cat chest xrays

RE: cat chest xrays

Noweia — Sat, 02 Jun 2018 22:57:36 GMT

My cat is asthmatic and he responded poorly to injectable steroids. Inhaler is only thing that works for him.

If it was heart would the steroids have made it worse rather than better?

RE: cat chest xrays

Anthony Todd — Thu, 31 May 2018 15:47:57 GMT

[quote user="Edward Jones"]In my experience pricking the lung parenchyma produces a significant pain reaction - probably because the tip of the needle slices the surface as the lung moves in relation to the thoracic wall. I usually do thoracocentesis ultrasound guided.[/quote]

I don't think I've ever had a cat react to a chest tap, during a consult with the owner present and a 22x1cm needle ever and, even if you only get <5mls of fluid, it's enough for cytology and SG immediately,without the risk of x-ray restraint and apart from the poor chance of picking up,say, 10ml on an Xray [and you still may need SG and/or cytology??]

I must have hit lung tissue often but neither cat or I noticed.

RE: cat chest xrays

Edward Jones — Thu, 31 May 2018 14:14:31 GMT

I think every dyspnoeic heart failure cat I've seen has had obvious pleural and/or pulmonic radiographic changes. To me (as a generalist!) these radiographs don't explain why the cat is dyspoeic, if it is cardiacogenic.

Therefore, the cause of the dyspoea is related to the bronchi. I think of asthma as a diagnosis of exclusion, but it's far more common than anything else. I'm not well practised in the other potential causes - toxoplasma, perhaps?

No harm in giving both furosemide and steroid, although it obfuscates the diagnosis by trial treatment.

I wouldn't do a thoracocentesis on the basis of these xrays and I wouldn't do it before taking xrays either. What's the point unless a pleural effusion has been confirmed? In my experience pricking the lung parenchyma produces a significant pain reaction - probably because the tip of the needle slices the surface as the lung moves in relation to the thoracic wall. I usually do thoracocentesis ultrasound guided.

RE: cat chest xrays

Beats — Thu, 31 May 2018 11:05:14 GMT

I went through the saved scans I had from yesterday and tried to take some screenshots for measuring LA in 4 chamber right parasternal long-axis view.

Unfortunately I doubt these are any more diagnostic than my attempts at short-axis view!

Anyway, resp rate still 60/min this morning, heart rate still 160/minute (no murmurs or gallops that I can hear, but again I wouldn't place much faith in my cat auscultation abilities), and stressing leads to mouth-breathing

I'm hedging my bets and giving some furosemide alongside the colvasone for now.

RE: cat chest xrays

Anthony Todd — Thu, 31 May 2018 09:56:58 GMT

[quote user="Lucy Fleming"] thought you meant a tap could differentiate between those processes, rather than that a negative tap would suggest them/ rule out other causes (though I have seen a number of cardiac cases that have had pulmonary oedema rather than pleural fluid, there's always the odd cat that doesn't read the textbook![/quote]

???

RE: cat chest xrays

Lucy Fleming — Thu, 31 May 2018 09:07:21 GMT

[quote user="Anthony Todd"]

[quote user="Lucy Fleming"]I don't really see how?[/quote]

Because you won't get a significant volume of fluid, ie enough [200mls??ish] to cause dyspnoea??

And it's always so well [surprisingly] tolerated IMHE, no local no restraint no clipping and prep['cos they're gasping for enough O2 to stay alive!!]

[/quote]

I misunderstood, my apologies - I thought you meant a tap could differentiate between those processes, rather than that a negative tap would suggest them/ rule out other causes (though I have seen a number of cardiac cases that have had pulmonary oedema rather than pleural fluid, there's always the odd cat that doesn't read the textbook! )

RE: cat chest xrays

Joyce Whitehead — Thu, 31 May 2018 08:41:12 GMT

I would certainly love to see the training document David, I find measuring feline hearts tricky but am trying to improve!

RE: cat chest xrays

David Mills — Thu, 31 May 2018 00:52:26 GMT

[quote user="Beats"]

[quote user="David Mills"]

OK first pic a little off kilter and I think you've measured the left auricle.

In short axis view should be more lined up like this

[/quote]

That's extremely helpful. Thankyou. I thought the left auricle was confined to above where it says "[set] to anc". I'll try to do the long-axis views for LA assessment as I can see how I can easily be slicing through the wrong bits and merrily measuring them anyway in attempts at short-axis!

[/quote]

No worries.

Left auricle starts approximately where the aortic valve starts on SA view (looking l to r) - it's the "comma" underneath the aortic valve.

I've a teaching document of feline echo with pics I produced a few years ago - pm me if you'd like it forwarded.

It can be posted on here if people want it - Mr G, Ms B, let me know how/format etc.

There was a great presentation on echo training at bsava abstracts this year, an hour can make all the difference apparently. There are plenty of people out there who are semi obsessed with hearts whom Im sure would be happy to go to practices like I do.

RE: cat chest xrays

Anthony Todd — Wed, 30 May 2018 23:45:03 GMT

[quote user="Liz Barton"]As soon as these blue cats walk in I always take them straight into oxygen [/quote]

Yes, that seems like a good idea, although they seemed much relieved if I got 200 odd mls out of their chest while the O2 was organised, and if not, they were relieved by the O2, so a double whammy.

RE: cat chest xrays

Beats — Wed, 30 May 2018 23:33:28 GMT

[quote user="David Mills"]

OK first pic a little off kilter and I think you've measured the left auricle.

In short axis view should be more lined up like this

[/quote]

RE: cat chest xrays

Liz Barton — Wed, 30 May 2018 21:27:22 GMT

[quote user="David Mills"]ersonally - and because of these issues with alignment (through the commisures of the aortic valve with a high heart rate - difficult) - I use the long axis for about 98% of feline cardiology.[/quote]

I find this view more reliable too - and you can do an LA:Ao too if you line them up parallel.

As soon as these blue cats walk in I always take them straight into oxygen for a few minutes before even handling, then once a bit more settled and discussed with owner I'll frequently give 0.2mg/kg butorphanol to reduce the sympathetic drive - settles them really well and leads to a much safer X-ray/tap/scan.

RE: cat chest xrays

David Mills — Wed, 30 May 2018 21:16:25 GMT

[quote user="Beats"]

OK. I'll hold off on the furosemide and see what breathing, heart rate etc like in morning.

only have 2 pics to hand, but can try to get videos or screenshot other views if I have them:

[/quote]

OK first pic a little off kilter and I think you've measured the left auricle.

In short axis view should be more lined up like this

Personally - and because of these issues with alignment (through the commisures of the aortic valve with a high heart rate - difficult) - I use the long axis for about 98% of feline cardiology.

So like this (bisecting the lovely round atrium is easier and you know you're in the right plane)

I only worry about left atrial diameter, most cats v similar size hearts so no need to reference to aorta.

Not to say this has enlarged left atrium, but to nail the yes/no cardiac might be worth measuring again?

RE: cat chest xrays

Jill Butterworth — Wed, 30 May 2018 20:37:39 GMT

I went on some CPD a while ago and for these very unstable cats, that you hardly dare get out of the box, they recommended a single combined SQ injection of furosemide/dexamethosone/terbutaline to cover the bases of cardiac and asthma to hopefully ease breathing before you attempt a chest radiograph.

RE: cat chest xrays

Beats — Wed, 30 May 2018 19:46:17 GMT

OK. I'll hold off on the furosemide and see what breathing, heart rate etc like in morning.

only have 2 pics to hand, but can try to get videos or screenshot other views if I have them:

RE: cat chest xrays

David Mills — Wed, 30 May 2018 19:34:56 GMT

[quote user="Beats"]

That's amazing help guys, thanks!

Those xrays were taken on Friday evening. Cat presented hiding under hedge and in pain. Was mouth-breathing on presentation and I reckoned was dyspnoea rather than pain. heart rate was 120/minute, some expiratory wheezes, breath sounds in all quadrants, and I reckoned asthma. Gave 0.5ml colvasone and in morning was reported much better with resp rate of 40/minute and seemed much more settled. Was given another 0.5ml colvasone and went home that evening.

2.5mg pred given most days since and resting resp rate of 35/minute at home on at least 2 evenings since.

up to 3am this morning, breathing appeared normal.

6am was mouth-breathing.

I've put the ultrasound on the heart and was not convinced at all that the left atrium was enlarged, but I don't put too much weight on my ultrasonographic assessment of hearts... I've saved some pictures, so if I can fathom the tech, then some poorly positioned echo images may appear on this thread...

Breathing has been steady at 60/minute this afternoon/evening, had 2.5mg pred with owners this morning and 0.5ml colvasone IM with me this afternoon. Is getting some supplemental oxygen (not sure needed really at this stage). Heart rate is 156/minute presently.

Furosemide ain't going to hurt and may well be CHF, so I'll give some while pondering further. I don't think cost of NT-proBNP would be a go-er for this case.

There wasn't any pleural fluid to tap that I'm aware of.

[/quote]

Sounds like asthma then! Would be worse if cardiac and that HR suggests vagal influence from resp dz.

I often find need fairly high doses oral pred in a crisis, 5mg/cat minimum. And I love depo for these. Some treat for cat lungworm too.

There was a prospective paper recently on causes of acute dyspnoea in cats, by Chris Little and others. I also presented an abstract a few years ago from our audit - from memory about 60pc were cardiac.

RE: cat chest xrays

Beats — Wed, 30 May 2018 19:27:22 GMT

That's amazing help guys, thanks!

2.5mg pred given most days since and resting resp rate of 35/minute at home on at least 2 evenings since.

up to 3am this morning, breathing appeared normal.

6am was mouth-breathing.

Furosemide ain't going to hurt and may well be CHF, so I'll give some while pondering further. I don't think cost of NT-proBNP would be a go-er for this case.

There wasn't any pleural fluid to tap that I'm aware of.

RE: cat chest xrays

Anthony Todd — Wed, 30 May 2018 18:36:39 GMT

[quote user="Kate Richardson"]But the chest X-ray quite clearly shows no pleural effusion so no benefit to blind thoracocentesis[/quote]

1 I would have done a tap and an SG etc before you'd even turned the machine on.

2. You can't do a chest Xray during a consult so you don't get them going from blue to pink in 5 minutes if there is a lot of fluid.

3. I've never had a problem or an adverse effect, only no fluid, or positive but, apart from the diagnostic delay, let alone the relief of 500 odd mls out of a chest, some X-rayed cats have died during the X-ray, let alone the diagnosis let alone any treatment, let lone draining the fluid is delayed.

4. If there is fluid you get the SG straight away, hence an instant clue of what's going on, and can send the fluid off that night for cytology if suspicious.

[had one, got a lot of what looked like pure blood [oh, sh1t, must have hit something vascular, looked at the nails; shredded, cat accident; chest bleed??]

RE: cat chest xrays

David Mills — Wed, 30 May 2018 18:27:37 GMT

[quote user="Kate Richardson"]Interesting that you think cardiac David Mills I thought the cardiac silhouette[/quote]

Very much working dx

RE: cat chest xrays

Kate Richardson — Wed, 30 May 2018 18:19:21 GMT

But the chest X-ray quite clearly shows no pleural effusion so no benefit to blind thoracocentesis, however before you start defending this Anthony, I think there is merit in this in an unstable cat and in some cases would take priority over X-ray, I usually stick ultrasound on chest for an even quicker and atraumatic way of assessing for prescience of pleural fluid, but I appreciate not everyone will have immediate access to u/s

Interesting that you think cardiac David Mills I thought the cardiac silhouette was subjectively enlarged but the lungs picture didn’t fit, however I couldn’t get a detailed view on my phone, so maybe you are right. I would have stuck the ultrasound on and had a look at the LA.

So Beats whats the answer?

RE: cat chest xrays

Julie Innes — Wed, 30 May 2018 18:16:11 GMT

I'm like Lucy here, Anthony- a great fan of the chest tap, if I hear reduced heart sounds at all, and often before considering rads. If in doubt, ultrasound also a great tool to confirm fluid quickly.

But in this case, we have rads and not a lot of history (tap may even have been done prior to xray), and the rads don't fit with pleural effusion. And while I agree it is well tolerated, it's got to be a little stress inducing to the cat, especially if it isn't helping.

How do you diagnose asthma from cytology from a chest tap? (I'm not being facetious, if there is a way to do it I'd be interested)

RE: cat chest xrays

Anthony Todd — Wed, 30 May 2018 17:48:14 GMT

[quote user="Lucy Fleming"]I don't really see how?[/quote]

Because you won't get a significant volume of fluid, ie enough [200mls??ish] to cause dyspnoea??

And it's always so well [surprisingly] tolerated IMHE, no local no restraint no clipping and prep['cos they're gasping for enough O2 to stay alive!!]

RE: cat chest xrays

Lucy Fleming — Wed, 30 May 2018 17:39:03 GMT

[quote user="Anthony Todd"]Most of [quote user="David Mills"]pneumonia, inhaled irritants, asthma etc etc[/quote] pretty well eliminated by a chest tap??[/quote]

I don't really see how? (And I am an advocate for tapping for fluid if possible/ tolerated in these dyspnoeic felines)

RE: cat chest xrays

Anthony Todd — Wed, 30 May 2018 17:35:18 GMT

[quote user="David Mills"]Based on rads and zero history[/quote]

"breathing fast, not eating, not moving, not happy" I'd predict. Not really diagnostic!

Most of [quote user="David Mills"]pneumonia, inhaled irritants, asthma etc etc[/quote] pretty well eliminated by a chest tap??

RE: cat chest xrays

David Mills — Wed, 30 May 2018 17:18:45 GMT

Based on rads and zero history (!), looks cardiac. Some small air bronchgrams on dv causally. Heart appears enlarged but I don't put much stock in heart size in cats.

LA measurement to confirm/refute.

Other possibilities pneumonia, inhaled irritants, asthma etc etc

RE: cat chest xrays

Anthony Todd — Wed, 30 May 2018 17:14:36 GMT

[quote user="Rob Davis"]what would you be hoping to achieve?[/quote]

Either fluid or nothing, therefore probably lungs not "fluid" related.

Even a few drops gives you SG and cytology.

Often you find loads and you can make the cat go from blue to pink in minutes and in the consult too.

Although it seems "traumatic" [must be careful using that word] I never had any adverse effects and cats tolerate it well.

We had a referred cat die when it went to the RVC for a chest Xray.... so I was always careful with man-handling these cats after that. They go bluer awful quick.