Uncovering the Hidden Pressure Chamber
Symptoms
An 8-year-old female spayed mixed-breed dog, presented for clinical evaluation after showing pronounced lethargy, severe systemic fatigue, and a distinctly elevated, rapid heart rate during physical examination.
Further abdominal assessment revealed noticeable fluid distension alongside a palpably enlarged, structurally abnormal spleen, signalling widespread systemic strain requiring urgent diagnostic imaging.
Visualisation
Imaging Modalities Used: Transthoracic Echocardiography (M-Mode, B-Mode, Spectral Doppler) and Abdominal Ultrasonography.
The Ultrasound Revelation
Right Atrial Mass: A 1.5 x 1.8 cm lesion originating on the external right atrial wall.
Hemopericardium & Tamponade: Severe fluid buildup in the pericardial sac (aspirate confirmed pure blood) creating cardiac tamponade physiology.
Pseudohypertrophy: Severe underfilling of both left and right ventricles leading to secondary wall thickening (IVSd 1.3 cm, LVFWd 2.36 cm) and elevated ejection fraction (95%).
Abdominal Findings: Concurrent enlarged, heterogeneous spleen paired with abdominal ascites, pointing toward a primary cardiac hemangiosarcoma with potential splenic involvement or multicentric disease.
Next Steps:
Perform emergency therapeutic pericardiocentesis to relieve tamponade pressure and restore cardiac output.
Conduct a full abdominal ultrasound further to evaluate splenic architecture and stage for metastatic spread.
Submit pericardial fluid for cytology, keeping low diagnostic sensitivity in mind.
Discuss surgical options (pericardiectomy/splenectomy) and prognosis with the owner.
Important Lessons
Recognise Pseudohypertrophy: Cardiac tamponade severely reduces preload, causing collapsed chamber dimensions that can easily mimic hypertrophic cardiomyopathy or true myocardial thickening.
Look Beyond the Chest: Finding hemopericardium should always prompt a complete abdominal search particularly inspecting the spleen to rule out multicentric hemangiosarcoma.
About
"I dedicate my expertise to giving every pet the care they deserve."
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- 082 449 8897
- mscan@jdata.co.za
- Sandbaai | Hermanus
- mscan.marligrewar