What Is Your Diagnosis?

Christina J. Choate Animal Health Center, Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS 39762.

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Erin Brinkman-Ferguson Animal Health Center, Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS 39762.

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History

A 9-year-old spayed female Scottish Terrier was referred for evaluation of moderate to severe ventral edema and a pendulous abdomen first recognized by the owners 3 days earlier. On physical examination, vital signs (heart rate, respiratory rate, and rectal temperature) were within reference limits and pitting ventral edema and severe ascites with a ballotable fluid wave were noted. On auscultation, heart sounds were extremely muffled on the right side. The results of a CBC revealed mild anemia (29%; reference range, 34% to 60%), thrombocytopenia (98,000 platelets/μL; reference range, 160,000 to 650,000 platelets/μL), and neutrophilia (14,520 cells/μL; reference range, 3,000 to 11,500 cells/μL). Serum biochemical analysis revealed high alanine aminotransferase (119 U/L; reference range, 10 to 90 U/L) and alkaline phosphatase (1,122 U/L; reference range, 11 to 140 U/L) activities. Radiographs of the thorax were obtained (Figure 1).

Figure 1—
Figure 1—

Right lateral (A) and ventrodorsal (B) radiographic views of a 9-year-old spayed female Scottish Terrier evaluated because of ventral edema and a distended abdomen of 3 days' duration.

Citation: Journal of the American Veterinary Medical Association 238, 11; 10.2460/javma.238.11.1407

Diagnostic Imaging Findings and Interpretation

Generalized cardiomegaly is evident on radiographic images. On the ventrodorsal view, the width of the heart appears > 50% the width of the thorax. On the lateral view, the heart occupies more than 4 intercostal spaces with an increase in height. The cardiac silhouette is enlarged and irregularly shaped with a prominent bulge on the right side (Figure 2).

Figure 2—
Figure 2—

Same radiographic image as in Figure 1. Notice that the cardiac silhouette is enlarged and irregularly shaped with a prominent bulge on the right side (arrows).

Citation: Journal of the American Veterinary Medical Association 238, 11; 10.2460/javma.238.11.1407

On echocardiographic examination, an irregularly shaped, mottled, echogenic mass approximately 6 cm in diameter along the free wall of the right ventricle (Figure 3) was observed. The mass caused deviation of the heart to the left and severe compression of the right atrial and ventricular chambers.

Figure 3—
Figure 3—

Right parasternal long-axis echocardiographic image of the same dog as in Figure 1. A large space occupying mass (arrows) within the pericardium is visualized compressing the right side of the heart.

Citation: Journal of the American Veterinary Medical Association 238, 11; 10.2460/javma.238.11.1407

Contrast-enhanced computed tomography of the thorax revealed a 7 × 5.7 × 7.1-cm mass on the right ventricular free wall (Figure 4). Portions of the mass had contrast enhancement similar to that of the myocardium. This contrast enhancement was seen extending from the right ventricular free wall into the mass as ill-defined, finger-like extensions. The mass caused severe leftward deviation of the heart and compression of the right ventricular lumen. There were several 3- to 4-mm-diameter soft tissue density structures at the periphery of multiple lung lobes visible when the images were viewed in a lung window (images not provided), indicative of metastasis.

Figure 4—
Figure 4—

Transverse contrast-enhanced computed tomographic image (slice thickness, 1.25 mm) obtained at the level of the tracheal bifurcation in the same dog as in Figure 1. A large, contrast-enhancing mass (arrows) is seen extending from the right ventricular free wall.

Citation: Journal of the American Veterinary Medical Association 238, 11; 10.2460/javma.238.11.1407

Comments

A neoplastic mass of right ventricular myocardial origin was suspected with pulmonary metastasis. The patient was taken to surgery for a palliative pericardectomy and debulking of the mass. Intraoperatively, the mass was found to be originating entirely from the right ventricular wall. It also appeared cavitary and filled with clotted blood. Histologic evaluation revealed that the mass was a hemangiosarcoma. The patient recovered uneventfully from surgery and was discharged 5 days later. Because of the poor prognosis and presence of metastasis, the owners elected not to pursue adjunctive chemotherapy. The patient survived approximately 7 weeks.

Primary cardiac hemangiosarcoma is an infrequently reported disease most commonly seen in German Shepherd Dogs, with a mean age at diagnosis of 10 years. The most common site for the tumor to occur is the right atrium. Long-term prognosis for cardiac hemangiosarcoma is poor, with survival times in patients receiving pericardectomy and mass debulking reported to range from 2 days to 8 months.

Because of the risks associated with obtaining aspirates or biopsy specimens, a definitive diagnosis of cardiac hemangiosarcoma is rarely made before exploratory thoracotomy or necropsy. Echocardiography in the dog of this report allowed differentiation between cardiomegaly and an intrapericardial mass as causes for the enlarged cardiac silhouette. Contrast-enhanced computed tomography helped identify the tissue of origin of the mass and revealed suspected pulmonary metastasis, not visible with any other diagnostic modality.

  • Figure 1—

    Right lateral (A) and ventrodorsal (B) radiographic views of a 9-year-old spayed female Scottish Terrier evaluated because of ventral edema and a distended abdomen of 3 days' duration.

  • Figure 2—

    Same radiographic image as in Figure 1. Notice that the cardiac silhouette is enlarged and irregularly shaped with a prominent bulge on the right side (arrows).

  • Figure 3—

    Right parasternal long-axis echocardiographic image of the same dog as in Figure 1. A large space occupying mass (arrows) within the pericardium is visualized compressing the right side of the heart.

  • Figure 4—

    Transverse contrast-enhanced computed tomographic image (slice thickness, 1.25 mm) obtained at the level of the tracheal bifurcation in the same dog as in Figure 1. A large, contrast-enhancing mass (arrows) is seen extending from the right ventricular free wall.

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