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3 year MN DSH Presented for inappetence and rapid breathing Referred into the cardiology service.

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What's Your Diagnosis? Answers posted after the Imaging Interpretation Session

Uniform soft tissue opacification in the area of the left cranial lung lobe, including its bronchial tree – heterogeneous moderate interstitial to alveolar pattern in the right cranial lung that is concentrated around the bronchus – left caudal primary bronchus is severely narrowed – diaphragmatic flattening indicative of hyperinflation – cardiac silhouette is enlarged, with rounded contours and suspected rounded protruding contours on craniodorsal margin (best defined in the right lateral image) and caudolateral margin (best defined on the DV image) – right middle and bilateral caudal vascular enlargement.

1) Soft tissue infiltrative process of the left cranial lung, involving bronchial tree

2) Cardiomegaly with possible mass-like components

3) Right cranial interstitial to alveolar pattern

4) Right middle and caudal lung vascular pattern

At presentation, cat was placed in oxygen and given Lasix based on breathing pattern. The cat was referred to the cardiology service due to concerns for congestive heart failure. These radiographs preceded the echocardiogram. The echocardiogram was delayed to determine if Lasix therapy improved breathing or radiographic changes. The second radiographic series was similar. Adjunct tests performed following initial radiographic series included SNAP BNP: positive and SNAP FeLV/FIV: negative

Echocardiogram findings included : pericardial effusion, tachycardia, inflow obstruction of pulmonary veins, left atrial compression obstruction secondary to pericardial mass versus hepatized lung mass. Due to lack of improvement with Lasix therapy and worsening of cardiopulmonary issues, the cat was euthanized. Lymphoma was diagnosed from the mass identified affected the pericardium, adjacent mediastinum and hilar area of left cranial lung. Pericardial lymphoma in cats is considered a rare form of extra-nodal lymphoma. Feline mediastinal lymphoma has been associated with patients young in age and positive feline leukaemia virus (FeLV) status. Patients with lymphoma in these locations present with pleural effusion and frequently respiratory distress.

References

Shih et al. (2014). Cardiac involvement secondary to mediastinal lymphoma in a cat: regression with chemotherapy. J Vet Cardiol. 2014 Jun;16(2):115-20. doi: 10.1016/j.jvc.2014.01.002. Epub 2014 Apr 2.

Amati et. al (2014) Pericardial lymphoma in seven cats. J Feline Med Surg. 2014 Jun;16(6):507-12. doi: 10.1177/1098612X13506199. Epub 2013 Oct 9.

Image courtesy of Dr. Phil Fox, DVM, MS, DACVIM. Notice the severe locally extensive nature of the mass. From the imaging, the radiologists and cardiologists enjoyed the debate of where the mass was originating from (pericardium vs lung vs mediastinum). Everyone was right!

Image courtesy of Dr. Phil Fox, DVM, MS, DACVIM. Notice the severe locally extensive nature of the mass. From the imaging, the radiologists and cardiologists enjoyed the debate of where the mass was originating from (pericardium vs lung vs mediastinum). Everyone was right!