Input appreciated-chest x-ray cat

RE: Input appreciated-chest x-ray cat

Lucy Fleming — Tue, 21 May 2019 12:06:12 GMT

Poor cat! Thanks for the update.

RE: Input appreciated-chest x-ray cat

alison silvester — Tue, 21 May 2019 09:48:24 GMT

UPDATE. Its taken a while for various reasons but CT confirmed the presence of a mass and it was biopsied via tracheoscopy. Unfortunately it is a squamous cell carcinoma, either arising from the tracheal wall or invading through it. At one point is occupying 2/3rds of the tracheal lumen and is 3cm long in total. She also has small airway disease and didn't do as well off steroids so she has been restarted on prednisolone and is being treated with Palladia initially.

RE: Input appreciated-chest x-ray cat

alison silvester — Sat, 13 Apr 2019 17:28:18 GMT

Not sure! Would inhaled steroids be more effective than oral if is asthma type thing? Not sure if bronchodilators useful? Could it be a laryngeal paralysis? Not sure how they present in cats? Is it ruled out by the fact the larynx could spasm? If the lesion in chest is unrelated can ignore it, if it is something sinister then I guess at least the owner knows the aim is control not cure. Feel the right thing to do is attempt to get a diagnosis and then treat as necessary or be able to advise owner there isn't something else they should be doing? Was on medrone and in interim now is on pred. Still not sure there is inflammation to treat or if there is a mechanical/functional obstruction.

RE: Input appreciated-chest x-ray cat

Anthony Todd — Sat, 13 Apr 2019 16:36:03 GMT

[quote user="alibali"]I was suspecting asthma but now despite steroids the symptoms remain. It's a strange one! [/quote]

Sorry mssed that before!

You could try a different steroid, again starting with a jab. I've never been impressed with oral [pred?] except pulse doses in skin cases.

What else is there to relieve symptoms considering the likely pathology?

RE: Input appreciated-chest x-ray cat

alison silvester — Sat, 13 Apr 2019 15:53:40 GMT

Had at the start and also gave short acting injection yesterday as was worried the interfering might exacerbate. Had temporary releif at the start on oral steroid as on initial presentation I was suspecting asthma but now despite steroids the symptoms remain. It's a strange one!

RE: Input appreciated-chest x-ray cat

An On MRCVS — Sat, 13 Apr 2019 15:42:27 GMT

[quote user="Anthony Todd"]

[quote user="alibali"]

Wonder about some kind of laryngeal collapse? Still unsure how or if lesion in chest related. Will post results from referral!

Thanks again

[/quote]

Can I politely and respectfully suggest that a trial injection of a short-acting C'steroid will almost certainly give temporary symptomatic relief.

This could be the end result anyway.

The continuing diagnostic process can still continue, but this is where the art should come in, as what are the chances of further investigation finding a magic permanent cough relief even if a diagnosis is found?

[/quote]

Can I politely and respectfully suggest you read the original post? You will see that a short acting corticosteroid was given at the outset.

RE: Input appreciated-chest x-ray cat

Anthony Todd — Sat, 13 Apr 2019 15:39:34 GMT

[quote user="Liz Barton"]Might, however, affect diagnostics. Always a trade off[/quote]

This is always quoted but mainly for histo [I think] Histo in this one mightn't be high on the list though...

Glad to hear this response. because, in coughing animals, it is pretty well always effective even in cardiac cases and doesn't affect diagnosis.

Hardly ever used, and usually derided as dangerous.

RE: Input appreciated-chest x-ray cat

Liz Barton — Sat, 13 Apr 2019 14:50:22 GMT

[quote user="Anthony Todd"]Can I politely and respectfully suggest that a trial injection of a short-acting C'steroid will almost certainly give temporary symptomatic relief.[/quote]

For sure - totally agree. Might, however, affect diagnostics. Always a trade off. If the owners want a definitive diagnosis and the cat is okay then best to hold off. Obviously welfare comes first, so if the cat was struggling absolutely an injection of dex would be the first thing I'd reach for too.

RE: Input appreciated-chest x-ray cat

Anthony Todd — Sat, 13 Apr 2019 14:33:00 GMT

[quote user="alibali"]

Wonder about some kind of laryngeal collapse? Still unsure how or if lesion in chest related. Will post results from referral!

Thanks again

[/quote]

Can I politely and respectfully suggest that a trial injection of a short-acting C'steroid will almost certainly give temporary symptomatic relief.

This could be the end result anyway.

RE: Input appreciated-chest x-ray cat

Liz Barton — Sat, 13 Apr 2019 13:54:17 GMT

[quote user="alibali"]Chest x-ray attached is full inspiratory, so suspect lesion at 3rd rib is more convincing and I do think bronchial pattern present although could be degree of age change and chronic change as she has been reported to have a life long intermittent cough just never as severe.[/quote]

I'd agree. That tracheal lesion is bizarre. Thanks for the update - really interesting and please do let us know what they find on CT!

RE: Input appreciated-chest x-ray cat

alison silvester — Sat, 13 Apr 2019 10:00:34 GMT

Couldn't add both at once for some reason!

RE: Input appreciated-chest x-ray cat

alison silvester — Sat, 13 Apr 2019 09:59:05 GMT

Had her in for GA and examine etc yesterday. Induction unremarkable. Larynx appeared normal, started to spasm as becoming light from propofol but resolved with topping this up. Intubated easily. No obvious foriegn body/polyp/mass in pharynx but very reactive on handling soft palate. Chest x-ray attached is full inspiratory, so suspect lesion at 3rd rib is more convincing and I do think bronchial pattern present although could be degree of age change and chronic change as she has been reported to have a life long intermittent cough just never as severe. Opted to refer her to somewhere with scope and CT. On recovery once extubated her breathing varied between normal/no effort/no noise, inspiratory effort with stridor and inspiratory effort with upper airway obstruction therefor silent/no breath sounds. This was easily resolved with changing neck position and once she could hold her head up returned to normal breathing, unless she purred in which case abdominal effort increase with upper respiratory noise. Wonder about some kind of laryngeal collapse? Still unsure how or if lesion in chest related. Will post results from referral!

Thanks again

RE: Input appreciated-chest x-ray cat

alison silvester — Thu, 11 Apr 2019 07:15:43 GMT

Its booked in for tomorrow so I will update then!!

RE: Input appreciated-chest x-ray cat

Liz Barton — Mon, 08 Apr 2019 22:17:41 GMT

[quote user="alibali"]Have managed to convince them to go ahead with GA and further investigation![/quote]

Are you going to scope it? I'd be really interested to know what you find, but am in agreement with those thinking of pathological tracheal kink at level of 3rd rib, displaced by soft tissue. With the history of lifelong cough I wonder if this could be a congenital abnormality - maybe a vascular ring anomaly causing tracheal diversion? Or that could be a red herring and you may be dealing with a recent mass lesion. May now be exacerbated clinically with small airway disease causing the more severe signs.

Interesting case; would love know what you find and how the case goes. Best of luck with it!

RE: Input appreciated-chest x-ray cat

Chris Barker — Mon, 08 Apr 2019 20:53:09 GMT

Actually I think there is small airway disease present in the caudal lung field where there is subtle bronchial patterning. However you then have to decide whether this is a clinical issue or simply represents age-related change. In the cranial lung fields (and overlying the cardiac shadow) the bronchial change is present in larger airways and may represent pathology of a different nature I would recognise a soft tissue density overlying the tracheal shadow below the 3rd rib (uniform density, well marginated). The dorsal wall of the tracheal is 'buckled' above this mass and no tracheal lumen can be seen behind the soft tissue shadow - this is not the 'usual' kink in the trachea which can be seen in dogs with certain neck positions. I suspect that this is a pathological lump, either directly beneath the trachea, or even in its ventral wall, causing tracheal displacement / narrowing

RE: Input appreciated-chest x-ray cat

Anthony Todd — Mon, 08 Apr 2019 17:34:46 GMT

[quote user="Sammy82"]minimise systemic side effects. [/quote]

Again, [and again], if the dose is correct and minimally but effective, at maximum intervals and/or only when needed, and never continuous, systemic side effects are zero.

Together with the sometime experience that, for whatever reason, the allergen or whatever, goes away, much to everyone's surprise.

RE: Input appreciated-chest x-ray cat

Sammy82 — Fri, 05 Apr 2019 17:56:49 GMT

If long-term steroids are needed an inhaler might be preferable to minimise systemic side effects.

RE: Input appreciated-chest x-ray cat

alison silvester — Fri, 05 Apr 2019 16:51:02 GMT

Thank you both. That was my suspicion but I still feel the respiratory noise is coming from further up. Have managed to convince them to go ahead with GA and further investigation!

Thanks again

Alison

RE: Input appreciated-chest x-ray cat

Charlotte Marshall — Fri, 05 Apr 2019 14:07:24 GMT

I agree there looks like a narrowing but whether it is intra or extra luminal I couldn't say.

RE: Input appreciated-chest x-ray cat

Richard Carter — Fri, 05 Apr 2019 13:02:27 GMT

will put my neck out - small stricture anterior to heart in trachea? lung tissue looks to be in good condition, nice clear tissue, minimal bronchial disease, diaphragm intact, heart normal size. Tried to enlarge but not happening on my computer. Think response to steroid but not abs significant - volume improves at X^3 for changes in diameter so any reduction in obstruction, huge improvement air flow.

think any further exam will involve a ga to chk back throat, larynx, scope trachea so if not going to happen, in a 14 year old cat, 1-2.5mg preds sid not worst thing in world