Today’s case is a 7 year old domestic shorthairÂ cat with chronic cough.
On thoracic radiographs, here is collapse of the right middle lung lobe with evidence of the lobar sign on this lateral projection. In addition there are interstitial to alveolar infiltrates in the ventral thorax worse on the right side. The cardiovascular structures appear within normal limits. The trachea is diffusely small in size and the wall appears thickened. There is a diffuse bronchial pattern.
The CT images show that there is severe thickening of the lobar bronchi to the cranial lobes, and also of the proximal portions of the mainstem bronchi. The right cranial lobar bronchus is bronchiectatic, and a large intraluminal soft tissue occlusion is identified peripherally. Multiple other peripheral airways reveal intraluminal soft tissue accumulation. The right middle lobe is collapsed. There are multifocal patchy areas of interstitial and peribronchial infiltrates throughout all lung lobes, but most severe within the caudal lobes.
Chronic inflammatory disease with bronchiectasis
Bronchoscopy showed moderate to severe tracheal erosions just distal to the larynx. There was extremely thickened mucosa throughout the entire trachea with a redundant tracheal membrane. Grade 1/4 tracheal collapse was seen throughout its length. Marked mucus accumulation was seen in the mid region of the trachea with a slight stenosis at ~ the level of the thoracic inlet. Bronchoscopy also revealed severe blunting at the carina. Many airways could not be entered because of mucus plugging or stenosis, and bronchiectasis could not be directly visualized.
BAL of 2 sites revealed increased cellularity (1700-1800 cells) with increased numbers/percentages of neutrophils (5-15%). Mild previous hemorrhage was noted and the BAL sample revealed no bacteria on cytology. Because the larger airways appeared to be more severely affected than the bronchoalveolar compartment, a sample of tracheobronchial mucus was submitted for cytology, which contained large numbers of neutrophils, with many lysed cells and streams of DNA. Many neutrophils contained short rods to coccobacilli. BAL cultures for aerobic, anaerobic, and Mycoplasma species were negative.
The bronchiectasis indicates that the airway disease is chronic and irreversible, and will probably predispose the cat to recurrent pneumonia. Treatment plans include nebulization and antibiotics as needed.
Case originally posted on December 27, 2007