Case Study

Cardiac mass and pericardial effusion with tamponade in a 12 year old MN Golden Retriever

A 12-year-old neutered male Golden retriever dog with history of Lyme disease was presented for acute onset lethargy, vomiting, and anorexia. On physical examination, the dog’s mucous membranes were slightly pale but with a normal CRT. An arrhythmia could be ausculted. The dog’s abdomen was tender and doughy on palpation, and he was marginally dehydrated. 4DX test was positive for both Lyme and Anaplasma. CBC showed leukocytosis, neutrophilia, and monocytosis.

A 12-year-old neutered male Golden retriever dog with history of Lyme disease was presented for acute onset lethargy, vomiting, and anorexia. On physical examination, the dog’s mucous membranes were slightly pale but with a normal CRT. An arrhythmia could be ausculted. The dog’s abdomen was tender and doughy on palpation, and he was marginally dehydrated. 4DX test was positive for both Lyme and Anaplasma. CBC showed leukocytosis, neutrophilia, and monocytosis. The patient was initially treated with a bland diet but several days later was represented for intermittent episodes of dyspnea, tachypnea, and cyanotic mucous membranes, lasting 10-15 minutes at a time.

DX

Cardiac mass; Pericardial effusion with tamponade.

Sonographic Differential Diagnosis

8cm right auricular mass. Pericardial effusion with tamponade.

Image Interpretation

A large amount of pericardial effusion with tamponade was evident, and an 8cm right auricular mass was easily visualized. Normal internal volume to contractility were present after the drainage procedure.

Outcome

The patient was treated with antibiotics and recommended that activity be restricted. Several weeks later the patient collapsed on a walk and became unresponsive. Intravenous medications and oxygen therapy failed to improve patient’s condition. Cardiac tamponade and an 8cm right auricular mass was still evident on echocardiography. Via ultrasound guidance, another 250 mls of blood was extracted from the pericardial sac, which resulted in a marked improvement. At the last communication, the owner was preparing to make the decision to euthanize in the event of another collapse or compromised breathing.

Clinical Differential Diagnosis

Infectious disease: Lyme disease, anaplasmosis; GI tract hemorrhage. Cardiac disease: cardiomyopathy, myocarditis, pericardial effusion, neoplasia; Peritonitis; Splenic neoplasia; Pleural effusion.

Sampling

Ultrasound guided pericardiocentesis drained 240cc of frank blood with a mild amount of residual right pericardial fluid present. Strong cardiac function was returned.