Heart v. Lung v. ?

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Heart v. Lung v. ?

 
 
  • 12 year old MN DSH, bottle raised from kitten, indoor only
  • Aggressive
  • Inappetant and lethargic x 1 day

    •  
     
    • 12 year old MN DSH, bottle raised from kitten, indoor only
    • Aggressive
    • Inappetant and lethargic x 1 day
    • Coughing episode 2 weeks ago with tachypnea, resolved without treatment
    • 2 weeks ago, stressed due to visiting dog
    • Owner notes tachypnea
    • Exam is NSF except tachypnea without dyspnea, no abdominal component, normal lung sounds, no heart murmur, pulses synchronous, tachycardic but cat is worked up
    • Rads are attached
    • Crappy echo images attached (machine didn’t save what I thought it was saving). You’ll have to trust me that the LA wasn’t enlarged.
    • Blood work shows mild anemia (28%), thrombocytopenia (75K), chem normal, unable to get UA
    • FeLV/FIV negative in house snap
    • Brief abd u/s NSF

    Looking for thoughts on these images. Component of HCM? Pneumonia?

    Thanks, Liz

     

Comments

rlobetti
February 17, 2014 at 12:31 pm -

With  io murmur, normal La,

With  io murmur, normal La, and synchronous pulses heart disease is unlikley. Anemia not severe enough to cause a problem unless it has been peracute in onset.

Do you have a VD or DV view of the thorax as this would make for a better intrepretation of the lungs. Consider asthma and possibly hyperthryroidism.

rlobetti
February 17, 2014 at 12:31 pm -

With  io murmur, normal La,

With  io murmur, normal La, and synchronous pulses heart disease is unlikley. Anemia not severe enough to cause a problem unless it has been peracute in onset.

Do you have a VD or DV view of the thorax as this would make for a better intrepretation of the lungs. Consider asthma and possibly hyperthryroidism.

EL
February 17, 2014 at 12:34 pm -

I agree with remo. Coughing

I agree with remo. Coughing cat is asthma/bronchial or hw not typically cardiac. Plus the pulmonary vasculature is fine and the cvc is tapering nicely so no vascular overload.

EL
February 17, 2014 at 12:34 pm -

I agree with remo. Coughing

I agree with remo. Coughing cat is asthma/bronchial or hw not typically cardiac. Plus the pulmonary vasculature is fine and the cvc is tapering nicely so no vascular overload.

Liz
February 17, 2014 at 3:36 pm -

Weird…two of these images

Weird…two of these images didn’t post. Clarify: there was one episode of coughing two weeks ago. Cat hasn’t coughed before or since. Cat is just tachypneic now. Thoughts on caudal lung field in lateral rad? Air bronchograms?

 

Liz
February 17, 2014 at 3:36 pm -

Weird…two of these images

Weird…two of these images didn’t post. Clarify: there was one episode of coughing two weeks ago. Cat hasn’t coughed before or since. Cat is just tachypneic now. Thoughts on caudal lung field in lateral rad? Air bronchograms?

 

Liz
February 17, 2014 at 3:54 pm -

Here’s the VD

Here’s the VD Remo.

Unfortunately, I’m at home, and the echo images are at the EC, so I can’t repost those. 

Liz
February 17, 2014 at 3:54 pm -

Here’s the VD

Here’s the VD Remo.

Unfortunately, I’m at home, and the echo images are at the EC, so I can’t repost those. 

rlobetti
February 17, 2014 at 7:29 pm -

Thanks for the VD image –

Thanks for the VD image – still need to chase asthma/hyperthryoidism.

Liz
February 17, 2014 at 9:05 pm -

Remo, you think those air

Remo, you think those air bronchograms are just asthma? 

rlobetti
February 17, 2014 at 7:29 pm -

Thanks for the VD image –

Thanks for the VD image – still need to chase asthma/hyperthryoidism.

Liz
February 17, 2014 at 9:05 pm -

Remo, you think those air

Remo, you think those air bronchograms are just asthma? 

EL
February 17, 2014 at 9:08 pm -

asthma and secondary

asthma and secondary pneumonitis/bronchitis. You may get comet tails on intercostal approaches to the radiodensities but doubt you will have anythigneasy enough to sample. In the minor potential for very early mets you could scan the abdomen fully its a 12 year old and if no hx of asthma they usually dont get asthma all of a sudden at 12. Watch yourself on brief abdomens… a scenario I saw on second opinion a while back similar chest…. right adrenal tumor but was only a cm large that could be missed on a “brief abdomen.” Regardless of economics if you put a probe on a cavity do the whole thing. Experience talking here…

EL
February 17, 2014 at 9:08 pm -

asthma and secondary

asthma and secondary pneumonitis/bronchitis. You may get comet tails on intercostal approaches to the radiodensities but doubt you will have anythigneasy enough to sample. In the minor potential for very early mets you could scan the abdomen fully its a 12 year old and if no hx of asthma they usually dont get asthma all of a sudden at 12. Watch yourself on brief abdomens… a scenario I saw on second opinion a while back similar chest…. right adrenal tumor but was only a cm large that could be missed on a “brief abdomen.” Regardless of economics if you put a probe on a cavity do the whole thing. Experience talking here…

Liz
February 17, 2014 at 9:58 pm -

FAST u/s in the Er setting is

FAST u/s in the Er setting is a different animal.  I appreciate the warning but the owners are well counseled here and charged only 90 bucks looking for large left atrium and free fluid.

Liz
February 17, 2014 at 9:58 pm -

FAST u/s in the Er setting is

FAST u/s in the Er setting is a different animal.  I appreciate the warning but the owners are well counseled here and charged only 90 bucks looking for large left atrium and free fluid.

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