10-month-old male DSH was presented with the history of on and off dyspnoea of about 2-month duration. The cat is eating well and active. On physical examination, mild dyspnoea was noticed, and generalised edema of the skin was noticed. The edema in the thoracic area was so severe tha the skin was hanging. X-Ray showed bilateral pleural effusion and midl effacement of the intestinal serosa. Blood work was done and it was normal. Abdominal US showed perisplenic anechoci fluid accumulation and very prominent pylorus, probably due to the edema. There was hypoechoic fluid in the chest with some echogenic debris swirling in that. It was drained and it was very mildly straw-coloured, mostly it looked like water (pic attached). The TS concentration of the fluid was about 2g/dL. The cat was faintly positive on the FIP test. BUt the Albumin to globulin ratio was 1.57. I did the cardiac US. LA: Ao ratio is normal. The right atrium is not enlarged. The cyto of the fluid doesn’t show sepsis. So from here
1) CHF
2) Righ-sided heart failure
3) Chylous effusion
4) Pyothorax
5) FIP has been ruled out
has been ruled out. The cat is passing some mucoid diarrhea also. Again the albumin is within the normal limits so can’t be PLE – also the cat is too young for PLE
Don’t know now what is the cause of the pleural and peritioneal effusion and massive subcut edema. Noticed mild hepatic congestion but not convinced that this is the cause of the peritoneal effusion
Comments
The US was done in under GA.
The US was done in under GA. I gave alfaxalone but the cat remained aggressive and then there was no other option than doing it under GA
Sorry for rushing. The cat
Sorry for rushing. The cat seems to be detriorating and looking quite letgargic, though breathing is normal
Most likley dealing with CHF
Most likley dealing with CHF as there seems to be dilation of the ventricles. Any murmurs present?
Color-flow may also help.
So the mild ventricular
So the mild ventricular dilation could be because of that?
There is no heart murmur and
There is no heart murmur and there is a tiny regurgitation jet for both atria. Atria don’t seem highly enlarged. Please note that the echo was done under GA with medetomidine as the cat was very aggressive. I have uploaded the color flow videos for the mitral and the tricuspid valve. Can you please have a look
This is more of a
This is more of a telemedicine case than a forum post but here goes:
In your 4 chamber the left atrium is normal size about 1.3 cm and la/ao is normal so you can count out left sided failure. Therefore the pleural effusion is non cardiogenic as lefts sided wedge pressur ewould have to be excessive to cause cardiogenic pleural effusion and since the lA is normal then count the left heart out here. The right heart is enlarged but right chf doesnt cause pleural effusion as well but thoracic disease that cause pleural effusion created increased pulmonary pressures and hence right heart enlargement, pulm hypertension and potential failure wiht cvc dilation and ascites. The cvc is big and there is ascites so right chf is possible cause. Need TR velocities for that and would expect > 3.5 m/sec or so but also obstructive caudal thoracic disease, also potentially the cause of pleural effusion, can also cause passive congestion CVC and ascites. So I would tap the pleural fluid and cytospin as well as drain the thorax and CT it. Palliative tx with lasix for now oxygen and whatever else needed clinically and ride out the effusion cytology and CT. despite the other testing i would still run an fip titer on the pleural effusion. FIP makes the most sense here in this age cat.
For your use the uploader for
For your use the uploader for telemed cases is located on the sonopath.com home page mid left for elaborate cases such as this. Forum is mostly for 3-4 images/videos and quick bullets to start discussions. Regardless its a great post:)
Thanks Erric for the reply. I
Thanks Erric for the reply. I have started the treatment for FIP with the FIP injections available on curefip and will see how it goes
I wanted to give an update on
I wanted to give an update on this case. It is progressing in a weird way. The pleural effusion sample was also sent for FIP and it came back negative also. The cat was administered GS injections for FIP for 2 weeks and every week it needed thoracocentesis. Prednisolone was started and it reduced subcu edema and the ascites also. The cat was sent for CT and still no underlying cause for the pleural effusion cpuld be identified. The only which seems to work for this cat is steroids, which reduce the subcut edema and the rate of refilling of the thoracic cavity – fluid still comes back in the chest. Probably and idiopathic case of pleural effusion or some unidentifiable disease!