– 10 yr old M 130lb Landseer referred for ultrasound due to ascites and muffled heart sounds; no x-rays taken
– bloodwork pretty boring; small petechial hemorrhage spots noted on ventral abdomen when shaving
– marked pericardial effusion, abdominal effusion, abdomen clean except for a single 2cm isoechoic nodule in the liver
– no obvious tumours in the heart to me (scanned laying down and standing up)
– drained 400ml brownish fluid from the pericardial space – spun down and sending for cytology (but know may not help with diagnosis)
– 10 yr old M 130lb Landseer referred for ultrasound due to ascites and muffled heart sounds; no x-rays taken
– bloodwork pretty boring; small petechial hemorrhage spots noted on ventral abdomen when shaving
– marked pericardial effusion, abdominal effusion, abdomen clean except for a single 2cm isoechoic nodule in the liver
– no obvious tumours in the heart to me (scanned laying down and standing up)
– drained 400ml brownish fluid from the pericardial space – spun down and sending for cytology (but know may not help with diagnosis)
– abdominal tap clear, serosanguinous fluid
– neoplasia would be my primary concern here – would you agree? (ddx: neoplasia, idiopathic pericardial effusion, infection)
– here are two clips of the right atrium – one with pet laying down and one standing up – anything suspicious to you?
Also – just want to make sure that I am correct in assuming that CHF does not cause this degree of pericardial effusion? The referring vet was concerned about[videoembed id=7632][videoembed id=7631][videoembed id=7633] heart disease in this patient.
Comments
Pericarditis? neoplasia??
Pericarditis? neoplasia?? Spin down the fresh fluid right away and make your own slides form the sediment. It will conserve cells for a better read. I would start doxy clindamycin in hopes of infectious. immune mediated possible as well. Try rescanning in a few days if there is a mass it may grow into view. Seems like a strange color for idiopathic.
In your videos the raur looks a little ragged but not obvious neoplasia. Nice views! There was a study on the ph or glucose level of the fluid and neoplasia but I cant recall the findings. Peter?? Remo??
Anything in the abdomen that says neoplasia?? spleen? liver?? hepatic ln??
Pericarditis? neoplasia??
Pericarditis? neoplasia?? Spin down the fresh fluid right away and make your own slides form the sediment. It will conserve cells for a better read. I would start doxy clindamycin in hopes of infectious. immune mediated possible as well. Try rescanning in a few days if there is a mass it may grow into view. Seems like a strange color for idiopathic.
In your videos the raur looks a little ragged but not obvious neoplasia. Nice views! There was a study on the ph or glucose level of the fluid and neoplasia but I cant recall the findings. Peter?? Remo??
Anything in the abdomen that says neoplasia?? spleen? liver?? hepatic ln??
Difficult to call neoplasia
Difficult to call neoplasia on these images – agree that should spin effusion down ASAP and evaluate the cells. Can consider doing serum cardiac troponin I, which has been shown to be elevated with tumors rather than with idiopathic effusion. Another consideration in this case would be a hemorrhagic diathesis, esepcially as there are petechial hemorrhages. May considering doing a bleeding panel. If all normal then most likely would be idiopathic. To date there has been no conclusive evidence of immune-mediated effusion. Bacterial/fungal infections can be ruled out on culture and cytology.
Here is the reference that Eric was referring to:
de Laforcade AM, Freeman LM, Rozanski EA, Rush JE. J Vet Intern Med. 2005;19:833-6. Biochemical analysis of pericardial fluid and whole blood in dogs with pericardial effusion.
Studies evaluating pericardial fluid analysis in dogs to determine the etiology of pericardial effusions have yielded conflicting results. The purpose of this prospective study was to compare acid-base status, electrolyte concentrations, glucose, and lactate of pericardial fluid to peripheral blood from dogs with pericardial effusion and to compare these variables between dogs with neoplastic and non-neoplastic pericardial effusion. Acid-base status, electrolyte concentrations, glucose, hematocrit, urea nitrogen, and lactate concentrations were evaluated in peripheral blood samples and in pericardial effusion samples of 41 client-owned dogs with pericardial effusion. Common abnormal findings in the peripheral blood of dogs with pericardial effusion included hyperlactatemia (n = 38 [of 41]; 93%), hyponatremia (n = 25/41; 61%), hyperglycemia (n = 13/41; 32%), and hypermagnesemia (n = 13/41; 32%). Bicarbonate, sodium, ionized calcium, glucose, and hematocrit were all significantly lower in the pericardial fluid compared with peripheral blood, whereas lactate, chloride, and PCO2 were significantly higher in the pericardial fluid. When comparing the concentrations of variables in the pericardial fluid of dogs with neoplasia (n = 28) to those without neoplasia (n = 13), pH, bicarbonate, and chloride were significantly lower in dogs with neoplasia, whereas lactate, hematocrit, and urea nitrogen were significantly higher in the pericardial fluid of dogs with neoplasia. The difference between peripheral and pericardial glucose concentrations was significantly larger in dogs with neoplasia than in dogs without neoplasia. Although differences between variables in dogs with neoplastic and nonneoplastic pericardial effusion were documented, clinical relevance is likely limited by the degree of overlap between the 2 groups.
Difficult to call neoplasia
Difficult to call neoplasia on these images – agree that should spin effusion down ASAP and evaluate the cells. Can consider doing serum cardiac troponin I, which has been shown to be elevated with tumors rather than with idiopathic effusion. Another consideration in this case would be a hemorrhagic diathesis, esepcially as there are petechial hemorrhages. May considering doing a bleeding panel. If all normal then most likely would be idiopathic. To date there has been no conclusive evidence of immune-mediated effusion. Bacterial/fungal infections can be ruled out on culture and cytology.
Here is the reference that Eric was referring to:
de Laforcade AM, Freeman LM, Rozanski EA, Rush JE. J Vet Intern Med. 2005;19:833-6. Biochemical analysis of pericardial fluid and whole blood in dogs with pericardial effusion.
Studies evaluating pericardial fluid analysis in dogs to determine the etiology of pericardial effusions have yielded conflicting results. The purpose of this prospective study was to compare acid-base status, electrolyte concentrations, glucose, and lactate of pericardial fluid to peripheral blood from dogs with pericardial effusion and to compare these variables between dogs with neoplastic and non-neoplastic pericardial effusion. Acid-base status, electrolyte concentrations, glucose, hematocrit, urea nitrogen, and lactate concentrations were evaluated in peripheral blood samples and in pericardial effusion samples of 41 client-owned dogs with pericardial effusion. Common abnormal findings in the peripheral blood of dogs with pericardial effusion included hyperlactatemia (n = 38 [of 41]; 93%), hyponatremia (n = 25/41; 61%), hyperglycemia (n = 13/41; 32%), and hypermagnesemia (n = 13/41; 32%). Bicarbonate, sodium, ionized calcium, glucose, and hematocrit were all significantly lower in the pericardial fluid compared with peripheral blood, whereas lactate, chloride, and PCO2 were significantly higher in the pericardial fluid. When comparing the concentrations of variables in the pericardial fluid of dogs with neoplasia (n = 28) to those without neoplasia (n = 13), pH, bicarbonate, and chloride were significantly lower in dogs with neoplasia, whereas lactate, hematocrit, and urea nitrogen were significantly higher in the pericardial fluid of dogs with neoplasia. The difference between peripheral and pericardial glucose concentrations was significantly larger in dogs with neoplasia than in dogs without neoplasia. Although differences between variables in dogs with neoplastic and nonneoplastic pericardial effusion were documented, clinical relevance is likely limited by the degree of overlap between the 2 groups.
Thanks Remo and Eric
I am
Thanks Remo and Eric
I am hoping the cytology may be of some assistance in this case. Made smears right away with the centrifuged fluid (have not looked at it myself-late Friday case!) The dog has lost weight and body condition and is generally unwell. The fact that he is 10 and a giant breed in itself worries me (making me think neoplasia is highly possible). I have not done a clotting profile on this patient but platelet count is normal and HCT is low end normal. The abdomen scan was pretty clear except for a single liver nodule (see newly attached).
The clients are not interested in referral -have dicussed possibiity of a pericardiectomy esp. if idiopathic.
Thanks Remo and Eric
I am
Thanks Remo and Eric
I am hoping the cytology may be of some assistance in this case. Made smears right away with the centrifuged fluid (have not looked at it myself-late Friday case!) The dog has lost weight and body condition and is generally unwell. The fact that he is 10 and a giant breed in itself worries me (making me think neoplasia is highly possible). I have not done a clotting profile on this patient but platelet count is normal and HCT is low end normal. The abdomen scan was pretty clear except for a single liver nodule (see newly attached).
The clients are not interested in referral -have dicussed possibiity of a pericardiectomy esp. if idiopathic.
I totally agree. As mentioned
I totally agree. As mentioned in the study cited by Remo, there was a considerable overlap between groups. I do not consider any of the parameters mentioned in this study very useful in practice. Most important is a thorough follow up. Yes, I would always spin down the fluid and submit a slide for cytology, but even if it´s negative (no neoplastic cells), I would never be too certain unless I have an at least 8 week – follow up. But please be aware that a neoplastic lesion can be easily missed if there´s no pericardial effusion present.
I totally agree. As mentioned
I totally agree. As mentioned in the study cited by Remo, there was a considerable overlap between groups. I do not consider any of the parameters mentioned in this study very useful in practice. Most important is a thorough follow up. Yes, I would always spin down the fluid and submit a slide for cytology, but even if it´s negative (no neoplastic cells), I would never be too certain unless I have an at least 8 week – follow up. But please be aware that a neoplastic lesion can be easily missed if there´s no pericardial effusion present.