PERICARDIAL EFFUSION- CANINE: 9 year old, male neutered Maltese x Shih-tzu
History:
This patient presented to a Melbourne veterinary clinic for coughing after exercise over the past week. A low grade heart murmur was auscultated as well as tachycardia. Thoracic radiographs revealed cardiomegaly. The clinic requested an echocardiogram be performed by the Soundiagnosis mobile ultrasound team.
Echocardiogram Image Interpretation:
A small to moderate volume pericardial effusion was noted, with slight collapse of the right atrium in diastole suggesting early/developing cardiac tamponade. The left atrium was severely enlarged, with a left atrium: aorta ratio of 3.0 (Swedish method). There was severe mitral regurgitation and severe thickening of the mitral valve leaflets, particularly the septal leaflet which appeared to be flailing suggestive of chordae tendineae rupture. There was moderate mitral valve prolapse. There was a small amount of irregular echogenic tissue floating in the pericardial sac which did not appear vascularised. There was also a small volume of pleural effusion but no abdominal effusion was observed on a brief assessment.
Soundiagnosis Dx: Pericardial effusion – DDx left atrial tear; neoplastic effusion; coagulopathy; idiopathic pericardial effusion unlikely given patient signalment.
Small amount of irregular echogenic material floating in the pericardial sac. DDx. Thrombus or inflammatory debris; neoplasia. Severe left atrial enlargement, mitral regurgitation and thickened mitral valve leaflets with possible chordae tendinae rupture. DDx. Myxomatous mitral valve disease most likely; endocarditis less likely.
Image 1: Left atrium/aorta ratio on the right parasternal short axis view, Swedish measurement. Pericardial effusion is also visible at the top of the image.
Image 2: Colour Doppler image of the left apical 4-chamber view showing severe mitral regurgitation.
Outcome:
Pericardiocentesis was not performed due to the concern for a possible left atrial tear, as this may result in worsening haemorrhage into the pericardial sac. A coagulation profile was recommended as well as treatment with pimobendan and furosemide and close monitoring for deterioration. However unfortunately in this case the owners of the animal elected euthanasia.