Hello
I was hoping for some guidance on Emma a 14 year old FS DSH that has been diagnosed with hyperthyroidism but is apparently dispalying all the symptoms of a “Thyroid Storm”. Radiographs yesterday showed some pleural effusion and pulmonary edema with what appeared to be a small heart.
Hello
I was hoping for some guidance on Emma a 14 year old FS DSH that has been diagnosed with hyperthyroidism but is apparently dispalying all the symptoms of a “Thyroid Storm”. Radiographs yesterday showed some pleural effusion and pulmonary edema with what appeared to be a small heart.
Today the thoracic US showed what appeared to be a small heart with a moderate amount of pleural fluid. The heart almost appeared as it does when there is PCE present although I did not see any PCE. Cranial to the base of the heart there were 2 elongate circular structures that I do not typically see cranial to the Aorta. They do appear to have blood flow but are almost twice the diameter of the aorta. I first thought it was pleural fluid but Doppler showed blood flow. So I am wondering it is a possible aneurysm or a normal structure.
The cat was fractious and the images we got were the best that we could get. The first is to show the heart. The next few are fanning images to try and capture the heart and areas of concern in one clip.
Any advice on what I am seeing would be greatly appreciated and if anyone knows the pathology of heart failure in a thyroid storm that would be great. Literature indicates that they do not fully understand why cats with a thyroid storm suffer heart failure.
Thanks. Brent.
Comments
I forgot to mention that on
I forgot to mention that on the second image in the Anechoic structure there is a strand of hyperechoic material (possibly) fat visible inside the lumen. So my thought was pleural fluid again but it is completely compartmentalized and it did (according) to my doppler show low blood flow. Thanks again. Brent.
I have seen these structures
I have seen these structures you refer to in the cranial chest of old cats when scaninng the thorax and have assumed its just the aorta as it exits the heart that gets big and curvy with age. If no colour flow, they can also get cysts in this region.
Thanks for the post. Its a
Thanks for the post. Its a bit of a strange case. Unfortunately the cat was euthanized. Owner declined a necropsy. I tried to trace the aorta and it appeared to course ventral to these structures but couldn’t be certain. I will have to go back to the xrays and concentrate on that area to see if there is evidence of cysts.
Do you agree the heart looks abnormal as if hypovolemic?
Thanks Brent
The presence of pleural or PC
The presence of pleural or PC effusion in light of an la/ao of < 1.4 (about 1:1 in your views) means that the effusion is not cardiogenic. So I do 2 things immediately when i see that. 1) I look for primary neoplasia in the abdomen as mets to chest and pleural effusion is the most common scenario in these cases then more innocuous things such as pleuritis, PTE, idiopathic chyle and such can also occur but is lower on the list. 2) I sample the effusion and cytospin immediately making slides to look for exfoliating neoplasia sucha as carcinomatosis often from lung carcinoma which is common in older cats.
Thank you! Great advice
Thank you! Great advice moving forward!
Brent