiography was performed by injection of a radiopaque contrast agent directly into a mesenteric lymph node and subsequent injection of methylene blue solution into another mesenteric lymph node. Surgical treatment resulted in complete resolution of the clinical signs and pleural effusion. CLINICAL RELEVANCE: To the authors' knowledge, this is the first report of the development of chylopericardium prior to development of chylothorax in a dog. Treatment with thoracic duct ligation and pericardectomy resulted in complete resolution of the effusion and clinical signs.     

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 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.     

Pericardial effusion associated with metastatic disease from an unknown primary tumor in a dog

A 6.5-year-old, spayed female Siberian husky presented with signs of cardiac tamponade and weakness. Pleural, pericardial, and abdominal effusion were identified with radiographs and ultrasound. Pericardiocentesis relieved signs of tamponade, and the dog was clinically improved. Pericardial effusion recurred, and pericardiectomy was performed. Histopathological examination of excised tissues failed to reveal evidence of infectious or neoplastic disease. After pericardiectomy, clinically apparent thoracic effusion persisted. The dog was euthanized, and postmortem histopathological examination revealed emboli of metastatic carcinoma cells in the epicardium. The location of intrathoracic disease in this dog made antemortem diagnosis difficult, if not impossible.     

Intrapericardial Cysts in the Dog

Intrapericardial cysts were identified as the cause of impaired cardiac filling in six young dogs. Pneumo-pericardiography and two-dimensional echocardiography showed the cysts in 2 of 2 dogs and in 4 of 4 dogs, respectively. One dog, which was also infected with heartworms, died before surgical excision of the cyst could be performed. In the remaining dogs, surgical excision of the cysts and subtotal pericar-diectomy was successfully accomplished. Histologic examination of the excised tissue from one dog suggested that it was a pericardial coelomic cyst. The gross and histologic characteristics of the cysts removed from the other five dogs resembled those of acquired cystic hematomas. The etiopathogenesis of these cysts was uncertain, but all cysts were connected to a fatty pedicle of tissue. In one dog, a stalk of tissue was observed to enter the pericardium through a small peritoneopericardial diaphragmatic hernia. In four dogs, the stalk of tissue was adhered to the apex of the parietal pericardium. These observations suggested that intrapericardial cysts, in some dogs, develop in association with, and possibly as a result of, congenital herniation and entrapment of omentum or a portion of the falciform ligament into the pericardial sac. (Journal of Veterinary Internal Medicine 1993; 7:364–369. Copyright © 1993 by the American College of Veterinary Internal Medicine.)     

Idiopathic hemorrhagic pericardial effusion in eight dogs

Idiopathic hemorrhagic pericardial effusion was diagnosed in 8 dogs. The patients were typically males of large or giant breeds and a wide age range was represented. In all dogs clinical features of acute or chronic cardiac tamponade and right-sided heart failure were present. The pericardial effusion in each case was identified by thoracic radiography, electrocardiography, and echocardiography. Cytologic examination of the fluid did not allow differentiation from hemorrhagic effusions caused by neoplasia. Bacterial and fungal cultures were negative in 5 dogs. In 6 cases, a presumptive diagnosis was based on the absence of cardiac masses on 2-dimensional echocardiography, contrast pericardiography, or both. The condition was managed successfully by partial pericardiectomy in 5 cases. The definitive diagnosis in each case was established by gross cardiac examination at surgery or necropsy and by histologic examination of tissues. Blood vessels and lymphatics of the parietal and visceral pericardia appeared to be the primary targets of the disease process.     

Resolution of chylopericardium after balloon dilatation of tricuspid valve stenosis in a Labrador Retriever

A 2-year-old 33 kg female castrated Labrador Retriever was referred for exercise intolerance, hyporexia, and abdominal distention. Point-of-care ultrasound revealed ascites, hepatic congestion, severe pericardial effusion, and cardiac tamponade. Pericardiocentesis was performed, and the chylous nature of the fluid was confirmed by cytology, triglyceride, and cholesterol measurements. Repeated pericardiocentesis was necessary within 24-h after admission, after which a pericardial stay-catheter was placed. Cardiac ultrasound revealed severe tricuspid valve stenosis. Balloon dilatation of the stenotic valve was performed, resulting in a significant drop in the mean diastolic trans-valvular Doppler gradient and long-term resolution of the chylopericardium. No other cause for the pericardial effusion could be identified, suggesting that this is the first described case of chylopericardium due to tricuspid valve stenosis.     

Pericardial effusion and cardiac tamponade in a cat with extranodal lymphoma

A five-year-old domestic longhaired cat was evaluated for a seven-day history of worsening respiratory distress. Serum analysis for feline leukaemia virus antigen was positive. Pleural effusion was detected on thoracic radiographs and echocardiography revealed a pericardial effusion and cardiac tamponade. Cytological evaluation of the pleural and pericardial effusions showed lymphoblastic cells indicative of disseminated lymphoma. Following thoracocentesis and pericardiocentesis, the cat was treated for lymphoma using the University of Wisconsin-Madison chemotherapy protocol. The cat was sent home after three days and, at the time of writing (six months after initial presentation), was still symptom free. To the authors' knowledge, this is the first report confirming pericardial effusion and cardiac tamponade in the cat as a direct result of an extranodal lymphoma with cytological evidence of neoplastic cells in the pericardial fluid.     

Pericardiocentesis and principles of echocardiographic imaging in the patient with cardiac neoplasia

Ultrasonography is a safe, noninvasive, sensitive, and specific tool for evaluation of the heart and pericardium in patients with cardiac neoplasia. In small animals, the incidence of cardiac neoplasia is low. In dogs, hemangiosarcoma and chemocdectoma are the two most common types of cardiac neoplasia. In cats, lymphosarcoma is the most common form of cardiac neoplasia. Pericardial effusion is a common and potentially life-threatening consequence of cardiac neoplasia. Pericardial effusion leads 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. Pericardiocentesis is used to stabilize animals with life-threatening cardiac tamponade, and to obtain fluid samples for diagnostic evaluation. The fluid should be quantified and characterized. If the etiology of the effusion is not known, then a sample of the fluid should be submitted for fluid analysis and cytology. Serious complications associated with pericardiocentesis are rare. Complications include cardiac puncture, arrhythmias, and laceration of the tumor or coronary artery, resulting in intrapericardial hemorrhage.