This is a 12 year old mixed breed dog (owned by one of our receptionists). He has an occasional cough, is rubbing his face a lot. He does have dental disease, but I’m worried about this:
This is a 12 year old mixed breed dog (owned by one of our receptionists). He has an occasional cough, is rubbing his face a lot. He does have dental disease, but I’m worried about this:
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Hi!
Yes, this looks like a
Hi!
Yes, this looks like a heart base mass. Mostly they are paragangliomas (former chemodectomas), but a few others are also possible.
Mostly they grow slowly and can cause either pericardial effusion or cough or both.
Surgical tumor mass reduction and histopath can be considered. Otherwise watchful waiting. Sometimes they compress pulmonary veins causing lobar pulmonary edema.
If pericardial effusion becomes the major problem, pericardectomy (endoscopically) is a good option.
Peter
Darn it Peter you keep
Darn it Peter you keep renaming my pathology I just presented last night talking about chemodectomas/aortic body tumors!! Now I”m behind the times again lol.
Here’s an excerpt form the Curbside guide
https://sonopath.com/products/book
on cardiac neoplasia…. better a paraganglioma (The tumor formerly known as chemodectoma:) as opposed to HSA thats for sure.
Pericardial Effusion and Cardiac Neoplasia
http://www.sonopath.com/CardiacNeoplasiaEffusion
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 Anim Prac 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.
Thank you!
Thank you!