10 weeks old kitten

RE: 10 weeks old kitten

Dave Dickson — Sun, 22 Sep 2019 21:01:13 GMT

Hi Kate

I think the minute you stop asking for second opinions on your own cases, you need to think about retiring. That, or you are omniscient.

I'm not sure about the PE either. How big was it? It could have been myocarditis, but I'm not aware of any cases of FeLV causing myocarditis and it seems a bit of a stretch to say that myocarditis would cause the murmur (most cases are silent). I think that the murmur was haemic, as you say, or possibly unrelated heart disease.

If the PE was small (1-2mm) then I'd put it down to age. If larger (5-10mm or wider on scan) then perhaps there was some exudative process going on. Haemorrhagic PE is vanishingly rare in cats - it's nearly always secondary to CHF or primary inflammatory disease.

Well done testing for FeLV - I bet a bottle of wine that given the same case, I'd have gone for an echo too. The retrospectoscope is my second favourite diagnostic test (after echo, of course).

Dave

RE: 10 weeks old kitten

Kate Richardson — Sun, 22 Sep 2019 20:53:56 GMT

This was a really good reminder to me that sometimes 2 plus 2 doesn't equal 4- and that discussing cases is invaluable no matter how experienced you think you are. I was convinced this was a primary cardiac case and would have probably have sent this for an echo before running bloods unless I had discussed it with others. Still not quite sure what the pericardial effusion is about though in this case (and probably won't get opportunity to sample it to know more given what we now now so if any one could shed light on that for me I'd be grateful- could it be due to myocarditis? I suppose it could be haemorrhage, although the platelet count was low it wasn't that low (about 100 from memory but the smear exam suggested number were adequate and clumps were seen). I hypothesize the anaemia has been slowly developing given the kitten is so bright considering, although is starting to go downhill from speaking to the owners over the weekend. Assuming passed in utero from mum, who is a feral farm cat with another litter on the way.....farmer was reluctant to give away this kitten, so don't know how much chance there is of them being allowed to trap mum and test her

RE: 10 weeks old kitten

David Mills — Sun, 22 Sep 2019 17:25:03 GMT

FIV has been associated with myocarditis in cats, and subsequent dysfunction. Suspect FeLV could cause something similar.

RE: 10 weeks old kitten

Michael Woodhouse — Sun, 22 Sep 2019 17:17:05 GMT

[quote user="Kate Richardson"]sadly FeLV positive[/quote]

Time to get a new kitten then. Heaps of cats wanting a home.

RE: 10 weeks old kitten

Kate Richardson — Sun, 22 Sep 2019 12:49:07 GMT

Thanks Dave and Anthony for your replies

I don't scan many 10 week old kittens!

Had a chat with another cardiologist who said similar, but thought it unusual to only get signs of right sided failure without signs of left failure as well and

Ran some bloods and severe anaemia, neutropaenia, sl low platelets, biochem unremarkable, so checked for retroviruses and sadly FeLV positive Suspect the murmur is a haemic

RE: 10 weeks old kitten

Dave Dickson — Thu, 19 Sep 2019 14:55:51 GMT

Hi Kate

Can you locate the murmur to the left or right side? Any thrill?

Off the top of my head, differentials for right heart failure at this age are pulmonic stenosis, tricuspid dysplasia (usually part of an endocardial cushion defect in a cat), double-chambered right ventricle, cor triatriatum dexter, ASD, cardiomyopathy and complex congenital. I might have forgotten some. It would be very young for a VSD to reverse and cause RCHF, but possible. All of the above are pretty rare in cats.

The other main consideration is that the murmur is incidental (small VSD top of the list here) and the changes on echo are just normal variant (judging chamber enlargement at this age in a wriggly kitten is extremely challenging). A tiny amount of abdominal fluid is normal in a kitten. The liver changes therefore could be something else entirely - I don't scan that many 10wo kitten abdomens so I'd be hard pressed to know what is truly normal at this age. You may have a much better idea than me though!

Do you have any videos or images? These might help push me one way or the other.

The cheapest test right now would be a PCV to see if evidence of cyanotic heart disease (R-L shunt).

No signs so I wouldn't treat just yet.

Hope that helps

Dave

RE: 10 weeks old kitten

Anthony Dennison — Thu, 19 Sep 2019 14:45:33 GMT

Given the age and severity of clinical presentation, I'd agree that it's congenital. Possibly a septal defect? Was there any cyanosis to suggest a right to left sided shunt?