Читать книгу Point-of-Care Ultrasound Techniques for the Small Animal Practitioner - Группа авторов - Страница 245

We are recognizing a new patient subset, the acute PCE case, with an unremarkable cardiac silhouette and respiratory distress, and a likely cardiac chamber rupture as the contributing factor. Traditional signs of muffled heart sounds, pulsus paradoxicus, electrical alternans on electrocardiogram, and a globoid heart on thoracic radiography are insensitive even in the chronic PCE case, let alone the acutely collapsed respiratory distressed case (Stafford Johnson et al. 2004; MacDonald et al. 2009; Guglielmini et al. 2012; Côté et al. 2013). Moreover, treatment strategies differ, as does the success of pericardiocentesis and definitive treatment. For example, if a cardiac chamber has acutely ruptured because of a right atrial mass, then the PCE may return in minutes to hours with repeated cardiac tamponade and obstructive shock. The case of a right atrial mass from hemangiosarcoma is a strong argument for the Global FAST approach, and rapidly staging the patient within minutes of presentation. Metastatic rate is high, 50–66% in one study (MacDonald et al. 2009).

Global FAST screens for hemoabdomen and lung metastasis, because if the patient is staged as isolated disease, then surgical removal of the cardiac tumor may be effective. The insertion of an indwelling pericardial catheter and autotransfusion(s) may be your only effective option (much different from traditional teaching paradigms). Moreover, performing a rough pericardiocentesis and opening the pericardial sac as a temporary pericardial window, used as a cheap, quick option in the past, will backfire with the patient then exsanguinating into an even larger space, the pleural cavity.