Elderly cat chest radiographs

RE: Elderly cat chest radiographs

Bob Russell — Mon, 18 Jun 2018 10:36:14 GMT

The cat is back to his normal according to the owner. They have declined further investigation for now.

I am quite convinced there is an element of chronic lung disease and the increase in heart size may be the result of this.

I suspect a full answer would require better/more X-rays and/or CT but he is an old boy and back to his normal self. Bloods were WNL.

I don't think I would be reaching for the needle at this stage as the DV, poor though it might be, does not suggest enough fluid for me to investigate.

Good discussion - thanks!

RE: Elderly cat chest radiographs

Anthony Todd — Sun, 17 Jun 2018 16:57:51 GMT

Sorry David, your touche, I should have added then you may need an xray if tap negative.

But it really isn't painful, judging by all the ones I've done.

PS we both forgot pneumothorax.....

RE: Elderly cat chest radiographs

David Mills — Sun, 17 Jun 2018 16:52:55 GMT

[quote user="Anthony Todd"]A tap gives you all the information, if fluid, and eliminates most of the differentials if no fluid[/quote]

It doesn't.

Trauma

CHF

Infection (pneumonia)

Neoplasia

Can all present without pleural effusion.

I think the only thing a NEGATIVE chest tap would eliminate - and that's if you're in the right place - is a large pyothorax, or a chylothorax.

Then consider if it's a diaphragmatic hernia - sticking a needle blindly into intestinal contents.

Humans report pleural puncture is a very painful procedure.

Chest taps can be useful to differentiate between causes if there is pleural effusion present. But they are not a substitute for radiography or scanning. The latter can be used painlessly first to see if a chest tap is appropriate.

Do you know how many dyspnoeic cats present with pleural effusion or pleural space expansion?

RE: Elderly cat chest radiographs

Anthony Todd — Sun, 17 Jun 2018 16:32:08 GMT

[quote user="David Mills"]It would be almost impossible to harvest fluid from an animal without increase in pleural fluid, which would be visible on radiographs.[/quote]

[Last try!]

Of course!, my point exactly!

So while you were getting ready to X-ray yours, my cat [if full of fluid!], would be beginning to turn pink; someone would have spun some of the fluid and done the SG, looked for cells or seen pus or blood [trauma].

If no fluid, even I would be thinking about lung function etc.

A tap gives you all the information, if fluid, and eliminates most of the differentials if no fluid; it's immediate and easy.

Try it, next one you get.

RE: Elderly cat chest radiographs

David Mills — Sun, 17 Jun 2018 14:52:54 GMT

The width of the pleural space in a normal animal is around 0.2-0.3mm thick and there is around 10ml of fluid within that space. It would be almost impossible to harvest fluid from an animal without increase in pleural fluid, which would be visible on radiographs.

RE: Elderly cat chest radiographs

Utlendigur — Sun, 17 Jun 2018 14:05:35 GMT

[quote user="Anthony Todd"]

And, if you've got a massive hydro/pyothorax,relief in 20 minutes and a diagnosis.

Why, oh why, are modvets so against a simple, painless, quicker, [in my hands and often] more diagnostic procedure.

[/quote]

They are not (other than in your mindset) if there is a massive pleural effusion but there is NO FLUID on the xray

Personally I have never found cytology on pleural effusions very helpful for picking up neoplasia, even when there is an obvious mass on the xray - most don't seem to shed cells.

I would still be a bit worried about a miliary-type neoplasia on those xrays

RE: Elderly cat chest radiographs

Anthony Todd — Sat, 16 Jun 2018 17:33:48 GMT

[quote user="Rob Davis"]I would suggest that if there's not enough fluid to be seen on a radiograph then I would be surprised if there was enough fluid to tap...[/quote]

So, as I said, even 1ml would be enough to pick up tumour cells, SG and other cytology which may have given you [mainly with the SG] more, and more definite, info of tumour, infection, heart failure, pyothorax and some I can't think of....

Why is a radiograph better, putting aside the possible problems with getting the picture in an animal in some O2 deficit.

And, if you've got a massive hydro/pyothorax,relief in 20 minutes and a diagnosis.

Why, oh why, are modvets so against a simple, painless, quicker, [in my hands and often] more diagnostic procedure.

I can only thing it's the [modern?] trend favouring a non-invasive procedure?

RE: Elderly cat chest radiographs

Rob Davis — Sat, 16 Jun 2018 17:13:02 GMT

[quote user="Anthony Todd"]Well there's "no fluid on Xray" so obviously not a massive hydrothorax, but would an xray pick up say, <10mls which=[/quote]

I would suggest that if there's not enough fluid to be seen on a radiograph then I would be surprised if there was enough fluid to tap...

[quote user="Anthony Todd"]Remember I'm advocating a chest tap instead of an Xray, as the first stage, and in the consult immediately [apart from cytology and SG].[/quote]

I know, we've covered this before and as previously, the question is about the radiographs which have already been taken... I don't think a chest tap would have added anything here now the radiographs have been done.

RE: Elderly cat chest radiographs

serena holmes — Sat, 16 Jun 2018 16:21:22 GMT

I would conv myself it’s not a cardiac cause with a quick la measurement before I went on the asthma route As the heart looks a bit enlarged on the lateral view. I would probably also cover for lungworm-apparently profender 2 wks apart is effective for this.

RE: Elderly cat chest radiographs

Anthony Todd — Sat, 16 Jun 2018 15:37:12 GMT

sorry for all the strange ="", dunno how they came in??

RE: Elderly cat chest radiographs

Anthony Todd — Sat, 16 Jun 2018 15:32:47 GMT

[quote user="Rob Davis"]But there's no fluid....[/quote]

Well there's "no fluid on Xray" so obviously not a massive hydrothorax, but would an xray pick up say, <10mls which="" is="" enough="" for="" sg="" and="" cytology="" the="" next="" obvious="" diagnostic="" step="" but="" a="" tap="" would="" have="" done="" it="" already="" p="">

"no fluid" looks like a primary lung problem then

Remember I'm advocating a chest tap instead of an Xray, as the first stage, and in the consult immediately [apart from cytology and SG].

With less pain and discomfit than a lot of I/M injections [to settle that point] so you are getting more information at less risk, and categorical information at that.....

Also, as most of these cats come in serious respiratory distress you can drain the < litre of fluid straight away. [try both sides, which I may not have mentioned previously]

Sorry for another turbo but this subject comes up again and again so my reply does too.

RE: Elderly cat chest radiographs

Rob Davis — Sat, 16 Jun 2018 15:16:05 GMT

[quote user="Anthony Todd"]

[quote user="Rob Davis"]I don't understand what you're getting at...[/quote]

SG and cytology?? Transudate/exudate, bacteria, pus cells other tumour cells etc.

"miliary nodules" a bit less significant? ie no tumour cells in cytology [or very significant if found!]

[/quote]

But there's no fluid.....

RE: Elderly cat chest radiographs

Anthony Todd — Sat, 16 Jun 2018 13:19:17 GMT

[quote user="Rob Davis"]I don't understand what you're getting at...[/quote]

SG and cytology?? Transudate/exudate, bacteria, pus cells other tumour cells etc.

"miliary nodules" a bit less significant? ie no tumour cells in cytology [or very significant if found!]

RE: Elderly cat chest radiographs

Rob Davis — Sat, 16 Jun 2018 12:05:23 GMT

[quote user="Anthony Todd"]Then you can be pretty sure you've got a lung problem and makes the "miliary nodules" a bit less significant?[/quote]

I'm probably being dim, but I don't understand what you're getting at....

RE: Elderly cat chest radiographs

Bob Russell — Fri, 15 Jun 2018 11:21:53 GMT

I took a DV view with the cat in an oxygen tent. It was calm and settled. The view was far from perfect but told me there was little chance of fluid being present. A lateral view was therefore unlikely to be particularly risky.

No needles, no discomfort and very little risk to the cat.

Had I not been able to see lots of dark lung, I may well have 'stuck a needle in'.

I already knew this cat is asthmatic but that does not guarantee a lifetime free from heart disease or neoplasia!

RE: Elderly cat chest radiographs

Anthony Todd — Thu, 14 Jun 2018 22:28:09 GMT

[quote user="Joyce Whitehead"]Maybe because there wasnt any fluid to tap? [/quote]

Then you can be pretty sure you've got a lung problem and makes the "miliary nodules" a bit less significant?

RE: Elderly cat chest radiographs

Joyce Whitehead — Thu, 14 Jun 2018 22:22:30 GMT

[quote user="Anthony Todd"]

As usual I'm going to ask why you didn't do a simple chest tap which may well have given you enough fluid to advance the diagnosis, but chest taps don't seem to be fashionable these days.

[/quote]Maybe because there wasnt any fluid to tap?

RE: Elderly cat chest radiographs

Anthony Todd — Thu, 14 Jun 2018 21:30:40 GMT

[quote user="Bob Russell"] I would not and have not ruled out the more sinister completely and not surprisingly the owners have declined CT![/quote]

As usual I'm going to ask why you didn't do a simple chest tap which may well have given you enough fluid to advance the diagnosis, but chest taps don't seem to be fashionable these days.

RE: Elderly cat chest radiographs

Bob Russell — Thu, 14 Jun 2018 12:47:40 GMT

Bloods were all within normal range and he appears to have made an almost uneventful recovery from what was probably an asthma attack.

I was concerned there might be something pushing up on the trachea. I would not and have not ruled out the more sinister completely and not surprisingly the owners have declined CT!

Many thanks!

RE: Elderly cat chest radiographs

Chris Barker — Wed, 13 Jun 2018 23:06:28 GMT

Have to say I'd be perfectly content with those X-ray. No major masses, no specific lobar consolidation, intact diaphragm, no significant pleural effusion - I do not recognise any nodules and the changes seem typical of bronchial/bronchiolar/'asthmatic' disease I'd be happy to give the cat steroids - the only extra I would give would be a course of Azithromycin to cover any possible Mycoplasmal disease

RE: Elderly cat chest radiographs

Liz Barton — Wed, 13 Jun 2018 22:33:35 GMT

I'd be concerned on the lateral you have some miliary nodules and therefore worried about neoplasia. Either that or severe/advanced BI disease (most likely asthma). If you took bloods how was the haematology - inflammatory/eosinophiia/normal?

Either way steroids likely to help (though not great for the kidneys obv).

RE: Elderly cat chest radiographs

Glen McIntosh — Wed, 13 Jun 2018 14:43:12 GMT

I think the images are of pretty decent quality.

I am seeing a generalised bronchial/bronchointerstitial pattern, with possibly some right middle lung lobe atelectasis. The heart does not look particularly enlarged and I can't see any overtly enlarged pulmonary vessels.

That would all fit with feline asthma, which would also seem to fit with the history as well.

RE: Elderly cat chest radiographs

Bob Russell — Wed, 13 Jun 2018 14:26:09 GMT

Radiographs have not come out well in the post so i will fiddle with them a bit later. The actual images are much better!