- 13 year old mn Jack Russell Terrier presented for evaluation for treatment for severe dental disease. Had a dental performed one year ago at another clinic and experienced adverse cardiac effects.
- Chest radiographs show a mass adjacent to the right atrium and possible other nodules in the chest.
- Dog has runs of tachycardia (>200bpm) but this occured when we would change his position and he would relax and the rate would then revert to normal (<150bpm).
- 13 year old mn Jack Russell Terrier presented for evaluation for treatment for severe dental disease. Had a dental performed one year ago at another clinic and experienced adverse cardiac effects.
- Chest radiographs show a mass adjacent to the right atrium and possible other nodules in the chest.
- Dog has runs of tachycardia (>200bpm) but this occured when we would change his position and he would relax and the rate would then revert to normal (<150bpm).
- Echocardiogram shows an encapsulated 3.5cm mass with both anechoic fluid and solid portions. On right parasternal views, the mass can be seen adjacent to the right atrium and right ventricle when advancing the probe cranially. On RPLVOV views, the mass could be seen in the cranial mediastinum adjacent to the right atrium and aorta. I could not visualize the mass from any of the standard LP and left apical views.
- A mild mitral valve insufficiency is present but no volume overload and good systolic function is present.
- I know I can access the solid portion of the mass for an FNA but opted not to since the fluid filled portion made me concerned about HSA of RA origin. Other differentials include chemodectoma, cystic thymoma, and less likely LSA.
- Any other thoughts on the origin of this mass? Would you aspirate it? Also, this dog really, really needs a dental. Any recommendations on how to manage anesthesia on that?
Comments
I’m with you in that I would
I’m with you in that I would put HSA at the top of the list for this mass based on location and appearance.
I dont see any anesthetic contraindications based on the overall compensated appearance of the heart. Opioid / benzo combo or propofol would be fine.
I would consider a 25 ga needle for FNA into the solid portion under sedation or brief anesthesia with a clean window and normal coag panel. If you get fluid, immediate cytospin / cytology of it. As long as the risks and pros / cons are discussed ie bleeding into the pleural or pericardial space or possible inconclusive results, I would likely try to get more info and possible oncology consult if neoplasia can be confirmed…if you feel comfortable doing it.
On another note, I too would
On another note, I too would consider this to be a HSA but since histopathologists at the best of times have difficulty differentiating or calling splenic HSA over hemorhage it may not be worth the risk in the end.
Thank you all for your
Thank you all for your thoughts and advice. I offered the fna with a discussion of the risks. The owner has opted not to pursue the FNA. The owner will likely still pursue the dental since this actually a significant problem for the dog at this time.