Dyspnoic Cat

Re: Dyspnoic Cat

Martin Atkinson — Thu, 03 Oct 2013 16:06:59 GMT

[quote user="John Flynn"]

There's an earlier post by Frances Barr if you scroll back through the pages.

(Oh, and it looks like Mike Martin, as in the Mike Martin, has clicked to suggest this is the answer also)

[/quote] Hold on a minute, Frances agreed with me before Mike agreed with her!! Who needs an expert?

Re: Dyspnoic Cat

John Flynn — Thu, 03 Oct 2013 01:30:27 GMT

[quote user="vetmeddeni"]What is the solution please??? Cert and diploma holders[/quote]

There's an earlier post by Frances Barr if you scroll back through the pages.

Yes the Frances Barr as in editor of some of BSAVA imaging manuals.

(Oh, and it looks like Mike Martin, as in the Mike Martin, has clicked to suggest this is the answer also)

Gotta love it when experts like that chime in

Re: Dyspnoic Cat

Anonymous — Thu, 03 Oct 2013 00:21:08 GMT

Lateral radiograph: there is a widespread / diffuse peribronchial - interstitial pattern, there is also a lobar sign inbetween the cranial and caudal lobes, the cardiac silhouette is difficult to interpret but the trachea is not elevated and the LA looks wnl. Dv view: cardiac silhouette appears to be wnl, caudal pulmonary vein and artery are of the same size and not bigger than the 9 th rib, lobar sign is visible on the left? Lung ( what is left and right?), again a diffuse interstitial paatern, not sure about air bronchograms on my screen here Ddx: pulmonary interstitial and alveolar disease due to exsudate/oedema/haemorrhage Try stabilising with prednisolone and marbofloxacin or better? Doxycycline; if no major improvement , proceed with bronchscopy and BAL That would be my answer... What is the solution please??? Cert and diploma holders

Re: Dyspnoic Cat

Mark Hedberg — Mon, 30 Sep 2013 08:51:00 GMT

[quote user="Neil Wheadon"]

[quote user="Mark Hedberg"]my dad was born in northern Idaho[/quote]

I visited your folks in Idaho as the photo shows, they confirmed that indeed Montana, like the world is flat.

(Cat lost to follow up - sorry)

[/quote]

Yeah, fun times. :) You probably accidentally *did* visit relatives of mine!

Re: Dyspnoic Cat

Neil Wheadon — Sun, 29 Sep 2013 01:26:14 GMT

[quote user="Mark Hedberg"]my dad was born in northern Idaho[/quote]

I visited your folks in Idaho as the photo shows, they confirmed that indeed Montana, like the world is flat.

(Cat lost to follow up - sorry)

Re: Dyspnoic Cat

nikki — Wed, 11 Sep 2013 20:37:55 GMT

I had an asthmatic cat recently with spontaneous pneumothorax (first time I've seen that in an asthmatic). It is now doing well on inhaled steroids and has stopped coughing.

Re: Dyspnoic Cat

Martin Atkinson — Wed, 11 Sep 2013 14:53:13 GMT

[quote user="bob lehner"]

Just curious as to why asthma is so high on everyone's list - I thought the cardinal radiographic signs for F.A. were big black over-inflated lungs with a marked bronchial pattern. Quick look at BSAVA Manual of Cardio-Resp Medicine makes no mention of pneumo-thorax in radiographic findings for F.A.. Quotes approx 10% as having a collapsed right middle lung lobe only.

Is pneumo-thorax a common finding in this condition ?

[/quote] a) its a cat and asthma is common and the symptoms fit, b) IME the biggest problem with diagnosing asthma on X-ray is that there are no characteristic radiographic changes - indeed often none, only BAL will give a diagnosis and even that is often spurious, c) I've never seen an asthmatic cat with pneumothorax either but it is logical that anything that is causing extreme physical effort on inhalation could cause a spontaneous pneumothorax.

Re: Dyspnoic Cat

Anthony Dennison — Wed, 11 Sep 2013 02:00:29 GMT

With severe chronic asthma could emphysema develop? One of these areas rupturing could cause a pneumothorax

Re: Dyspnoic Cat

Rob Loxley — Tue, 10 Sep 2013 23:28:28 GMT

[quote user="bob lehner"]Is pneumo-thorax a common finding in this condition ?[/quote]

The literature puts it as a fairly rare finding, but reported (presumably in the cats that didn't read the book!)

Re: Dyspnoic Cat

bob lehner — Tue, 10 Sep 2013 19:22:18 GMT

[quote user="Frances Barr"]Assuming there's no suggestion of a physical airway obstruction (like an inhaled foreign body), I'd go for asthma too as most likely.[/quote]

Is pneumo-thorax a common finding in this condition ?

Re: Dyspnoic Cat

Jenny Smith — Tue, 10 Sep 2013 17:36:09 GMT

No, Andy Brown... Obviously same school of thought though!!

Re: Dyspnoic Cat

Mark Hedberg — Tue, 10 Sep 2013 14:55:02 GMT

[quote user="Sarah Wheadon"]Mark, if you'd ever cycled up through the Bitterroot Mountains in Western Montana, you would know it is anything but flat and boring. Big, yes, but breathtakingly beautiful.

[/quote]

Oh, I know - my dad was born in northern Idaho, but it's fun to wind up the cyclists :)

Re: Dyspnoic Cat

Rob Loxley — Tue, 10 Sep 2013 13:46:14 GMT

[quote user="Jenny Smith"] straight into oxygen on arrival[/quote]
[quote user="Jenny Smith"]I do my xrays later in the night, once the cat is more stable, or allow the day vets to complete them[/quote]

I like the Kruuse oxygen tents as you can sit them on an xray plate and get a useful picture.

[quote user="Jenny Smith"]As an aside, at my induction course for my OOH job, our clinical tutor (ECC diplomate) showed us an x-ray of a severe pleural effusion cat and asked 'what's wrong with this?' His answer was 'this x-ray shouldn't exist'[/quote]

Dez Hughes?

Re: Dyspnoic Cat

Sarah Wheadon — Tue, 10 Sep 2013 13:44:40 GMT

Mark, if you'd ever cycled up through the Bitterroot Mountains in Western Montana, you would know it is anything but flat and boring. Big, yes, but breathtakingly beautiful.

Re: Dyspnoic Cat

Martin Atkinson — Tue, 10 Sep 2013 11:30:40 GMT

[quote user="Jenny Smith"]We need to trust our clinical exam findings more, if you suspect an effusion/pneumo then it probably is, and a chest tap is much less stressful for a dyspnoeic animal than being pinned down to the table for decent diagnostic rads (in my opinion at least!)[/quote] Too true, we had a cat in a couple of weeks ago breathing its last on the cons table, no time for X-ray or even prepping the chest, straight in with the needle while nurse held O2 mask on its face and 5 minutes and 150ml pleural effusion later the cat was up off its death bed and trying to jump off the table. It was Cheyne-Stoking at one point and the nurses were urging me to call it but it had a heart beat so I persisted. Once stable we X-rayed and found another 50ml fluid to draw off. Subsequently it was PTS because the effusion kept recurring despite huge doses of frusemide and repeat drainage. PM exam revealed a heart base mass involving the pericardium adherent to the mediastinal pleura. Nurses were right in the end (as they usually are) even if for the wrong reason.

Re: Dyspnoic Cat

Jenny Smith — Tue, 10 Sep 2013 07:35:00 GMT

Interesting debate :)

I like dyspnoeic cats (I know, I know, I'm weird!) and the challenges they present for diagnostics and work up when they are pretty fragile patients. My personal approach is straight into oxygen on arrival, then watch breathing pattern as kitty settles. Then have a good listen. Usually by this point I'm tending towards pleural space vs parenchymal vs cardiac just from the breathing pattern, chest sounds and general capsule history on presentation from the owner. Then give frusemide as a first line and steroid as a second if things don't fit or suspect they will help - so increased lung sounds for fruse or history of coughing for dex.

If I suspect the fruse/dex aren't helping, or I think it's a pleural space disease, I will attempt thoracocentesis as my first procedure. Like lots of other pro-needlers have said, you get a diganosis and therapeutic benefit all in one.

If kitty is too stressed by the procedure, or looks like they will be then I place an iv and sedate with diazepam/ketamine to effect. Usually 0.1-0.4ml/cat (1ml/10kg of a 50:50 mixture is my preferred cocktail), and then perform the centesis.

I do my xrays later in the night, once the cat is more stable, or allow the day vets to complete them if O finances are a concern (I work soley OOH).

As an aside, at my induction course for my OOH job, our clinical tutor (ECC diplomate) showed us an x-ray of a severe pleural effusion cat and asked 'what's wrong with this?' His answer was 'this x-ray shouldn't exist'. We need to trust our clinical exam findings more, if you suspect an effusion/pneumo then it probably is, and a chest tap is much less stressful for a dyspnoeic animal than being pinned down to the table for decent diagnostic rads (in my opinion at least!)

Just my two pennies

Jen

Re: Dyspnoic Cat

Mark Hedberg — Mon, 09 Sep 2013 20:58:31 GMT

[quote user="Sarah Wheadon"]Probably won't get a reply to this as he's currently leading a cycle tour round Wyoming and Montana! Sarah (the long suffering wife)

[/quote]

Ah, Montana - old Indian word for "Big, flat, and really boring" :)

Re: Dyspnoic Cat

Anthony Todd — Mon, 09 Sep 2013 20:36:07 GMT

[quote user="Sarah Wheadon"]Probably won't get a reply to this as he's currently leading a cycle tour round Wyoming and Montana! Sarah (the long suffering wife)

[/quote]

At least he'll know how dyspnoea feels by the end of that......

Re: Dyspnoic Cat

Sarah Wheadon — Mon, 09 Sep 2013 20:25:14 GMT

Probably won't get a reply to this as he's currently leading a cycle tour round Wyoming and Montana! Sarah (the long suffering wife)

Re: Dyspnoic Cat

Anthony Todd — Mon, 09 Sep 2013 19:36:22 GMT

So how's the cat?

What did all the tests etc. decide?

Re: Dyspnoic Cat

Frances Barr — Mon, 09 Sep 2013 13:22:44 GMT

I agree with Martin. This cat has a pneumothorax, predominantly left sided, and also a pneumomediastinum. I also agree that this is most likely to be secondary to the dyspnoea rather than the primary cause. There's a widespread alveolar lung pattern - which may be partly due to partial lung collapse but I suspect not entirely.

Assuming there's no suggestion of a physical airway obstruction (like an inhaled foreign body), I'd go for asthma too as most likely. But if the cat doesn't respond to treatment, further investigations would be needed - while acknowledging the risk of doing anything to a dsypnoeic cat.

Re: Dyspnoic Cat

Martin Atkinson — Thu, 05 Sep 2013 10:43:54 GMT

IMO this cat doesn't have a pleural effusion but it does have a pneumothorax, that is not enough to cause the dyspnoea so is probably spontaneous due to hyper ventilating. Sticking a needle in its chest and trying to remove the air may help but if its persistant it will need a drain and water trap device. Also think asthma most likely unless you can get a lung biopsy to say otherwise, BAL is indicated but you'll risk killing it with that if do it before its stabilised.

Re: Dyspnoic Cat

Anthony Todd — Mon, 02 Sep 2013 22:24:52 GMT

BTW what happened to the OP cat?

Re: Dyspnoic Cat

Anthony Todd — Mon, 02 Sep 2013 22:23:22 GMT

[quote user="Neil Wheadon"]Are these cats as fragile as they seem where Robin can sedate and i can X-Ray them?[/quote]

Trouble is you only find out when they die....

Re: Dyspnoic Cat

Neil Wheadon — Mon, 02 Sep 2013 21:43:04 GMT

[quote user="Robin Grimmer"] always sedate these cats - and haven't lost one yet.[/quote]

This is turning into a really interesting discussion

Are these cats as fragile as they seem where Robin can sedate and i can X-Ray them? What combination do you use and dose?

Neil