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Radiographic case study: A dyspnoeic persian cat

Clinical History:

1 year old female entire persian cat.

Fell down hard approximately 12 hours previously and is now dyspnoeic.

(scroll down for radiographs)

Right lateral thorax

Dorsoventral thorax

Radiographic Interpretation:

There is marked enlargement of the cardiac silhouette. The cardiac silhouette is generally increased in height and width on the lateral view and there is a prominent bulge at the right cranial aspect on the DV view, in the region of the right atrium. The caudal pulmonary vessels are difficult to evaluate but the left caudal lobar pulmonary vein is extremely enlarged at the level of the 11th rib (not typical place for measurement). The cranial lobar vessels appear to be within normal limits. There is a tortuous soft tissue tubular opacity present in the caudal mid thorax on the lateral views which may correspond to a pulmonary artery in the left caudal lobe on the DV view. There is a diffuse mottled increase in soft tissue opacity throughout the lung fields and particularly in the region of the right middle and right caudal lung lobes. This is an alveolar to interstitial pattern, with areas of air alveolograms. There is a moderate amount of gas present within the oesophagus. The liver is slightly enlarged and the stomach has increased content for a cat. Immediately caudal to the liver on the lateral view there is an oblong soft tissue opacity. This may represent the spleen and is well defined.

Figure 1: The left caudal lobar pulmonary vein is enlarged

Figures 3 & 4: Note the enlargement in the right atrium (blue arrows) and the tortuous left pulmonary artery (yellow arrows)

Figure 5: Unusual soft tissue opacity caudal to the stomach which probably represents the spleen

1. Cardiomegaly with suspected right atrial enlargement and pulmonary artery enlargement.
2. Pulmonary venous congestion
3. Alveolar interstitial pattern
4. Possible splenomegaly.

Additional comments:
The changes are supportive of an underlying cardiac pathology with secondary cardiogenic oedema. Cardiac ultrasound is recommended once the patient is stabilised for additional information on the underlying aetiology. Given the young age and severe changes, a congenital cardiac disease resulting in left to right shunting is suspected (eg. ASD, VSD, PDA, endocardial cushion defect). It is much less likely in my opinion that the changes relate to contusions. This would not fit with the other changes unless a large amount of intravenous fluids had been administered leading to a volume overload (very unlikely to result in such severe cardiac and vascular changes).