Non Cardiogenic Pleural Effusion in a 1 year old Cat Presenting for Dyspnea

Case Study

Non Cardiogenic Pleural Effusion in a 1 year old Cat Presenting for Dyspnea

A 1-year-old male DSH was presented for neutering but developed peracute onset dyspnea and cyanosis. Proteinuria was present. Toxoplasma serology was negative. Bloodwork was unremarkable. Mild respiratory distress and tachypnea were present. No heart murmurs were noted.

A 1-year-old male DSH was presented for neutering but developed peracute onset dyspnea and cyanosis. Proteinuria was present. Toxoplasma serology was negative. Bloodwork was unremarkable. Mild respiratory distress and tachypnea were present. No heart murmurs were noted.

Sonographic Differential Diagnosis

Non cardiogenic pleural effusion. Hemothorax with granulomatous type lesions in the cranial mediastinum. Minor pericardial effusion. FIP is strongly suspected in this patient. Metastatic neoplasia is also possible.

Image Interpretation

The echocardiogram in this patient demonstrated normal left atrial size and structure with no evidence of “smoke” or thrombi. The cranial and caudal mitral valve leaflets presented normal linear structure, extension in systole, and union in diastole. No significant dystrophic or vegetative changes were noted. The left ventricle presented normal free wall and septal thicknesses with linear contour. The chamber was neither dilated nor restricted. No septal deviation was noted neither into the left ventricular outflow tract, nor dilation into the right ventricle. The myocardium presented normal echogenicity without evidence of significant fibrotic or ischemic disease. Contractility of the ventricular walls was adequate and in normal range for this patient evidenced by the fractional shortening measurement. The left ventricular outflow tract demonstrated normal laminar flow without evidence of hemodynamically significant insufficiency or excessive outflow velocity. Subjective assessment of the right atrium and auricle revealed normal size, structure and content. No evidence of masses was noted. Tricuspid valvular assessment demonstrated linear morphology. The right ventricle was of normal size (1/3 diameter of LV), chordae structure, myocardial echogenicity and thickness. No evidence of dilation nor restriction was noted. Pulmonic tract assessment revealed normal valve structure, laminar flow, and diameter (approx.1:1 pa/ao ratio. A minor amount of pericardial effusion was noted. A moderate amount of pleural effusion was noted in the caudal thorax with echogenic fluid. Pleurocentesis was performed and found to be frank blood. Cranial mediastinal tissue thickening was noted in this patient. This is consistent with granulomatous disease such as FIP or neoplasia. Chronic infectious agents are also possible, yet less likely. The diaphragm was visualized without interruption.

DX

Non cardiogenic pleural effusion

Outcome

Two weeks later bloodwork was WNL and anemia was resolved.

Clinical Differential Diagnosis

Cardiac – cardiomyopathy (dilated/restrictive/hypertrophic), myocarditis.
Pulmonary – edema, lobe torsion, thrombo-embolism.
Pleural space – effusion, diaphragmatic hernia, penumo-thorax.

Sampling

Cytology of the lung was non diagnostic. Cytology of the spleen revealed reactive hypersplenism. Cytology of the left kidney revealed renal epithelial hyperplasia.

Patient Information

Patient Name : Jax H
Gender : Male, Intact
Species : Feline
Type of Imaging : Ultrasound
Status : Complete
Liz Wuz Here : Yes
Code : 15-00146 Jax H

Clinical Signs

  • Cyanosis
  • Dyspnea

Exam Finding

  • Lethargy
  • Panting
  • Respiratory Distress
  • Tachypnea
  • Weakness

Clinical Signs

  • Cyanosis
  • Dyspnea

Urinalysi

  • Protein Present
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