chest xray advice

RE: chest xray advice

Martin Atkinson — Wed, 14 Feb 2018 18:48:53 GMT

[quote user="Anthony Todd"]Because steroids are BAD [remember some cyclist called Armweak or something][/quote]AFAIK His Lanceness didn't take corticosteroids or even anabolics; EPO, growth hormone, insulin and blood transfusion yes. It was Sir Bradley who had Triamcinolone for his ahem...allergy!

RE: chest xray advice

Anthony Todd — Wed, 14 Feb 2018 17:39:13 GMT

[quote user="Christina Smith"] Likewise dex. Why hold back ?[/quote]

Because steroids are BAD [remember some cyclist called Armweak or something]

Doesn't matter if they're effective. often of diagnostic value, and totally harmless if used sensibly.

RE: chest xray advice

Thomas Johnson — Wed, 14 Feb 2018 16:34:01 GMT

[quote user="Martin Atkinson"]

I've never diagnosed Aelurostrongylus in a cat. I saw several cases of Filaroides back in the time before time itself began, but none for the last 25 years probably. Maybe routine worming is a lot more prevalent/effective.

[/quote]

A lot of cats at our practice get Profender, which has a license for adult Aelurostrongylus.

RE: chest xray advice

Martin Atkinson — Wed, 14 Feb 2018 09:00:26 GMT

RE: chest xray advice

mariette asselbergs — Wed, 14 Feb 2018 00:15:48 GMT

[quote user="Joyce Whitehead"]

[quote user="David Mills"]

[quote user="robloxley"]

Worth making sure treated for lungworm - there was a recent vet record piece from Danielle GunnMoore - and treatment options including Profender

[/quote]

I read this. Triumph of referral vs first opinion.

Has anyone ever diagnosed clinically significant feline lungworm on this thread? There's a fabulous tendency at the moment to find it - quite oblivious to what the underlying prevalence is - and treat it, without any idea whether it does any good.

[/quote]

i have (only one case to be fair). Feral tom cat from one of our farm clients, came in for neutering in a trap. Into crush cage to anaesthetise and too wild to examine. Once anaesthetised it was clear he had a respiratory issue. Chest X-ray showed awful diffuse consolidation of both lungs. Discussed options with the farm and opted to pts. We PM’d him, as we were a little concerned about TB, but histo revealed aelurostrongylus.

[/quote][quote user="Joyce Whitehead"]

[quote user="David Mills"]

[quote user="robloxley"]

Worth making sure treated for lungworm - there was a recent vet record piece from Danielle GunnMoore - and treatment options including Profender

[/quote]

I read this. Triumph of referral vs first opinion.

[/quote]

Exactly the same for me: farm cat (one of 35 on a farm with continuous TB) was runover and presented for PM since I had warned several times that the cats were overlooked as a source of the TB. Well it looked like TB, but it was Aelurostrongylus!

RE: chest xray advice

Bob Russell — Mon, 12 Feb 2018 15:39:23 GMT

If it is asthma a shot of dex will magically make it better. Unlikely to make any other problem worse so not much to lose.

I remember being told 1/3 of cats have evidence of lungworm and it is usually asymptomatic. No idea whether this is still up to date and correct but would also happily give a course of Panacur. The cat and owners will not be so enthusiastic about the Panacur.

RE: chest xray advice

Martin Atkinson — Mon, 12 Feb 2018 09:15:27 GMT

[quote user="David Mills"]It's about 2.5 rib spaces. [/quote]Its 3 rib spaces actually but that doesn't count as a yardstick, VHS does, its 8.5 which is >7.5.This may not be significant but its enlarged - end of.

RE: chest xray advice

Anthony Todd — Sun, 11 Feb 2018 12:08:06 GMT

[quote user="David Mills"]Shot of dex, lasts 72h, pennies, whilst you wait[/quote]

Seeing I am mentioned I'm allowed to affirm that one shot as mentioned will give you a definitive response [or not!].

Obvious improvement increases the chances of continued owner compliance with tabs. as there's no doubt the cat got this initial dose.

No improvement after just one shot then the 'roids won't help, no matter how many pills you dispense.

RE: chest xray advice

Joyce Whitehead — Sun, 11 Feb 2018 10:58:36 GMT

[quote user="David Mills"]

[quote user="robloxley"]

Worth making sure treated for lungworm - there was a recent vet record piece from Danielle GunnMoore - and treatment options including Profender

[/quote]

I read this. Triumph of referral vs first opinion.

[/quote]

RE: chest xray advice

Emma Middleton — Sun, 11 Feb 2018 09:00:36 GMT

Hi Claire,

In your position I would probably be trialling preds at anti inflam doses as others have said. Inhaled steroids obviously ideal long term but not always an option for reasons of patient compliance or cost. I find it so frustrating in these situations when a client perceives significant clinical symptoms as not needing treatment. Amazing how some people deem it ok for their cat to go around wheezing (or scratching!! ). Hopefully you can persuade them that just because it's always wheezed doesn't mean you can't do something about it and improve the cat's quality of life.

RE: chest xray advice

Christina Smith — Sun, 11 Feb 2018 01:48:15 GMT

Panacur cheap as chips. Likewise dex. Why hold back ?

RE: chest xray advice

Claire Godfrey — Sun, 11 Feb 2018 01:14:02 GMT

Thanks all for your replies. Heart sounds normal on clinical exam. I appreciate it is difficult on phone photos of the xrays. Will be having a discussion with owners but I don’t think they want any further testing. I’m not really sure they actually want to do anything as the cat is not worsening, has been like this all the time they have owned it! Thanks

RE: chest xray advice

David Mills — Sat, 10 Feb 2018 21:03:32 GMT

[quote user="robloxley"]

Worth making sure treated for lungworm - there was a recent vet record piece from Danielle GunnMoore - and treatment options including Profender

[/quote]

I read this. Triumph of referral vs first opinion.

RE: chest xray advice

David Mills — Sat, 10 Feb 2018 21:00:44 GMT

[quote user="Chris Milligan"]I'd caution against dex [/quote]

Why? At anti inflammatory doses.[quote user="Chris Milligan"]until you've got rads where you can see if the diaphragm is flattened or sharp in the caudal dorsal margin or if there's a bronchial pattern (none of which do I see here and these are the hallmarks of asthma).[/quote]

Nope. Most asthma cases have no changes at all.

I'm not (yet) Anthony Todd but at the moment you want more rads. Atko wants a BAL. Cat still wheezy. Never seen pneumonitis with cat flu viruses without upper resp signs. Shot of dex, lasts 72h, pennies, whilst you wait. And people wonder about spectator articles

[quote user="Martin Atkinson"]More than one specialist agrees that the >7.5 is abnormal for a cat.[/quote]

So what?

It's about 2.5 rib spaces. Chambers normal. Most cardiomyopathies no change in silhouette until end stage.[quote user="Martin Atkinson"]The heart is enlarged[/quote]

It isn't.

RE: chest xray advice

Martin Atkinson — Sat, 10 Feb 2018 09:32:13 GMT

[quote user="David Mills"]Heart is WNL.[/quote]It is difficult to measure on a screenshot of a photograph but the VHS is 8.5. More than one specialist agrees that the >7.5 is abnormal for a cat. The heart is enlarged but the symptoms are not of cardiac failure

RE: chest xray advice

Chris Milligan — Sat, 10 Feb 2018 04:23:14 GMT

It's hard to hang your hat on anything here as it's a phone photo of a rads - looks like there's some motion blur though might be your phone, overexposure in the lateral and the caudal aspect of the diaphragm has been clipped off - this is a key site to check for the aforementioned asthma. I don't see a pattern in what you have here that screams mets or a mass but beyond that it's difficult to say much else.

History is a concern for recurrent pnuemonitis secondary to a cat flu virus or asthma. I'd caution against dex until you've got rads where you can see if the diaphragm is flattened or sharp in the caudal dorsal margin or if there's a bronchial pattern (none of which do I see here and these are the hallmarks of asthma).

A left and right lateral are generally recommended if you're concerned about thoracic masses

RE: chest xray advice

David Mills — Fri, 09 Feb 2018 19:29:29 GMT

Asthma. Heart is WNL.

Depo or preds. 5 day panacur course if it goes outside.

RE: chest xray advice

Martin Atkinson — Fri, 09 Feb 2018 18:53:19 GMT

[quote user="Thomas Johnson"]what does concern me about these radiographs though is that the cardiac silhouette looks bigger than I would expect.[/quote]VHS is about 8.5 so is >7.5 I would worry about with cat, but I think they're both expiratory so it makes it look bigger. Still not likely to cause the wheezing. Is there a murmur Claire? Might be worth an NT-proBNP.

RE: chest xray advice

Thomas Johnson — Fri, 09 Feb 2018 17:31:22 GMT

Asthma seems the most likely cause of wheezing in a cat, and often very little to see on radiographs, what does concern me about these radiographs though is that the cardiac silhouette looks bigger than I would expect.

RE: chest xray advice

Rob Loxley — Fri, 09 Feb 2018 16:52:25 GMT

Worth making sure treated for lungworm - there was a recent vet record piece from Danielle GunnMoore - and treatment options including Profender

RE: chest xray advice

Martin Atkinson — Fri, 09 Feb 2018 14:26:52 GMT

Its difficult to tell as you've got the front legs pulled back which may be giving the impression there is increased radiopacity in the cranial thorax on the lateral view but the DV looks OK to me.

Plus I'd never be confident on diagnosing asthma from radiographic changes I would like a BAL.

RE: chest xray advice

Claire Godfrey — Fri, 09 Feb 2018 13:49:53 GMT

Tried to post the xrays again

RE: chest xray advice

Claire Godfrey — Fri, 09 Feb 2018 13:48:20 GMT

Yes and there are asthmatic changes, that is exactly what I expected but now I am worried I can see a mass and not sure if I am seeing things.

RE: chest xray advice

Martin Atkinson — Fri, 09 Feb 2018 12:50:11 GMT

Can't open the images but wheezy is more likely to be asthma. I don't think it would have had a mediastinal mass for 6 years and survived!!