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Pericardial Disease
Ashley B. Saunders, DVM, DACVIM (Cardiology) and Sonya G. Gordon, DVM, DVSc, DACVIM (Cardiology)

Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, USA

The pericardium is a multilayered structure surrounding Signalment
the heart that isolates the heart from the remainder of the Although these are congenital abnormalities, they can be
thorax. It creates a potential space that can be filled by detected incidentally in adults so the age at presentation
fluid, tissue, or air/gas. While pericardial disease is rela- can vary greatly.
tively uncommon, it can lead to life‐threatening conditions
when intrapericardial pressure rises and cardiac output is
compromised. A combination of restricted filling, reduced History and Clinical Signs
diastolic function, partial obstruction to inflow into the
atria, and reduced cardiac output can manifest clinically as PPDH
weakness, collapse, tachycardia, jugular venous distension, Clinical signs with PPDH depend on which abdominal
and ascites. Pericardiocentesis is recommended to alleviate organs herniate. Up to 69% of animals have clinical signs
clinical signs of pericardial effusion and cardiac tampon- including tachypnea/dyspnea, cough, vomiting, anorexia,
ade. Congenital and acquired pericardial diseases in cats and exercise intolerance. Common physical examination
and dogs will be discussed in detail. abnormalities include muffled heart and lung sounds, bor-
borygmus auscultated in the thorax, and heart murmur.

Congenital Intrapericardial Cysts
Symptomatic animals have presenting signs similar to
those with pericardial effusion and cardiac tamponade
Etiology/Pathophysiology (see Pericardial Effusion section).
Peritoneopericardial diaphragmatic hernia (PPDH)
occurs during development in dogs and cats when the Diagnosis
septum transversum does not form or fuse normally,
resulting in a communication that allows abdominal Thoracic radiograph findings include enlarged or glo-
contents to displace into the pericardial space. The tis- boid cardiac silhouette and, in the case of PPDH, a loss of
sues and organs herniated most often are omentum, distinction between the cardiac silhouette and dia-
liver, gallbladder, and small intestine. Concurrent con- phragm or abnormal densities (gas or fat) within the car-
genital abnormalities including portosystemic shunt are diac silhouette (Figure 28.1a,b). Ultrasound confirms the
often present in animals with PPDH. presence of effusion and which organs have herniated.
Intrapericardial cysts have been rarely reported in dogs The diagnosis of PPDH can be an incidental finding dur-
and cats and in some cases were associated with PPDH. ing diagnostic imaging for another reason.

Epidemiology Therapy

The overall prevalence of PPDH at two veterinary insti- Surgical repair of PPDH is recommended more often
tutions was 0.025%, with a greater prevalence in cats for young animals (median age 1.1 years) and those
than dogs. with clinical signs. Successful surgical management of

Clinical Small Animal Internal Medicine Volume I, First Edition. Edited by David S. Bruyette.
© 2020 John Wiley & Sons, Inc. Published 2020 by John Wiley & Sons, Inc.
Companion website: www.wiley.com/go/bruyette/clinical