Eosinophilic pericardial effusion in a cat with complex systemic disease and associated peripheral eosinophilia.

An 11-year-old domestic shorthair cat was referred for investigation of dry cough of 1-week duration and cardiomegaly. Echocardiography revealed pericardial effusion, and eosinophils were identified as the predominant cell type in fluid collected by pericardiocentesis. Thoracic computed tomography imaging and bronchoscopy were supportive of mild lower airway disease, while bronchoalveolar lavage confirmed eosinophilic inflammation and concurrent Mycoplasma felis infection. A few months after the initial presentation, there was clinical deterioration, and further investigation suggested intestinal lymphoma. It was hypothesized that pericardial effusion and lower airway inflammation were an early manifestation of hypereosinophilic syndrome, possibly as a paraneoplastic consequence of lymphoma.

PERICARDIAL MESOTHELIOMA AND ASSOCIATED PERICARDIAL EFFUSION IN A TIGER RAT SNAKE (SPILOTES PULLATUS) TREATED WITH PERICARDIOCENTESIS.

A 1.5 kg, male, wild-caught tiger rat snake (Spilotes pullatus) presented with an externally visible distension of the body wall at the level of the heart. Ultrasound examination showed marked pericardial effusion. Pericardial fluid showed no bacterial or fungal growth, few leukocytes, and few suspected reactive mesothelial or neoplastic cells. Therapeutic pericardiocentesis was successfully performed, removing most of the fluid from the pericardial sac. The snake had mild lethargy and weakness immediately after the procedure but returned to normal behavior within 2 wk. Repeat pericardiocentesis was performed 6 mo after the initial presentation when moderate refilling of the pericardial sac was seen. The snake died 4 days after the second procedure with acute hemorrhage. Pericardial mesothelioma was diagnosed by histopathology after postmortem examination. This report provides the first documented case of mesothelioma in a tiger rat snake and the first description of the disease in colubrids.

Prospective evaluation of pericardial catheter placement versus needle pericardiocentesis in the management of canine pericardial effusion.

OBJECTIVE: To compare the safety and efficacy of pericardial catheter placement with needle pericardiocentesis in dogs with pericardial effusion (PE) DESIGN: Prospective, randomized clinical trial. SETTING: University teaching hospital. ANIMALS: Thirty client-owned dogs requiring pericardiocentesis between January 2017 and August 2019. INTERVENTIONS: Dogs were randomized to undergo PE drainage via indwelling pericardial catheter placement (catheter group) followed by elective drainage every 4-6 hours or needle pericardiocentesis (needle group) repeated as necessary. MEASUREMENTS AND MAIN RESULTS: Fifteen dogs were allocated to the catheter group and 15 to the needle group. Data collected included signalment, cause of effusion, occurrence of arrhythmias pre-, during, and post-pericardiocentesis, procedural length, and details of repeated drainages. There was no significant difference between mean procedural times for pericardial catheter placement (17.7 min [±11.8]) and needle pericardiocentesis (12.1 min [±8.6]) (P = 0.192) or the rate of new arrhythmias in the catheter (36%) and needle (64%) groups (P = 0.24). Pericardial catheters were kept in situ for a median of 21 hours (range, 14-85). Three of 15 (20%) dogs in the needle group required repeated pericardiocentesis within 24 hours of initial pericardiocentesis. Pericardial catheters enabled repeated large volume PE drainage in 4 cases (median, 10.6 mL/kg; range, 8-5-10.6). CONCLUSIONS: Pericardial catheters appear to offer a safe alternative to needle pericardiocentesis. Minimal sedation is required for placement, and they can be placed quickly. Their indwelling nature and use was not associated with a higher rate of arrhythmia compared to that of needle pericardiocentesis alone, and may be beneficial in the event that clinically significant PE recurs.

Presumptive seeding metastasis of pericardial mesothelioma following repeated pericardiocentesis in a dog.

A dog with a history of recurrent pericardial effusion that required repeated pericardiocentesis was presented to the surgical service at the Ontario Veterinary College Health Sciences Centre for thoracoscopic pericardiectomy. Physical examination revealed a subcutaneous mass in the right lateral thorax. Cytology of the subcutaneous mass and histopathology of the pericardium were consistent with mesothelioma. This article details the first reported case of pericardial mesothelioma with suspected extra-thoracic metastasis following pericardiocentesis in a dog.

Implantation métastasique présumée d'un mésothéliome péricardique à la suite de péricardiocentèses répétées chez un chien. Un chien avec une historique d'effusions péricardiques récurrentes qui nécessitaient des péricardiocentèses répétées fut présenté au service de chirurgie du Ontario Veterinary College Health Sciences Centre pour une péricardiectomie thoracoscopique. L'examen physique a révélé une masse souscutanée dans le thorax latéral droit. L'examen cytologique de la masse sous-cutanée et l'histopathologie du péricarde étaient cohérents avec un mésothéliome. Le présent article donne les détails du premier cas rapporté chez un chien de mésothéliome péricardique avec métastase extra-thoracique suspectée consécutive à la suite de péricardiocentèses.(Traduit par Dr Serge Messier).

Plasma N-terminal pro-brain natriuretic peptide concentrations before and after pericardiocentesis in dogs with cardiac tamponade secondary to spontaneous pericardial effusion.

OBJECTIVE: To determine if concentrations of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) are increased in dogs with cardiac tamponade and if there is a significant increase in plasma NT-proBNP after pericardiocentesis. ANIMALS: Ten client-owned dogs with spontaneous cardiac tamponade. METHODS: Prospective clinical study. Cardiac tamponade was suspected from physical examination and confirmed with echocardiography. Blood was collected and plasma NT-proBNP concentrations were measured before and 30-60 min following pericardiocentesis and resolution of cardiac tamponade. Within-subject changes in plasma NT-proBNP were compared by the Wilcoxon signed-rank test. RESULTS: The plasma NT-proBNP concentrations measured within the reference interval in seven of 10 dogs before pericardiocentesis and in six of 10 dogs following pericardiocentesis. Following pericardiocentesis, there was a statistically significant increase in median NT-proBNP concentration (733 pmol/L, range 250-3,297) compared with the values measured before (643 pmol/L, range 250-3,210, P = 0.004). The NT-proBNP concentration increased in 90% of the dogs following pericardiocentesis. CONCLUSIONS: An upper reference limit of 900 pmol/L for plasma NT-proBNP is insensitive for the diagnosis of pericardial effusion and cardiac tamponade in dogs. Plasma NT-proBNP concentration commonly increases following pericardiocentesis, perhaps related to improved ventricular filling and stretch.

Evaluation of Pericardial Effusion in Dogs and Successful Treatment Using a Hemodialysis Fistula Needle: A Retrospective Study.

The aim of this retrospective study was to assess epidemiology and echocardiographic findings of pericardial effusion in canine patients and to determine the clinical usefulness and safety of a new pericardiocentesis technique, using a "fistula needle" for hemodialysis. A database of 5304 dogs of different breeds, age, gender, type, and severity of the cardiac disease, referred for a specialist cardiology and echocardiographic examination from 2009-2016, was reviewed. All the dogs were subjected to echocardiography; when possible and required, an echo-guided pericardiocentesis was performed by mean of a 17G "fistula needle" commonly used for hemodialysis. Complete echocardiography was repeated at the end of each pericardiocentesis. Pericardial effusion was identified by echocardiography in 91 dogs (1.71%), 20 were female (21.98%) and 71 were male (78.02%). PE caused cardiac tamponade in 38/91 cases (41.76%). A clear evidence of a neoplasm was found in 33 cases (36.26%). In 32 cases (35.16%) severe degenerative mitral and tricuspid valve disease was detected as the cause of the pericardial effusion. Echo-guided pericardiocentesis was performed in 28 cases (30.77%) with cardiac tamponade. No adverse effects were found in any of the patients during the 48 hours of follow up after pericardiocentesis. This study showed the high incidence of pericardial effusion due to severe bilateral degenerative valve disease in adult to elderly dogs of different breeds. Moreover, the use of a "fistula needle" for pericardiocentesis in dogs showed no adverse effects.

Focal intramural pericardial effusion and cardiac tamponade associated with necrotic adipose tissue in a dog.

CASE DESCRIPTION A 1-year-old castrated male German Shepherd Dog was examined because of an acute onset of lethargy, tachypnea, and inappetence. CLINICAL FINDINGS On initial physical examination, the dog was tachypneic with muffled heart sounds on thoracic auscultation and a palpable abdominal fluid wave. Transthoracic echocardiography revealed focal intramural pericardial effusion and cardiac tamponade. TREATMENT AND OUTCOME The patient underwent emergency therapeutic pericardiocentesis, followed by right lateral intercostal thoracotomy and subtotal pericardiectomy. A 3 × 5-cm mass located between the parietal and visceral layers of the pericardium was resected. The histologic diagnosis was necrotic adipose tissue with granulomatous inflammation and fibroplasia. The patient also underwent exploratory laparotomy and umbilical herniorrhaphy during the same anesthetic episode and recovered from surgery without apparent complications. There were no further clinical signs of cardiac disease. CLINICAL RELEVANCE The patient described in the present report underwent successful subtotal pericardiectomy for treatment of a benign focal lesion causing recurrent pericardial effusion and cardiac tamponade. Prompt diagnosis and intervention may have contributed to the positive outcome in this case.

Repeated pericardiocentesis as palliative treatment for tamponade associated with cardiac lymphoma in a Holstein cow.

Maintaining a good quality of life for cows with cardiac manifestation of lymphoma may be valuable, especially in high-producing cows. This report describes the medical management of cardiac lymphoma in a cow by means of repeated pericardiocentesis. The cow survived for 34 days and was productive.

Intraoperative echocardiography and surgical treatment of traumatic pericarditis in a pregnant cow.

Traumatic pericarditis is one of the most significant bovine cardiac diseases. The authors describe the use of intraoperative echocardiography and successful surgical treatment of a case of traumatic pericarditis. A seven-year-old Hungarian Simmental dairy cow in late pregnancy showed severe oedema of the throat region and brisket, as well as jugular distension. Cardiac auscultation demonstrated tachycardia with a normal cardiac rhythm. The heart sounds were muffled, but no cardiac murmur or splashing sounds were heard. A large amount of echogenic fluid with some strands of fibrin was seen in the pericardial and right pleural cavities by ultrasonography. Ultrasound-guided pericardiocentesis demonstrated the presence of a thick, fetid and purulent exudate. Pericardiotomy was performed in standing position with sedation and local anaesthesia. After costal resection, intraoperative echocardiography was performed. It showed an echogenic tract between the caudal pericardium and diaphragm, but no foreign body was seen. Two weeks after the surgery, the cow delivered a healthy bull-calf. Intraoperative echocardiography - not reported earlier - can be applied to evaluate the entire bovine pericardial sac and heart. The report also demonstrates that surgical treatment of traumatic pericarditis can be successful in carefully selected cases.

Adverse events associated with pericardiocentesis in dogs: 85 cases (1999-2006).

OBJECTIVE: To quantify the frequency of adverse events occurring during or post pericardiocentesis and to determine if adverse events are related to the cause of the pericardial effusion or frequency of pericardiocentesis. DESIGN: Retrospective study. SETTING: Referral hospital. ANIMALS, INTERVENTION AND MEASUREMENTS: Medical records of 85 dogs that underwent 112 episodes of pericardiocentesis were reviewed. Any adverse events during pericardiocentesis and in the 48 hours post pericardiocentesis were noted. The frequency of adverse events was compared between dogs with a suspected neoplastic cause and a suspected nonneoplastic cause of their pericardial effusion and also between the first and subsequent pericardiocenteses. MAIN RESULTS: The incidence of adverse events was 10.7% within 1 hour of pericardiocentesis and 15.2% within 48 hours. There was no significant difference in the frequency of adverse events between the groups. Most adverse events identified were dysrhythmias. Forty-one percent of those dogs with adverse events were euthanized or died within 48 hours. CONCLUSION: The incidence of adverse events seen within 48 hours of pericardiocentesis was 15.2%.

Therapeutic pericardiocentesis in the dog and cat.

Pericardial effusion is a potentially life-threatening problem leading to a rise in the intrapericardial pressure resulting in varying degrees of hemodynamic compromise. Cardiac tamponade occurs when the intrapericardial pressure equals or exceeds right ventricular diastolic filling pressures leading to a decreased cardiac output. In dogs, the most common causes of pericardial effusion that require pericardiocentesis are cardiac neoplasia and idiopathic pericardial effusion (IPE). The incidence of cardiac neoplasia in dogs is low, and it is rare in cats. In dogs, hemangiosarcoma and chemodectoma are the two most common types of cardiac neoplasia. In cats, lymphosarcoma is the most common form of cardiac neoplasia, but they are more likely to develop pericardial effusion secondary to congestive heart failure or feline infectious peritonitis. Common histories include lethargy, dyspnea, anorexia, collapse, and abdominal distension. Pericardiocentesis is used to stabilize animals with life-threatening cardiac tamponade, relieve the pressure leading to right-sided heart failure, and obtain fluid samples for diagnostic evaluation. The fluid should be quantified and characterized. Serious complications associated with pericardiocentesis are rare. Complications include cardiac puncture, arrhythmias, and laceration of a tumor or coronary artery resulting in intrapericardial hemorrhage or sudden death.

A retrospective study of clinical findings, treatment and outcome in 143 dogs with pericardial effusion.

A retrospective study of 143 dogs with pericardial effusion is presented, including a statistical analysis of survival time. Cases were classified into those in which a mass was seen on echocardiography (echo-positive) and those in which no mass could be identified (echo-negative). Forty-four dogs were echo-positive and 99 were echo-negative. The median survival time (MST) was 1068 days for echo-negative dogs and 26 days for echo-positive dogs. Dogs with a history of collapse were more likely to present with a mass on echocardiography. Those presenting with collapse had an MST of 30 days compared with 605 days for those without collapse. Echo-negative dogs tended to present with ascites and generally had a larger volume of pericardial effusion. The median survival for dogs presenting with ascites was 605 days compared with 45 days for those without ascites. Among echo-negative dogs, 64 per cent had a relapse of their effusion. Subtotal pericardiectomy was performed in 31 echo-negative dogs. The procedure had a perioperative mortality of 13 per cent but provided a favourable long-term prognosis. Dogs undergoing pericardiectomy had a median survival of 1218 days compared with 532 days for those not undergoing surgery.

Pericardiocentesis and principles of echocardiographic imaging in the patient with cardiac neoplasia.

Ultrasonography is a safe, noninvasive, sensitive, and specific tool for evaluation of the heart and pericardium in patients with cardiac neoplasia. In small animals, the incidence of cardiac neoplasia is low. In dogs, hemangiosarcoma and chemocdectoma are the two most common types of cardiac neoplasia. In cats, lymphosarcoma is the most common form of cardiac neoplasia. Pericardial effusion is a common and potentially life-threatening consequence of cardiac neoplasia. Pericardial effusion leads to a rise in the intrapericardial pressure, resulting in varying degrees of hemodynamic compromise. Cardiac tamponade occurs when the intrapericardial pressure equals or exceeds right ventricular diastolic filling pressures, leading to a decreased cardiac output. Pericardiocentesis is used to stabilize animals with life-threatening cardiac tamponade, and to obtain fluid samples for diagnostic evaluation. The fluid should be quantified and characterized. If the etiology of the effusion is not known, then a sample of the fluid should be submitted for fluid analysis and cytology. Serious complications associated with pericardiocentesis are rare. Complications include cardiac puncture, arrhythmias, and laceration of the tumor or coronary artery, resulting in intrapericardial hemorrhage.

[Cardiac tamponade due to pericardial mesothelioma in an 11-year-old dog: diagnosis, medical and interventional treatments]. / Herztamponade durch ein Perikardmesotheliom bei einem 11-jährigen Hund: Diagnose, medikamentelle und interventionelle Behandlungen.

In a dog presenting with the clinical signs of exercise intolerance and ascites, cardiac tamponade due to suspected idiopathic pericarditis was diagnosed based on thoracic radiographs, electrocardiogram (EKG) and cardiac ultrasound. Pericardial effusion recurred soon after pericardiocenteses, prescription of colchizine and again after balloon pericardiotomy. After partial pericardectomy by thoracoscopy and after obtaining a histological diagnosis of mesothelioma adjuvant intracavitary chemotherapy using cisplatin was performed. Already one week later the dog developed marked dyspnea due to severe pleural effusion. The dog was maintained at acceptable life quality judged based on playfulness and appetite using repeated pleuro-centeses for an additional two months, when the dog was euthanized due to uncontrollable pleural effusion. Despite extensive treatments life span from initial presentation to euthanasia was only 5 months. Necropsy revealed extensive mesothelioma metastases covering the whole pleura, epicardium and remaining pericardium. Diagnostic and therapeutic aspects of (recurrent) pericardial effusion are discussed based on this case.