Case Study

RAD – Consolidation of the left cranial lung lobe with bilateral pleural effusion; bronchial pattern; splenomegaly in a 14 year old DSH cat

The patient is a 3-14 year old MN DSH cat presented for a second opinion; history of decreased urination, activity and appetite.

Physical exam – QAR, murmur 2/6, lungs -wnl; abdomen distended and doughy CBC: RBC 3.3, HCT 5.7, Hemo 5.7,platelets 192 (all decreased) – regenerative anemia.

Chemistry: TP 15.9 (H), Albumin 1.8 (Low), BUN 91(H), Creatinine 5.9 (H), Phos 9.8 (H), Ca 7.2 (L), Na 144 (L), Chol 50 (L), Trigly 11(L); Amylase 5388 (H) Urine Analysis: USG 1.1010, pH 6.5, Protein 2+

The patient is a 3-14 year old MN DSH cat presented for a second opinion; history of decreased urination, activity and appetite.

Physical exam – QAR, murmur 2/6, lungs -wnl; abdomen distended and doughy CBC: RBC 3.3, HCT 5.7, Hemo 5.7,platelets 192 (all decreased) – regenerative anemia.

DX

Consolidation of the left cranial lung lobe with mild pleural effusion; moderate bronchial pattern; possible splenomegaly; possible cholangiohepatitis/cystitis

Image Interpretation

RADs- lateral and VD thorax, lateral abdomen – Radiographic findings:
Osseous structures:
Overall mild degenerative changes are associated with the axial sceleton. An incidental
isolated ossicle is seen at one of the shoulder joints.
No aggressive osteolytic lesions are evident on the radiographs.
Intrathoracic structures:
The degree of inspiration is fair.
The cranial compartment of the left cranial lung lobe shows a lobar alveolar
consolidation. The lung volume is maintained. The cranial lobes present mild
retraction from the parietal pleural surface. A mild amount pleural fluid is seen in the
region of the cranial and middle lung lobes. The remainder of the lung reveals a
moderate bronchial pattern within the caudodorsal region.
The trachea and mediastinum are within normal limits. The carina is its anticipated position, the lobar bronchi are normal for course. There is no mediastinal midline shift.
The cardiac silhouette is within normal limits for size and shape. The major vessels
and pulmonary vasculature are within normal limits. There is no sign of vascular
congestion.

Intraabdominal structures:
The serosal detail is within normal limits. The liver is within normal limits. A
moderate amount of mineral opaque material is seen associated with the region of the
gallbladder. The splenic head reveals mild rounding and questionable enlargement.
The kidneys are normal for size and shape. A mild amount of mineral opaque material
is seen in the region of both renal pelvices. The urinary bladder is within normal limits.
The stomach contains a mild amount of gas. The small intestinal loops are non dilated
and of even diameter. The colon contains a moderate amount of fecal matter and gas.

Outcome

The radiographs are negative for aggressive osteolytic bone lesions.
Solid consolidation of the cranial compartment of the left cranial lung lobe with mild
bilateral pleural effusion is noted – the two main differential diagnoses here are lobar
neoplasia with pleural carcinomatosis versus lobar pneumonia with reactive/septic
pleuritis. The findings do not support the presence of a lobar torsion or lung atelectasis.
Consider ultrasound guided sampling for further definition. This should be enforced
with the patient sedated or under general anesthesia. The patient has to be monitored
for develeopment of pneumothorax after the procedure. The risk of development of a
relevant pneumothorax iss lightly higher in cats as compared with dogs in my
experience. But the diagnostic accuracy of fine needle aspiration oft he lung is
reasonable to justify the procedure and superior to bronchoalveolar lavage to rule
out/in neoplastic lung infiltrates.
Moderate bronchial pattern – incidental age related versus allergic feline lower airway
disease. Likely unrelated to the current clinical presentation.
Possible splenomegaly – requires ultrasonographic verification depending on the
clinicla indication.
Gallbladder sand – usually not significant but may be associated with chronic
cholangiohepatitis/-cystitis and obstructive biliary disease on occassion.
Renal sand/calculi – likely non obstructive and incidental at this point.
Overall a full abdominal ultrasound with non cardiac thoracic ultrasound and possible
sampling of the left cranial lung would certainly make sense to further define the
abdominal changes and evaluate for possible structural changes of the kidneys that
may not be apparent radiographically.