What is your diagnosis? Intracardiac thrombus

Left Atrial Mural Thrombosis and Hemopericardium in a Dog with Myxomatous Mitral Valve Disease

A 14-year-old mixed-breed dog with a 2-year history of myxomatous mitral valve disease was examined for collapse and lethargy. At the presentation, pale oral mucous membranes, rapid and weak femoral pulses, and muffled heart sounds with a moderate left apical systolic murmur were revealed. Echocardiographic examination showed pericardial effusion with organized echogenic material originating from the left atrial wall. Tamponade of the right atrium and severe left atrial enlargement were also observed. Multiple views of the left atrium and left auricle allowed to visualize a hyperechoic mass adherent to the endocardium of the left atrial wall. Contrast-enhanced ultrasonography study allowed to rule out active intrapericardial hemorrhages, and echo-guided pericardiocentesis was performed. No recurrence of pericardial effusion was observed, but the dog suddenly died after 10 days. The postmortem examination confirmed multifocal left atrial thrombosis attached to the endomyocardial tears.

The Rare Occurrence of a Left Atrial Thrombus in a Dog

Intracardiac thrombi are rare in dogs. If they occur, they are mostly seen in the right atrium while only two case reports describing a mural left atrial thrombus in dogs are available. This case report describes a 14-year-old mixed-breed bitch that was presented at the clinic because of dyspnoea. The dog suffered from alopecia for about three years and displayed polyuria and polydipsia for a number of months. Clinical examination revealed intensified inspiratory and expiratory respiratory sounds and various heart sounds. Chest X-ray showed cardiomegaly (VHS 11) and a mixed bronchoalveolar lung pattern of the caudal lung. A transthoracic echocardiography was performed and showed a moderate mitral regurgitation, a highly dilated left atrium, a low-grade pulmonary insufficiency, and a minimal aortic and tricuspid insufficiency. Additionally, a free-floating ball thrombus was found in the left atrium. Hyperadrenocorticism was indicated by an ACTH stimulation test. The previous medical therapy of the referring veterinarian consisted of benazepril and furosemide and was complemented by clopidogrel. The pet owners declined any further clinical diagnostics and therapy. The dog died 19 days later. This is the first reported case of a dog with a free-floating left atrial thrombus. Specific therapeutic strategies for intracardiac thrombi in the dog are currently not available, and therefore, every patient should be treated individually.