Today’s case is a 4 year old female domestic short haired cat. Take a look at these thoracic radiographs and post your findings in the comments section.
4 year old female DSH
Teaching and learning about veterinary diagnostic imaging.
Diffuse broncho-interstitial lung pattern. Cardiomegaly. Mineralised opacities on lateral rads superimposed on the kidneys. I wonder if the right caudal pulmonary artery is enlarged on the VD view?
dd: Pneumonitis/Cardiac disease with edema/Lymphoma/Metabolic disease due to uremia-in case of ranal disease/ Bronchopneumonia.
There is air in the esophagus, visible mostly on the LL and DV views. Possible cardiomegaly- the atria seem to be enlarged. But the pulmonary vasculature is within normal limits. Diffuse interstitial pattern.
I would suspect megaesohagus in this cat? An esophagram is recommended
Right, the two main findings are cardiomegaly and an interstitial pattern. Feline cardiomegaly can be hard to pick up, so I recommend comparing it to a normal thorax if you have one available. What methods and measures could you use to determine whether the heart is enlarged?
There is a little bit of air in one lateral projection that disappears on the other. I usually consider this transient because of the stress of taking the radiographs. I didn’t give you much history to go on, but you’d want to take that into account.
image 1 (LL ) of mature cat, normal body condition, microchip near the scapular region, some rugal fold in the neck region, contenitive instrument in the neck region. Thorax, inspiratory. Pulmonary cranial field with vascular pattern, pulmonary caudo dorsal field with broncho-interstitial pattern, pulmonary caudo ventral more inflated with broncho interstitial pattern. Superimposed scapula in the cranial mediastinum. cardiac shape round, increased sternum/cardiac contact. Cranial abdomen. mild epatomegaly, normal gastric axis, focal increased radiopacity in the kidney cranial pole.
image 2 (RL) Thorax inspiratory. Little amount of gas in the esophagous, vascular pattern in the cranial pulmonary field, diffuse broncho-interstitial pattern in the dorso-caudal and caudo-ventral field. the cranial margin of the cardiac shape looks more prominent. Cranial abdomen. two focal increased radiopacity in the kidneys region.
image 3 (DV) Thorax vascular pattern in the cranial lung lobes, Cardiac apex shifted to the right. Cranial abdomen. kidneys normal in size and shape. spleen normal in size and shape. gastric fundus distended with gas and some rugal folds are visible.
the x-ray study of the thorax is suspicious of cardiac disease an ecocardiogram could complete the exam
possible differential diagnosis are (parasitic)Aelurostrongylosis, (inflammatory) Pneumonitis, at least neoplastic
I use the modified VHS (taking measurements on VD and then count vertebra from T4 on the lateral view). Also the heart width shouldn’t be more than 1/2 of the thoracic width on VD, and not more than 2.5 intecostal spaces on the lateral (it’s tricky in cats due to more sternal contact when they are older). Also usually there should be some space between the caudal waist and the diaphragm on the lateral view. Any other methods?
That’s exactly right; the vertebral heart score and % thoracic width are things you can measure, while the shape and approximate volume of the heart on the lateral projection are a bit more subjective. The shape of the heart is also important in cats. Remember the “valentine” description? Perhaps appropriate considering the date tomorrow!
On right lateral projection, the enlarged cardiac silhouette with the increased contact on the sternum. VHS scale is normal with 7.1 but the width of the cardiac silhouette is bigger than 2.5 times of intercostal space. Mineralized material at cranio-dorsal abdomen superimposed on the kideny, which is an incidental finding.
Mild hepaotmegaly extending beyond the coastal arch.
On DV projection, heart apex displace to right. Right cardiac silhouette seems enlarged.
Pulmonary artery vessel appears enlarged in the right thorax.
Mild Interstitial pattern of the all lung lobes and more on bilateral cranial thorax.
DDX – HCM, DCM(less likely) with secondary pulmonary edema(mild or clinically not obvious) and the pulmonary arterial vessel dilation.
Question to anyone – the point of pulmonary arterial vessel where the 9th rib meet seems dilated. Is it wrong?
Thorax in 3 views:
main findings:roundish cardiac silhouette shape on lateral view ,enlargement of the left atrium with apex pointing to the right, on DV view valentine shape of cardiac silhouette , however normal pulmonary vasculature
diffuse interstitial lung pattern with bronchial interstitial pattern in the ventrocaudal area of the lung
incidental findings:chip in the soft tissue of the neck and 2 mineral opacities in the region of the adrenal glands
Radiographic diagnosis
cardiomegaly L than R sided without any signs of congestive heart failure
diffuse interstitial pattern with focal more bronchiointerstitial with thin bronchial rings pattern
incidental: Mineralisation of adrenal glands -normal finding in cats
DDx Cardiomopathy most likely HCM less likely RCM, DCM Echocardiography is recommended and blood analysis for hyperthyroidism often associated with HCM in cats
diffuse interstitial pattern could be associated with a previous or beginning lung disease or be a normal finding due to the “contrasty” image