Pictures show:

  1. Cross-section CT scan showing the large abscess next to the heart and below the lung
  2. Full CT scan showing the large abscess next to the heart and liver
  3. Intraoperative image showing the abscess to the left of the incision, with inflamed tissue around the lungs
  4. Tommie the cat recovering after the operation at Paragon Veterinary Referrals

The case

Tommie, an 11-year-old domestic short-haired cat, had a history of weight loss, anorexia and increased respiratory rate when he was first referred to us at Paragon Veterinary Referrals.

He was initially diagnosed with pyothorax by cardiologist Debra Hyman, who managed the condition with chest drains.

Unfortunately, Tommie’s clinical signs returned despite a good initial response to treatment and he was sent for a CT scan.

The scans revealed a series of large abscesses attached to his thoracic viscera, which required urgent surgery, which I carried out with soft tissue specialist Mickey Tivers.

It was the most extensively-affected case of surgically-managed pyothorax I have seen.

The scans showed abscesses in the right caudal and accessory lobes, involving the mediastinum and the pleura. The extent of Tommie's problem was exceptionally severe and the operation was extremely complicated.

Precise and gentle tissue handling was required to prevent inadvertent damage to the heart, lungs and major blood vessels. A midline sternotomy was performed, and the ventral mediastinum was resected.

The abscess was identified in the right hemithorax, traversing from the cupula to the diaphragm. The capsule was resected from the cranial vena cava, cranial and middle lung lobes, the pericardium and diaphragm.

The pleura was partially resected from the thoracic wall. I then performed a right caudal and accessory lung lobectomy, where the accessory lung lobe was adhered to the caudal vena cava.

Superficial damage to the cranial and middle lobes required repair of tears in the parenchyma, and after a thorough lavage, a narrow bore thoracostomy was then placed, and the sternum and skin were closed routinely.

Tommie recovered well from anaesthesia and surgery in Paragon’s cat-specific ward, and was eating normally the same evening. He was discharged a few days later.

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