Case of the Week

RE: Case of the Week

Lucy Fleming — Sun, 08 Mar 2020 00:29:05 GMT

Did anyone else get taught "conditions beginning with P" as neutrophil "sinks" in their uni days? Pyometra was always the one that stuck in my head, should have remembered pyothorax!

I wonder if the thick purulent material meant less volume was occupied so no visible resp signs?

RE: Case of the Week

Anthony Dennison — Fri, 06 Mar 2020 11:53:38 GMT

See if this works? Yes there was an effusion, but it was of a real mixed echogenicity, and the pericardium was thickened and hyoerechoic.

Thoracic radiographs confirmed a pleural effusion, worse on the right side. Needle thoracocentesis was attempted but nothing would come out - the needle was getting clogged with really thick pus.

A wire guided chest drain was placed on the right hand side (haven't got xrays on hand to add on, but personally I think I advanced the tube too much as it curled around within the thorax).

Initially the pus was so thick the only way of draining anything out was by extensive lavage (used about 200ml fluid total in 20ml aliquots). Cat was hospitalised for a further 2 days with repeated lavage. I removed the drain last night as lavage was starting to come back clearer and send the cat home on metronidazole and amoxyclav.

Thought it was interesting this cat had no respiratory signs at all, just weight loss. Not sure how long the pyothorax had been present but the stuff inside the chest was so thick and horrible. Still awaiting culture but cytology confirmed pyothorax with small numbers of phagocytosed bacteria noted.

www.vetsurgeon.org/.../0458.VID_5F00_20200303_5F00_124710.mp4

RE: Case of the Week

Kate Richardson — Fri, 06 Mar 2020 11:24:01 GMT

I'm going to assume it had a pleural effusion, but I don't think its fair (and a bit pointless) getting us to guess what you saw! You might as well just give us your findings!

RE: Case of the Week

Anthony Dennison — Fri, 06 Mar 2020 11:16:28 GMT

[quote userid="6386" url="~/001/veterinary-clinical/small-animal/f/misc-case-discussions/28937/case-of-the-week/220103"]

Plus urine sample and TLI.

Up to date with parasite treatment?

[/quote]

Didn't do, no. Not up to date with parasite treatment

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/f/misc-case-discussions/28937/case-of-the-week/220113"]FIP. [/quote]

On the differential list but not overly suspicious.

I'll give you a clue - the abnormality I noted was in a different body cavity to the one I originally set out to scan.

RE: Case of the Week

David Mills — Thu, 05 Mar 2020 21:34:54 GMT

FIP.

RE: Case of the Week

Kate Richardson — Thu, 05 Mar 2020 14:40:15 GMT

Plus urine sample and TLI.

Up to date with parasite treatment?

RE: Case of the Week

Anthony Dennison — Wed, 04 Mar 2020 10:45:34 GMT

Lymphocytes were a mixed population, some big active ones.

I did an abdominal ultrasound - kidneys were large (left 4.3cm, right 4.9cm). Structure was normal, good corticomedullary definition. They were similar echogenicity to the spleen, but both seemed slightly hyoerechoic compared to normal.

No free abdominal fluid, intestines normal wall layering and thickness. The gallbladder wall was hyoerechoic but not thickened, and contents were normal.

I noticed something odd within the scan window when scanning around the liver looking for evidence of abdominal free fluid though...

RE: Case of the Week

Lucy Fleming — Wed, 04 Mar 2020 10:04:41 GMT

Problem list: weight loss (despite good or even increased appetite), hyperglobulinaemia, neutropaenia and mono- and lymphoctyosis, possible renomegaly.

Suggesting antigenic stimulation/ inflammatory focus (possibly neutrophil demand outstripping production...) but other nastier things a possibility.

I'd also probably want a look at the circulating lymphocytes on the smear (or realistically I'd like a pathologist to look at them), an abdominal ultrasound (to look for free fluid, changes in gut wall, enlargement of mesenteric lymph nodes, renal architecture) and if possible send blood away for folate/ cobalamin.

RE: Case of the Week

Nicola Cole — Tue, 03 Mar 2020 21:45:15 GMT

You mentioned a blood smear (for platelets)-what did the lymphocytes look like?

RE: Case of the Week

Anthony Dennison — Tue, 03 Mar 2020 17:47:35 GMT

We repeated PABs as I wanted to check renal parameters (were normal). Globulins were still raised at 61.

Confident with our machine. Haven't done a manual count in this case but previously has always matched.

RE: Case of the Week

Thomas Johnson — Tue, 03 Mar 2020 17:44:16 GMT

[quote userid="11308" url="~/001/veterinary-clinical/small-animal/f/misc-case-discussions/28937/case-of-the-week"]

Haematology revealed:

a marked neutropaenia at 0.43 x 10^9 (ref range 2.3-10.29)

Monocytosis 1.94 x 10^9 (ref range 0.05-0.67)

Lymphocytosis 10.61 x 10^9 (ref range 0.92-6.88)

Platelets were low but this was likely due to clumping, checked by smear.

FIV/FeLV negative

What would you do next?

[/quote]

Interesting, how reliable do you find the results from your haematology analyser? Does a manual differential agree? Did you repeat the biochemistry to see if the globulins are still raised?