Cat with right sided discharge

Re: Cat with right sided discharge

Evelyn Barbour-Hill — Thu, 26 Jul 2012 01:16:49 GMT

There might be someone near you who can do endoscopy and digital Xrays.

[quote user="claire godfrey"]Slightly frustrating as case seen by colleagues and randomly booked in on ops day, makes it difficult to follow properly![/quote]

I'm sure it makes it difficult. I could never work like that.

Re: Cat with right sided discharge

Claire Godfrey — Wed, 25 Jul 2012 19:49:21 GMT

Thanks all,

Will remember open mouth next time!! Slightly frustrating as case seen by colleagues and randomly booked in on ops day, makes it difficult to follow properly!

Xrays are a bit clearer in real life, not sure if it is the camera or my technique at taking them!

No small endoscope, will check with owner and if not clearing/getting worse will get back in for a nasal flush!

Thanks lots

Re: Cat with right sided discharge

Mark Holmes — Wed, 25 Jul 2012 16:07:46 GMT

I find cats noses best xrayed with an open mouth and a 5% beam angulation. Put the cat on its back and tie the maxilla to the table or plate so it remains horizontal as you open the mouth and tie that open. A slight beam angle allows you to get a good image and includes the caudal nasal passages which is difficult with an intraoral plate.

Re: Cat with right sided discharge

Evelyn Barbour-Hill — Wed, 25 Jul 2012 15:02:47 GMT

No evidence of middle ear disease on these, but the radiographs are not absolutely clear. On the DV the right middle ear is not quite the same as the left but that may just be because of the slight angulation.

I think the finger-like projection is the retroglenoid process, R pretty well superimposed on L.

There seems possibly to be greater opacity, without destruction, in the R nasal passages but it's hard to judge on these views.

Frontal sinus shows nicely on the lateral.

Haematology and selected serology might be useful, probably worth doing.

I'd be wanting (no criticism intended) more "refined' radiographs, and most definitely, indispensably, an intra-oral view of the nasal passages (or if you can't get that, the nearest equivalent achievable by an open-mouth view) exposed for detail. Also important, retrograde endoscopy to view the choanae and nasopharynx. Also orthograde endoscopy up the nostrils as far as possible (which is further than you might think). Also copious flushing through of the nasal passages (have a good throat pack in place!) with a Jackson catheter.......... this could produce diagnostic material, and may sometimes, embarrassingly, be curative!

If all that's out of the question right now and the owner just wants "something done", then a longish course of amoxy/clav per os. No corticosteroid (unless you really have to). If the eye needs topical treatment, then Fucithalmic or Clinagel or Tiacil or something, (not Maxitrol!). If you need to treat external ear, your usual favourite lotion.

Such cases can be frustratingly hard to get to the bottom of. Neoplasia has to be on your list. The blood in the discharge is worrying but not diagnostic in any way.

Re: Cat with right sided discharge

David Mills — Wed, 25 Jul 2012 15:01:26 GMT

Nose flush required I think. There's a great article on the technique to maximise results in the new "secondopinionvet" journal launched this month. Strange name, but it's launched this month and is free to practices in both hard and electronic format:

http://secondopinionvet.co.uk/

You need to register to access it (and also to sign up for hard copies).

Re: Cat with right sided discharge

Kate Richardson — Wed, 25 Jul 2012 14:51:28 GMT

Hi Claire,

Unfortunataley I can't make out a lot from the xrays. Bullaes look clear on lateral although cannot be certain as superimposed on each other. Unfortuanately I think you will need to go back and do some open mouth or intraoral pics to visualise the nasal cavity properly plus some bullae xrays. I would also do a good nasal flush whilst under GA as you may dislodge a FB. Obviously endoscopy/rhinoscopy would be lovely if you have a small anough scope and the expertise, but may not be available to you?

I would be thinking possible FB such as blade of grass, but also mass lesion eg lymphoma if it is unilateral, as sounds as though you have ruled out a polyp.

You could also assess air flow through each nostril using a cold microscope slide and blocking each nostril off in turn to assess air flow which may be helpful. Sometimes even a firm swabbing up the affected nostril and smearing on a slide may yield some useful cells.

Gut feeling though- mass lesion

Re: Cat with right sided discharge

Mark Hedberg — Wed, 25 Jul 2012 14:29:38 GMT

An open mouth picture would be a bit more useful; the mandible's superimposed over the nasal cavity.