Today’s case is an 11 year old female neutered domestic short haired cat with episodes of coughing 10-15 times per day. Take a look at the case and post your comments!
11 year old female domestic shorthaired cat
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The ventral margins of cranial lung lobes are rounded. There is a silhouette signal (the cardiac silhouette cannot be seen in its totality) – pleural efusion. It seems to be present an enlargement of the cranial mediastinum on DV projection that could be a mediastinal mass. On lateral projections there is opacity increased in cranial portion of the thorax. But there isn’t caudal significant displacement of carina neither mass effect over the trachea. There is an interstitial and bronchial pattern on the lung fields with “donnuts” and peribronchial infiltrates – signal of active and acute lung injury.
On the lateral views the cranial border of the heart can not be seen, due to a soft tissue/fluid opacity in the cranial thorax. There is a minimal amount of air in the esophagus and spondylosis of few of the thoracic vertebra- which are most likely incidental findings.
On the DV view there is widening of the cranial mediastinum (mass?). There is also bronchointerstitial pattern and prominent pulmonary vasculature.
The heart can not be evaluated, and due to the prominent vasculature, a cardiac disease can not be ruled out.
On the lateral views, there is increased opacity of the lung field in particular cranial to the heart which is more severe on the left lateral projection. The cardiac silhouette is obliterated, specifically in the cranial border; Furthermore, several interlobar fissure sings are discernible overlying and also craniodorsal to the heart. Caudal pulmonary lung lobes show moderate alveolar infiltrates. Spondylosis deformance and degenerative changes affecting several thoracic vertebrae is detected as an incidental finding.
On the dorsoventral projection, the cardiac shadow still could not be delineated and caudal pulmonary arteries and veins are distended with more prominency on the right side. Caudal lung lobes show patchy alveolar opacities and peribronchial infiltrates. Cranial mediastinum seems enlarged.
Differential diagnosis should include pleural effusion, cardiogenic pulmonary edema secondary to pulmonary hypertension and left heart failure. Echocardiography is recommended to further evaluate the cardiac structure. Enlargement of the cranial mediastinum could be due to fluid accumulation or a soft tissue mass. Positional studies, such as horizontal beam radiography with the patient in erect position, could differentiate a mediastinal mass from fluid. CAT scans are also beneficial to rule out any possible masses.
Dear Allison, I was wondering if the difference in radiographic appearance of the lung field on left versus right lateral projections could be suggestive of anything.
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