2024年6月16日 (日) 15:40的版本

1 摘要

An adult mixed-breed dog was presented for 1-day history of anorexia and cough. Thoracic radiographs revealed moderate generalized cardiomegaly with globoid-shaped cardiac silhouette and mild bilateral pleural effusion.

一只成年混种犬因厌食和咳嗽 1 天病史而就诊。胸片显示中度全身性心脏扩大，伴有球状心脏轮廓和轻度双侧胸腔积液。

Echocardiography showed mild tamponating pericardial effusion and diffuse severe thickened pericardium.

超声心动图显示轻度心包积液和弥漫性重度心包增厚。

Complete blood count and blood chemistry at presentation were not specific.

就诊时的全血细胞计数和血化成分不具有特异性。

A coagulation profile was completed and showed severe prolongation of prothrombin time and partial thromboplastin time.

完成凝血功能检查，显示凝血酶原时间和部分凝血活酶时间严重延长。

Intravenous therapy with vitamin K was started at 5mg/kg BID and on follow-up echocardiography performed 12 hours later there was evidence of complete regression of the pericardial thickening and pericardial effusion.

以 5mg/kg BID 开始静脉注射维生素 K 治疗，12 小时后进行随访超声心动图检查，有证据表明心包增厚和心包积液完全消退。

To the authors' knowledge, this is the first case report describing severe pericardial thickening, constrictive pericarditis, and cardiac tamponade secondary to spontaneous anticoagulant-induced hemopericardium in dogs. 据作者所知，这是第一份描述严重心包增厚、缩窄的病例报告狗自发性抗凝血诱发的心包炎和心包填塞。

Pericardial effusions are well described in dogs; however, their association with rodenticide intoxication in the canine population is not widely described.

心包积液在狗中得到了很好的描述;然而，它们与犬类种群中杀鼠剂中毒的关联尚未得到广泛描述。

2 病例详细描述

A 2-year-old female indoor spayed mixed-breed dog was initially presented to her veterinarian for a 1-day history of anorexia and cough. The owners did not report history of exposure to rodenticides. The dog presented muffled heart sounds and thoracic radiographs revealed moderate globoid enlargement of the cardiac silhouette [vertebral heart score (VHS) of approx. 13], mild bilateral pleural effusion, and mild retraction of the lung lobes. Complete blood count (CBC) and chemistry panel at presentation were unremarkable [red blood count (RBC) 6.1 ×1012/l, reference range: 5.65–8.87×1012/l; Hct 39.4%, reference range: 37.3%–61.7%; Hgb 16.3 g/dl, reference range: 13.1–20.5 g/dl; white blood count (WBC) 11.7 × 109/l, reference range: 6–16.9×109/l; and segmented neutrophils 7.4 × 109/l, reference range: 2.8–10.5 × 109/l]. Platelet count (PLT) was within normal limits at 212 × 109 /l (reference range: 175–500 × 109/l). The chemistry panel revealed mild hyperglycemia (145 mg/dl, reference range: 60–110mg/dl), mild hypoalbuminemia 2.4 g/dl (reference range: 2.5–4.4 g/dl) and hypoglobulinemia 1.7 g/dl (reference range: 2.3–5.2 g/dl). CBC and chemistry data at presentation are reported in Table 1.

一只 2 岁的雌性室内绝育混种狗最初因厌食和咳嗽 1 天病史而被送往兽医处。业主没有报告接触杀鼠剂的历史。这只狗表现出低沉的心音，胸片显示心脏轮廓中度球状肿大 [椎体心脏评分 （VHS） 约为 13]，轻度双侧胸腔积液和肺叶轻度回缩。就诊时全血细胞计数 （CBC） 和生化检查无明显异常 [红细胞计数 （RBC） 6.1 ×1012/l，参考范围：5.65–8.87×1012/l;Hct 39.4%，参考范围：37.3%–61.7%;Hgb 16.3 g/dl，参考范围：13.1–20.5 g/dl;白细胞计数 （WBC） 11.7 × 10^9/l，参考范围：6–16.9×10^9/l;和分段中性粒细胞 7.4 × 10^9/L，参考范围：2.8–10.5 × 10^9/l]。血小板计数 （PLT） 在 212 × 10^9 /l 时在正常范围内（参考范围：175-500 × 10^9/l）。生化检查显示轻度高血糖（145 mg/dl，参考范围：60-110mg/dl）、轻度低白蛋白血症 2.4 g/dl（参考范围：2.5-4.4 g/dl）和低球蛋白血症 1.7 g/dl（参考范围：2.3-5.2 g/dl）。表1报告了就诊时的全血细胞计数和化学数据。

The patient was referred to an emergency and specialty center for further evaluation. On presentation to the referral center that same day, the patient was reported to have a temperature of 37.4°C. On initial examination, the dog was tachycardic (heart rate 160 bpm), with cyanotic mucous membrane and prolonged refill time (>2 seconds). The patient had abnormal jugular pulses. Cardiac auscultation revealed mildly muffled heart sounds with regular rhythm. Respiratory rate was 34 breaths per minute. Oscillometric blood pressure evaluation was lower than normal limits (systolic pressure average of 100 mmHg). The QRS complexes were attenuated and electrical alternans was appreciated. Thoracic point of care ultrasound confirmed the presence of pericardial and pleural effusion. A complete echocardiographic examination demonstrated the presence of severe pericardial thickening, mild pericardial effusion, mild pleural effusion, and hemodynamic changes consistent with constrictive pericarditis (CP). Computed tomography (CT) was scheduled to further characterize cardiac abnormalities and for presurgical pericardiectomy planning.

患者被转诊至急诊和专科中心进行进一步评估。当日到转诊中心就诊时，病人体温为37.4°C。 初步检查时，狗有心动过速（心率 160 次/分），粘膜发绀，再充盈时间延长（>2 秒）。患者颈静脉搏动异常。 心脏听诊显示心音轻度低沉，心律规律。呼吸频率为每分钟 34 次。示波血压评估低于正常限值（收缩压平均值为 100 mmHg）。QRS波群衰减，电交替物受到赞赏。胸部床旁超声证实存在心包积液和胸腔积液。完整的超声心动图检查显示存在重度心包增厚、轻度心包积液、轻度胸腔积液和符合缩窄性心包炎 （constrictive pericarditis， CP） 的血流动力学改变。计划进行计算机断层扫描 （CT） 以进一步表征心脏异常和术前心包切除术计划。

3 胸片解读 (Thoracic radiographs interpretation)

就诊时的胸片显示气管抬高，与脊柱平行。心脏轮廓适度扩大，胸骨接触宽阔，球状，边缘清晰（VHS约13）。有轻度双侧胸腔积液和肺叶轻度回缩。颅腹肺叶显示轻度弥漫性非结构性混浊增加，与间质-肺槽肺模式相符，很可能与回缩和轻度肺不张有关。影像学检查结果与心包积液相符，伴有心包填塞和右心衰竭的体征。

Thoracic radiographs at presentation showed elevation of the trachea which was parallel to the spine. The cardiac silhouette was moderately enlarged, with a broad sternal contact, a globoid shape and sharply defined margins (VHS approx. 13). There was mild bilateral pleural effusion and mild retraction of the lung lobes. The cranioventral lung lobes showed mild diffuse unstructured increase in opacity compatible with an interstitio-toalveolar lung pattern, most likely related to retraction and mild atelectasis. Radiographic findings were compatible with pericardial effusion with signs of cardiac tamponade and right-sided heart failure.