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Patient Information

13 Years
Female, Spayed


Long axis 5-chamber and heart based views reveal sever pericardial effusion with essentially normal internal chamber volumes and an la/ao ratio of 1.4.
A mildly echogenic tissue density structure is present attached to the pericardium measuring 2.56 x 0.77 cm.


“When in doubt, put a needle in it…..carefully". Cardiomegaly in a cat doesn’t mean just heart failure or neoplasia.

Presenting radiographic history: “Wow that's the biggest cat heart I have ever seen.” The diagnosis was just a probe and a needle away. Case managed by Dr. Christine Stockmal at American AH, Randolph, New Jersey . Imaging by Dr. Eric Lindquist of & New Jersey Mobile Associates.

Sonogram: Jasmine the cardiomegaly cat

History: This 13- year-old DSH FS cat presented for lethargy, anorexia and tachypnea. The patient has a history of diabetes, labored breathing, weakness in the hind limbs, anemia. Hematocrit 25.4, BUN 61, urine specific gravity 1.022, WBC 35000 with monocytosis. The radiographs revealed severe cardiomegaly.

Clinical Differential Diagnosis

(Remo Lobetti PhD, DECVIM): Cardiac disease - dilated cardiomyopathy, hypertrophic cardiomyopathy, pericardial effusion Renal disease - chronic kidney disease, pyelonephritis, neoplasia, renoliths Pulmonary thrombo-embolic disease.

Sonographic Differential Diagnosis

(Lindquist DMV, DABVP): Pericarditis, neoplasia, vasculitis, F.I.P.


30 cc of hemorrhagic effusion was removed for the pericardium via US-guided pericardiocentesis.


Cardiac fluid analysis revealed intracellular and extracellular cocci bacteria forming chains. Culture revealed Beta-hemolytic Streptococcus 3+. Cytological Dx: Septic suppurative pericarditis.


**Special thanks to Dr. Christine Stockmal & staff at American Animal Hospital, Randolph, New Jersey, USA for the clinical management of this case.


An efficiency clip of the 5-chamber long axis view allows for further evaluation of the pericardial space and the tissue structure that appears attached to the epicardium as well. Again, differentiation between clot and mass cannot be made.
US-guided pericardiocentesis (22-gauge heparinized IV catheter seen in the 1 o’clock position) was performed to relieve any tamponade effect on the heart, perform fluid and cytology analysis as well as culture. 30 cc of hemorrhagic effusion was obtained and assumed to be the cause of the anemia.