Budd–Chiari‐like syndrome in a dog with a chondrosarcoma of the thoracic wall

Abstract

Objective: To describe a dog with Budd–Chiari‐like syndrome secondary to caudal vena cava compression from a thoracic wall chondrosarcoma. Case summary: A 9‐year‐old spayed female Shetland Sheepdog cross with a recent history of non‐productive cough developed severe abdominal distension and dyspnea. Marked ascites and enlarged hepatic veins were identified with ultrasonography. At surgery, a right thoracic wall mass was found to be compressing the caudal vena cava. Fluid analysis of the ascites revealed a modified transudate with elevated protein concentration, consistent with Budd–Chiari‐like syndrome. Clinical signs resolved following thoracotomy and complete resection of the mass. New or unique information provided: Obstruction of venous blood flow can result from compression exerted by a space‐occupying thoracic wall mass on the caudal vena cava. Clinical resolution can be achieved with return of adequate venous circulation by removal of the mass and alleviation of the external pressure.

Portal Hypertension: Pathophysiology, Diagnosis, and Treatment

“…When obstruction occurs in the hepatic venous outflow in the caudal vena cava or larger extrahepatic hepatic veins, it is known as Budd‐Chiari syndrome 74 . Budd‐Chiari syndrome most often is because of intraluminal (tumor, thrombosis, congenital fibrous webs) or extraluminal (tumor) compression 44,82–89 …”

A Review of the Pathophysiology, Classification, and Analysis of Canine and Feline Cavitary Effusions

“…40 The immature or atypical lymphoid cells are usually larger than neutrophils, have a moderate amount of clear to blue cytoplasm, variably shaped nuclei with prominent and often bizarre, angular nucleoli, and finely stippled nuclear chromatin. 2,13 Clinical pathologists can often diagnose lymphosarcoma based on cellular morphology when it is the underlying cause of an effusion, but additional diagnostic tests are now available for effusions whose definitive diagnosis is more elusive, such as PCR for analysis of antigen receptor rearrangements (PARR) and flow cytometry.…”

“…5 Proteinrich transudates result from increased hydrostatic pressure within the postsinusoidal vessels of the liver secondary to congestive heart failure or potentially from mass lesions obstructing blood flow from the hepatic vein or caudal vena cava into the right side of the heart (i.e., a Budd-Chiari-like syndrome). 7,13 The increase in hydrostatic pressure within the vessels of the liver causes a protein-rich fluid to leach out of the liver into the abdominal cavity. Because cell membrane permeability does not change, cells do not accumulate in the effusion.…”

Resolution of Budd‐Chiari syndrome secondary to needle foreign body migration in a dog: treatment with surgery and intravascular stenting

“…Additionally, this region of the liver is especially prone to transudation of protein, as the hepatic sinusoidal vessels have larger fenestrations than other capillary beds, allowing for leakage of larger molecules such as proteins. Moreover, volume overload of the thoracic duct can lead to protein-rich lymph leakage from the hepatic perisinusoidal space and through the liver capsule itself (Johnston 1987a and b, Whelan and others 2007). …”

“…Although elevated D-dimer concentrations have been noted commonly and may be associated with a hypercoagulable state in dogs, neoplasia was most often implicated as the primary instigator of thrombosis in several studies (Kyles and others 2003, Rollois and others 2003, Saridomichelakis and others 2004, Whelan and others 2007, Schlicksup and others 2009). Indeed, neoplastic causes are consistently more highly represented than non-neoplastic causes of both BCS and BCLS cases reported in the veterinary literature.…”