A 20 yr old neutered male Siamese cat was presented to the AcaseAweek clinic for dyspnea, anorexia, and lethargy. The cat was brought in by people who were watching it while the owners have been away. Vaccination and heartworm prevention status’s are both unknown.
Physical exam:
Weight: 4.5kg
T: 101.2 F
P: 220
R:60
Mouth: severe odontoclastic resorptive lesions and gingivitis
Auscultation: Severe gallop rhythm with grade III systolic murmur with PMI greatest over the LAV valve, respiratory sounds: crackles.
Abdominal palpation: very distended with a fluid wave. No masses were palpated.
Musculoskeletal: Generalized Weakness
General appearance: depressed, dyspneic, weak
CBC and chemistry panel were unremarkable except a mildly elevated BUN and creatinine.
ELISA snap test was positive for heartworm.
Abdominocentesis cytology revealed an obstructive transudate that was mildly cellular, containing mostly round, mesothelial type cells with some neutrophils and few lymphocytes.
Once the cat was stabilized, thoracic and abdominal radiographs were taken and are shown below:
Abdominocentesis cytology revealed an obstructive transudate that was mildly cellular, containing mostly round, mesothelial type cells with some neutrophils and few lymphocytes.
Once the cat was stabilized, thoracic and abdominal radiographs were taken and are shown below:
What are the radiographic findings?
What is your diagnosis?
Give differentials for your diagnosis.
How will you treat and manage this case?
Solution to this case
1 comment:
Radiographic Diagnosis: Valentine appearing heart because of biatrial enlargement
Diagnosis: Hypertrophic Cardiomyopathy (HCM)with accompanying abdominal neoplasia (mainly because of the age of the patient and presence of mesothelial cells in the obstructive transudate, dynamic aortic outflow obstruction can also be a cause, which accompanies HCM)
Differential Diagnosis:
Hyperthyroidism
Aortic Stenosis
Systemic Hypertension
Acromegaly
Noncardiac causes of pleural effusion (eg. pyothorax, chylothorax, neoplasia, diaphragmatic hernia)
Treatment and Management:
Minimize stress
Administer Diltiazem at 7.5-15 mg/cat PO q 8 hrs or 10 mg/kg PO q 24 hrs (Cardizem)
Give also Propanolol at 2.5-10 mg/cat PO q8h-12h. Avoid beta blockers with emboli
Aspirin 80mg/cat q 2-3 days
Furosemide at 1-2 mg/kg PO IM, IV q 8h-24h
Nitroglycerin Ointment for venodilation, it lowers atrial filling pressures thereby reducing pulmonary edema or pleural effusion
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