1 / 12

Cranial Vena Cava Syndrome Isn’t that the thing with heartworm disease???

Cranial Vena Cava Syndrome Isn’t that the thing with heartworm disease???. Trisha Oura, DVM March 1, 2010. Acc # 125214 (Motown). - 10 yo FS GSD - 3 week history of submandibular swelling now cervical and forelimb Coughing (especially at night), decreased appetite

myron
Télécharger la présentation

Cranial Vena Cava Syndrome Isn’t that the thing with heartworm disease???

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Cranial Vena Cava SyndromeIsn’t that the thing with heartworm disease??? Trisha Oura, DVM March 1, 2010

  2. Acc # 125214 (Motown) • - 10 yo FS GSD • - 3 week history of submandibular swelling now cervical and forelimb • Coughing (especially at night), decreased appetite • Thoracic radiographs: pulmonary nodules • Abdominal ultrasound: cavitated splenic mass • CT:

  3. Bilobed, partially mineralized thyroid mass with esophageal compression • Vascular filling defects • left external jugular v, cranial vena cava • Pulmonary nodules • Cervical, thoracic lymphomegaly • Marked subcutaneous edema Cranial vena cava syndrome

  4. Cranial Vena Cava Syndrome • Uncommonly reported in veterinary literature • Bronchogenic carcinoma, LSA = 95% human cases • Pathophysiology: • Compression, invasion, intraluminal obstruction • Elevated hydrostatic pressure • Interstitial fluid leakage, overwhelms lymphatics

  5. CrVCS • Clinical signs: • Subcutaneous, pitting edema (head, neck, forelimbs), jugular/scleral/conjunctival venous distension ** usually symmetrical ** • Pleural effusion (chylous), rarely pericardial • Gradual or acute onset • Collateral circulation within 1 week

  6. CrVCS • Reported causes: • Thymoma (canine) • Mediastinal lymphoma • Fungal (blastomycosis) • Carcinoma • Aortic body tumors • Pacemaker and IV catheter associated thrombi

  7. CrVCS • Ddx: • Angioedema • Snake bite • Trauma • Salivary mucocele • Abscess/cellulitis • Hypoalbuminemia/vasculitis (usually generalized) • Diagnostics: Image! Image! Image! and aspirate…

  8. CrVCS • Treatment • Remove the underlying cause if possible • Surgery/chemotherapy/radiation for neoplasia • Remove catheters/lead wires • Thrombolytics • Interventional • Balloon/Stent • Prognosis: • Guarded to poor • Collateral circulation • Invasive tumors not amenable to therapy

  9. Pacemaker induced caval thrombus and stricture formationCunningham SM, et al. JAVMA 2009;235:1467-1473. • 2 cases with pacemakers placed years ago • 1 = acute clinical signs (dyspnea, swelling) • Large volume recurrent PF • CrVC thrombus/stricture on CT • Thrombolytics, anticoagulants, balloon venoplasty • 1 = chronic, ‘incidental’ • Found at pacemaker replacement • Collateral vessels seen on angiography • Balloon venoplasty

  10. Pacemaker induced caval thrombus and stricture formation Case 1: acute onset clinical signs Case 2: asymptomatic, incidental Good outcome > 6 months!

  11. Not to be confused with….Heartworm Caval Syndrome • Life-threatening • Thought to occur with large numbers of worms maturing in short time • Severe pulmonary hypertension,  CO • Adults migrate from MPA to RA, RV +/- vena cava • Mechanical disruption of TV, physical obstruction • Trauma to RBC, hemolysis, anemia, icterus • Experimentally = as low as 12 worms (mean = 40)

  12. References • Bove CM, et al. Outcome of minimally invasive surgical treatment of heartworm caval syndrome in dogs: 42 cases (1999-2007). J Am Vet Med Assoc 2010;236:187-192. • Cunningham SM, MK Ames, JE Rush, EA Rozanski. Successful treatment of pacemaker-induced stricture and thrombosis of the cranial vena cava in two dogs by use of anticoagulants and balloon venoplasty. J Am Vet Med Assoc 2009;235:1467-1473. • Ncastro A, E Cote. Cranial vena cava syndrome. CompendContinEducPract Vet 2002;24:701-710.

More Related