Cranial Vena Cava Syndrome Isn’t that the thing with heartworm disease???
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Cranial Vena Cava Syndrome Isn’t that the thing with heartworm disease??? Trisha Oura, DVM March 1, 2010
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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 - PowerPoint PPT Presentation
Transcript of Cranial Vena Cava Syndrome Isn’t that the thing with heartworm disease???
Cranial Vena Cava SyndromeIsn’t that the thing with heartworm disease???
Trisha Oura, DVMMarch 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- Thoracic radiographs: pulmonary nodules- Abdominal ultrasound: cavitated splenic mass- CT:
-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 edemaCRANIAL VENA CAVA
SYNDROME
Cranial Vena Cava Syndrome
Uncommonly reported in veterinary literatureBronchogenic carcinoma, LSA = 95% human
casesPathophysiology:
Compression, invasion, intraluminal obstruction
Elevated hydrostatic pressureInterstitial fluid leakage, overwhelms
lymphatics
CrVCS
Clinical signs:Subcutaneous, pitting edema (head, neck,
forelimbs), jugular/scleral/conjunctival venous distension** usually symmetrical **
Pleural effusion (chylous), rarely pericardial
Gradual or acute onsetCollateral circulation within 1 week
CrVCS
Reported causes: Thymoma (canine)Mediastinal lymphomaFungal (blastomycosis)CarcinomaAortic body tumorsPacemaker and IV catheter associated thrombi
CrVCS
Ddx: Angioedema Snake bite Trauma Salivary mucocele Abscess/cellulitis Hypoalbuminemia/vasculitis (usually
generalized)Diagnostics: Image! Image! Image! and aspirate…
CrVCSTreatment
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
Pacemaker induced caval thrombus and stricture formationCunningham SM, et al. JAVMA 2009;235:1467-1473.
2 cases with pacemakers placed years ago1 = acute clinical signs (dyspnea, swelling)
Large volume recurrent PFCrVC thrombus/stricture on CTThrombolytics, anticoagulants, balloon venoplasty
1 = chronic, ‘incidental’Found at pacemaker replacement
Collateral vessels seen on angiographyBalloon venoplasty
Pacemaker induced caval thrombus and stricture
formation
Case 1: acute onset clinical signsCase 2: asymptomatic, incidental
Good outcome > 6 months!
Not to be confused with….Heartworm Caval Syndrome
Life-threateningThought to occur with large numbers of worms
maturing in short timeSevere pulmonary hypertension, CO Adults migrate from MPA to RA, RV +/- vena
cavaMechanical disruption of TV, physical
obstructionTrauma to RBC, hemolysis, anemia, icterusExperimentally = as low as 12 worms (mean
= 40)
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. Compend Contin Educ Pract Vet 2002;24:701-710.
