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Pericardial Effusion in the Dog 1266.e1

Pericardial Effusion in the Dog
VetBooks.ir Gross Appearance of Effusion Echocardiographic Appearance Next Test

Hemangiosarcoma Hemorrhagic; “port wine” color; usually Small, medium, or large amount of anechoic Referral to cardiologist if unsure
does not clot (rarely, may clot if brisk effusion; right atrial/right atrioventricular (pseudomasses are common
hemorrhage); cytologic examination mural or epicardial mass may or may not on echocardiography of dogs
unhelpful be seen; diastolic right atrial and/or right without tumors/normal dogs)
ventricular collapse may be seen. Serum cardiac troponin levels
possible if mass not visualized
Idiopathic benign pericarditis Hemorrhagic; “port wine” color; does not clot; Small, medium, or large amount of anechoic Serum cardiac troponin levels
cytologic examination unhelpful effusion; diastolic right atrial and/or right Pericardiocentesis if indicated,
ventricular collapse may be seen. and monitor for recurrence in
subsequent days/weeks
Mesothelioma Generally hemorrhagic; does not clot; cytologic Small, medium, or large amount of anechoic Pericardial biopsy/pericardiectomy
examination unhelpful effusion; diastolic right atrial and/or right
ventricular collapse may be seen; rarely,
pericardium is noted to be thickened; rarely,
forms a heart base mass.
Heart base tumor Generally hemorrhagic; does not clot Small, medium, or large amount of anechoic Referral to cardiologist if unsure
(chemodectoma; rarely effusion; mass characteristically seen (pseudomasses are common
ectopic thyroid carcinoma, between aortic root and either atrium; on echocardiography of dogs
mesothelioma, or other) diastolic right atrial and/or right ventricular without tumors/normal dogs)
collapse may be seen. Pericardiocentesis if evidence of
tamponade, and monitor for
recurrence over subsequent
weeks/months Differentials, Lists, and Mnemonics
Hemorrhage/hemopericardium Frank blood; erroneous centesis from the Typically small to medium volume of effusion; Platelet count, PT
(coagulopathy, left atrial atrium or ventricle produces a similar spontaneous contrast (particulate specks
rupture) appearance. or swirling waves of echogenic material)
or frank clots may be present; diastolic
atrial and/or right ventricular collapse may
be seen with left atrial rupture or with
anticoagulant rodenticide toxicosis; marked
atrial enlargement is always present if atrial
rupture is the cause (barring penetrating
trauma).
Inflammatory (e.g., bacterial Serosanguineous, rarely grossly purulent Generally small volume of effusion; echogenic C&S, aerobic and anaerobic, of
pericarditis) (exudate); because of small volume of particles may be seen in the effusion, pericardial effusion
effusion, pericardiocentesis is often representing small clumps of inflammatory Surgical exploration if effusion is
challenging or dangerous and should not be cells, bacteria, and fibrin (bacterial infection) septic
performed unless clinical (right heart failure or clumps of proteins/globulin.
signs) and echocardiographic (atrial collapse)
signs of tamponade are present.
Hypoalbuminemia Serosanguineous and watery (pure transudate); Generally very small volume of effusion; Serum albumin level
because of small volume and low pressure anechoic No evidence of increased central
of effusion, pericardiocentesis is challenging venous pressure (no jugular
or dangerous, is of little additional diagnostic distention, hepatic veins are of
value, and generally is contraindicated. normal diameter on abdominal
ultrasound)
Uremia Serosanguineous and watery (pure transudate); Generally very small volume of effusion; Serum/blood urea nitrogen,
because of small volume and low pressure anechoic creatinine, urinalysis
of effusion, pericardiocentesis is challenging No evidence of increased central
or dangerous, is of little additional diagnostic venous pressure (no jugular
value, and generally is contraindicated. distention, hepatic veins are of
normal diameter on abdominal
ultrasound)
Lymphoma Serosanguineous or hemorrhagic Small to medium volume of effusion Cytology can be diagnostic;
pericardial biopsy rarely indicated
Pericardial cyst Hemorrhagic Small, medium, or large volume of effusion Thoracotomy and excisional biopsy
Intrapericardial mass distinctly attached to
apical aspect of pericardium (not attached
to heart)
Right heart failure Serosanguineous (modified transudate) Right heart abnormality (tricuspid valve Thoracic radiographs
insufficiency causing marked right atrial Abdominal ultrasound should
enlargement, pulmonic stenosis, right identify enlarged hepatic veins.
ventricular hypertrophy, etc.); no diastolic
collapse of right atrium or ventricle (unless
[rarely] right atrial rupture is present)
C&S, Culture and susceptibility; PT, prothrombin time.
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