CASE 34 (SLIDE C15-00344) PERICARDIAL EFFUSION IN A DOG JONATHAN LEBOVITZ, DVM & MPH CANDIDATE, CLASS OF 2016 NICOLE WEINSTEIN, DVM, DACVP VIRGINIA-MARYLAND COLLEGE OF VETERINARY MEDICINE
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
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
DIAGNOSTICS Pericardiocentesis yielded 40 ml of fluid, which exhibited an unusual shimmer
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
CYTOLOGIC DESCRIPTION OF PERICARDIAL FLUID Many cholesterol crystals Low numbers of inflammatory leukocytes Occasional clusters of mesothelial cells Many erythrocytes
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
INTERPRETATION Chronic neutrophilic inflammation; Hemorrhage; Presence of numerous cholesterol crystals; Mesothelial proliferation with atypia
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
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
ACKNOWLEDGEMENTS Nicole Weinstein Katie Boes Michael Aherne Wendy Morré William Monroe
REFERENCES 1. Raskin RE, Meyer D. Canine and Feline Cytology: A Color Atlas and Interpretation Guide. 2nd Ed. St. Louis, MO: Elsevier Health Sciences; 2010. 2. Barcin C, Yalcinkaya E, Kabul HK. Cholesterol pericarditis associated with rheumatoid arthritis: a rare cause of pericardial effusion. Int J Cardiol 2013;166:e56 8. 3. 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;18:354 358. 4. Ikede BO, Zubaidy A, Gill CW. Pericardial Mesothelioma with Cardiac Tamponade in a Dog. Vet Pathol 1980;17:496 500.