Hi guys,
This cat presented with innapetence and a grade 3 murmur was found. There is mild HCM with pericardial effusion. Question is, is this amount significant? It does seem to collapse the right ventricle but there is no clinical evidence of right or left CHF. Also, the IVS looks patchy and hypoechoic on the M mode… is this atypical?
Thanks for your input,
Silvana
Hi guys,
This cat presented with innapetence and a grade 3 murmur was found. There is mild HCM with pericardial effusion. Question is, is this amount significant? It does seem to collapse the right ventricle but there is no clinical evidence of right or left CHF. Also, the IVS looks patchy and hypoechoic on the M mode… is this atypical?
Thanks for your input,
Silvana
Comments
Maybe if you upload a few
Maybe if you upload a few images or video we can comment more specifically but if the la is normal size and there is pc effusion look for other causes like neoplasia, vasculitis, infectious and so forth. Often in that case there is something in the abdomen to suggest neoplasia. If the la is big > 1.5 cm or so, then the pc effusion is likely owing to left chf and cats dump it into the pc as well as the pleural space. I will see if I have a couple of examples of both later to demo the difference.
Maybe if you upload a few
Maybe if you upload a few images or video we can comment more specifically but if the la is normal size and there is pc effusion look for other causes like neoplasia, vasculitis, infectious and so forth. Often in that case there is something in the abdomen to suggest neoplasia. If the la is big > 1.5 cm or so, then the pc effusion is likely owing to left chf and cats dump it into the pc as well as the pleural space. I will see if I have a couple of examples of both later to demo the difference.
Here is a case with pc
Here is a case with pc effusion from left chf and you can see the enlarged la. This is an oblique view to demonstrate the minor pc effusion along with the enlarged la
Here is a case with pc
Here is a case with pc effusion from left chf and you can see the enlarged la. This is an oblique view to demonstrate the minor pc effusion along with the enlarged la
And this is a different cat
And this is a different cat with pericardial effusion from infectious pericarditis… case of the month Sept 2012. The la/ao ratio is within 1.4-1.5 or so here where it is around 2.0 or 2cm la in the prior case. Obviously other hemodynamics have to be taken into consideration as well as lasix and other meds on board but this is a good general rule: “If the la diameter is < 1.4 cm in a cat the pc or pleural effusion is NOT LIKELY cardiac. ".... unless a bunch of lasix was given before the exam then interpretation can get a little sticky. Usually non cardiogenic effusions have volume contracted hearts so the LA is around 1.2 cm or less. This is when I am definitely doing pleuro or pericardiocentesis for analysis and immediate cytospin and slide prep to conserve cell integrity for evaluation.
And this is a different cat
And this is a different cat with pericardial effusion from infectious pericarditis… case of the month Sept 2012. The la/ao ratio is within 1.4-1.5 or so here where it is around 2.0 or 2cm la in the prior case. Obviously other hemodynamics have to be taken into consideration as well as lasix and other meds on board but this is a good general rule: “If the la diameter is < 1.4 cm in a cat the pc or pleural effusion is NOT LIKELY cardiac. ".... unless a bunch of lasix was given before the exam then interpretation can get a little sticky. Usually non cardiogenic effusions have volume contracted hearts so the LA is around 1.2 cm or less. This is when I am definitely doing pleuro or pericardiocentesis for analysis and immediate cytospin and slide prep to conserve cell integrity for evaluation.
forgot to upload the pc
forgot to upload the pc effusion pericarditis image so here it is.
forgot to upload the pc
forgot to upload the pc effusion pericarditis image so here it is.
Hi!
I can only agree to
Hi!
I can only agree to Eric’s comments (sorry for being late, was traveling with the plane). The most likely cause of PE in cats is congestive heart failure. But in this case you see an markedly enlarged LA. Most cats that I see with PE due to cardiac reasons have either severe end stage HCM or RCM. If you are not sure based on your echo you could take a blood sample for NT-proBNP. But this does only help you if it’s really positive and not in the grey zone. Another option is to post the videos. In most cases with PE due to CHF there is either pulmonary edema or pleural effusion seen on the initial rads.
Other reasons are neoplastic (e.g. lymphoma in cats) or infectious. Take a sample for analysis. Still, the absence of neoplastic cells does not rule out a neoplastic origin of the PE.
Regarding collapse of RV: Usually, PE can lead to collapse of the RA because this is the chamber with the lowest pressure. In cats this is a rare finding, particularly if the PE is due to CHF. In these cases you can also have right heart failure but this is mostly caused by RV diastolic dysfunction.
As Eric said, I would also perform an abdominal scan to look out for neoplastic changes.
best Regards
Peter
Hi!
I can only agree to
Hi!
I can only agree to Eric’s comments (sorry for being late, was traveling with the plane). The most likely cause of PE in cats is congestive heart failure. But in this case you see an markedly enlarged LA. Most cats that I see with PE due to cardiac reasons have either severe end stage HCM or RCM. If you are not sure based on your echo you could take a blood sample for NT-proBNP. But this does only help you if it’s really positive and not in the grey zone. Another option is to post the videos. In most cases with PE due to CHF there is either pulmonary edema or pleural effusion seen on the initial rads.
Other reasons are neoplastic (e.g. lymphoma in cats) or infectious. Take a sample for analysis. Still, the absence of neoplastic cells does not rule out a neoplastic origin of the PE.
Regarding collapse of RV: Usually, PE can lead to collapse of the RA because this is the chamber with the lowest pressure. In cats this is a rare finding, particularly if the PE is due to CHF. In these cases you can also have right heart failure but this is mostly caused by RV diastolic dysfunction.
As Eric said, I would also perform an abdominal scan to look out for neoplastic changes.
best Regards
Peter
Thank you Eric and Peter.
I
Thank you Eric and Peter.
I thought I’ve posted the videos initially, but something happened. Here I’ll try again.
According to my measurements, the LA/Ao ratio was 1.6, so yes, it was enlarged, but I didn’t seem that much to me compared to other cases that I’ve seen without pericardial effusion.
Please have a look a the images and tell me what you think.
Yes, Peter, I am from Australia ( born in Argentina) We met in Bologna last year, remember?
Cheers,
Silvana
Thank you Eric and Peter.
I
Thank you Eric and Peter.
I thought I’ve posted the videos initially, but something happened. Here I’ll try again.
According to my measurements, the LA/Ao ratio was 1.6, so yes, it was enlarged, but I didn’t seem that much to me compared to other cases that I’ve seen without pericardial effusion.
Please have a look a the images and tell me what you think.
Yes, Peter, I am from Australia ( born in Argentina) We met in Bologna last year, remember?
Cheers,
Silvana
Mmmm, I seem to be struggling
Mmmm, I seem to be struggling to upload the videos. Already added them as media, and they appeared to be attached but cannot see them in my post. What am I doing wrong?
Mmmm, I seem to be struggling
Mmmm, I seem to be struggling to upload the videos. Already added them as media, and they appeared to be attached but cannot see them in my post. What am I doing wrong?
Yes, seeing you on your
Yes, seeing you on your homepage, I remember that I´ve alrealy met you. Sorry, Silvana, I have an awful memory for people…
Still, I hope to see you again on one of the next IVUSS meetings!
Eric, could you check this video problem?
Yes, seeing you on your
Yes, seeing you on your homepage, I remember that I´ve alrealy met you. Sorry, Silvana, I have an awful memory for people…
Still, I hope to see you again on one of the next IVUSS meetings!
Eric, could you check this video problem?
I will have a look at the
I will have a look at the video as soon as I have access to them. If you cant get a sample of the fluids because it´s too less and there´s no systemic sign of infection or tumor, you could try a low dose of Furosemide (1 mg/kg bid) and recheck to see of the PE vanishes. If you got rads, you could post them as well.
Cheers and thanks for the case!
Peter
I will have a look at the
I will have a look at the video as soon as I have access to them. If you cant get a sample of the fluids because it´s too less and there´s no systemic sign of infection or tumor, you could try a low dose of Furosemide (1 mg/kg bid) and recheck to see of the PE vanishes. If you got rads, you could post them as well.
Cheers and thanks for the case!
Peter
Silvana in the meantime go to
Silvana in the meantime go to my sonopath home page and click on “spa” on the bottom and just x in the * boxed and follow the instructions to upload the videos in 1 older but “zip/compress” the folder first and I will try to troubleshoot the upload with IT. It has been working fine on our end
Silvana in the meantime go to
Silvana in the meantime go to my sonopath home page and click on “spa” on the bottom and just x in the * boxed and follow the instructions to upload the videos in 1 older but “zip/compress” the folder first and I will try to troubleshoot the upload with IT. It has been working fine on our end
I’ve added the videos to the
I’ve added the videos to the post.
I’ve added the videos to the
I’ve added the videos to the post.
Thanks for uploading the
Thanks for uploading the videos, Paulo.
Hope that Eric or Peter will have a look soon.
Silvana
Thanks for uploading the
Thanks for uploading the videos, Paulo.
Hope that Eric or Peter will have a look soon.
Silvana
Eyeballing the videos I would
Eyeballing the videos I would say the pc effusion is likely secondary to left CHF with the la about 1.8-1.9 cm or so and this contrasts the pericarditis case I put up there. If you Tx the left chf the pc effusion should diminish which is not the case in pericarditis such as my image
Eyeballing the videos I would
Eyeballing the videos I would say the pc effusion is likely secondary to left CHF with the la about 1.8-1.9 cm or so and this contrasts the pericarditis case I put up there. If you Tx the left chf the pc effusion should diminish which is not the case in pericarditis such as my image