Pericardial Effusion

This is Big Jake.  "When he lays around the house, he really lays around the house." [rim-shot!]  His 147 pounds are covering my exam table and slopping off the edge.  Five days ago he came in because he had been panting in the early morning.  He seemed to feel better by the time they came in, but he did seem to be favoring his left hind leg, and you could see where he had been licking it.  I couldn't find much, but we radiographed the foot (no mean feat, as he covers the X-ray table, too — how to get him on the table, with his foot in the middle of the table, without the rest of Jake in the way?  Not to mention lifting him!)

So we sent him home with some anti-inflammatory/pain reliever and a little "wait and see".  He progressed to be more and more uncomfortable.  He panted more, couldn't get comfortable and quit eating.  It wasn't the medicine, because he refused to take that.  His owner noted that he was more uncomfortable lying down, and often resumed a sitting position to relieve his discomfort.  That "sitting up to get comfortable" is a hallmark of patients who are having breathing problems.  So, we asked her to bring him back in. [If you're wondering about the delay, the owner lives 60 miles away.  She doesn't just rush in on a moment's notice.]

His exam wasn't much different from the other day, and his lungs sounded okay.  The clinical signs and history still say something's wrong in his chest, and this is it.  His heart looks like a basketball.  I've talked about big hearts in a previous post.   Is it a stretched out of shape, weak, flabby heart?  A big, thickened, overly muscular heart?  A heart trapped in a pericardial sac full of fluid?  [A pericardial effusion is exactly that.] The ultrasound exam (echocardiogram) will tell us.  Of course, getting Big Jake in position was a logistical challenge[, but we finally got it done.  It's a big sac full of fluid, putting constant pressure on his heart, interfering with its function, making him hurt.

As with anything else on a dog this big, tapping and draining that sac was a pretty big project.  It was certainly more challenging than the case I had last fall.  We drained 600 cc (20 ounces) of fluid, giving him dramatic relief.  Unfortunately, he's going to need a chest surgery to remove that sac (and the heart-base tumor that we think is in it).  He feels better for now, though.