Atrial Wall Tumours

RE: Atrial Wall Tumours

Mark Patteson — Sat, 23 May 2020 18:38:41 GMT

you got the important bit here. Your view probably depends more on the probe than the machine (you need a low frequency probe to get a good 4 chamber view of a 40Kg dog) but I often use a 12 MHz phased array or actually I like to use a curvilinear to look at the RAA wall as you don't need much depth and you get a fantastic image if you turn the persistence off and narrow the sector.

RE: Atrial Wall Tumours

Anthony Dennison — Thu, 21 May 2020 17:08:57 GMT

Sorry, you are both right... it is the right atrial inflow so of course it isn't the pulmonary vein .

This was in the right atrium, the dog had quite a significant pericardial effusion and cardiac tamponade as well as a pleural effusion. It presented tachypnoeic after collapsing multiple times in the previous 24 hours. Dog was euthanased shortly after I discovered the mass.

I find larger dogs (this was a 40kg German Shepherd) more difficult to perform echos on - may be my probe but I cannot always get a full 4 chamber view, and often have to just do a chamber at a time which is not ideal.

RE: Atrial Wall Tumours

Mark Patteson — Wed, 20 May 2020 11:44:19 GMT

oh dear
Actually, it looks like this is in the RA/right auricle. The pulmonary veins come into the LA so you can't see them here (although I can't be certain of the view this is I guess a view taken from the right). The mass isn't obstructing flow yet - some colour flow on it will probably show flow going around it. The location and appearance are highly suggestive of haemangiosarcoma I am afraid.
People have been known to FNA these (but ducks look like ducks and quack). Currently, no effusion means no need to do more.
More has been done, so chemotherapy is an option if you have a cytological answer but the pros/cons are seldom thought to be beneficial enough to do this We have removed a couple of RA wall masses - but those right at the tip of the auricle and have then done chemo. But for me, that's a small subset (clearly no mets, dogs had a CT to be sure first) It's been know to stent these if they cause RA obstruction and right-sided failure without tamponade. Whether you go that way depends on individual case details and owner preference (and cost).
I seldom advise surgery or chemotherapy - for me - it's doing your favourite walks and have their favourite food and make the most of it because chances are the dog is currently asymptomatic. Sadly not for long usually. The average is weeks- a few months. Some owners can't get their heads round this or the fact that the dog may become acutely weak if / when the PE recurs, so you need a decision that the owner can deal with. Maybe i am an old cynic but my advice is don't promise salvation because you could try something that's been reported a few times as a success because I am afraid most of these will have repeated PEs and don't live more than a few months

RE: Atrial Wall Tumours

Dave Dickson — Wed, 20 May 2020 09:24:32 GMT

Sorry I didn't reply sooner Anthony, this slipped past me.

It's hard to see exactly where you are on this view. The pulmonary veins enter the left atrium (in a normal dog) so do you mean cranial or caudal vena cava?

As a very general rule of thumb, I find that masses occurring within the atria often have a better prognosis than masses outside, ie between the atrial wall and pericardium. I'm not sure if this is due to tumour behaviour, or because a mass that bleeds into the atrium has no haemodynamic effect as bleeding inside the heart is fine. However I've had a handful of dogs with massive intra-atrial masses live years. Clearly, that is biased by the cases (I don't see the dead ones!) and it is pure anecdote, but I've learned never to prognosticate on these and just tell owners anything may happen.

A few brave souls have tried things like stenting the venous inflow if it obstructs and causes caval syndrome, but it's not something I'm keen on or would do in my own dog. In human medicine there are some fancy ways to shrink these masses (cryo, alcohol ablation, locally-delivered chemotherapy etc.) but I'm not aware that anyone is doing it in VetMed. likely there will be a surgeon somewhere who has attempted removal but that's not something I'd be tackling.

Hope that helps. If you have a RPLA view showing the mass that would help me orientate myself a bit.

Dave