A 10-year-old SF DSH was presented for evaluation of weight loss, increased respiratory effort, and the presence of a chylous pleural effusion.
A 10-year-old SF DSH was presented for evaluation of weight loss, increased respiratory effort, and the presence of a chylous pleural effusion.
Given the chylous nature of the effusion with the large amount of small lymphocytes even though it is of lymphatic origin an abdominal sonogram should be performed in search of lymphoma with potential concurrent metastatic type scenario. It is debatable on whether the cardiac presentation is completely responsible for the chylous effusion noted. Cortisone usage should be investigated as this presentation would also be consistent with corticosteroid induced congestive heart failure. However, in my experience chylous effusion is not typical in this scenario. If Depo-Medrol or Vetalog injection has been given in the last two weeks, this scenario is possible. Regardless, primary treatment for left sided congestive heart failure would be recommended with Lasix at 12.5 mg/kg s.i.d. as well as Enalapril at 0.25-0.5 mg/kg s.i.d. Aspirin therapy at 20 mg every 48 hours should be considered with repeat sonogram in 7-10 days. However, in the meantime an abdominal sonogram would be recommended in order to rule out primary sources of lymphoma as a security measure.
The cardiac presentation presented enlarged left atrium, mainly in the four chamber long axis view. This measured approximately 2.0 cm. Mitral insufficiency was noted. Some mild septal thickening and left ventricular myocardial remodeling was noted with mild left ventricular overload. The contractility appeared mildly subnormal, yet adequate. The pulmonary artery was prominent. Pleural effusion was noted with minor reactive type pattern in the pleura. This is most consistent with unclassified cardiomyopathy and pleural effusion. The right atrium and right ventricle were structurally uneventful.
The patient presented with jaundice, vomiting and elevated bilirubin and is now deceased.
Cardiac disease – cardiomyopathy (dilated/hypertrophic/restrictive), pericardial effusion, left atrial embolism Thorax – neoplasia (lymphoma/mesothelioma/metastatic neoplasia), thoracic duct trauma
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