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.     

Pericardial effusion and cardiac tamponade caused by intrapericardial granulation tissue in a dog

Objective – To describe and report successful surgical management of pericardial effusion and cardiac tamponade in a dog caused by intrapericardial granulation tissue.
Case Summary – An 8-month-old, intact male, Greater Swiss Mountain Dog was referred for cardiac evaluation following 2 weeks of progressive lethargy, abdominal distention, and difficulty breathing. On the day of presentation, the dog had an episode of acute collapse. A 14-cm multilocular pericardial cystic lesion causing collapse of the right atrial free wall and resulting in pericardial tamponade was observed on echocardiogram. After the dog subsequently experienced two acute episodes of pericardial effusion, a subtotal pericardectomy was performed and clinical signs resolved. The histopathologic diagnosis of the mass was inflammation and granulation tissue, likely caused by a resolving hematoma or abscess.
New or Unique Information Provided – This is the first report of intrapericardial granulation tissue as the cause of pericardial effusion and cardiac tamponade.     

Renal failure associated with pericardial effusion in a dog.

Signs of heart failure due to cardiac tamponade developed in a young dog with previously unrecognized renal disease. The uremic syndrome was considered the likely cause of the effusive pericarditis found at necropsy. In a review of necropsy records from 150 dogs with renal disease, 11 had pericardial lesions.     

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.     

Atrial rupture and pericardial effusion as a complication of chronic mitral valve endocardiosis

A 9-year-old Labrador mixed breed dog, known to suffer from heart disease, was presented. It had recently collapsed on the street. Based on clinical findings and ultrasonography the tentative diagnosis of an atrial rupture with bleeding into the pericardial sac, resulting into a cardiac tamponade, was made. The dog's state of health improved under treatment, including infusion, sedation and analgesia. Therefore pericardiocentesis was unnecessary. The dog was released from hospital the next evening and the medical therapy of its heart disease was continued. The animal died 85 days later.     

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.     

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.     

Metastatic pericardial tumors in a dog with equivocal pericardial cytological findings

A metastatic tumor associated with pericardial effusion was diagnosed in a 6-year-old, female, mixed-breed dog. Echocardiography identified multiple echogenic masses adherent to both visceral and parietal pericardium, while results of pericardial fluid cytology were non-diagnostic. The distribution pattern of the masses is remarkable in that they protruded from both pericardial surfaces, rather than one, and demonstrated an oscillatory motion during the cardiac cycle. Pathological examination confirmed the diagnosis of multiple metastatic tumors of the pericardium, with the primary tumor being an anaplastic gastric adenocarcinoma.     

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.     

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 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.     

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.     

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.     

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.     

Pneumopericardium associated with a pulmonary-pericardial communication in a dog

A 6-year-old 18-kg (39-lb) spayed female Standard Poodle was referred for treatment of pneumopericardium. The dog did not have severe clinical signs relating to the pneumopericardium, and the diagnosis was made incidentally while investigating the cause of a cough. Computed tomography revealed an air-filled structure consistent with a bulla to the right of the heart base that appeared to communicate with the pericardial cavity Because spontaneous resolution of the pneumopericardium seemed unlikely and cardiac tamponade was a possibility, exploratory thoracotomy was performed. A lobulated bulla was found at the hilus of the right middle lung lobe adhered to the underlying pericardial sac, and a 4-cm-diameter communication from the pericardium to the pulmonary bulla was found. Right middle lung lobectomy was performed, and the pericardiotomy and pericardial opening were sutured. The dog recovered without complications. In previously reported cases of pneumopericardium involving a cat and a dog, the condition resolved spontaneously. In this dog, in contrast, surgical resection of the affected lung lobe with pericardial reconstruction was required for resolution of the pneumopericardium.     

Beating heart mitral valve replacement with a bovine pericardial bioprosthesis for treatment of mitral valve dysplasia in a Bull Terrier

OBJECTIVES: To describe an open, beating heart surgical technique and use of a bovine pericardial prosthetic valve for mitral valve replacement (MVR) in the dog. STUDY DESIGN: Clinical case report. ANIMALS: Male Bull Terrier (17-month-old, 26 kg) with mitral valve dysplasia and severe regurgitation. METHODS: A bovine pericardial bioprosthesis was used to replace the mitral valve using an open beating heart surgical technique and cardiopulmonary bypass. RESULTS: Successful MVR was achieved using a beating heart technique. Mitral regurgitation resolved and cardiac performances improved (left ventricular end-diastolic diameter decreased from 57.6 to 48.7 mm, and left atrium/aorta ratio returned to almost normal, from 1.62 to 1.19). Cardiopulmonary by-pass time and total surgical duration were decreased compared with standard cardioplegic techniques. Surgical recovery was uneventful and on echocardiography 6 months later valve function was excellent. CONCLUSION: Considering the technique advantages (no cardiac arrest, ischemic reperfusion injury, and hypothermia, or the need for aortic dissection and cannulation for administration of cardioplegic solution), short-term mortality and morbidity may be reduced compared with standard cardioplegic techniques. CLINICAL RELEVANCE: Based on experience in this dog, beating heart mitral valvular replacement is a seemingly safe and viable option for the dog and bovine pericardial prosthesis may provide better long-term survival than mechanical prostheses.     

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.     

Pericardial mesothelioma in a Bengal tiger (Panthera tigris).

A 17-year-old Bengal tiger (Panthera tigris) presented with dyspnea and tachypnea. Radiographs revealed severe pleural and pericardial effusion, but no obvious mass. During attempts to remove the fluid under anesthesia, the cat developed cardiac tamponade and died. At necropsy, a nodular mass was found at the heart base and was identified as a pericardial mesothelioma. This is the first report of this tumor in any large cat.     

Pneumopericardium,pneumomediastinum, pneumothorax and pneumoretroperitoneum complicating pulmonary metastatic carcinoma in a cat

This report describes a case of severe spontaneous tension pneumopericardium with concurrent pneumomediastinum, pneumothorax and retropneumoperitoneum in a cat presenting with dyspnoea and signs of cardiac tamponade secondary to metastatic pulmonary carcinoma. Spontaneous pneumopericardium is an extremely uncommon condition consisting of pericardial gas in the absence of iatrogenic/traumatic causes. In humans, it has been described secondary to pneumonia or lung abscess and very rarely secondary to pulmonary neoplasia.