Jackson: 9 Year Old, M/N GoldenDoodle presented for weakness and ADR, Lung sounds muffles
U/S: large PCE (Drained 550ml’s bloody fluid); I do not see an obvious cardiac mass….There is a hypoechoic splenic mass that loses architecture. No abdominal fluid was evident.
Jackson: 9 Year Old, M/N GoldenDoodle presented for weakness and ADR, Lung sounds muffles
U/S: large PCE (Drained 550ml’s bloody fluid); I do not see an obvious cardiac mass….There is a hypoechoic splenic mass that loses architecture. No abdominal fluid was evident.
So assuming that there is not a cardiac mass (I never trust my own eyes on these), could a focal HSA lesion in the spleen (assuming the splenic lesion is a HSA) account for such a large volume PCE. It seems unlikely to me and more likely that this is either idiopathic pericarditis or there’s a HSA in the heart and I’m not seeing/finging it.
Thoughts, Opinions and Better Eyes than mine are most appreciated.
Thanks
Sam
Comments
Not sure why this didn’t
Not sure why this didn’t post…I tried to upload a Rt. Auricular loop but it didn’t load.
I don’t see a cardiac mass
I don’t see a cardiac mass either in this case – but as you said, this means nothing. It has been reported that 8.7-25% of dogs with splenic HAS have a right atrial mass. The. detection rate of right auricular tumors was shown in one study to be as low as 60%. Troponin might help as values >025 ng/ml is associated with a high probability of cardiac HAS in dogs with pericardial effusion.
So what you can do is:
-) measure cTnI
-) take chest rads to rule out metastasis or – even better- perform a CT scan.
-) take the spleen out (or just the part containing the tumor) and submit it for histopath.
-) If the spleen is neg for HAS, re-check the. heart repeatedly (I usually do it after 1,2,4,8,16,.. weeks or earlier if the dog develops PE again).
-) If HAS is confirmed, start with Chemo. Once you see a resectable auricular mass, resect it
-) if the spleen is neg for HAS, I would NEVER rule out a cardiac tumor unless I still can’t see one after 1 year.
I hope this helps
Best wishes,
Peter
Thanks Peter,
I’d not heard
Thanks Peter,
I’d not heard of (or remembered) those stats before…good to know. We did chest rads which alerted to the PCE and saw no pulmonary dz. I doubt that a CT or Heart Sx is in the future of this dog.
That leaves me w/ splenectomy or monitoring +/- FNA. I started the dog on prednisone for idiopathic pericarditis but I realize it’s questionable if it helps or if these all aren’t just tumors in progress causing PCE
I’ll pass this my associate and keep my fingers crossed…I think our initial plan was re-scan heart and spleen in a couple weeks if dog is stable.
SAm
Thanks Peter,
I’d not heard
Thanks Peter,
I’d not heard of (or remembered) those stats before…good to know. We did chest rads which alerted to the PCE and saw no pulmonary dz. I doubt that a CT or Heart Sx is in the future of this dog.
That leaves me w/ splenectomy or monitoring +/- FNA. I started the dog on prednisone for idiopathic pericarditis but I realize it’s questionable if it helps or if these all aren’t just tumors in progress causing PCE
I’ll pass this my associate and keep my fingers crossed…I think our initial plan was re-scan heart and spleen in a couple weeks if dog is stable.
SAm