Thorax

Allison Zwingenberger

University of California, Davis

Publication Date: 2008-08-13

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History

1 year old female neutered Chihuahua with recent onset of dyspnea.

Findings

Images are post-contrast 2 mm helical acquisition with a soft tissue algorithm and soft tissue and lung window.

There is a large amount of pericardial effusion, as well as severe thickening and contrast enhancement of the pericardium. The distended pericardial sac is displacing the lung lobes dorsally and causing significant atelectasis of the lung lobes. The left main stem bronchus is compressed by the pericardium. The pericardium is in contact focally only with the apex of the heart. The epicardium is intensely contrast enhancing.

There is a moderate volume of pleural effusion seen on the left side. There is a large amount of irregular contrast enhancing tissue within the caudal mediastinum, ventral to the heart and a lesser amount in the cranial mediastinum. The abdominal aorta appears decreased in size.

Diagnosis

Evidence of severe pericarditis and epicarditis. Inflammatory mass along the mediastinum, but mostly within the caudal and middle mediastinum. These findings are suggestive of a migrating foreign body causing septic pericardial effusion and pyothorax. The small abdominal aorta may indicate hypotension and poor venous return.

Discussion

At surgery, the pericardium was removed and the purulent fluid lavaged from the pleural space. The right middle lung lobe was adhered to the caudal mediastinal inflammatory tissue and was removed. The surface of the heart was covered in a thick layer of fibrous and inflammatory tissue. No foreign body was identified.