Septic pericarditis and pneumopericardium in a dog with an oesophageal foreign body

Case Report: Septic Pericarditis With Achromobacter xyloxidans in an Immunosuppressed Dog

A 5-year-old female spayed French Bulldog presented for anorexia and increased respiratory rate. On presentation, she was dyspneic with stridor and increased bronchovesicular sounds. Point-of-care ultrasound identified pericardial effusion. Thoracic radiographs identified pleural effusion, a wide cranial mediastinum, and multifocal unstructured interstitial pulmonary opacities. Bloodwork revealed a moderate leukocytosis characterized by a mature neutrophilia with a left shift, hypoalbuminemia, mildly increased alkaline phosphatase activity, and moderate hypokalemia. Thoracic CT findings revealed moderate pericardial and bilateral pleural effusion, mediastinal effusion, and moderate cranial mediastinal lymphadenopathy. Diagnostic thoracocentesis and pericardiocentesis revealed septic exudates with bacilli. Two days later, a median sternotomy and pericardiectomy were performed. Aerobic cultures of the effusions grew Achromobacter xylosoxidans ss deitrificans. The patient was treated with Amoxicillin-clavulanate and enrofloxacin for 12 weeks and clinically fully recovered. Achromobacter xylosoxidans has not been reported as a cause of purulent pericarditis and pyothorax in a dog. Uniquely, this patient is suspected of developing this infection secondary to immunosuppression.

Gastroesophageal intussusception secondary to induction of emesis with subsequent development of septic pericardial effusion after corrective surgery

A juvenile boxer dog was diagnosed with gastroesophageal intussusception that occurred after the induction of emesis with apomorphine. A ventral midline coeliotomy and diaphragmotomy were performed and the intussusception was manually reduced. Despite initial satisfactory recovery, the dog was diagnosed with cardiac tamponade 1 week post-operatively. Escherichia coli was cultured from pericardial and pleural effusion samples. During subtotal pericardiectomy surgery the pericardium was found to be markedly thickened with adhesions to the epicardium, thoracic wall and diaphragm. Substantial haemorrhage and refractory hypotension necessitated the administration of a blood transfusion during surgery. The dog entered cardiac arrest in the immediate post-operative period and cardiopulmonary resuscitation was unfortunately unsuccessful. Gastroesophageal intussusception should be considered a possible severe adverse effect of administering apomorhine to induce emesis in dogs. Additionally, septic pericardial and pleural effusions may occur post-reduction of gastroesophageal intussusception.

Septic pericarditis caused by a migrating grass awn in a cat

Septic pericarditis and cardiac tamponade associated with migrating grass awn foreign bodies is reported rarely in companion animals. We report such a case in a previously healthy, 9-year-old, neutered female, indoor-outdoor, domestic long-hair cat who presented for acute tachypnea. Large volume pericardial effusion and pericardial tamponade was identified by thoracic-focused assessment with sonography. Following removal of 108 mL of purulent pericardial effusion by pericardiocentesis, the cat improved. Cytologic examination of pericardial fluid demonstrated septic, suppurative inflammation, Pasteurella sp. was cultured from pericardial effusion, and antibiotics were administered. Subsequent echocardiographic examination revealed large volume pericardial effusion, pericardial thickening, and a linear foreign body within the pericardial space. Whole-body computed tomography confirmed pericardial thickening, pericardial, and pleural effusion. A 16-mm long grass awn was identified within the pericardial space during thoracic exploratory surgery performed through a median sternotomy. Successful foreign body removal and subtotal pericardiectomy was accomplished. Histopathology of pericardial tissue disclosed chronic pericarditis with lymphoplasmacytic-to-pyogranulomatous inflammation, and transmural presence of grass awn foreign body. The cat responded to supportive therapy and was discharged 4 days postoperatively. When examined 3 weeks later, the cat appeared healthy with normal appetite. The cat remained healthy as of this writing, 487 days following surgery. To the author's knowledge, this is the first report in the cat of septic pericarditis and cardiac tamponade resulting from a migrating grass awn foreign body.

Septic pericarditis and pericardial abscess secondary to a migrating foreign body in a dog

Abscess formation in the pericardial space has been described as a rare complication of trauma, congenital defects, penetrating foreign body, or extension of local myocardial infection in the dog. Presented here is a case of a juvenile dog with septic pericardial effusion secondary to an isolated intrapericardial abscess. Surgical pericardiectomy was successful in removing the abscess and nidus for septic effusion in this patient, and histopathology of the abscess tissue was suggestive of foreign plant material migration as the nidus for abscess formation. Recheck echocardiogram at the six-month postoperative period showed no recurrence of pericardial effusion or abscessation. Although abscess formation and septic pericarditis secondary to foreign body migration is an uncommon cause for large volume pericardial effusion, this should be considered as a differential particularly in a young and previously healthy dog.