Hello
This is an 8 year old Springer Spaniel cross that presented for lethargy today. His abdomen was distended and an abdominal ultrasound was performed. There was a moderate to marked amount of abdominal effusion with no obvious changes on any organs. Liver looked normal with no overt distention of hepatic veins.
Hello
This is an 8 year old Springer Spaniel cross that presented for lethargy today. His abdomen was distended and an abdominal ultrasound was performed. There was a moderate to marked amount of abdominal effusion with no obvious changes on any organs. Liver looked normal with no overt distention of hepatic veins.
So without identifying the cause of the abdominal effusion we performed quick echo and found what appears to be a tumor that seems expansive. I have seen a few previously that have always been confined to the Rt atrium and have more often than not been accompanied by pericardial effusion.
In this case there was no pericardial effusion. There was a very low grade low frequency murmur present.
I am thinking hemangiosarcoma but have read of lymphoma, rhabdomyosarcoma, etc.. heart based tumors. Does not have a typical presentation or appearence of a chemodectoma?
With nothing on the spleen we thought tapping the abdomen would not necessarily be useful for cytology. We did not do it today. The dog is hypoproteinemic and owners will most likely be treating in a palliative manner.
I am asking if sonographically we can give a semi-reliable diagnosis of type of tumor based on the images? Is there distinctive features of tumors in this area that can aid in classifying them? i.e. echogenicity, borders, and invasiveness?
Thanks. Brent
Comments
Interesting tumor… It seems
Interesting tumor… It seems to be deriving from the myocardium and is muscle echogenicity so rhabdo/mesenchymal would be my first thought, ectopic thyroid carcinoma is a potential as it looks like its almost mineralizing.. lympho third thought especially with the ascites may be multicentric manifestation… how about an FNA??? LOl kidding… so lets delve into the ascites… you can often get a good cyto read even on transudates with a large volume cytospin and take the sediment and slide that out right away and at least get a direction. If the CVC and HV are not dilated and this mass doesn’t extend into the CVC inflow to obstruct then its either an oncotic pressure issue, hepatic cirrhosis/portal hypertension or a lymphatic obstruction issue. The oncotic pressure issue must have an albumin < 1.5 g/dl to cause third spacing… so if its higher than that then likely lymphatic like lymphomatosis or similar. If poirtal hypertension the liver will be “smoked” with pathology/cirrhosis/fibrosis. If the albumin is < 1.5 then the protein loss must be renal, Gi or liver and if liver then a diffuse liver pathology/cirrhosis/fibrosis pattern will be present as it would in portal hypertension.
You may have 2 things going on here as well.
Hope this helps and here is the latest on cardiac neoplasia from Curbside Guide that I’m doing final image edits on this morning so off to graphic design this afternoon!!!:)
http://www.sonopath.com/products/book
Pericardial Effusion and Cardiac Neoplasia
http://sonopath.com/members/case-studies/search?text=pericardial+effusion&species=All
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.
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.
Interesting tumor… It seems
Interesting tumor… It seems to be deriving from the myocardium and is muscle echogenicity so rhabdo/mesenchymal would be my first thought, ectopic thyroid carcinoma is a potential as it looks like its almost mineralizing.. lympho third thought especially with the ascites may be multicentric manifestation… how about an FNA??? LOl kidding… so lets delve into the ascites… you can often get a good cyto read even on transudates with a large volume cytospin and take the sediment and slide that out right away and at least get a direction. If the CVC and HV are not dilated and this mass doesn’t extend into the CVC inflow to obstruct then its either an oncotic pressure issue, hepatic cirrhosis/portal hypertension or a lymphatic obstruction issue. The oncotic pressure issue must have an albumin < 1.5 g/dl to cause third spacing… so if its higher than that then likely lymphatic like lymphomatosis or similar. If poirtal hypertension the liver will be “smoked” with pathology/cirrhosis/fibrosis. If the albumin is < 1.5 then the protein loss must be renal, Gi or liver and if liver then a diffuse liver pathology/cirrhosis/fibrosis pattern will be present as it would in portal hypertension.
You may have 2 things going on here as well.
Hope this helps and here is the latest on cardiac neoplasia from Curbside Guide that I’m doing final image edits on this morning so off to graphic design this afternoon!!!:)
http://www.sonopath.com/products/book
Pericardial Effusion and Cardiac Neoplasia
http://sonopath.com/members/case-studies/search?text=pericardial+effusion&species=All
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.
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.
Fantastic information. Much
Fantastic information. Much appreciated.
Brent
Fantastic information. Much
Fantastic information. Much appreciated.
Brent
Glad you appreciate it:)
Glad you appreciate it:)
Glad you appreciate it:)
Glad you appreciate it:)