Today's Veterinary Practice

SEP-OCT 2015

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tvpjournal.com | September/October 2015 | TOday'S VeTerinary PracTice TOday'S TecHnician Peer reviewed 71 idiopathic pericardial effusion is another cause of hemorrhagic pericardial effusions, most commonly seen in medium to large breed dogs, such as golden retrievers, Labrador retrievers, and Saint Bernards. Male dogs of a median age of 7 years are commonly affected. 4 Less common causes of hemorrhagic pericardial effusion include left atrial rupture, coagulopathy, penetrating trauma, and uremic pericarditis. 5 Transudative Effusions Pure transudative fuids are typically clear, with a specifc gravity < 1.012 and protein concentration < 2.5 g/dL. in contrast, modifed transudates often appear slightly cloudy or have a pink tinge, with a specifc gravity of 1.015 to 1.030 and protein concentration of 2.5 to 5 g/dL. causes of transudative effusions include congestive heart failure, hypoalbuminemia, peritoneopericardial diaphragmatic hernia, pericardial cysts, and certain toxemias. 2 Exudative Effusions exudative effusions appear cloudy to opaque, with a protein concentration > 3 g/dL and specifc gravity > 1.015. although not common in small animals, sterile exudative effusions have been seen in dogs with leptospirosis, distemper, bacterial pericarditis, and idiopathic pericardial effusion, and in cats with feline infectious peritonitis and toxoplasmosis. 3 DIAGNOSTICS Imaging although less sensitive than echocardiography, radiography can be a useful start for primary care facilities. The overall cardiac silhouette appears enlarged, and excessive amounts of fuid can cause a globoid-shaped heart on both the ventrodorsal and lateral views (Figure 2). advanced imaging, such as magnetic resonance imaging, is now being used more often to diagnose the presence of cardiac masses in patients with pericardial effusion. Echocardiography echocardiography is the most frequently used test for detection of pericardial effusion and diagnosis of pericardial masses. Pericardial Effusion. Smaller effusions are frst seen over the posterobasal part of the left ventricle. 5 The effusion appears as a sonolucent, echo-free void between the parietal pericardium and the epicardium (Figure 3 ). in patients with large quantities of fuid, the heart may appear to be swinging back and forth during echocardiography. 3 When the effusion has increased and is circumferential, it may be graded as small, moderate, or large (Table 2). Cardiac Tamponade. When cardiac tamponade occurs, diastolic collapse of the right atrium and, sometimes, the right ventricle may be seen during the echocardiogram. The heart may also "swing," because it foats within the pericardial space in a phasic fashion. in these patients, right atrial collapse may last longer during the systolic phase. Lastly, hepatic vein distension and ascites can help support the presence of cardiac tamponade as well. FIGURE 2. Lateral thoracic radiograph of an enlarged and globoid-shaped heart due to an excessive amount of fuid accumulation in the pericardium. FIGURE 3. Echocardiogram image of a heart surrounded by pericardial fuid. RV = right ventricle; RA = right atrium; LV = left ventricle; LA = left atrium TABLe 2. Grades of Pericardial e ffusions G rades ec H o-free sPace in diastole Small effusions < 10 mm Moderate effusions Usually 10–20 mm Large effusions > 20 mm

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