This study compared the clinical, radiographic and B-mode ultrasonographic observations in pericarditis affected cattle (n=15) and buffaloes (n=15). Anorexia was a primary complaint in buffaloes whereas brisket edema and pyrexia were in cattle. Brisket edema was observed in all cattle in comparison to only 46.67% buffaloes diagnosed with pericarditis. Jugular engorgement was found to be related to the presence of brisket edema and it was more prominent in cattle compared to buffaloes. Tachycardia was present in all the bovine except one buffalo and it was more severe in cattle. The cattle showed typical radiographic features of pericarditis such as high fluid column, non-visibility of heart, dorsal gas cap on heart, gas opacities overlapping heart, and peri-vascular edema in the caudal lung lobe as compared to buffaloes. However, the sharp metallic foreign bodies were detected in 54.54% buffaloes compared to 33.33% cattle on the chest radiographs. On B-mode ultrasonography, 60% cattle had anechoic pericardial contents compared to 46.67% in buffaloes. The remaining animals had echogenic contents. Pleural and peritoneal fluid with or without fibrin was seen in 80% of cattle compared to 40% in buffaloes. In conclusions, clinical signs of brisket edema, jugular engorgement and tachycardia are more pronounced in cattle compared to buffaloes suffering from pericarditis. The cattle show characteristic features of pericarditis, radiographically and clinically, compared to buffaloes. B-mode ultrasonography helps to confirm pericarditis even in animals without pathognomonic clinical signs.
Traumatic reticulo-pericarditis is the most commonly reported pericardial disease in cattle (Braun et al., 2007, Buczinski et al., 2010) and buffaloes (Athar et al., 2011, Kumar et al., 2012). Brisket edema is considered a pathognomonic clinical sign. Radiography is used as a surveillance tool for reticular and thoracic affections and has been used as diagnostic aid for the diagnosis of pericarditis; however it has less sensitivity to differentiate various conditions of thoracic region. Ultrasonography has been evolved as a non-invasive and definitive diagnostic tool to diagnose pericaridits and differentiate various thoracic affections in bovines (Athar et al., 2011, Kumar et al., 2012).
Unlike developed countries, Indian sub-continent has different management practices and the diseases related to foreign body are still of major concern. Indian sub-continent has more number of buffaloes compared to cattle. Since pericarditis bears a poor therapeutic outcome so it needs to be differentiated from other similar conditions. Though cattle and buffaloes appear similar in morphology, but a few studies have highlighted difference in the heart rate, respiration rate and topography of reticulum and omasum (Kuzuno and Tereda 1940, Kumar and Saini 2011, Diniz et al., 2016) or sensitivity to pain behavior associated with traumatic reticulo-peritonitis (Abdelaal et al., 2009). So there is a need to document clinical, radiographic and ultrasonographic observations in pericarditis affected cattle and buffaloes.
Materials and Methods
This study was carried out on 30 clinical cases of bovine (15 buffaloes and 15 cattle) diagnosed with pericarditis on B-mode ultrasonography. The signalment, history, clinical signs, radiographic and B-mode ultrasonographic findings of all the bovine were recorded. Presence of brisket edema was categorized as severe (extending upto mandible or submandibular region) or moderate (not extending beyond brisket). For radiography, the bovines were subjected to thoraco-abdominal radiography (which included heart, diaphragm, heart and reticular interface, and the cranial reticulum) in left to right standing or recumbent positions using ceiling mounted movable Seimen’s 800mA X-ray machine. The radiographic exposure factors used were 90-113 KVp, 53mAs and 90-110 FFD. The radiographs were processed using Kodak computerized radiography (CR) system.
For B mode ultrasonography, one square feet area from 4th to 7th ICS on both sides behind the elbow and ventrally up to sternum was prepared. A 2-5 MHz convex multi-frequency transducer on Wipro Logiq 3 expert ultrasound machine was used to scan heart as described by Braun et al. (2001). The bovine were categorized based on the nature (echogenic and anechoic) of pericardial contents seen on B mode ultrasonography. The nature and extent of fluid in the pericardium, pleura and peritoneum was recorded.
The mean and Standard deviation of all the objective parameters recorded was calculated in Microsoft excel. The subjective parameters were compared using percentage. The student t-test was applied for the comparison of objective parameters for significance at 5 and 1% level.
Signalment and Clinical Findings
The comparative signalment and clinical findings of both the species are depicted in Table 1. The primary complaint of the owner was brisket edema in cattle and anorexia in buffalo, but detailed history revealed presence of pyrexia also as a common feature. From the signalment and clinical findings it was observed that more number of cattle develop early brisket edema in pericarditis and was of greater concern to the owner. The severity of brisket edema was more in cattle compared to buffaloes and none of the cattle found positive for pericarditis was without brisket edema (Fig. 1). The presence of brisket edema was also found to be related to the presence of jugular engorgement in bovine, with all the cattle having jugular engorgement.
Table1: The signalment and the clinical findings of bovine suffering from pericarditis
|S. No.||Cattle (n=15)||Buffalo (n=15)|
|Age||6.27 ± 2.19 years (3 to 9)||5.46 ± 1.99 year (3 to 10)|
|Body weight||403.07 ± 91.78 kg
(range 300 to 593)
|376.53 ± 69.63 kg
(range 250 to 525 kg)
|Primary complaint||Brisket edema||Anorexia|
|Severe brisket edema||73.33% (n=11)||None|
|Moderate brisket edema||26.67 % (n=4)||46.67% (n=7)|
|No brisket edema||None||53.33% (n=8)|
|Jugular engorgement||100% (n=15), significant||46.67% (n=7), those having brisket edema|
|Open mouth breathing||40% (n=6)
(2 persistent, 4 on stress)
|13.4% (n=2); one died soon after scanning.
Another buffalo had difficult respiration but no brisket edema.
|Mean Heart rate (beats/min)||118.05 (Range 94-137)||88.26 (Range 38-118)|
Fig. 1: Photograph showing comparative brisket edema in cattle and buffalo on clinical presentation
Tachycardia was recorded in all except one buffalo but the range of heart rate was higher in cattle (94-137 beats/min) compared to buffalo (38-118beats/min). The body weight of healthy Indian cross bred cattle is usually less than that of Indian buffalo, but in pericarditis affected bovines, the body weight of cattle was found to be non-significantly higher than that of buffaloes.
Radiographic Findings in Pericarditis Affected Bovine
Unclear diaphragm line was recorded in all the bovine radiographed for pericarditis. The fluid line in the chest was recorded to be higher in cattle (upto 24 cm) compared to buffaloes (upto 15cm). The low fluid line was seen in cows with moderate brisket edema; however, 2 buffaloes having fluid line on radiograph had mild to moderate brisket edema while one had none. The sharp metallic foreign body was seen in more number of buffaloes compared to cattle in chest (54.54% buffaloes and 33.33% cattle) and reticular region (36.36% buffaloes and 20.00% cattle). But the typical radiographic features of not appreciable caudal cardiac silhouette, dorsal gas cap and gas opacities overlapping heart were seen in more number of cattle compared to buffaloes (Fig. 2). The comparative radiographic findings in cattle and buffaloes are depicted in Table 2.
Table 2: Radiographic findings in cattle and buffaloes
|S. No.||Radiographic features||Cattle||Cattle %||Buffaloes||Buffalo %|
|2||Unclear Diaphragmatic line||15||100||11||73.33|
|3||No of bovine with fluid line in chest||15||100||4||36.36|
|4||Column of fluid line|
|a. Upto 15cm||4||26.67||4||26.67|
|b. 18-24 cm||11||73.33||0||0|
|5||Potential metallic foreign body in chest||5||33.33||6||54.54|
|6||Potential metallic foreign body in reticular region||3||20.0||4||36.36|
|7||Potential metallic foreign body in chest and reticular region||2||13.33||2||18.18|
|8||No appreciable caudal cardiac silhouette||9||60||4||36.36|
|9||Enlarged cardiac silhouette||6||40||6||54.54|
|10||Heart not seen due to fluid in chest||9||60||0||0|
|11||Dorsal gas cap on heart||6||40||1||9.09|
|12||Gas opacities overlapping heart||15||100||3||27.27|
Fig. 2: Standing lateral radiograph of chest showing fluid line (white line) with enlarged cardiac silhouette having gas cap at the dorsum (white hollow star). A potential metallic foreign body is also visible overlapping the heart (white arrow).
B-Mode Ultrasound Findings in Pericarditis Affected Bovine
The comparative B mode ultrasonographic findings in cattle and buffaloes are depicted in Table 3. All the buffaloes without brisket edema had anechoic pericardial contents, except one. Lowest pericardial column was observed in buffalo having echogenic pericardial contents, otherwise no specific pattern was noticed between extent and nature of pericardial contents.
Table 3: B mode ultrasound findings in cattle and buffaloes
|S. No.||Parameters||Cattle||Cattle %||Buffaloes||Buffalo %|
|2||Anechoic pericardial contents||9||60||7||46.67|
|3||Echogenic pericardial contents||6||40||8||53.33|
|4||Mean width of pericardial contents (n=15)||7.42 ±3.90
|Width of anechoic pericardial contents||3.5-12cm
|Width of echogenic pericardial contents||3.3-13cm
|5||Marked increase in pleural fluid with or without fibrin||12||80||5||33.33|
|6||Marked increase in peritoneal fluid with or without fibrin||12||80||6||40|
In cattle 3.3-7cm column of pericardial contents had Mean Heart Rate of 118.58 ± 14.94, while those having pericardial contents column of 8-13 cm had heart rate of 117.27 ± 9.62 beats/min. Thus, no significant difference was recorded in the heart rate of cattle based on the increase in the column of pericardial contents. It was recorded that more number of cattle had anechoic pericardial contents (Fig. 3) compared to buffalo while more number of buffalo had echogenic contents (Fig. 4).
Fig.3: Ultrasonogram showing anechoic pericardial contents (white line) from Rt (right) 5th ICS (intercostal space).
Fig.4: Ultrasonogram showing uniform echogenic pericardial contents (white line)
Bovine suffering from pericarditis show variable clinical signs (Radostits et al., 2007, Braun 2009, Buczinski 2010, Imran et al et al., 2011, Mohamed 2010, Kumar et al., 2012). Sub-mandibular and brisket edema, jugular distension and abnormal heart sounds are characteristic features of pericarditis in cattle (Radostits et al., 2007, Braun 2009). In this study all the cattle had brisket edema but it was present only in 46.67% buffaloes. Even the edema was not severe enough to extend upto the submandibular region in buffaloes as it was recorded in cattle (73.33%). This difference in the pattern (presence and severity) of brisket edema, which is considered a pathognomonic clinical sign in cattle, might be related to species difference as well. It may be hypothesized that since the skin of cow is thin and elastic compared to buffaloes, the sub-cutaneous changes are more pronounced in cattle. Previous literature also reports the presence of brisket edema only in 73% (Mohamed, 2010) and 69.23% (Kumar et al., 2012) buffaloes diagnosed with the aid of ultrasonography. It has been reported that compared with cattle, submandibular and brisket edema, jugular distension and abnormal heart sounds were characteristic signs for the advanced stages of traumatic pericarditis in buffaloes (Mohamed 2010, Kumar et al., 2012). The lack of typical clinical signs of pericarditis in buffaloes leads to difficult early diagnosis of the disease compared to cattle. Brisket edema in cases of pericarditis in cattle is also reported to be absent, if a foreign body tract is draining into the reticulum (Braun, 2009). A relationship of cardiac tamponade with the severity of brisket edema and jugular engorgement has also been reported in cattle (Jesty et al., 2005, Braun et al., 2007). Abdelaal et al. (2009) stated that signs of pain and systemic reactions were more commonly observed in pericarditis affected cattle compared to that in buffaloes. Tachycardia has been reported as the primary clinical sign in cardiac disease and its severity is reported to be dependent on the degree of compression of heart by pericardial effusions (Jesty et al., 2005), however, no such relation was recorded in this study.
Radiography is the primary imaging tool to diagnose chest or reticular diseases in bovines. Caudal cardiac silhouette and ventral diaphragm may be completely obliterated, non-specifically, in cases of pericarditis because of fibro-purulent lesions in the chest region and gas opacity in the caudo-ventral thorax may be indicative of bacterial infection (Braun, 2009). It was observed that in 54.54% (n=6) buffaloes, enlarged dorso-caudal cardiac silhouette was appreciated on radiographs as fluid opacity in chest was less in buffaloes compared to cattle. Presence of gas opacities, in the heart region and/or linear metallic foreign body cranial to the diaphragm, might also make a tentative diagnosis for pericarditis, though there is a need to differentiate it from reticular diaphragmatic hernia, particularly in buffaloes. However, absence of foreign body in the chest region does not rule out pericarditis, as thick radio-dense adhesions of fibrino-purulent material may obscure foreign bodies from view or the foreign body might have migrated back into the reticulum (Braun, 2009). Previous study by Kumar et al. (2012) reported that more than half of the bovine animals suffering from pericarditis revealed metallic foreign bodies on the chest radiograph, which corroborate to the findings of this study. Though, in cattle, only 33% radiographs had potential metallic foreign bodies in the chest region, which might be related to presence of more fluid opacity in the chest of pericarditis affected cattle.
Earlier studies conclude that confirmatory diagnosis of pericarditis can be made using B-mode ultrasonography at the level of elbow in 4-5th ICS from both right and left sides (Braun et al., 2001, Kumar et al., 2012). Pericardial effusions may vary from anechoic to echogenic accompanied with or without fibrin (Mohamed 2010, Imran et al., 2011, Kumar et al., 2012). In this study, it was found that in cattle the width of fluid column in the pericardial sac, irrespective of its nature, is responsible for the development of brisket edema as it puts pressure on the major blood vessels. Presence of pleural fluid displacing the lungs medially and moderate to severe peritoneal fluid (with or without fibrin) has also been reported in cattle (Braun 2009, Kumar et al., 2012). Fluid retention within the body might be the cause for significantly higher body weight in pericarditis affected cattle. But, comparatively less brisket edema and low fluid retention in the body cavities might be the reason for significantly reduced body weight in pericarditis affected buffaloes of this study.
Pericarditis affected cattle depict characteristic clinical and radiographic features as compared to buffaloes which highlights species differences. The B-mode ultrasonography aids in the diagnosis of pericarditis in the absence of typical clinical signs in bovines.