Thursday, September 8, 2011

599. Update on the labrador retriever with the "double chin" - cardiac tamponade

I hope this article brings veterinary medicine alive to the final year students about to take their 5th year examinations in November 2011 in Australia and wish them all the best.


http://www.sinpets.com/F5/201108030cardiac-tamponade-labrador-retriever-heart-base-tumour-likely-ultrasound-singapore_ToaPayohVets.htm - Part 1




I sent the dog to a vet who did the X-rays and the ultrasound of the heart as well as pericardiocentesis as I don't have the equipment in my very small practice of 50 sq m.

"The X-ray of the lateral view does not show a mediastinal mass," he agreed that the ventral/dorsal view had shown such a mass. Therefore, he did not support my tentative diagnosis of mediastinal mass. More investigations will be needed.

The dog's skin swelling returned to normal after a few days of lasix. But the dog is fully cured.








X-rays of cardiac tamponade. Is there an anterior mediastinal mass or not? I say yes, but the vet I consulted say no as he says that the lateral view does not show the mass. Will need more investigation and review.
An anterior mediastinal mass could be due to a tumour like thymoma or thyroid enlargement extending backwards and other causes. The pericardial effusion fluid showed mitotic cells. The ultrasound showed a heart mass tumour. Reviews are necessary.






Pericardial effusion is seen on echocardiography (right and above) --->

The dog had no more "double chin" 3 days after pericardiocentesis and on furosemide injection and oral medication which lasted 8 days. 13 days after pericardiocentesis, the dog was reviewed. He had put on weight and is no longer short of breath as before. More alert and barks at outside dogs on walk at night. The furosemide medication is continued. "Spend more time with him," I advised the owner. This is a beloved companion and a most gentle big dog.

September 6, 2011 report
"Let him enjoy his life," I said to the lady owner as I phoned her about the 2nd blood test done on Sep 6, 2011 and compared it to that done in Aug 25, 2011 when the dog had anaemia. Blood transfusion cost $1,200 when she asked me. I had not advised her as I did not think that this dog whose gums were pinkish would need one and in any case, it would be costly. So, I advised good food like liver, egg yolk, iron, folic acid and multivitamin tablet supplementation.

Compare the blood results

Aug 25, 2011. Can't breathe. I couldn't hear sounds. Double Chin. Both paws swollen and other parts of body. I gave 60 mg Lasix Iv and sent to Vet 2 for ultrasound, X-ray and 3rd opinion as to the cause of this "double chin" which I suspected was due to a large mediastinal mass. Cardiac Tamponade. Pericardiocentesis done and goes home. Vet 2 said possible heart tumour at base of heart and mitotic figures seen in pericardial fluid indicated neoplasia.

Aug 25, 2011
Haemoglobin 8.1 (12-18)
Red cell count 3.5 (5.5-8.5)

Sep 6, 2011. Left paw swollen slightly. Heart sounds can be heard at 30% of the normal breed size which was used as benchmark and teaching for my assistant and the lady owner. The belly looked a bit swollen when lying sideways. Lasix tablets had been given for 8 days from Aug 25, 2011 to Sep 2, 2011. Then no furosemide. I had advised to continue for the life span of the dog and so had phoned the owner to come for review.

Sep 6, 2011
Haemoglobin 10.3 (12-18)
Red cell count 4.3 (5.5-8.5). > 20% increase in red cell count due to good nutrition and supplements.
I could feel the spleen much enlarged like a child's shoe. That was not possible earlier. X-ray did show splenomegaly. Bad news.

WHITE CELL COUNT normal range. However see the composition:

Aug 25, 2011
WBC 7.8 (6-17) - normal
Neutrophils 91%
Lymphocytes 7%
Monocytes 0.5%
Eosinophils 0.9%
Basophils 0%
Platelets 191 (200-500)
PCV 0.24 (0.37-0.55)


Sep 6, 2011
WBC 8.5 (6-17) - normal
Neutrophils 57%
Lymphocytes 21%
Monocytes 8.7%
Eosinophils 11.5%
Basophils 1.5%
Platelets 316 (200-500)
PCV 0.27 (0.37-0.55)
Why the increase in monocytes and eosinophils? Is it associated with splenomegaly and endo-parasites? Heartworm blood test on 6 Sep was negative.

The Labrador now barks at passers-by outside and is more active. No long walks. Urine colour now much lighter and normal said the owner. Not so thin as there is flesh above spinal process. But weight was 35kg compared to 38 kg on Aug 25, 2011. "The water inside the skin and heart must have weighed 3 kg," the owner remarked. It was possible.

HISTORY
Jun 21, 2011. Diarrhoea and fever. 2 days. Recovered with tolfedine medication.
Aug 11, 2011. Very weak. owner gave tolfedine medication 60mg tablet 2x/day for 2 days. Recovered
Aug 16, 2011. Appetite normal but lethargic.
Aug 22, 2011. Neck swelling prominent. double chin. Went to Vet 1 who diagnosed "fat" or suspect cancer. X-ray abdomen and blood test normal.
Aug 25. 2011. Consulted me. Cardiac tamponade based on ultrasound and X-ray. Pericardiocentesis done by Vet 2. Medication for 8 days and advised review after that.
Sep 6, 2011. Reviewed. Left fore paw swollen and other signs as above.

Overall, the owner said by August 29, 2011, no more double chin or preputial and other swellings.


Pericardial fluid taken one had cell with mitotic figures. A heart tumour could not be ruled out.

More images are at:
http://www.sinpets.com/F5/20110904cardiac-tamponade-labrador-retriever-heart-base-tumour-likely-ultrasound-singapore_ToaPayohVets.htm

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