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Left Ventricular Cardiac Mass Invading The Pericardium In A 13-Year-Old MN Beagle Mix: Our Case of the Month

Patient Information

Age
13 Years
Gender
Male, Neutered
Species
Canine

Keywords

Clinical Signs

Blood Chemistry

CBC

Exam Findings

Images

Left ventricular mass from SDEP® ECHO position 1, 4-5 chamber long axis. The mass measured 3.82 cm x 3.30 cm.
Left ventricular mass invasion into the pericardium.
Invaded left ventricle from SDEP® ECHO position 3 "beer can" right auricular view.
Left ventricular mass squeezing down the mitral valve - see color Doppler.
Multi-focal, hypoechoic splenic nodules measuring with disrupted architecture and target type appearance.

You don't see this type of mass everyday - thank goodness! This poor fellow won the dreadful mass lottery. When our team thinks of heart masses, they expect them to pop up in the area of the right auricle and can be managed to a degree; this left ventricular location on the other hand, not so much. Kelly Vazquez, CVT, SDEP® certified clinical sonographer from our SonoPath Mobile Veterinary Ultrasound team captured these diagnostic images, detailed interpretation provided by Eric Lindquist, DMV, DABVP, Cert. IVUSS, founder and CEO of SonoPath.com. Thanks to Bergen County Veterinary Center and Dr. Laurel Gess for providing compassionate patient care for a less than stellar prognosis.

History

A 13-year-old MN Beagle mix with history of increased weakness and respiratory effort presented for a heart murmur, suspected pulmonary edema, enlarged liver, and possible cranial abdominal mass. The patient was abdominally retracting while breathing, but his mucous membranes remained consistently pink. The patient was started on furosemide 12.5 mg 3 tabs BID and Pimobendan 5 mg BID. CBC and blood chemistry found moderately high WBC count; poss. bands, Alk. Phos. 663. Urine specific gravity was 1.023.

Image Interpretation

The left ventricle septum and left ventricular free wall in this patient revealed infiltrative, mixed hypoechoic tissue proliferation and culminating in a focal 3.8 cm mass at the junction of the left ventricular free wall and the left atrium. This pattern is strongly consistent with myocardial sarcoma. Impingement of the mass into the left atrial lumen was noted. Some infiltrative pattern also continued into the right ventricle. Myocardial sarcoma pattern involving left ventricle, left atrial free wall, and right ventricle. The mass extends into the pericardium. A slight amount of pericardial effusion was noted. Concurrently the spleen revealed multi-focal, hypoechoic nodules measuring up to 1.87 cm with disrupted architecture and target type appearance, likely related to the myocardial pathology.

DX

Myocardial sarcoma pattern involving left ventricle, left atrial free wall, and right ventricle. Probable concurrent splenic involvement.

Outcome

FNA of the splenic nodules was recommended and immediate chemotherapeutic intervention with followup echocardiogram. The prognosis is poor long term. Unfortunately, this patient was too compromised to survive long enough for any kind of treatment and passed away a few short days after diagnosis.

Videos

Left ventricular mass from SDEP® ECHO position 1.
Mitral valve with color Doppler.
Invaded left ventricle from SDEP® ECHO position 3 "beer can" technique right auricular view.