CASE 34 (SLIDE C ) PERICARDIAL EFFUSION IN A DOG

Transcription

1 CASE 34 (SLIDE C ) PERICARDIAL EFFUSION IN A DOG JONATHAN LEBOVITZ, DVM & MPH CANDIDATE, CLASS OF 2016 NICOLE WEINSTEIN, DVM, DACVP VIRGINIA-MARYLAND COLLEGE OF VETERINARY MEDICINE

2 HISTORY AND PHYSICAL EXAM Signalment: 8-year-old castrated male Labrador retriever History: Abdominal distention for one month Physical exam: Tachycardia, muffled heart sounds, intermittent pulse deficits, and jugular pulses

3 DIAGNOSTICS Thoracic radiographs, a partial abdominal ultrasound, and an echocardiogram Pericardial effusion with cardiac tamponade and right-sided heart failure Pleural and abdominal effusion On echocardiogram: Mass-like lesions near the right ventricle, right auricle, and one on the ascending aorta

4 DIAGNOSTICS Pericardiocentesis yielded 40 ml of fluid, which exhibited an unusual shimmer

5 PERICARDIAL FLUID CHARACTERISTICS Color Clarity RBC count WBC count Total protein Cholesterol Triglycerides Red-tinged Cloudy 40,000/uL 1,760/uL 2.4 g/dl 72 mg/dl 7 mg/dl

6 CYTOLOGIC DESCRIPTION OF PERICARDIAL FLUID Many cholesterol crystals Low numbers of inflammatory leukocytes Occasional clusters of mesothelial cells Many erythrocytes

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11 MESOTHELIAL CELLS Cytokeratin Vimentin Mesothelial origin supported with cytokeratin and vimentin Can occur secondary to chronic effusion regardless of primary etiology 1 Cannot definitively differentiate between reactive versus neoplastic on cytology

12 INTERPRETATION Chronic neutrophilic inflammation; Hemorrhage; Presence of numerous cholesterol crystals; Mesothelial proliferation with atypia

13 CHOLESTEROL CRYSTALS Rare finding Suggest cell membrane damage 1 In humans, associated with hypothyroidism, rheumatoid arthritis, and tuberculosis 2 Previous reports: Seen in a 9-year-old dog with hypothyroidism 3 11-year-old basset hound with mesothelioma on necropsy; cholesterol clefts were seen on histopathology, but crystals not seen on earlier cytology 4

14 CASE OUTCOME Patient developed complications due to repeated draining of fluid Owners were reluctant to continue with treatment or explore further diagnostics Patient was euthanized Owners did not want a necropsy performed

15 ACKNOWLEDGEMENTS Nicole Weinstein Katie Boes Michael Aherne Wendy Morré William Monroe

16 REFERENCES 1. Raskin RE, Meyer D. Canine and Feline Cytology: A Color Atlas and Interpretation Guide. 2nd Ed. St. Louis, MO: Elsevier Health Sciences; Barcin C, Yalcinkaya E, Kabul HK. Cholesterol pericarditis associated with rheumatoid arthritis: a rare cause of pericardial effusion. Int J Cardiol 2013;166:e MacGregor JM, Rozanski EA, McCarthy RJ, et al. Cholesterol-Based Pericardial Effusion and Aortic Thromboembolism in a 9-Year-Old Mixed-Breed Dog with Hypothyroidism. J Vet Intern Med 2004;18: Ikede BO, Zubaidy A, Gill CW. Pericardial Mesothelioma with Cardiac Tamponade in a Dog. Vet Pathol 1980;17: