Metastatic osteosarcoma tumor thrombus in a Cavalier King Charles Spaniel presenting with dyspnea

A six-year-seven-month-old female neutered Cavalier King Charles Spaniel was referred for the investigation of progressive dyspnea and hyphema in the right eye with secondary glaucoma. Previous medical history included a high-grade soft tissue spindle cell sarcoma removed from the cranial sternal region one year before. On presentation at the referral hospital, the dog was tachypneic and dyspneic. The heart rhythm was regular and there was a soft left-sided systolic murmur. Echocardiography identified the presence of a mass significantly occluding left heart inflow, with no other lesions identified. Thoracic radiographs documented a localized alveolar pattern within the left caudal lung lobe. The size of the heart and pulmonary vessels were within normal limits, indicating a non-cardiogenic alveolar pattern. Given the clinical presentation of dyspnea and high index of suspicion of intra-cardiac neoplasia, the dog was considered to have a grave prognosis and therefore euthanized. Post-mortem gross and histopathologic examination revealed the presence of a metastatic osteosarcoma tumor thrombus in the left atrium and pulmonary vein, metastatic osteosarcoma infiltrating the myocardium, lungs, the uveal tract of the right eye, and both adrenal glands. Whitney grade II myxomatous changes were noted on the mitral and tricuspid valve leaflets. This report describes an unusual intra-cardiac tumor thrombus in a dog presenting with dyspnea. Cavalier King Charles Spaniels presenting with dyspnea often raise suspicion for myxomatous mitral valve disease. However, as demonstrated in this case, other more unusual causes of dyspnea should also be considered in the absence of classic clinical findings.