– 10 year old MN Labx presented for acute collapse and pale mm
– cardiac scan showed mild pericardial effusion and large mass in right auricular appendage
– I am pretty sure this is a mass (hemangiosarcoma) but could a blood clot look like this as well?
– 10 year old MN Labx presented for acute collapse and pale mm
– cardiac scan showed mild pericardial effusion and large mass in right auricular appendage
– I am pretty sure this is a mass (hemangiosarcoma) but could a blood clot look like this as well?
Comments
Yep That’s a whopper!
Yep That’s a whopper! Echotexture is too organized to be a clot. Typical right auricular position for HSA. Great images:
Here’s an excerpt from the curbside guide chapter on cardiac neoplasia. I am working on the layout/editing this am when I got this post as its finally out of editing. Should be available end of next month with any luck!
The cover is on the bottom right in products page:
http://sonopath.com/products
Pericardial Effusion & Cardiac Neoplasia
Description:The pericardiumis a fibrous sac that encloses the heart and the great vessels—aorta, pulmonary artery, proximal pulmonary veins, and vena cava—located at the heart’s base. It is attached caudally to the diaphragm and under normal circumstances contains 1-15 mL of fluid. The latter is comprised of phospholipids that lubricate the heart and allow it to expand and contract without generating friction. The pericardium also fixes the heart, prevents excess motion, and links the diastolic distensibility of the ventricles, thus limiting the degree to which either the left or the right ventricle will distend during diastole. When there are acute changes in venous return (i.e., during exercise), the pericardium plays a critical role in limiting ventricular filling. In cases of chronic cardiac enlargement, the pericardium also becomes distended, and its ability to limit ventricular filling, especially when the heart is at rest, becomes compromised. Pericardial tamponade occurs when there is a rapid accumulation of fluid and the pressure inside the pericardium increases significantly. With tamponade, ventricular filling is restricted and cardiac output is decreased. The right atrium and ventricle are the most vulnerable to this condition as these compartments have thinner walls and a lower pressure.
Etiology:Causes of pericardial effusion include:
The majority of neoplastic masses consist of hemangiosarcoma and heart-based tumors (chemodectomas or ectopic thyroid adenocarcinoma). Idiopathic pericardial effusionis a diagnosis of exclusion; the effusion is typically hemorrhagic. Approximately 50% of dogs will be cured with a single pericardiocentesis, while some dogs will require multiple pericardiocenteses as well as surgery.A peritoneal-pericardial diaphragmatic hernia is a congenital hernia seen in dogs and cats in which the abdominal contents (i.e., liver, small intestine, spleen, stomach) herniate into the pericardial sac. Constrictive pericarditis is an uncommon condition in which a non-distensible, thickened, fibrotic pericardium develops over time.
Clinical Signs:One will observe the following clinical signs, which often present in combination: ascites, lethargy, exercise intolerance, pale mucous membranes, weak pulses, pulsus paradoxus, and respiratory distress.
Diagnostics: Survey radiographs will reveal hepatomegaly, cardiomegaly (generalized or sectorial globoid), and small pulmonary vessels. Pulmonary edema is typically not found, although one may discover concurrent pulmonary metastatic disease. An ECG will show electrical alternans or small complexes, but often the changes are very subtle and difficult to detect.
Echocardiography is usually considered the gold standard for diagnosing pericardial effusion. Findings include:
Cytology is helpful in the diagnosis of lymphoma, septic pericarditis, and idiopathic effusion, but not in cases of neoplasia.
According to a study that found troponin l levels to be higher in dogs with neoplastic pericardial effusion, the cardiac troponin I assay can be helpful in the diagnosis hemangiosarcoma.
Prognosis:
References:
Cagle LA, Epstein SE, Owens SD, et al. Diagnostic yield of cytology analysis of pericardial effusion in dogs. J Vet Int Med 2014;28:66-71.
Feigenbaum H. Pericardial disease. In: Feigenbaum H, ed. Echocardiography, 5th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 1994:556-588.
Jackson J, Richter KP, Launer DP. Thorascopic partial pericardectomy in 13 dogs. J Vet Int Med 1999;13:529-33.
Johnson MS, Martin M, Binns S. A retrospective study of clinical findings, treatment and outcome in 143 dogs with pericardial effusion. J Small An Pract 2004 ;45:546-52.
Kienle RD, Thomas WP. Echocardiography. In: Nyland TG and Mattoon JS, eds. Small Animal Diagnostic Ultrasound, 2nd ed. Philadelphia, PA: WB Saunders; 2000:354-423.
Miller MW, Sisson DD. Pericardial disorders. In: Ettinger SJ and Feldman EC, eds. Textbook of Veterinary Internal Medicine, 5th ed. Philadelphia, PA: WB Saunders; 2000:923-36.
Rajagopalan V, Jesty SA, Craig LE, et al. Comparison of presumptive echocardiographic and definitive diagnoses of cardiac tumors in dogs. J Vet Int Med 2013;27:1092-96.
Shaw SP, Rozanski EA, Ruhs JE. Cardiac troponins I and T in dogs with pericardial effusion. J Vet Int Med 2004;18:322-24.
Sidley JA, Atkins CE, Keene BW, et al. Percutaneous balloon pericardiotomy as a treatment for recurrent pericardial effusion in 6 dogs. J Vet Intern Med 2002;16:541.
Sisson D, Thomas WP. Pericardial disease and cardiac tumors. In: Fox PR, Sisson D, Moïse NS, eds. Textbook of Canine and Feline Cardiology, 2nd ed. Philadelphia, PA: WB Saunders; 1999:679-701.
Sisson D, Thomas WP, Reed J, et al. Intrapericardial cysts in the dog. J Vet Int Med 1993;7:364-69.
Yep That’s a whopper!
Yep That’s a whopper! Echotexture is too organized to be a clot. Typical right auricular position for HSA. Great images:
Here’s an excerpt from the curbside guide chapter on cardiac neoplasia. I am working on the layout/editing this am when I got this post as its finally out of editing. Should be available end of next month with any luck!
The cover is on the bottom right in products page:
http://sonopath.com/products
Pericardial Effusion & Cardiac Neoplasia
Description:The pericardiumis a fibrous sac that encloses the heart and the great vessels—aorta, pulmonary artery, proximal pulmonary veins, and vena cava—located at the heart’s base. It is attached caudally to the diaphragm and under normal circumstances contains 1-15 mL of fluid. The latter is comprised of phospholipids that lubricate the heart and allow it to expand and contract without generating friction. The pericardium also fixes the heart, prevents excess motion, and links the diastolic distensibility of the ventricles, thus limiting the degree to which either the left or the right ventricle will distend during diastole. When there are acute changes in venous return (i.e., during exercise), the pericardium plays a critical role in limiting ventricular filling. In cases of chronic cardiac enlargement, the pericardium also becomes distended, and its ability to limit ventricular filling, especially when the heart is at rest, becomes compromised. Pericardial tamponade occurs when there is a rapid accumulation of fluid and the pressure inside the pericardium increases significantly. With tamponade, ventricular filling is restricted and cardiac output is decreased. The right atrium and ventricle are the most vulnerable to this condition as these compartments have thinner walls and a lower pressure.
Etiology:Causes of pericardial effusion include:
The majority of neoplastic masses consist of hemangiosarcoma and heart-based tumors (chemodectomas or ectopic thyroid adenocarcinoma). Idiopathic pericardial effusionis a diagnosis of exclusion; the effusion is typically hemorrhagic. Approximately 50% of dogs will be cured with a single pericardiocentesis, while some dogs will require multiple pericardiocenteses as well as surgery.A peritoneal-pericardial diaphragmatic hernia is a congenital hernia seen in dogs and cats in which the abdominal contents (i.e., liver, small intestine, spleen, stomach) herniate into the pericardial sac. Constrictive pericarditis is an uncommon condition in which a non-distensible, thickened, fibrotic pericardium develops over time.
Clinical Signs:One will observe the following clinical signs, which often present in combination: ascites, lethargy, exercise intolerance, pale mucous membranes, weak pulses, pulsus paradoxus, and respiratory distress.
Diagnostics: Survey radiographs will reveal hepatomegaly, cardiomegaly (generalized or sectorial globoid), and small pulmonary vessels. Pulmonary edema is typically not found, although one may discover concurrent pulmonary metastatic disease. An ECG will show electrical alternans or small complexes, but often the changes are very subtle and difficult to detect.
Echocardiography is usually considered the gold standard for diagnosing pericardial effusion. Findings include:
Cytology is helpful in the diagnosis of lymphoma, septic pericarditis, and idiopathic effusion, but not in cases of neoplasia.
According to a study that found troponin l levels to be higher in dogs with neoplastic pericardial effusion, the cardiac troponin I assay can be helpful in the diagnosis hemangiosarcoma.
Prognosis:
References:
Cagle LA, Epstein SE, Owens SD, et al. Diagnostic yield of cytology analysis of pericardial effusion in dogs. J Vet Int Med 2014;28:66-71.
Feigenbaum H. Pericardial disease. In: Feigenbaum H, ed. Echocardiography, 5th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 1994:556-588.
Jackson J, Richter KP, Launer DP. Thorascopic partial pericardectomy in 13 dogs. J Vet Int Med 1999;13:529-33.
Johnson MS, Martin M, Binns S. A retrospective study of clinical findings, treatment and outcome in 143 dogs with pericardial effusion. J Small An Pract 2004 ;45:546-52.
Kienle RD, Thomas WP. Echocardiography. In: Nyland TG and Mattoon JS, eds. Small Animal Diagnostic Ultrasound, 2nd ed. Philadelphia, PA: WB Saunders; 2000:354-423.
Miller MW, Sisson DD. Pericardial disorders. In: Ettinger SJ and Feldman EC, eds. Textbook of Veterinary Internal Medicine, 5th ed. Philadelphia, PA: WB Saunders; 2000:923-36.
Rajagopalan V, Jesty SA, Craig LE, et al. Comparison of presumptive echocardiographic and definitive diagnoses of cardiac tumors in dogs. J Vet Int Med 2013;27:1092-96.
Shaw SP, Rozanski EA, Ruhs JE. Cardiac troponins I and T in dogs with pericardial effusion. J Vet Int Med 2004;18:322-24.
Sidley JA, Atkins CE, Keene BW, et al. Percutaneous balloon pericardiotomy as a treatment for recurrent pericardial effusion in 6 dogs. J Vet Intern Med 2002;16:541.
Sisson D, Thomas WP. Pericardial disease and cardiac tumors. In: Fox PR, Sisson D, Moïse NS, eds. Textbook of Canine and Feline Cardiology, 2nd ed. Philadelphia, PA: WB Saunders; 1999:679-701.
Sisson D, Thomas WP, Reed J, et al. Intrapericardial cysts in the dog. J Vet Int Med 1993;7:364-69.
I will be the first to buy
I will be the first to buy your book! Thanks EL
I will be the first to buy
I will be the first to buy your book! Thanks EL
Recent publication on the use
Recent publication on the use of chemotherapy without any surgery:
Mullin CM, Arkans MA, Sammarco CD, Vail DM, Britton BM, Vickery KR, Risbon RE, Lachowicz J, Burgess KE, Manley CA, Clifford CA. Doxorubicin chemotherapy for presumptive cardiac hemangiosarcoma in dogs. Vet Comp Oncol. 2014. doi: 10.1111/vco.12131.
Sixty-four dogs were treated with single-agent doxorubicin (DOX) for presumptive cardiac hemangiosarcoma (cHSA). The objective response rate (CR + PR) was 41%, and the biologic response rate (CR + PR + SD), or clinical benefit, was 68%. The median progression-free survival (PFS) for treated dogs was 66 days. The median survival time (MST) for this group was 116 days and was significantly improved compared to a MST of 12 days for untreated control dogs (P = 0.0001). Biologic response was significantly associated with improved PFS (P < 0.0001) and OS (P < 0.0001). Univariate analysis identified larger tumour size as a variable negatively associated with PFS. The high rate of clinical benefit and improved MST suggest that DOX has activity in canine cHSA.
Recent publication on the use
Recent publication on the use of chemotherapy without any surgery:
Mullin CM, Arkans MA, Sammarco CD, Vail DM, Britton BM, Vickery KR, Risbon RE, Lachowicz J, Burgess KE, Manley CA, Clifford CA. Doxorubicin chemotherapy for presumptive cardiac hemangiosarcoma in dogs. Vet Comp Oncol. 2014. doi: 10.1111/vco.12131.
Sixty-four dogs were treated with single-agent doxorubicin (DOX) for presumptive cardiac hemangiosarcoma (cHSA). The objective response rate (CR + PR) was 41%, and the biologic response rate (CR + PR + SD), or clinical benefit, was 68%. The median progression-free survival (PFS) for treated dogs was 66 days. The median survival time (MST) for this group was 116 days and was significantly improved compared to a MST of 12 days for untreated control dogs (P = 0.0001). Biologic response was significantly associated with improved PFS (P < 0.0001) and OS (P < 0.0001). Univariate analysis identified larger tumour size as a variable negatively associated with PFS. The high rate of clinical benefit and improved MST suggest that DOX has activity in canine cHSA.
Awesome remo I hadnt seen
Awesome remo I hadnt seen this article! Hey we have one of those from 2010. I did this with one of my NJ mobile clients back then and worked well just have a 16 g catheter ready and an attentive owner and some doxy to shoot… 6 months quality of life for the normal rockwell golden retriever family:)
http://sonopath.com/resources/cases-month/2010?page=1
Had they asked me to participate we could have made it an even 65 cases for the study:)
Awesome remo I hadnt seen
Awesome remo I hadnt seen this article! Hey we have one of those from 2010. I did this with one of my NJ mobile clients back then and worked well just have a 16 g catheter ready and an attentive owner and some doxy to shoot… 6 months quality of life for the normal rockwell golden retriever family:)
http://sonopath.com/resources/cases-month/2010?page=1
Had they asked me to participate we could have made it an even 65 cases for the study:)