11 years male neutered old portuguese water dog
3 days ago had an acute onset of vomiting and a barium sereies performed by another vet did not reveal an obstruction.
On presentation the dog was lethargic, jaundice with muffled heart sounds.
Blood work revealed leukocytosis, bilirubinemia and a regenerative anemia.
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Findings:
Thorax:
The cardiac silhouette appears moderately enlarged and mildly globoid in shape.
There is a small amount of free pleural fluid, with more on the right than the left.
The caudal vena cava is mildly distended.
The pulmonary parenchyma appears unremarkable for a dog of this age.
Abdomen:
The liver and spleen are slightly prominent. Abdominal serosal detail is within normal limits.
There is mineral opaque material within the colon, probably barium.
There are multiple small mineral opacities within the urinary bladder.
Conclusions:
The size and shape of the cardiac silhouette is most suggestive of pericardial effusion. The caudal vena cava distention and pleural effusion are likely secondary to cardiac tamponade. In a dog of this age neoplasia must be suspected as the cause. The mild hepato- splenomegaly is a nonspecific finding, and may be attributed to hematologic disorders, congestion or neoplasia.
The significance of the cystic calculi is unclear
Diagnosis:
Echocardiography revealed pericardial effusion.
The effusion was hemorrhagic.
There was a probable right atrial mass (this could also be a blood clot). The liver was hypoechoic and the hepatic veins were dilated. The spleen was mildly distended with venous dilatation and irregular margins. Rule outs for the liver: diffuse neoplasia vs congestion due to cardiac tamponade. Spleen: extramedullary hematopesis, hyperplasia, inflammation vs diffuse neoplasia.
The hemolysis was probably due to a shearing effect on the blood cells by a mass which is attached to the vasculature of the heart (HSA), or systemic lymphoma which causes immune response which results in hemolysis and pericardial effusion.
No definitive diagnosis was obtained.
Discussion:
Differentials for generalized cardiomegaly include peritoneal pericardial diaphragmatic hernia, pericardial effusion and dilated cardiomyopathy.
In this case there were signs of right side heart failure (pleural effusion, enlarged vena cava, hepatomegaly), therefore pericardial effusion with cardiac tamponade is more likely. DCM will result in congestive heart failure (pulmonary edema). It is unlikely to see signs of right side heart failure with no signs of congestive heart failure in the case of DCM.
In the abscence of echocardiography another way to reinforce the diagnosis would be ECG, which might demonstrate electrical alterans.
For an example see http://www.cvmbs.colostate.edu/clinsci/wing/emcases/answer3.htm
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