– 9 year old MN Labrador presented for ascites and enlarged heart on chest rads; surprisingly doing well otherwise
– rDVM started pet on lasix and enacard and ordered echocardiogram
– echo showed pericardial effusion, pleural effusion; ascites with dilated hepatic veins; rest of abdominal scan normal
– no LAE noted and no obvious cardiac masses
– 300ml yellow fluid removed via pericardiocentesis; cytology consistent with a mild neutrophilic population of cells; bacterial culture negative; we stopped the heart meds
– 9 year old MN Labrador presented for ascites and enlarged heart on chest rads; surprisingly doing well otherwise
– rDVM started pet on lasix and enacard and ordered echocardiogram
– echo showed pericardial effusion, pleural effusion; ascites with dilated hepatic veins; rest of abdominal scan normal
– no LAE noted and no obvious cardiac masses
– 300ml yellow fluid removed via pericardiocentesis; cytology consistent with a mild neutrophilic population of cells; bacterial culture negative; we stopped the heart meds
– pet did well for a few days then now 1 week later presented for severe ascites – pericardial effusion back
– removed 240ml of same coloured fluid; also performed abdominal fluid drainage to increase comfort of the patient ( 2.9L serosanguineous)
I have never seen this colour of fluid after pericardiocentesis (usually bloody) At first I thought I was tapping the thoracic fluid but I was definitely in the pericardial sac and fluid went down after centesis and I could feel the epicardium with the tip of the catheter which produced VPC’s Any thoughts? I have recommended referral for pericardiectomy.
Comments
I would pull a fresh sample
I would pull a fresh sample spin it down and check the sediment immediately for neoplastic cells. CT of the chest would be ideal to check heart based mass in area of vena cava inflow and caudal mediastinum that may be small and out of view but strategically obstructive. Scan the abdomen for primary neoplasia and use the cranially oriented transdiaphragmatic view through the liver using the pericardial fluid and cvc as windows and sweep high and low looking for masses caudal to the heart. Mesenchymal tumors do this. Usually idiopathics are bloody. great post let us know what you find.
I also discussed CT with the
I also discussed CT with the owner and I am really hoping they will go for referral with this one. Abdominal scan was uneventful.
Thanks!
Seen one case with a similar
Seen one case with a similar colored pericardial effusion that finally had a pericardectomy done with no obvious neoplastic lesions – attributed to idiopathic effusion.
Good to know! I hope we find
Good to know! I hope we find out on this one
Thanks Remo
A follow-up to this case:
A follow-up to this case: patient was referred for pericardectomy. CT was not performed however no masses were noted at surgery and the patient is doing very well. So far this has been deemed an Idiopathic Pericardial Effusion by the referral hospital.