Pericardial effusion

From Dog
Pericardial effsuon in a 5-year-old Golden Retriever due to rodenticide toxicity, showing a patchy alveolar infiltrate on air bronchograms (arrow heads) around the heart base area, and obscure cardiac silhouette[1]

Pericardial effusion, defined as the leakage of serum, blood or pus into the pericardial sac, is a relatively common heart disease of the dog.

A pericardial effusion is a potentially life-threatening problem as it causes an increase in the intrapericardial pressure resulting in varying degrees of hemodynamic compromise[2].

There are numerous causes of this condition, including:

- Congenital pericardial cysts
- Mitral valve endocardiosis
- Mitral valve dysplasia
- Peritoneopericardial diaphragmatic hernia
- Tricuspid dysplasia
- Tetralogy of Fallot
- Hemangiosarcoma
- Cardiac rhabdomyosarcoma
- Leiomyoma
- Leiomyosarcoma[3]
- Pericardial lipoma
- Chemodectoma
- Ectopic thyroid carcinoma
- Mesothelioma[4]
  • Infectious pericarditis
- Mycobacterium spp
- Nocardia spp
- Staphylococcus aureus (botryomycosis)[5][6]
- Coccidioides immitis[7]
- Aspergillus niger[8]
- Actinomyces spp, Mycobacterium spp
- Echinococcus spp
- Trypanosoma cruzi (metacyclic trypomastigote stage)[9]
- Endocarditis
- Pericarditis
- Myocarditis
  • Idiopathic
- Benign idiopathic effusion

Clinically affected dogs often present with weakness, anorexia, dyspnea and sometimes fever, depending on inciting cause[14]. Pulsus paradoxus and jugular venous distention are common ancillary findings.

Auscultation frequently reveals a 'muffled' heart sound, with associated murmurs and occasional ectopic beats, tachycardia or arrhythmias. Ascites may be evident of right-sided congestive heart failure is present[15].

Diagnosis is usually achieved via ultrasonography or radiography, showing obscuration of the cardiac silhouette, increased pulmonary opacity, pleural effusion and air bronchograms.

A marked elevation in serum creatinine kinase (0.3 to 2.9 U/L) and cardiac troponin 1 (reference range: 0.0 to 0.7 ng/mL) are a consistent finding[16].

Secondary cardiac tamponade, pericarditis, pulmonary edema and congestive heart failure may ensue, depending on cause

Treatment usually requires aggressive use of diuretics such as furosemide or pericardiocentesis. Pericardiocentesis is performed at the right hemithorax with the dog in the left lateral recumbent position, using an 18 or 16 gauge over-the-needle catheter to puncture the costochondral junction of the 5th intercostal space.

A subtotal pericardectomy may be required palliatively in cases of recurrent pericardial effusion, especially associated with cardiac neoplasias[17]. In cases of benign idiopathic effusion, pericardial windows can be created to alleviate chronic tamponade[18].

Although neoplastic pericardial effusion carries a poor prognosis, benign idiopathic pericardial effusion does not[19].

References

  1. Park C et al (2011) Successful therapy of coumatetralyl rodenticide induced pericardial effusion with pericardiocentesis in a dog. Can Vet J 52(2):165-168
  2. Gidlewski J & Petrie JP (2005) Therapeutic pericardiocentesis in the dog and cat. Clin Tech Small Anim Pract 20:151–155
  3. Fews D et al (2008) Leiomyosarcoma of the pericardium, with epicardial metastases and peripheral eosinophilia in a dog. J Comp Pathol 138(4):224-228
  4. Avakian A et al (2008) Lipid-rich pleural mesothelioma in a dog. J Vet Diagn Invest 20(5):665-667
  5. Casamián-Sorrosal D et al (2008) Septic pericardial effusion associated with pulmonary and pericardial botryomycosis in a dog. J Small Anim Pract 49(12):655-659
  6. Peterson PB et al (2003) Septic pericarditis, aortic endarteritis, and osteomyelitis in a dog. J Am Anim Hosp Assoc 39(6):528-532
  7. Shubitz LF et al (2001) Constrictive pericarditis secondary to Coccidioides immitis infection in a dog. J Am Vet Med Assoc 218(4):537-540
  8. Carpenter DH et al (2001) ECG of the month. Cardiac tamponade secondary to A. niger-induced constrictive pericarditis. J Am Vet Med Assoc 218(12):1890-1892
  9. Bahia MT et al (2002) Comparison of Trypanosoma cruzi infection in dogs inoculated with blood or metacyclic trypomastigotes of Berenice-62 and Berenice-78 strains via intraperitoneal and conjunctival routes. Rev Soc Bras Med Trop 35(4):339-345
  10. Gillette SM et al (1992) Late radiation response of canine mediastinal tissues. Radiother Oncol 23(1):41-52
  11. Parra JL et al (2009) Pericardial effusion and cardiac tamponade caused by intrapericardial granulation tissue in a dog. J Vet Emerg Crit Care (San Antonio) 19(2):187-192
  12. Elliott JM & Mayhew PD (2011) Diagnostic challenges and treatment options of a suspected pericardial metallic projectile foreign body in a dog. J Vet Emerg Crit Care (San Antonio) 21(6):684-691
  13. Yue-Chun L et al (2010) Establishment of a canine model of cardiac memory using endocardial pacing via internal jugular vein. BMC Cardiovasc Disord 10:30
  14. Parra JL et al (2009) Pericardial effusion and cardiac tamponade caused by intrapericardial granulation tissue in a dog. J Vet Emerg Crit Care (San Antonio) 19(2):187-192
  15. Crumbaker DM et al (2010) Thoracoscopic subtotal pericardiectomy and right atrial mass resection in a dog. J Am Vet Med Assoc 237(5):551-554
  16. Chun R et al (2010) Comparison of plasma cardiac troponin I concentrations among dogs with cardiac hemangiosarcoma, noncardiac hemangiosarcoma, other neoplasms, and pericardial effusion of nonhemangiosarcoma origin. J Am Vet Med Assoc 237(7):806-811
  17. Morges M et al (2011) Pericardial free patch grafting as a rescue technique in surgical management of right atrial HSA. J Am Anim Hosp Assoc 47(3):224-228
  18. Holak P et al (2009) Thoracoscopic creation of a pericardial window in dogs. Pol J Vet Sci 12(3):419-421
  19. Boddy KN et al (2011) Cardiac magnetic resonance in the differentiation of neoplastic and nonneoplastic pericardial effusion. J Vet Intern Med 25(5):1003-1009