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Chronic Respiratory Disease in a Domestic Shorthair Cat April 30th, 2014 Jamie Zhen.

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Presentation on theme: "Chronic Respiratory Disease in a Domestic Shorthair Cat April 30th, 2014 Jamie Zhen."— Presentation transcript:

1 Chronic Respiratory Disease in a Domestic Shorthair Cat April 30th, 2014 Jamie Zhen

2 12 year-old male castrated Domestic Shorthair cat History Lethargy Inappetence Weight loss Chronic coughing o one instance of hemoptysis Unusual rDVM thoracic radiographs

3 12 year-old male castrated Domestic Shorthair cat History Lethargy Inappetence Weight loss Chronic coughing o one instance of hemoptysis Unusual rDVM thoracic radiographs 6 other strictly indoor cats FeLV/FIV negative No changes in urination & defecation

4 Physical Exam Temperature: 103.3 F Heart rate: 210 bpm Respiratory rate: 30 bpm No heart murmur Harsh lung sounds bilaterally Mild serous ocular & nasal discharge Moderate dental tartar and halitosis Right thyroid slip No abnormalities on abdominal palpation

5 CHRONIC COUGH Upper airway Inflammatory: pharyngitis, tracheitis Neoplasia: mediastinal, laryngeal, tracheal Lower airway & Parenchymal Inflammatory: bronchitis Infectious Bacterial Viral Fungal: Coccidiomycosis, Histoplasmosis Parasitic: Heartworm, Lungworm, Paragonimus Protozoal: Toxoplasmosis NeoplasiaPrimary/metastatic VascularPulmonary thromboembolism Bronchial compression Pleural space disease Problems & Differential Diagnoses

6 Thyroid slip Neoplasia: adenoma, carcinoma, metastatic Hyperplasia Elevated temperature Hyperthermia Fever Lethargy Inappetence Weight loss

7 Complete blood count Chemistry panel Urinalysis T4 Level Imaging: o Thoracic radiographs o CT scan Diagnostic Plan

8 CBC ResultReference Range Hematocrit13% (Low)31 - 48 MCV64 fL (High)40 - 52 MCHC30 g/dL (Low)32 - 35 Absolute Reticulocyte count22.5 thou/uL (NORMAL)8.5 - 60.7 WBC432 thou/uL (High)5.1 - 16.2 Segmented neutrophils380 thou/uL (High)2.3 - 11.6 Band neutrophils38.9 thou/uL (High)0 - 0.1 Monocytes8.6 thou/uL (High)0 - 0.7 Platelet count52 thou/uL (Low)195 - 624 CHEMISTRY Potassium2.8 mEq/L (Low)3.8 - 5.7 Bloodwork Abnormalities

9 severe macrocytic, hypochromic, minimally regenerative anemia severe inflammatory leukogram with left shift & toxic changes severe thrombocytopenia (platelet clumps were present) Complete blood count mild hypokalemia Chemistry panel no significant clinical abnormalities Urinalysis 1.34 ug/dL (LOW), Reference range: 1.5 - 4 Hyperthyroidism less likely T4 Level Thoracic radiographs CT scan Imaging: Diagnostics

10 Thoracic Radiographs

11 CT Scan CRANIAL CAUDAL

12 Differential Diagnoses CHRONIC COUGH Upper airway Inflammatory: pharyngitis, tracheitis Neoplasia: mediastinal, laryngeal, tracheal Lower airway & Parenchymal Inflammatory: bronchitis Infectious Bacterial Viral Fungal: Coccidiomycosis, Histoplasmosis Parasitic: Heartworm, Lungworm, Paragonimus Protozoal: Toxoplasmosis NeoplasiaPrimary/metastatic VascularPulmonary thromboembolism Bronchial compression Pleural space disease

13 Tracheal wash Further Diagnostics o Productive cough during procedure o Collected contents

14 Tracheal Material Cytology Result: ●Carcinoma ●Purulent inflammation ●Necrosis Criteria of Malignancy ●Mitotic figures ●Multinucleation ●Pleomorphism (variable shape) ●Changes in nuclear to cytoplasmic ratio ●Variable nucleolar size, shape or multiple nucleoli ●Anisocytosis (variable cell size) ●Anisokaryosis (variable nuclear cell size)

15 Poor Euthanasia Educational necropsy Prognosis

16 Histology NORMAL LUNG 1. Terminal bronchiole 2. Respiratory bronchiole 6. Alveoli 7. Smooth muscle 40x 20x

17 Cytokeratin 7 Stain: epithelial cell marker Immunohistochemistry 20x Cytokeratin 19 Stain: epithelial cell marker of bronchioles

18 Primary lung tumors rare in cats o 70-80% adenocarcinomas Signs o Early: weight loss, lethargy, weakness, vomiting, pyrexia o Late: dyspnea, tachypnea, coughing, hemoptysis Diagnosis o Routine laboratory data not diagnostic  Case report Dole et al 2004: Paraneoplastic leukocytosis in cat with primary lung tumor o Radiographic appearance: solitary lung masses, pleural effusion (~33%) o Definitive diagnosis often made at necropsy Bronchogenic Adenocarcinoma

19 Metastases o Other areas of lungs, lymph nodes, long bones, liver, spleen, pancreas, adrenal glands o Eyes, skeletal muscle o Digits: feline lung-digit syndrome Prognosis: POOR o Hahn & McEntee (1998), n = 21 cats  Moderately differentiated tumors: Median survival times with complete surgical resection ~700 days  Poorly differentiated tumors Median survival time 75 days o Maritato et al (2014), n = 20 cats  Surgical resection of primary lung tumor Median survival time 11 days  Negative prognostic indicators clinical signs (dyspnea), pleural effusion, metastases, poorly differentiated tumors Bronchogenic Adenocarcinoma

20 Diagnostics o ~$1387 o CT scan subsidized Necropsy o educational Cost

21 1. Dole RS et al. Paraneoplastic leukocytosis with mature neutrophilia in a cat with pulmonary squamous cell carcinoma. Journal of Feline Medicine and Surgery. (2004) 6(6):391-395 2. Kahn & McEntee. Prognosis factors for survival in cats after removal of a primary lung tumor: 21 cases (1979-1994). Veterinary Surgery. (1998) 27:307-311 3. Langlais LM et al. Pulmonary adenocarcinoma with metastasis to skeletal muscle in a cat. Practitioners’ Corner. (2006) 47:1122-1123 4. Maritato et al. Outcome and prognostic indicators in 20 cats with surgically treated primary lung tumors. Journal of Feline Medicine and Surgery. (2014) 16(4):1-6 5. Petterino C et al. Bronchogenic adenocarcinoma in a cat: an unusual case of metastasis to the skin. Veterinary Clinical Pathology. (2005) 34(4):401-404 6. Rossi F et al. Unusual radiographic appearance of lung carcinoma in a cat. Journal of Small Animal Practice. (2003) 44:273-276 7. Schoen K et al. Hypercalcemia of malignancy in a cat with bronchogenic adenocarcinoma. J Am Anim Hosp Assoc. (2010) 46:265-267 Picture References: 1. http://themetapicture.com/chemistry-question/ http://themetapicture.com/chemistry-question/ 2. http://kittentoob.com/cat-news/http://kittentoob.com/cat-news/ 3. http://www.purinaveterinarydiets.com/resources/files/cat_chart.pdfhttp://www.purinaveterinarydiets.com/resources/files/cat_chart.pdf 4. http://www.shutterstock.com/pic-95776864/stock-photo-bad-breath-cat-cartoon.htmlhttp://www.shutterstock.com/pic-95776864/stock-photo-bad-breath-cat-cartoon.html 5. http://vecto.rs/designs/felinehttp://vecto.rs/designs/feline 6. http://aercmn.com/services/internal-medicine/treatment-cats-with-hyperthryroid-disease/http://aercmn.com/services/internal-medicine/treatment-cats-with-hyperthryroid-disease/ 7. http://www.howtobeaheroine.com/2012/11/13/a-decision/house-its-not-lupus-its-never-lupus/ 8. http://www.familyvet.com/Cats/Resp.htmlhttp://www.howtobeaheroine.com/2012/11/13/a-decision/house-its-not-lupus-its-never-lupus/http://www.familyvet.com/Cats/Resp.html 9. http://mousebreath.com/2012/12/millionaires-prefer-dogs-to-cats/http://mousebreath.com/2012/12/millionaires-prefer-dogs-to-cats/ 10. https://www.atdove.org/Addon/ET-Wash/PrintArticle.pdfhttps://www.atdove.org/Addon/ET-Wash/PrintArticle.pdf 11. http://www.freemake.com/blog/best-summer-memes-with-grumpy-cat/http://www.freemake.com/blog/best-summer-memes-with-grumpy-cat/ 12. http://cal.vet.upenn.edu/projects/histo/Labrespiratory.htm http://cal.vet.upenn.edu/projects/histo/Labrespiratory.htm References

22 Dr. Cheryl Balkman Dr. Erica Behling-Kelly Dr. John Lucy Dr. Heather Daverio Dr. Alana Rosenblatt Class of 2014 All Staff in CUHA Acknowledgements

23 Questions?

24 Bone marrow aspirate o Granulocytic hyperplasia o Erythroid hyperplasia Further Diagnostics

25 Blood Smear


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