Sonopath Forum

lv bouncing ball!

While attending IVUSS my associate saw this 9 yr old Clumber spaniel for adr. Abdominal rads showed effusion. Bloodwork normal albumin 2.2. Abdominal scan hyperechoic mesentery throughout no masses seen. Velocity portal,cvc sl diminished . color flow appears normal. Modified transudate found. Went to the chest and found decreased systolic ftn. I’m interested in the structure seen left ventricle. I have seen this before in one patient and it is papillary never grew or changed. What do we call this?? It showed no doppler signal within the mass.

Comments

Peter

September 24, 2016 at 2:34 pm -

Hi!
Thanks for the awesome

Hi!

Thanks for the awesome clip!

I would suspect a thrombus here since there is an anechoic border between the myocardium and the mass. – still I’m not 100% sure. If so, I would search for a coagulation disorder. The marked systolic dysfunction can be a risk factor.

Left atrial thrombi have been described in CKCS. In human medicine they sometimes develop in context with myocardial infarction.

I have never seen a histopath of one of these, though.

Peter

September 24, 2016 at 3:13 pm -

… of course, DDx include

… of course, DDx include fibroma, myxoma,….

echocardiographically, it;s difficult to almost impossible to accurately discriminate tumor from thrombus since the local perfusion cannot be evaluated (heart is movin, low PRF causes artifacts)

So, the only thing we can do is search for a hypoechoic margin between mass and myocardium, search for risk factors (coagulation, stasis, endothelial damage)

Peter

sherilin

September 24, 2016 at 6:52 pm -

Thanks alot!!Well

Thanks alot!!Well unfortunately I am not sure this fellow is going to do well. If the opportunity presents I will try to get histopath and report back. I’ll explore coag dysftn we did not rule that out yet. Sheri

September 25, 2016 at 12:19 am -

Try a plavix trial and treat

Try a plavix trial and treat the underlying disease cauusing systolic dysfunction… myocarditis?? Infectious?

sherilin

September 25, 2016 at 12:36 pm -

Yes I will. Cause is still

Yes I will. Cause is still being investigated not sure ruled out common causes of infection so far. I fear I may run out of time before I get an answer his cardiac output was so poor. treating for that while await further investigation. Fingers crossed.

September 25, 2016 at 3:05 pm -

I can only say what I would

I can only say what I would do here and thats triple therapy (lasiz acei pimo), clindamycin and plavix and check an echo every few days given the sudden death potential. If you are in a chagas region like texas then consider that and i have no clue how to treat that:)

sherilin

September 26, 2016 at 11:15 am -

Thanks doing all as we speak.

Thanks doing all as we speak. I’m in Pa so Chagas not likely . I’ll post outcome.