Tommy – A multi-disciplinary case

Presentation

Tommy, a 6 year old French Bull Dog, was presented to our Internal Medicine Specialist as an emergency, suffering from cardiogenic shock. On clinical examination there were weak peripheral pulses, prolonged capillary refill time, and hypothermia. Point-of-care ultrasound examination revealed a pericardial effusion causing right sided tamponade, and an abdominal effusion. 

Treatment

An immediate ultrasound-guided pericardiocentesis was performed to stabilise Tommy, and subsequent echocardiographic examination with cardiologist Dr Antonio Moneva-Jordan revealed a 35mm diameter soft tissue mass at the heart base adjacent to the aorta and the left auricle. This was potentially a chemodectoma given the breed predisposition. 

Unfortunately, Tommy’s pericardial effusion recurred within 48 hours necessitating a repeat pericardiocentesis procedure. A CT scan revealed a contrast-enhancing left sided heart base mass along with a fluid filled capsule adjacent to it. Fortunately for Tommy, there was no evidence of metastatic spread. 

Surgeon Dr Jess Bedwell performed a surgical pericardectomy via a lateral thoracotomy approach the following day to prevent further tamponade. Our Critical Care Team were on hand to help with the challenging general anaesthetic. 

We are fortunate to have advanced anaesthesia equipment including ventilators and state-of-the-art monitoring. Tommy recovered extremely well from surgery. His thoracic drain was removed a few hours afterwards and was discharged home the following day.

Ongoing Care

Tommy has suffered no further clinical symptoms since has been home, and his long-term prognosis is relatively good.  He is due to start a course of chemotherapy (toceranib) under the care of our Medicine and Oncology Team with the aim of improving his long-term outlook even further.

At Moorview Referrals, our highly qualified and experienced teams work together to ensure the best possible outcome for our patients.

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