Cat Chest Radiographs - thoughts please

Re: Cat Chest Radiographs - thoughts please

Anthony Todd — Fri, 28 Nov 2014 12:15:52 GMT

[quote user="Evelyn Barbour-Hill"]Tried catheters a few times, but they kink.[/quote]

True I guess, never tried them, but some aren't some I/V catheters stiffer than others?

I think catheters have important advantages so some recommendations will be useful. I seem to remember some were really stiff and like cat urethral catheters?

Re: Cat Chest Radiographs - thoughts please

Anthony Todd — Fri, 28 Nov 2014 12:11:23 GMT

[quote user="Evelyn Barbour-Hill"]Dorsal recumbency is less stressful, and less likely to put the final excess pressure on the lungs, than ventral recumbency and lateral recumbency for two quick radiographs?[/quote]

SHivers, I meant sitting on the sternum, no wonder there was a 'it storm, me going on about no stress, no man-handling and then apparently tipping the cat upside down..... sorry, age is my only rather feeble excuse......

Re: Cat Chest Radiographs - thoughts please

James Laidlaw — Fri, 28 Nov 2014 08:08:53 GMT

It was a good guess then!

Re: Cat Chest Radiographs - thoughts please

Evelyn Barbour-Hill — Thu, 27 Nov 2014 21:48:58 GMT

[quote user="James Laidlaw"]Tired sarcasm? I'm not sure there's a font to express that. Comic sans maybe?[/quote]

Ask a graphic designer and you'll find that Comic Sans represents all that is s*** about Microsoft and amateur font designers.

Sorry, absolutely irrelevant, I know.

Re: Cat Chest Radiographs - thoughts please

Evelyn Barbour-Hill — Thu, 27 Nov 2014 21:42:56 GMT

[quote user="Anthony Todd"]Am I right in remembering over 100ml oer side?? What's the record??[/quote]

Dunno about the record, but I have several times removed over 400ml of pus in total. And thinking of the normal volume of a cat's thorax... no wonder it was ill

[quote user="Anthony Todd"] I think there are definite advantages with a catheter[/quote]

Tried catheters a few times, but they kink.

[quote user="Anthony Todd"]slide the cat in dorsal recumbency[/quote]

Dorsal recumbency is less stressful, and less likely to put the final excess pressure on the lungs, than ventral recumbency and lateral recumbency for two quick radiographs?

Re: Cat Chest Radiographs - thoughts please

James Laidlaw — Thu, 27 Nov 2014 18:10:45 GMT

[quote user="Malcolm Ness"]

[quote user="James Laidlaw"] I've seen that happen if you prefer EBVM.[/quote]

I don't understand that statement - it seems oxymoronic. What am I missing?

[/quote] Tired sarcasm? I'm not sure there's a font to express that. Comic sans maybe?

Re: Cat Chest Radiographs - thoughts please

Anthony Todd — Thu, 27 Nov 2014 17:51:42 GMT

[quote user="Malcolm Ness"]What am I missing?[/quote]

Malcolm, you must have drained loads of chests, back in the day with TGY, what did you and he do then and what do think think should be done now??

Re: Cat Chest Radiographs - thoughts please

Anthony Todd — Thu, 27 Nov 2014 17:47:04 GMT

[quote user="Anthony Dennison"]Do you insert the catheter in a cranial or caudal direction?[/quote]

Depends on what you get on first "suck" [this is after the needle is withdrawn, [now that I think there are definite advantages with a catheter]. If the 2ml syringe fills then change to a 50/60ml and draw off as much as you can in about 20ml lots, wait a minute 'cos apparently if you do it too quickly you can get shock.

Am I right in remembering over 100ml oer side?? What's the record??

Once they're pink, you can turn off the O2 ..... [that was intentionally snide, Rob, sorry]

Once you've got as much as poss. then start twiddling the catheter to get the last bit.. might pay to change to a 2 or 5 ml syringe at the end to get a better cyto sample [I'll be advised better I hope] The needle and, I assume the catheter is easy to sort of Kreepy Krawl round the ventral pleural space.

I welcome refinements and any criticism, these cats die if you don't do it right!

Re: Cat Chest Radiographs - thoughts please

Malcolm Ness — Thu, 27 Nov 2014 16:32:58 GMT

[quote user="James Laidlaw"] I've seen that happen if you prefer EBVM.[/quote]

I don't understand that statement - it seems oxymoronic. What am I missing?

Re: Cat Chest Radiographs - thoughts please

Anthony Dennison — Thu, 27 Nov 2014 15:23:01 GMT

[quote user="Anthony Todd"]so when you put the catheter in you can angle the catheter upwards by entering from below the level of the table, ie at an angle of minus 20-30 degrees.[/quote]

Do you insert the catheter in a cranial or caudal direction?

Re: Cat Chest Radiographs - thoughts please

Anthony Todd — Thu, 27 Nov 2014 15:12:25 GMT

[quote user="James Laidlaw"]Well then by all means tap the chest. I wasn't arguing that. I would just be concerned that a blue mm, mouth breathing cat's absolute priority would be a chest tap over stabilizing with O2 and minimal handling could lead some people into a rather upsetting result for the vet, patient and owner.

[/quote]

Fair enough, but don't be worried as I 've tried to point out more than once, it works and in minutes as well; never had one die or even show signs of distress and if there's no fluid then the diagnosis moves on using the advanced aids available these days.

When I said "slide the cat to the edge of the table" I should have said move the cat by gently sliding it to your very edge of the consult table so when you put the catheter in you can angle the catheter upwards by entering from below the level of the table, ie at an angle of minus 20-30 degrees.

Re: Cat Chest Radiographs - thoughts please

James Laidlaw — Thu, 27 Nov 2014 14:55:31 GMT

Well then by all means tap the chest. I wasn't arguing that. I would just be concerned that a blue mm, mouth breathing cat's absolute priority would be a chest tap over stabilizing with O2 and minimal handling could lead some people into a rather upsetting result for the vet, patient and owner.

Re: Cat Chest Radiographs - thoughts please

Anthony Todd — Thu, 27 Nov 2014 14:49:34 GMT

[quote user="James Laidlaw"]it's not going anywhere.[/quote]

Well I'm out too. when someone posts a procedure that they ,and others have done many times without incident and it's criticised by others, who haven't even done it once it certainly won't go anywhere.

By the way after you've "supplemented the oxygen" what's the next step if there's "no interference". What happens to the fluid if it's there in large amounts?

No wonder most dinovets don't bother posting here.

Re: Cat Chest Radiographs - thoughts please

James Laidlaw — Thu, 27 Nov 2014 10:22:30 GMT

Wouldn't it be better to supplement oxygen and no interference - sliding on the table and sticking a needle in can tip these cats over the edge? I don't want any part in the new-vet/dinovet discussion, it's not going anywhere.

Re: Cat Chest Radiographs - thoughts please

Anthony Todd — Thu, 27 Nov 2014 09:58:59 GMT

[quote user="James Laidlaw"]Other than restraining and chest tapping this patient might induce a rapid and permanent end to life... I've seen that happen if you prefer EBVM[/quote]

Sorry, but it has never happened with me. You don't need restraint, no stress, no clipping, done in seconds, just slide the cat in dorsal recumbency to the edge of the table, held by owner usually.

Anything more than this then I agree with you; very risky.

Seen them die when restrained/positioned for X ray though.

Ask other dinovets.

Re: Cat Chest Radiographs - thoughts please

James Laidlaw — Thu, 27 Nov 2014 09:52:49 GMT

[quote user="Anthony Todd"]Still seems to me that a tap has more advantages, and IME no disadvantages, particularly in a mouth-open blue cat right on the limit of O2 deprivation.[/quote]

Other than restraining and chest tapping this patient might induce a rapid and permanent end to life... I've seen that happen if you prefer EBVM.

Re: Cat Chest Radiographs - thoughts please

Anthony Todd — Thu, 27 Nov 2014 09:03:44 GMT

[quote user="Thomas Johnson"]A small volume pleural effusion is going to be harder to diagnose both by ultrasound or by attempted drainage. In my experience a small volume is easier to find by ultrasound than by doing a blind chest tap, it may be pocketed in one area and easier to drain using ultrasound guidance to place the needle.[/quote]

True, and without an ultrasound you'd never know it was there anyway. Usually though you can get enough to diagnose the cause. With modern flexible catheters there is a better chance of obtaining your fluid sample than with a needle, Not if it's walled of, I agree.

My reason for tapping the chest even if only small quantities of fluid is mainly for diagnosis. Small volumes would be resorbed if the condition was reversed anyway and would not affect respiratory function much, if at all.

Re: Cat Chest Radiographs - thoughts please

Thomas Johnson — Thu, 27 Nov 2014 08:45:11 GMT

[quote user="Anthony Todd"]

[quote user="robloxley"]If the cat has respiratory compromise due to pleural effusion it's pretty easy to see plonking the ultrasound probe on the chest; small volume pleural effusion can be harder to find, but is by its size less likely to be your major respiratory problem IME.[/quote]

So if it's a lot you've got to drain it anyway ,and if it's a little you might have missed it so best to do a chest tap to be sure?

[/quote]

A small volume pleural effusion is going to be harder to diagnose both by ultrasound or by attempted drainage. In my experience a small volume is easier to find by ultrasound than by doing a blind chest tap, it may be pocketed in one area and easier to drain using ultrasound guidance to place the needle.

Re: Cat Chest Radiographs - thoughts please

Anthony Todd — Wed, 26 Nov 2014 21:16:57 GMT

PS See the thread on the Hypokalaemic cat.

This is the sort of case, in the days of 47 evening consults, where it would have diagnosed as a "stroke", no investigations, no bloods, and either PTS or put in a cage and kept warm; things have advanced enormously and the better outcomes reflect this.

Sometimes though, and only sometimes, careful direct examination and focussed dealing with the presenting signs by obvious and direct action, as we did back in the day, can be more effective than indirect "non-invasive" methods.

People seem incapable of recognising this.

Re: Cat Chest Radiographs - thoughts please

Anthony Todd — Wed, 26 Nov 2014 20:58:44 GMT

[quote user="robloxley"]what the hell is that snide comment supposed to mean? yet again I see why people wouldn't want to post on these forums for the overt or covert criticism that is handed out[/quote]

Oh for heavens sake, it wasn't snide FFS sake, lighten up, I think the most consults someone did in the 60s in an evening surgery was 47.... I t was purely a reference to different times!

It wasn't better probably worse in a few cases where time and money was necessary, it was just different!

No wonder most dinovets won't post on this forum, more's the pity, because, amongst the old veterinary "artists" there's a lot more experience than I've got to offer.

Re: Cat Chest Radiographs - thoughts please

John Flynn — Wed, 26 Nov 2014 20:49:35 GMT

Hi Iain,

A fellow amateur here, so don't pay too much attention...

No cranial mediastinal mass that I can see - the kinked trachea on the first picture looks like the neck was flexed maybe when the radiograph was taken?

Noisy inspirations - would you say inspiratory dyspnoea? - makes me think of upper resp tract issues - ideally I'd check the larynx/pharynx.

Agree with bronchial pattern and signs of over-inlfation of lungs which may be consistent with asthma-like condition (in absence of upper resp tract issues).

Cardiac silhouette looks normal to my untrained eye and pulmonary vessels don't look engorged to me so I'm not suspicious of cardiac disease (but I'm sure I miss it all the time!)

No evidence of pleural effusion.

Re: Cat Chest Radiographs - thoughts please

Rob Loxley — Wed, 26 Nov 2014 20:02:02 GMT

[quote user="Anthony Todd"]

[quote user="robloxley"]Likewise looking at the respiratory pattern from afar. Muffled heart sounds do also make me worry about neoplasia.[/quote]

Didn't you think of a chest full of fluid as well?

[/quote]

That was what my 'also' was in reference too.

[quote user="Anthony Todd"]mind you an awful lot of posts between 6.30 and 7, geez, back in the day[/quote]

what the hell is that snide comment supposed to mean? yet again I see why people wouldn't want to post on these forums for the overt or covert criticism that is handed out

Re: Cat Chest Radiographs - thoughts please

Anthony Todd — Wed, 26 Nov 2014 18:48:30 GMT

[quote user="robloxley"]Likewise looking at the respiratory pattern from afar. Muffled heart sounds do also make me worry about neoplasia.[/quote]

Didn't you think of a chest full of fluid as well?

Didn't say "I would" or you'd think I was criticising you although I have the distinct feeling that you would cope.

Mind you an awful lot of posts between 6.30 and 7, geez, back in the day [I refer you to the scan of the appointment book...]

Re: Cat Chest Radiographs - thoughts please

Anthony Todd — Wed, 26 Nov 2014 18:46:47 GMT

[quote user="Evelyn Barbour-Hill"]Which gives a fairly strong indication whether there is a significant quantity of fluid there, no?[/quote]

So? What do you do next?

Re: Cat Chest Radiographs - thoughts please

Anthony Todd — Wed, 26 Nov 2014 18:45:38 GMT

[quote user="Robin Grimmer"]

Surely better to do an ultrasound to see if there's fluid first (quick and easy to do) rather than a bĺind tap where you could lacerate the lung?

[/quote]

Sorry, and I know I'll get slammed or worse, but I and other dinovets, have done loads of chest taps and have certainly hit the heart and got blood. also not hit the heart and got blood only to examine the nails and surmise that the cat had been hit by a car.!

So I think the risk of my lacerating the lung is exaggerated, and even if I [and I'm sure I have] the effects don't seem to matter, or I've never seen that they do.

And we've established that ,if there's a lot of fluid ,ie easily diagnosed by the favoured atraumatic method of ultrasound, you're going to do a chest tap any way and, er, it's not so good at picking up small amounts so, er, you'll do a tap to be sure...

Why the all pervading reluctance to deal with the problem directly. I could give you so many examples across so many threads???? [more ? to emphasise my frustration.