Clinical presentation, echocardiographic findings, treatment strategies, and prognosis of dogs with myxomatous mitral valve disease presented with pericardial effusion due to suspected left atrial tear: a retrospective case-control study.

INTRODUCTION/OBJECTIVES: Left atrial tear (LAT) is a life-threatening complication in dogs with myxomatous mitral valve disease (MMVD). The study objective was to describe clinical presentation, echocardiographic findings, treatment strategies, and survival in dogs with LAT compared to a control group of dogs with a similar stage of MMVD but no LAT. ANIMALS AND MATERIALS AND METHODS: Two-center retrospective case-controlled study including 15 dogs with and 15 dogs without LAT was conducted. Clinical and echocardiographic data were reviewed, and survival information were collected. RESULTS: Nine dogs in each group were in stage C of MMVD, while the remaining were in stage B2. No differences between groups were found regarding age, body weight, sex, kidney values, and echocardiography-derived cardiac dimensions. Most reported clinical signs associated with LAT included weakness, respiratory signs, and syncope. Treatment varied and was mainly focused on the management of congestive heart failure. Three dogs with LAT received a pericardiocentesis. All 15 dogs with LAT had died of cardiac causes, five dogs during the first seven days after admission. The median survival time for all 15 dogs with LAT was 52 days compared to 336 days in the control group (P=0.103). When excluding five dogs with LAT that died during the first seven days, the median survival increased to 407 days, not different compared to the control group (P=0.549). CONCLUSIONS: Dogs with MMVD and LAT have a high short-term mortality; however, when surviving the acute phase, the long-term prognosis may not differ from dogs with a similarly advanced degree of MMVD but without LAT.

Pericardial malignant mesothelioma diagnosed in a dog by immunocytochemistry of the pericardial fluid: a case report.

BACKGROUND: Pericardial effusions are one of the most common cardiac diseases in dogs. Common causes of haemorrhagic pericardial effusions include neoplasia, such as hemangiosarcoma, mesothelioma, chemodectoma, and ectopic thyroid tumours, and benign idiopathic pericardial effusion. Distinguishing among reactive mesothelial cells, malignant mesothelioma, and adenocarcinoma in body effusions is a diagnostic challenge. Therefore, the author aimed to discover whether the observed cells were reactive mesothelial, mesothelioma, or adenocarcinoma cells through immunocytochemistry using five markers (cytokeratin, vimentin, desmin, E-cadherin, and calretinin) in a canine patient. CASE PRESENTATION: A 2.1 kg, spayed female, 10-year-old Yorkshire Terrier dog presented to a local hospital with dyspnoea and was evaluated for pericardial effusion. The presence of pericardial fluid was confirmed, and she was referred to our hospital for further evaluation. In cytological evaluation, cells shed individually or in clusters were observed, along with numerous non-degenerative neutrophils and macrophages. The cells showed binucleation, anisocytosis, anisokaryosis, abnormal nucleoli, abundant basophilic cytoplasm, high nuclear-cytoplasmic ratio, and coarse chromatin. Large atypical multinucleate cells were also observed. Erythrophagia was observed, indicating chronic haemorrhage. Immunocytochemistry using pericardial fluid was positive for cytokeratin, vimentin, desmin, E-cadherin, and calretinin. Therefore, malignant mesothelioma was diagnosed. CONCLUSIONS: Immunocytochemistry is a very useful diagnostic technique because it can determine whether several fluorescent markers are simultaneously expressed in the same cell. Further, E-cadherin and calretinin can be used for the differential diagnosis of reactive mesothelial cells, malignant mesothelioma, and adenocarcinoma in dogs.

Subtotal Pericardiectomy and Epicardiectomy for Treatment of Septic Pericarditis and Constrictive Epicarditis in a Dog.

A 1 yr old, 1.7 kg, spayed female Chihuahua was presented for respiratory distress and an enlarged cardiac silhouette as seen on thoracic radiographs. Echocardiogram revealed pericardial effusion and cardiac tamponade. Computed tomography revealed marked pleural and pericardial effusion, thickening of the pericardium caudally, and a mass along the mediastinum. Pericardial fluid obtained via pericardiocentesis showed suppurative inflammation with mixed anaerobic bacteria isolated on culture. Subtotal pericardiectomy and partial lung lobectomy was performed to treat septic pericarditis. Postoperative echocardiogram showed increased right-sided pressures consistent with constrictive epicarditis, and 10 days after surgery, the dog was re-presented for right-sided heart failure. An epicardectomy was performed. A definitive source of infection was not identified, although a penetrating foreign body (e.g., grass awn) was suspected. The dog recovered and 10 yr follow up revealed no evidence of constrictive pathology on echocardiogram. This case report demonstrates the successful treatment of septic pericarditis and constrictive epicarditis via subtotal pericardiectomy and epicardiectomy.

DETERMINATION OF ECHOCARDIOGRAPHIC TECHNIQUES FOR CLINICAL ASSESSMENT OF GALAPAGOS (CHELONOIDIS NIGRA COMPLEX) AND ALDABRA (ALDABRACHELYS GIGANTEA) TORTOISES.

The first objective of this study was to establish clinically relevant techniques for cardiac echocardiography in nonanesthetized Galapagos (Chelonoidis nigra complex) and Aldabra (Aldabrachelys gigantea) tortoises. A second objective was to establish guidelines for determining normal echocardiographic anatomy and function in both species. Select echocardiographic reference values were defined for 17 healthy Galapagos tortoises and 27 healthy Aldabra tortoises. Tortoises were either placed in ventral recumbency on an elevated surface or allowed to stand in a natural position by using food distraction. An ultrasound probe was applied in the left or right cervicobrachial window and was positioned in two long axis views to evaluate the three chambers of the heart and the associated great vessels, the presence of pericardial effusion, the atrioventricular inflow velocities, and pulmonic and aortic outflow velocities. The heart rate was 28 ± 12 (median ± SD) bpm, and the ejection fraction was 60.5 ± 10%. Thirty-four of 44 tortoises had identifiable physiologic pericardial effusion. All tortoises were successfully imaged using the techniques described, with consistent identification of cardiac structure and assessment of function. This study provides echocardiographic reference intervals for the clinical evaluation of suspected cardiac disease in captive-managed Galapagos and Aldabra tortoises.

Presumed primary cardiac mast cell tumor, pericardial effusion, and arrhythmia in a dog.

A 13-year-old female spayed border collie cross presented for pericardial effusion, arrhythmia, and a suspected cardiac mass. Echocardiogram revealed severe thickening and hypokinesis of the interventricular septum with a heterogenous, cavitated myocardium, concerning for neoplasia. Electrocardiogram revealed predominantly accelerated idioventricular rhythm with frequent periods of nonsustained ventricular tachycardia. Occasional prolonged PR intervals terminating in an aberrantly conducted QRS complex were present. These beats were postulated to represent either first-degree atrioventricular block with aberrant QRS conduction or atrioventricular dissociation. Cytology of the pericardial effusion revealed atypical, suspected neoplastic, mast cells. The patient was euthanized, and postmortem examination confirmed full-thickness infiltration of the interventricular septum by a mast cell tumor, with metastasis to the tracheobronchial lymph node and spleen. Given the anatomic location of the mass, the observed atrioventricular nodal conduction delay may represent neoplastic infiltration of the atrioventricular node. Neoplastic infiltration of the ventricle was suspected to cause the accelerated idioventricular rhythm and ventricular tachycardia. To the authors' knowledge, this is the first reported case of a primary cardiac mast cell tumor causing arrhythmia and pericardial effusion in a dog.

Multidetector-row CT features and histopathological analysis of pericardial recesses in dogs.

At the level of pericardial reflections and near the great thoracic vessels, pericardial recesses (PRs) are present, where fluid can collect to increase the pericardial reserve volume. To date, these structures have not been described in vivo in veterinary patients. The aims of this observational and descriptive study were to describe the location and appearance of PRs in dogs, as seen with multidetector-row CT (MDCT), and to develop a dedicated imaging technique for their best visualization. Dogs who underwent MDCT examination of the whole body were included in the study and CT data were retrospectively evaluated. Dogs with any thoracic abnormality were excluded. MDCT analysis of the PR's was compared with the pathological features of PRs. PRs were identified as fluid-attenuating (10-30 HU), non-enhancing structures showing varied appearance. Two types of PRs were identified at the level of the transverse sinus of the pericardium and classified on the basis of their anatomic location: the aortic recess and the pulmonic recess. A third pericardial fluid-containing structure was seen in a little number of cases, at the level of the termination of the caudal vena cava into the right atrium. A dorsal, slight oblique multiplanar section through the aortic bulb resulted the best technique for visualization of all the recesses. Anatomo-pathological evaluation confirmed the location and the presence of pocket-like reflections of the pericardium identified with 3D-CT models. Knowledge of the CT appearance of the pericardial recesses is necessary in order to avoid their misinterpretation and subsequent unnecessary invasive investigations.

DEGENERATIVE CARDIAC DISEASE IN TWO SPECIES OF TORTOISE (CHELONOIDIS NIGRA COMPLEX, CENTROCHELYS SULCATA).

Cardiac lesions in tortoises are incompletely described in the literature. This retrospective case series includes 11 cases of degenerative cardiac disease in young tortoises from two species in human care: Galápagos tortoise complex (Chelonoidis nigra complex) (n = 9) and sulcata tortoises (Centrochelys sulcata) (n = 2). Eight tortoises were male, two were female, and sex was undetermined for one individual. The age range at the time of death was 10-32 yr with a mean of 19 yr. The most common clinical signs noted prior to death were peripheral edema, lethargy, and inappetence. Common necropsy findings included generalized edema and pericardial effusion. All cases had ventricular myocardial fibrosis and several cases had epicardial adhesions. Additional common findings included hepatic lesions (hepatic lipidosis, hepatic fibrosis, and hepatitis) and pulmonary lesions (pulmonary edema, pulmonary fibrosis, and pneumocytic hypertrophy). A definitive cause for degenerative cardiac disease was not identified in this case series, but the young age distribution of the tortoises suggests that inappropriate environmental parameters, husbandry, and diet should be investigated as possible underlying contributing factors.

Epidemiological, clinical, radiographic, echocardiographic findings and outcome in client-owned guinea pigs (Cavia porcellus) with cardiac disease: 80 cases (2010-2021).

OBJECTIVE: To characterize epidemiological, clinical, radiographic, and echocardiographic features of cardiac diseases in guinea pigs examined at a referral exotics center. ANIMALS: 80 guinea pigs. PROCEDURES: Medical records of guinea pigs that had echocardiography performed between June 2010 and January 2021 were reviewed. RESULTS: The percentage of guinea pig patients with cardiovascular disease was 2.8%. Clinical signs included dyspnea (46/80), lethargy (18/80), and anorexia (10/80). The most common physical examination finding was heart murmur (10/80). Radiographic abnormalities included subjective cardiomegaly (37/67), pleural effusion (21/67), and increased lung opacity (40/67). Median (range) vertebral heart score on right lateral (48/67) and ventrodorsal (39/67) projections was 9.0 vertebrae (6.6 to 13.2 vertebrae) and 10.8 vertebrae (7.9 to 13.2 vertebrae), respectively. The most common echocardiographic diagnosis was cardiomyopathy (30/80), categorized as restrictive (11/30), hypertrophic (10/30), or dilated (9/10). Other cardiac diseases included cor pulmonale (21/80), pericardial effusion (18/80), congenital heart disease (6/80), acquired valvular disease (3/80), and cardiovascular mass (2/80). Congestive heart failure was present in 36 of 80. Median survival time from diagnosis was 2.5 months (95% CI, 1.1 to 6.2 months). Animals that died from heart disease had a significantly shorter survival time than those that died from a noncardiac disease (P = .02). CLINICAL RELEVANCE: On radiographs, cardiomegaly, pleural effusion, and alveolar or interstitial lung pattern should be considered as indications for echocardiography in guinea pigs. Cardiomyopathy (restrictive, hypertrophic, or dilated), cor pulmonale, and pericardial effusion were the most common echocardiographic diagnoses. Further studies on diagnosis and treatment of cardiovascular diseases in guinea pigs are needed.

Echocardiographic, thoracic ultrasonographic, and CTA diagnosis of pericardial neoplasia in a dog.

A 12-year-old male neutered Yorkshire Terrier presented for coughing and respiratory distress. Transthoracic echocardiography initially misdiagnosed the patient with pericardial effusion; repeat echocardiography increased suspicion for neoplasia. A definitive diagnosis was not apparent. Findings on thoracic computed tomography and thoracic ultrasound were consistent with a diffusely thickened, heterogenous, hypoechoic soft tissue structure surrounding the heart. Fine needle aspirates were obtained using ultrasound guidance and routine cytology of the intrapericardial mass was consistent with neoplasia, with pericardial mesothelioma most likely. These novel findings highlight the importance of thoracic ultrasound and potential limitations of echocardiography in diagnosis of pericardial neoplasia.

Cardiac Inflammatory Myofibroblastic Tumours in Three Young Adult Cats.

Inflammatory myofibroblastic tumours (IMTs) of the heart are described in three young adult cats (case 1, 3.5 years old; case 2, 2.7 years old; case 3, 1.8 years old) that died due to pleural and pericardial effusions resulting from congestive heart failure. At necropsy, cardiac masses, measuring 4 × 3 × 2.5 cm (case 1), 3.5 × 2.5 × 2 cm (case 2) and 3 × 2.5 × 2 cm (case 3), were located mainly in the right auricle (case 1) and atrial septum (cases 2 and 3) with variable extension into the surrounding tissue. Histologically, the atrial masses in all three cats comprised proliferation of spindloid mesenchymal cells and an inflammatory infiltrate of plasma cells and lymphocytes in variable amounts of myxoid background. The spindloid cells were uniform and characterized by pale eosinophilic cytoplasm and a vesicular nucleus containing prominent nucleoli, with no remarkable cytological atypia or mitotic activity. Immunohistochemically, these cells were positive for vimentin and α-smooth muscle actin in all cases, supporting a myofibroblastic origin. The histopathological and immunohistochemical features were consistent with those of IMTs in humans and animals. There have been no previous reports of such tumours occurring in the heart of the cat.

Suspected sequential left atrial ruptures in a dog with myxomatous mitral valve disease.

An 11-year-old mixed breed dog was presented with exercise intolerance and syncope. At admission, transthoracic echocardiography revealed myxomatous mitral valve disease (MMVD) associated with severe left atrial (LA) enlargement and moderate anechoic pericardial effusion with a hyperechoic density suggestive of a thrombus. Rupture of the LA free wall secondary to MMVD was suspected, and medical therapy with furosemide and pimobendan was initiated. After one month, recheck echocardiography showed mild anechoic pericardial effusion and an acquired atrial septal defect with a left-to-right intracardiac shunting flow. In light of the dog's history, the latter finding was suspected to be secondary to a further rupture of the LA wall due to MMVD, this time affecting the interatrial septum. The images described here allow us to suspect that sequential LA wall ruptures developed over time in the same subject affected by MMVD, a clinical presentation not previously described in veterinary medicine.

Rare delayed cardiac tamponade in a pig after cardiac surgery.

OBJECTIVE: Delayed cardiac tamponade, a life-threatening complication of pericardial effusion in humans, has rarely been described in large animal models. We report here a pig with cardiac tamponade that developed 29 days after cardiac surgery. STUDY DESIGN: Case report. ANIMALS: One 45-kg domestic pig. METHODS: Open-chest surgery was performed on a pig to induce chronic heart failure. At 15 days after surgery, the pig's breathing appeared laboured; induced heart failure was considered the cause. Routine heart failure medications were administered. RESULTS: On day 28, the pig's status deteriorated. On day 29, echocardiography performed just before the pig's death showed a large pericardial effusion, mainly in the lateral and anterior walls of the right heart, with several fibre exudation bands. The right heart was severely compressed with an extremely small right ventricle. An emergency sternotomy was unsuccessful. Pathologic examination showed a severely thickened, fibrous pericardium. The pericardial sac was distended (up to 4.5 cm) and was full of dark brown, soft, friable material. Epicardial haemorrhage with a fresh, organised thrombus was noted in the pericardium. CONCLUSION: Delayed tamponade occurring at least 15 days after open-chest surgery is easy to misdiagnose or overlook in large animal models where attention is often focused on primary pathological model changes. To decrease mortality in animal models, researchers should be aware of potential complications and use the same level of follow-up monitoring of large animals as in clinical care.

Pericardial effusion in a dog due to T-cell lymphoma of granular lymphocyte type.

Pericardial effusions in dogs are most often diagnosed as haemorrhagic and idiopathic. Pericardial effusions secondary to an underlying neoplastic process are infrequently diagnosed, as neoplastic cells are rarely observed in a sample of the effusion. In the present report, we describe a 9-year-old dog with pericardial effusion due to T-cell lymphoma of granular lymphocyte type. Immunophenotyping and molecular clonality PCR were performed to confirm the cytologic diagnosis. To our knowledge, this is the first report of pericardial effusion in a dog due to T-cell lymphoma of granular lymphocyte type.

Treatment and outcomes of five dogs with intrathoracic migration of porcupine quills.

OBJECTIVE: To describe the perioperative findings and outcomes in dogs that underwent exploratory thoracotomy following porcupine quill migration and report (1) the use of traction alone for the removal of superficial quills in the pulmonary parenchyma, and (2) the use of exploratory pericardiotomy for the incidental identification of cardiac quills. ANIMALS: Five client-owned dogs. STUDY DESIGN: Short case series. METHODS: Medical records of dogs with pneumothorax or pericardial effusion secondary to porcupine quill migration from January 2019 to January 2022 were reviewed. Advanced imaging and a median sternotomy were performed in each dog. Demographics, preoperative findings, surgical treatment, and outcome were recorded. RESULTS: Pulmonary quills were treated with gentle traction or lung lobectomy. The intraoperative palpation or appearance of the pericardium prompted pericardiotomy in three dogs, exposing epicardial and intravascular quills. No evidence of these quills was detected on preoperative advanced imaging or on gross appearance of the pericardium. Quills were removed with a combination of gentle traction, purse-string sutures, and mattress sutures. Pneumothorax and pericardial effusion resolved postoperatively in all dogs. All dogs survived to discharge. CONCLUSION: Traction allowed removal of quills that were superficially attached to the pulmonary parenchyma without the need for subsequent lobectomy. Epicardial and myocardial quills were detected following pericardiotomy in three dogs despite the absence of quills grossly penetrating the pericardium. Preoperative imaging did not allow consistent detection of quills.

Resolution of chylopericardium after balloon dilatation of tricuspid valve stenosis in a Labrador Retriever.

A 2-year-old 33 kg female castrated Labrador Retriever was referred for exercise intolerance, hyporexia, and abdominal distention. Point-of-care ultrasound revealed ascites, hepatic congestion, severe pericardial effusion, and cardiac tamponade. Pericardiocentesis was performed, and the chylous nature of the fluid was confirmed by cytology, triglyceride, and cholesterol measurements. Repeated pericardiocentesis was necessary within 24-h after admission, after which a pericardial stay-catheter was placed. Cardiac ultrasound revealed severe tricuspid valve stenosis. Balloon dilatation of the stenotic valve was performed, resulting in a significant drop in the mean diastolic trans-valvular Doppler gradient and long-term resolution of the chylopericardium. No other cause for the pericardial effusion could be identified, suggesting that this is the first described case of chylopericardium due to tricuspid valve stenosis.

Septic pericardial disease and mediastinal abscessation in a cat with an intrathoracic needle foreign body.

OBJECTIVE: To describe the successful management of a cat with an intrathoracic sewing needle foreign body and septic pericardial effusion. CASE SUMMARY: A 10-year-old neutered female domestic longhair cat was referred for an intrathoracic metallic foreign body identified via thoracic radiography. Two weeks prior, the cat may have ingested a sewing needle. She was presented hemodynamically unstable; point-of-care thoracic ultrasound identified pericardial effusion with right atrial tamponade. Pericardiocentesis stabilized hemodynamic parameters. The effusion was grossly purulent, and bacterial culture grew an Actinomyces sp. The cat underwent a median sternotomy to remove the foreign body, debride associated mediastinal abscesses, and perform a partial pericardiectomy. Over the next 10 days, the cat was managed in hospital with a left unilateral thoracostomy tube and intermittent lavage of the pleural cavity. The cat was discharged, and follow-up at 7 days showed no evidence of pericardial or pleural effusion. NEW OR UNIQUE INFORMATION PROVIDED: Contrary to previous reports, this case shows that extra-gastrointestinal, specifically intrathoracic, sewing needle foreign bodies can cause significant morbidity in cats. To the authors' knowledge, this report is the first to describe septic pericardial disease resulting from documented foreign body ingestion in the cat. It is also the first case report of successful surgical management of mediastinal abscessation in the cat.

Acute severe pericarditis secondary to rodenticide intoxication in a dog.

Background: Pericardial effusions are well described in dogs; however, their association with rodenticide intoxication in the canine population is not widely described. Case Description: An adult mixed-breed dog was presented for 1-day history of anorexia and cough. Thoracic radiographs revealed moderate generalized cardiomegaly with globoid-shaped cardiac silhouette and mild bilateral pleural effusion. Echocardiography showed mild tamponating pericardial effusion and diffuse severe thickened pericardium. Compete blood count and blood chemistry at presentation were not specific. A coagulation profile was completed and showed severe prolongation of prothrombin time and partial thromboplastin time. Intravenous therapy with vitamin K was started at 5 mg/kg BID and on follow-up echocardiography performed 12 hours later there was evidence of complete regression of the pericardial thickening and pericardial effusion. Conclusion: To the authors' knowledge, this is the first case report describing severe pericardial thickening, constrictive pericarditis, and cardiac tamponade secondary to spontaneous anticoagulant-induced hemopericardium in dogs.

Myocarditis caused by Listeria monocytogenes in a dog.

BACKGROUND: Canine myocarditis can result from infection with bacteria Listeria monocytogenes. CASE REPORT: A 14-week-old female entire Staffordshire Bull Terrier was assessed for lethargy, inappetence and dyspnoea. Radiographs and echocardiography revealed fluid within the pericardial space, a plaque of marked hyperechogenicity within the right ventricular free wall, marked right atrial dilation and myocardial systolic dysfunction. Histopathology of the myocardium was consistent with severe pyogranulomatous myocarditis, with gram stain revealing gram-positive bacilli, consistent with a Listerial infection. Bacterial culture of the myocardium yielded a light growth of Listeria monocytogenes. CONCLUSION: To the best of the authors' knowledge, this is the first case of canine myocarditis caused by Listeria monocytogenes to be described and should be included as a differential diagnosis of myocarditis. Further, it prompts the consideration of potential zoonotic risks for veterinarians treating dogs with pericardial effusions.

Gastroesophageal intussusception secondary to induction of emesis with subsequent development of septic pericardial effusion after corrective surgery.

A juvenile boxer dog was diagnosed with gastroesophageal intussusception that occurred after the induction of emesis with apomorphine. A ventral midline coeliotomy and diaphragmotomy were performed and the intussusception was manually reduced. Despite initial satisfactory recovery, the dog was diagnosed with cardiac tamponade 1 week post-operatively. Escherichia coli was cultured from pericardial and pleural effusion samples. During subtotal pericardiectomy surgery the pericardium was found to be markedly thickened with adhesions to the epicardium, thoracic wall and diaphragm. Substantial haemorrhage and refractory hypotension necessitated the administration of a blood transfusion during surgery. The dog entered cardiac arrest in the immediate post-operative period and cardiopulmonary resuscitation was unfortunately unsuccessful. Gastroesophageal intussusception should be considered a possible severe adverse effect of administering apomorhine to induce emesis in dogs. Additionally, septic pericardial and pleural effusions may occur post-reduction of gastroesophageal intussusception.