Cranial Vena Cava Syndrome Isn’t that the thing with heartworm disease???
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Cranial Vena Cava SyndromeIsn’t that the thing with heartworm disease???
Trisha Oura, DVMMarch 1, 2010
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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:
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-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
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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
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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
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CrVCS
Reported causes: Thymoma (canine)Mediastinal lymphomaFungal (blastomycosis)CarcinomaAortic body tumorsPacemaker and IV catheter associated thrombi
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CrVCS
Ddx: Angioedema Snake bite Trauma Salivary mucocele Abscess/cellulitis Hypoalbuminemia/vasculitis (usually
generalized)Diagnostics: Image! Image! Image! and aspirate…
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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
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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
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Pacemaker induced caval thrombus and stricture
formation
Case 1: acute onset clinical signsCase 2: asymptomatic, incidental
Good outcome > 6 months!
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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)
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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.