Case Study

Septic suppurative pericarditis in a 13 year old FS DSH cat with diabetes

This 13- year-old DSH FS cat presented for lethargy, anorexia and tachypnea. The patient has a history of diabetes, labored breathing, weakness in the hind limbs, and anemia. Blood work revealed a hematocrit of 25.4%, BUN of 61, and a WBC count of 35000 with monocytosis. Urine specific gravity was 1.022. Chest radiographs revealed severe cardiomegaly.

This 13- year-old DSH FS cat presented for lethargy, anorexia and tachypnea. The patient has a history of diabetes, labored breathing, weakness in the hind limbs, and anemia. Blood work revealed a hematocrit of 25.4%, BUN of 61, and a WBC count of 35000 with monocytosis. Urine specific gravity was 1.022. Chest radiographs revealed severe cardiomegaly.

DX

Septic suppurative pericarditis.

Sonographic Differential Diagnosis

Pericarditis, neoplasia, vasculitis, feline infectious peritonitis (FIP).

Image Interpretation

Long axis 5-chamber and heart based views reveal severe pericardial effusion with essentially normal internal chamber volumes and an LA/Ao ratio of 1.4 (Image 1). A mildly echogenic tissue density structure is present attached to the pericardium measuring 2.56 x 0.77 cm (Image 2). An efficiency clip of the 5-chamber long axis view allows for further evaluation of the pericardial space and the tissue structure that appears attached to the epicardium as well (Video 1). Differentiation between clot and mass cannot be made. US-guided pericardiocentesis (22-gauge heparinized IV catheter seen in the 1 o’clock position) was performed to relieve any tamponade effect on the heart, perform fluid and cytology analysis as well as culture (Video 2). 30 cc of hemorrhagic effusion was obtained and presumed to be the cause of the anemia.

Outcome

Cardiac fluid analysis revealed intracellular and extracellular cocci bacteria forming chains.

Comments

Presenting radiographic history: “Wow that`s the biggest cat heart I have ever seen.” Cardiomegaly in a cat doesn’t mean just heart failure or neoplasia. When in doubt, put a needle in it:..carefully. The diagnosis was just a probe and a needle away. Case managed by Dr. Christine Stockmal at American AH, Randolph, New Jersey (http://www.americananimalhospital.com). Imaging by Dr. Eric Lindquist (http://www.sonopath.com/specialists_lindquist.asp) of SonoPath.com & New Jersey Mobile Associates.

Clinical Differential Diagnosis

Cardiac disease – dilated cardiomyopathy, hypertrophic cardiomyopathy, pericardial effusion. Renal disease – chronic kidney disease, pyelonephritis, neoplasia, renoliths. Pulmonary thrombo-embolic disease.

Sampling

30 cc of hemorrhagic effusion were removed from the pericardium via US-guided pericardiocentesis. Fluid analysis revealed intracellular and extracellular cocci bacteria forming chains. Culture revealed Beta-hemolytic Streptococcus.