Heart base mass, RV enlargement, TVI, and moderate to severe dyspnea in a 12 year old Shihtzu X

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Heart base mass, RV enlargement, TVI, and moderate to severe dyspnea in a 12 year old Shihtzu X

    • Chronic cough for 3 months followed by 3 days of progressively worsening dyspnea
    • Chest radiographs show a cranial mediastinal mass
    • Echocardiogram and thoracic ultrasound show a heart base mass.  In some views, there appears to be more than one mass, but it could be the same one wrapping around the heart base.  There is marked RV enlargement, some RA enlargement and a TVI of 5m/s.  There is mild LA enlargement.  There are no visible pleural or pericardial effusions.

        • Chronic cough for 3 months followed by 3 days of progressively worsening dyspnea
        • Chest radiographs show a cranial mediastinal mass
        • Echocardiogram and thoracic ultrasound show a heart base mass.  In some views, there appears to be more than one mass, but it could be the same one wrapping around the heart base.  There is marked RV enlargement, some RA enlargement and a TVI of 5m/s.  There is mild LA enlargement.  There are no visible pleural or pericardial effusions.
        • Cytology done on FNA of mass shows a fragile, epitheliod tumor with moderate atypia supporting malignancy and possible inflammation and often disrupted cells.  Differential diagnoses include heart base tumor, ectopic thyroid neoplasia, and other metastatic lesion.
        • Referral for CT was recommended.  Just wondering what the cause is of this dog’s severe dyspnea…pulmonary hypertension?  There did not appear to be pulmonary edema in the mid to caudal lung fields.  The cranial lung lobes were difficult to assess on radiographs due to the mass.  The LV appeared normal, but there was significant RV and RA enlargement.  The LA was only slightly enlarged.  Fractional shortening was good at 41%. 
        • The dog improved in hospital on oxygen and midazolam.  Diuretic therapy was also recommended.  Any other thoughts?  

Comments

EL
March 15, 2017 at 4:55 pm -

Looks like aortic body

Looks like aortic body tumor/chemodectoma and a new name maybe Peter can add to this. I have seen hypertension and pht associated with these and the mass surely extends beyond the ehco window and likely stepping on the pulmonaryvascular hose here hence pht. The curbside guide has a chapter in heart based tumors if you have it.

https://sonopath.com/products/book

 

 

Peter
March 15, 2017 at 8:15 pm -

Hi!
The location does not

Hi!

The location does not tello you much about the type of neoplasia. Paraganglioma or ectopic thyroid tumor are both possible.

Given the size of the mass this tumor can cause airway obstruction and secondary pulmonary hypertension (or primary, if lung arteries are obstructed as well). I think this is the most likely reason. I had a few of these cases. Some cardiac tumors cause cough rater than pericardial effusion.

In these cases medical therapy mainly aims at reducing cough. I woudl also give sildenafil and Vetmedin even though this might not change a lot.

Bad prognosis anyway.

If the owners want to go futher, a CT scan is necessary even though surgery is not really likely to be very successful here..

 

Regards

 

Peter

 

Electrocute
March 16, 2017 at 1:52 am -

Thanks Eric and Peter!  I

Thanks Eric and Peter!  I will keep you posted on CT results if client pursues it.

-M

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