Haemorrhagic Effusion, Pericardial

Introduction

This is a condition where blood accumulates in the pericardial sac.

Fluid accumulation within the pericardial sac may lead to fibrous thickening and opacity of the pericardium if prolonged. Villous proliferation of the serosa will occur due to the irritation caused by the presence of the fluid.

Large volumes of blood within the pericardial sac may cause cardiac tamponade.

Haemopericardium can be due to intrapericardial aortic rupture, causing sudden influx of blood into the pericardium, cardiac tamponade and death. This occurs spontaneously in horses, and occurs in pigs with a copper deficiency. In dogs, rupture of a right atrial haemangiosarcoma or, rarely, rupture of the left atrial wall due to 'jet lesions' associated with endocardiosis, is a cause of the condition.

Clinical Signs

In cases of haemopericardium, the causes of the condition tend to be sudden, therefore the only clinical sign in most cases is sudden death. If build up of blood is slow, then signs of right congestive heart failure will be seen, such as ascites, jugular distension, jugular pulse, hepatomegaly and lethargy.

Diagnosis

History and clinical signs can be indicative of the condition.

If the animal is alive, then pericardiocentesis can be used to determine what type of fluid is present in the pericardial sac. Ultrasound will show fluid in the pericardium and compression of the right ventricle and radiography will show and enlarged cardiac silhouette, indicating the presence of fluid.

Post mortem will diagnose the condition in animals presented with sudden death. There will be clotted blood surrounding the heart within the pericardial sac.

Treatment and Control

The only effective way to treat animals with pericardial effusions is pericardicentesis. This will relieve clinical signs even when only one third of the fluid is drained. This requires ECG monitoring throughout and for it to be ultrasound guided if possible. In cases of recurrent pericardial effusion, a pericardectomy can be performed as a palliative measure to reduce the amount of recurrence.

Test yourself with the Pericardial Pathology Flashcards

References

Boswood, A. (2008) Cardiovascular System Study Guide, Royal Veterinary College.
Ettinger, S.J. and Feldman, E. C. (2000) Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2 (Fifth Edition), W.B. Saunders Company.
Fossum, T. W. et. al. (2007) Small Animal Surgery (Third Edition), Mosby Elsevier.
Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) Equine Internal Medicine (Third Edition), Saunders.
Symth, B (2008) Cardiovascular System Study Guide, Royal Veterinary College.
Taylor, D.J. (2006) Pig Diseases (Eighth edition), St Edmunsdbury Press ltd.