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Pericardial Effusion 773

Technician Tips • Contact of tacrolimus ointment with human AUTHOR & EDITOR: Rance K. Sellon, DVM, PhD,
Because of marked pain and discomfort in the skin must be avoided; wear gloves when DACVIM
VetBooks.ir accomplish a good exam, including rectal exam, SUGGESTED READING Diseases and Disorders
handling.
perianal area, some dogs require sedation to
of the perianal region.
Client Education Patricelli AJ, et al: Cyclosporine and ketoconazole
for the treatment of perianal fistulas in dogs. J Am
• Prolonged, potentially lifelong, medical and Vet Med Assoc 220:1009, 2002.
dietary therapy to control lesions and clinical
signs is necessary for some dogs.

Pericardial Effusion Client Education
Sheet

BASIC INFORMATION • Weak pulses or pulsus paradoxus (decreased Differential Diagnosis
femoral pulse strength with inspiration) • Physical
Definition • Abdominal distention, palpable fluid wave ○ Hypovolemia
Fluid accumulation within the pericardial sac • Jugular distention and pulsation ○ Hypotension
(composed of blood, plasma, pus, chyle, or • Dyspnea/attenuated lung sounds if pleural ○ Causes of ascites (p. 79) and pleural
mixed) effusion effusion (p. 791)
• Radiographic
Epidemiology Etiology and Pathophysiology ○ Cardiac enlargement from heart disease
SPECIES, AGE, SEX Cause: ○ Expiratory radiograph
Depends on underlying cause; dogs: middle • Neoplasia: hemangiosarcoma, heart base ○ Normal variation/breed conformation
age or older (neoplastic, idiopathic) tumors (chemodectoma, ectopic thyroid • Echocardiographic
adenocarcinoma), mesothelioma in dogs; ○ Pleural effusion
GENETICS, BREED PREDISPOSITION lymphoma, rhabdomyosarcoma, fibrosar- ○ Marked left auricular enlargement (may
• Dogs: golden retrievers, Labrador retrievers, coma in dogs and cats mimic PE in some views)
German shepherds, boxers, bulldogs • Idiopathic pericarditis in dogs ○ Oblique views (may mimic mass)
• Cats: possibly purebreds with predisposition • Structural heart disease: CHF (rarely in
to hypertrophic cardiomyopathy (Maine cardiac tamponade), left atrial rupture Initial Database
coons, Ragdolls, Sphinx) • Infectious: FIP (cats), bacterial, systemic • Radiographs
fungal (endemic) ○ Thoracic: enlarged or globoid cardiac
RISK FACTORS • Traumatic (migrating foreign bodies, e.g., silhouette (only ≈80% sensitive and
• Dogs: mesothelioma associated with asbes- grass awn, porcupine quill) less specific), widened caudal vena cava,
tosis; speculative link between lymphoma • Metabolic or toxic: uremia, coagulopathy pleural effusion; thoracic mass, pulmonary
and exposure to volatile chemicals (rodenticide toxicosis, disseminated intra- metastasis possible but uncommon
• Cats: multi-cat household, feline infectious vascular coagulopathy) ○ Abdominal: hepatomegaly, poor serosal
peritonitis (FIP), congestive heart failure (CHF) Mechanism: detail (ascites)
• Cause, rate and volume of pericardial effu- • Echocardiogram: anechoic fluid in the
CONTAGION AND ZOONOSIS sion (PE) accumulation, and pericardial pericardial space; possible cardiac mass
Cats: FIP (cat-to-cat only) distensibility determine onset of clinical (right atrial/auricular or heart base most
signs (cardiac tamponade). common); diastolic right atrial (± right ven-
Clinical Presentation • Cardiac tamponade is the result of intra- tricular) collapse when cardiac tamponade is
DISEASE FORMS/SUBTYPES pericardial pressure exceeding filling pressure present
• Cardiac tamponade produces clinical signs of of the cardiac chambers (right atrium and • CBC, serum biochemistry panel, and
right-sided CHF and/or low cardiac output. ventricle). Diastolic filling is impeded, result- urinalysis: varies based on cause
• May occur as an incidental finding ing in elevated caval pressures and decreased • ECG: electrical alternans (≈30% of canine
○ During echocardiography stroke volume. cases), low-amplitude QRS complexes, sinus
○ Cardiomegaly on radiographs tachycardia, possible ventricular arrhythmias
○ Electrocardiographic (ECG) changes DIAGNOSIS • Plasma cardiac troponin I levels: higher in
dogs with PE compared with normal dogs;
HISTORY, CHIEF COMPLAINT Diagnostic Overview may be significantly higher when PE is caused
• Acute collapse or weakness PE is suspected in patients with a history of by hemangiosarcoma
• Lethargy or exercise intolerance clinical signs and/or physical exam findings con- • If clinical suspicion warrants: coagulation
• Abdominal distention sistent with cardiac tamponade. Confirmation profiles and/or infectious disease titers
• Dyspnea, orthopnea, coughing requires echocardiography. Further investigation
• Pale mucous membranes of primary cause (by echocardiography, thoracic Advanced or Confirmatory Testing
• Inappetence radiographs, abdominal sonography, and routine • Echocardiography is confirmative. CT is
complete blood and urine testing) is warranted. superior to echocardiography in detection
PHYSICAL EXAM FINDINGS Less commonly, PE is diagnosed incidentally of pulmonary metastasis but not cardiac
• Tachycardia in patients without clinical signs of cardiac tumors. MRI appears superior for detection
• Soft or muffled heart sounds tamponade. of cardiac tumors.

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