In collaboration with Dr. Adrien-Maxence Hespel from the University of Tennessee, we present the following radiology quiz. The goal of this case is to practice identifying radiographic findings and formulating a radiographic diagnosis based on a brief patient description. The final section provides additional information about the treatment.
5 year old male castrated cat. Has been treated for elevated renal values.
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The cardiac silhouette is moderately to severely enlarged occupying greater than 2/3 the height of the thoracic cavity and almost the entire width of the thoracic cavity on the ventrodorsal radiograph. The right cranial lobar pulmonary vein is mildly enlarged compared to the corresponding artery. The pulmonary arteries are enlarged and mildly tortuous. There is a mild, diffuse unstructured interstitial to bronchointerstitial pulmonary pattern.
There is a small volume of fluid in the pleural space of both hemithoraces which widens the pleural fissures. The cranial mediastinum is widened on the ventrodorsal radiograph and there is a focal, rounded, soft tissue opaque convexity immediately dorsal to the second sternebra. There is a small volume of incidental gas within the intrathoracic esophagus.
Severe cardiomegaly in conjunction with the enlarged right cranial lobar vein, pleural effusion and diffuse unstructured interstitial pulmonary pattern is most concerning for congestive heart failure from underlying cardiomyopathy and/or fluid overload. Echocardiography is recommended for further evaluation. The mild tortuosity of the pulmonary arteries may be a patient variant or represent a component of cardiovascular disease (vs. pulmonary hypertension). – The soft tissue convexity immediately dorsal to the second sternebra may represent an enlarged sternal lymph node or loculated pleural effusion.
Under-conditionned
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