– 13 yr old Yorkie presented for weakness, dehydration and increased respiratory effort (trying to die during echo)
– bloodwork unremarkable, rod bacteria seen in urine
– bilateral pyelectasia on ultrasound – presumed pyelonephritis
– heart enlarged on x-ray; echo suspicious for heart base tumour and PAH documented (no pulmonic stenosis)
Do you think there is a cardiac tumour here and what would be the basis of the PAH? (PTE, secondary to the cardiac tumour, pulmonary disease?)
Thank-you ahead of time and happy New Year!
– 13 yr old Yorkie presented for weakness, dehydration and increased respiratory effort (trying to die during echo)
– bloodwork unremarkable, rod bacteria seen in urine
– bilateral pyelectasia on ultrasound – presumed pyelonephritis
– heart enlarged on x-ray; echo suspicious for heart base tumour and PAH documented (no pulmonic stenosis)
Do you think there is a cardiac tumour here and what would be the basis of the PAH? (PTE, secondary to the cardiac tumour, pulmonary disease?)
Thank-you ahead of time and happy New Year!
Comments
OK- as usual I will give my 2
OK- as usual I will give my 2 cents- right or wrong.
Looks like a heart base mass.
Free wall and IVS look markedly thickened to me.
L atrtium does not appear to be filling fully- and looks small to me.
Looks like SAM of the anterior mitral valve to me- which could be the underlying cause of the ventricular wall hypertrophy
Not sure about the cause of the tricuspid insufficiency and pulmonary hypertension.
We will see what EL and Peter have to say. You get the best cases.
Happy new year
OK so the rv papillaries look
OK so the rv papillaries look thick but going with the odds and the breed heart based masses in yorkies are usually aortic body tumors… chemodectoma. Myocardial infiltrative masses are rare but do occur such as this one in the archive http://sonopath.com/members/case-studies/cases/intracardiac-mass-associated-triscupid-valve-8-year-old-mn-golden-retriev
The more frequent scenario in yorkies is that ubiquitous cor pulmonale and rv hypertrophy that can be quite pronounced and I think thats what is going on here. In your 5 chamber you are pointing to an area of where aortic body tumors grow but the echogenicity is more fat or fibrosis which happens here in older dogs. No pc effusion and solid contractiility so why would the clinical signs be associated with these “lesions” I would ask myself unless pht is the issue. There is PHT which yorkies get all the time secondary to chronic pulmonary disease. Are heaptic veins dilated that would indicate emerging right chf? I would downplay heart tumor here and leave it in the distant diffs but maybe peter would disagree. i think this muscle looks wonly too becaus chronic hypertroiphy crotates a biti and I think you are imaging the thick rv papillary at an angle which makes it looks strange in the normal heart based view.
Thanks for this. When I first
Thanks for this. When I first looked at this heart, I thought I was looking at an HCM cat. You could be right that the imaging plane is a little rotated as this little one was struggling during the exam as was I. Forgot to mention that Aortic max vel was 2.69 m/s, so some sort of aortic stenosis going on here as well.
Hi!
I agree with Eric, the
Hi!
I agree with Eric, the tissue you are pointing at does not have the typical appearance of a paraganglioma (aortic body tumor). What I can see is:
.) Left ventricular concentric hypertrophy with SAM visible on the 5-chamber view and dynamic obstruction of the LVOT on 5-chamber view. (could be pseudo-hyptrophy as well due to underloading)
.) Right heart enlargement with marked PA enlargement.
.) The myocardium looks a bit patchy (fibrosis vs infiltration)
.) The structure on the SAX view could be due to a slightly oblique view. Still, it can also be a thrombus formation within the right atrium. Papillary less likely since this region is usually RA.
My conclusions are:
.) Marked PHT – together with the findings on rads can explain the clinical signs sufficiently
.) DLVOTO
.) Tumorous infiltration of the possible (e.g. lymphoma).
.) based on rads: severe broncho-interstitial pattern.
Do you have a 4-chamber view as well to see the right atrium from another perspective?
Thanks and happy New Year!
Peter
Hi Peter and Happy New Year
Hi Peter and Happy New Year to you!
I have uploaded 3 more videos. The IVS looks quite flattened in the LV view too so I think my TR jet velocity is likely underestimated.
Thanks for your help on this one! Poor dog is a mess.