Intraluminal tracheal stenting for treatment of tracheal narrowing in three cats

OBJECTIVE: To describe the use of intraluminal tracheal stenting in 3 cats with either benign or malignant tracheal obstruction. STUDY DESIGN: Retrospective clinical study. ANIMALS: Three client-owned cats. METHODS: Medical records were reviewed and information regarding signalment, clinical signs, physical examination findings, diagnostic tests performed, treatment, outcome and follow-up were retrieved. Intraluminal tracheal stent placement was performed as previously described in the literature. RESULTS: Three cats received intraluminal tracheal stents for the treatment of tracheal obstruction due to 3 different underlying causes: stricture secondary to traumatic endotracheal intubation, stricture secondary to a previous tracheotomy, and neoplasia. Self-expanding metallic stents of varying sizes were placed, and all cats recovered uneventfully from the procedures. The cat with tracheal neoplasia was euthanized because of pulmonary metastatic disease 6 weeks post-stent placement. The two cats with tracheal obstructions secondary to benign strictures are currently 39 months and 32 weeks post-stent placement, respectively. No complications were noted during the post-stent period in any of the 3 cats. CONCLUSIONS: Intraluminal tracheal stenting was easily, safely, and rapidly performed without complications and resulted in immediate improvement in clinical signs in all three cases. None of the cats in this study developed significant stent-associated complications during the study period. CLINICAL RELEVANCE: Intraluminal tracheal stenting has the potential to be a viable option for the treatment of tracheal obstruction in cats and perhaps for similar disease processes in other veterinary patients.     

Surgical management of intrathoracic tracheal avulsion in cats: long-term results in 9 consecutive cases

OBJECTIVE: To evaluate the outcomes and complications in a consecutive series of cats undergoing surgical repair of intrathoracic tracheal avulsion injuries. STUDY DESIGN: Retrospective clinical study. ANIMALS: Nine client-owned cats. METHODS: The medical records of all cats undergoing surgical repair of intrathoracic tracheal avulsion injuries from 1994 to 1997 were reviewed. The results of physical examination, laboratory evaluations, radiography, tracheoscopy, surgery, and patient follow-up were reviewed. Complications that arose and long-term outcome were noted. RESULTS: Long-term resolution of clinical signs was achieved in all cats after resection of the damaged trachea and its repair by end-to-end anastomosis. Follow-up periods ranged from 12 months to 2.9 years. One cat developed unilateral left-sided laryngeal paralysis 2 to 3 months after surgery; however, this was transient and resolved without intervention within 6 months of surgery. CONCLUSIONS: Surgical management of intrathoracic tracheal avulsion injuries in cats can be accomplished via a right lateral thoracotomy. Careful anesthetic technique is an integral part of the surgical procedure if a successful outcome is to be achieved. The incidence of both short-term and long-term complications was low. Care should be exercised to visualize and protect the left recurrent laryngeal nerve if postoperative iatrogenic unilateral left-sided laryngeal paralysis is to be prevented. CLINICAL RELEVANCE: This retrospective study documents the successful surgical correction of a series of clinical cases of intrathoracic tracheal avulsion in cats.     

Macrophakia in three cats

This report describes three cases of bilateral macrophakia in 3-, 5-, and 9-year-old cats, respectively. All cats were presented because of visual deficits. Ophthalmic examination revealed macrophakia (the vitreous was replaced by the lens) and retinal changes (tapetal hyper-reflectivity, attenuation of retinal vessels, and retinal folds) in all cats. In addition, bilateral subconjunctival orbital fat prolapse in one cat and microphthalmos in another cat were present. To confirm the ophthalmologic diagnosis of macrophakia, gross pathology examination in one cat and ultrasound examination in another cat were performed.     

Fat malassimilation in three cats

Three cats were thin despite eating well. Steatorrhoea was confirmed in each by 72-hour fat assimilation tests. Fat digestibility in all 3 increased twofold when the diet was supplemented with pancreatic enzymes, suggesting the possibility of exocrine pancreatic insufficiency. However, examination of stained faecal smears gave evidence of both maldigestion and malabsorption of fat, without maldigestion of starch, and only one case had indications of protein maldigestion. In the latter cat, fat digestibility normalised with pancreatic enzyme supplementation and exocrine pancreatic insufficiency was considered likely. However, at post-mortem examination enteropathy and pancreatitis, but not exocrine pancreatic insufficiency, were found. The cause of fat malassimilation in these cats was unknown. The evaluation of malassimilation in cats is difficult because investigative tests used in other species are either unsuitable or have not been evaluated in cats.     

Congenital tarsal hyperextension in three cats

CASE DESCRIPTION: 3 kittens were examined because of a malformation affecting the hind limbs, resulting in an inability to bear weight or ambulate normally. CLINICAL FINDINGS: 2 kittens were younger than 6 weeks of age, and 1 was 4 months of age at the time of initial examination. The congenital abnormality was characterized by severe tarsal hyperextension in which weight was borne on the cranial aspect of the tarsus, and the plantar surface of the metatarsus faced dorsally. In 2 kittens, the condition affected both hind limbs, and in the older kitten, the condition was unilateral. In the 2 kittens in which radiographs were obtained, no bone abnormalities were detected. Full-cylinder fiberglass casts were applied and changed weekly to accommodate growth. Owners administered physical therapy after final cast removal. TREATMENT AND OUTCOME: Conservative management involving external coaptation and physical therapy led to favorable results in all 3 cats. CLINICAL RELEVANCE: Although further studies are needed to determine the etiology of the disorder, affected kittens may be successfully treated with conservative management. Owners should be committed to the necessity for returning cats for serial cast changes, care for pressure sores, and administration of physical therapy after cast removal.     

Mitral valve stenosis in three cats

Two-dimensional and M-mode echocardiography were used to diagnose mitral stenosis in two cats with heart failure. This appeared to be related to mitral valve complex malformation. Ultrasound findings included thickened mitral valve leaflets with inhibited mobility, reduced mitral valve orifice size, abnormal upward (cranial) motion of the caudal mitral leaflet during diastole and severe left atrial enlargement. Colour-flow and spectral Doppler imaging helped characterise this condition. Colour-flow Doppler mapping showed turbulence and increased mitral filling velocity (aliasing) at the site of stenosis and related jets of mitral regurgitation. Spectral Doppler recordings showed increased diastolic mitral filling velocities with spectral broadening and prolonged pressure half-time. Mitral stenosis should be included in the differential diagnosis of cats with severe left atrial enlargement when congenital or acquired mitral valve disease is detected; it may represent an advanced form of mitral valve complex malformation in some cases.     

Acute tularemia in three domestic cats.

Acute Francisella tularensis infection in 3 domestic cats was presumptively diagnosed on the basis of clinical signs and lesions and confirmed by culturing or immunofluorescent demonstration of the organism. Clinical findings include marked signs of depression, oral/lingual ulceration, regional or generalized lymphadenomegaly, hepatosplenomegaly, panleukopenia with severe toxic change of neutrophils, and hyperbilirubinemia with bilirubinuria. Lesions found at necropsy included icterus, oropharyngeal and lingual ulceration, multiple foci of necrosis in lymph nodes, spleen, liver, and lung, and severe segmental or diffuse enterocolitis. Results of serologic testing for F tularensis was positive in only 1 of the 3 cats. The organism was cultured aerobically from several tissues, including aspirated bone marrow obtained before death in 1 cat. Results of an indirect fluorescent antibody test, performed on fresh and formalin-fixed tissues of all cats, were positive. Because of the severe clinical course, opportunity to evaluate therapeutic regimens was not possible. Until now, confirmed diagnosis of feline tularemia only has been made retrospectively, in instances when cats were suspected to have transmitted infection to human beings in whom the primary diagnosis was made. The findings in this report provide a basis for presumptive diagnosis that will help to minimize public health risk associated with this potentially fatal zoonotic disease.     

Benign cranial mediastinal lesions in three cats

Cranial mediastinal lesions were detected in three cats, associated with respiratory impairment (case one), spontaneous pneumothorax (case two) and myasthenia gravis (case three), respectively. On gross and histological examination, the first case was considered either a lymphangioma or a branchial cystic mass of the thymic region of the mediastinum; a cystic lesion was suggested by sonographic detection of multiple anechoic cavitations within a circumscribed mass, while fine needle aspiration cytology excluded lymphosarcoma. The second case was diagnosed histologically as a cystic thymoma, but the third case was not examined microscopically. The masses were amenable to surgical excision in the first two cats, while this proved unnecessary in the third case because of resolution following treatment with dexamethasone. Corticosteroid responsiveness was unhelpful in distinguishing between these benign lesions and lymphosarcoma, as in two cases there was a partial or complete response to dosing with prednisolone or dexamethasone. These cases are presented to emphasise that conditions other than lymphosarcoma can produce cranial mediastinal lesions in cats, and that the prognosis for surgical treatment of lymphangiomas, multilocular thymic cysts and cystic thymomas can be excellent.     

Effects of theophylline on tracheal mucociliary clearance rates in healthy cats

OBJECTIVE: To determine tracheal mucociliary clearance rate (TMCCR) by use of a standard protocol in healthy anesthetized cats and to determine the effect of theophylline on TMCCR in healthy anesthetized cats. ANIMALS: 6 healthy cats. PROCEDURE: Cats were anesthetized with propofol, and a droplet of the radiopharmaceutical technetium Tc 99m macroaggregated albumin was placed endoscopically at the carina. Dynamic acquisition scintigraphic imaging was performed, using the larynx as the end point. The TMCCR was determined by measuring the distance the droplet traveled by frame rate. Each cat was imaged 6 times as follows: 3 times following placebo administration and 3 times following the administration of sustained release theophylline (25 mg/kg, PO). Serum theophylline concentrations were assessed during imaging to ensure therapeutic concentrations. RESULTS: The TMCCR in healthy adult cats anesthetized with propofol was 22.2 +/- 2.8 mm/min. Tracheal mucociliary clearance rate in cats receiving theophylline was 21.8 +/- 3.5 mm/min. Theophylline administration did not significantly alterTMCCR. CONCLUSIONS AND CLINICAL RELEVANCE: Theophylline has been shown to increase TMCCR in humans and dogs. In our study, we determined TMCCR in healthy anesthetized cats and found that it was not accelerated by the administration of theophylline.     

Feline urticaria pigmentosa in three related Sphinx cats

Abstract A pruritic maculopapular eruption with clinical and histological features similar to urticaria pigmentosa of humans is reported in three related Sphinx cats. All cats shared the same grandsire, had a juvenile onset of disease, and demonstrated similar historical, clinical and histological findings. Physical examination revealed widespread bilaterally symmetrical, erythematous, partially coalescing, crusted macules and papules on the trunk, limbs, neck and head. A few macules exhibited a dark brown pigmentation. Dermatographism could not be elicited in any of the cats. Histological examination of papules revealed the présence of a perivascular to diffuse dermal and subcutaneous infiltrate of well-differentiated mast cells. In one cat where systemic involvement was pursued, evidence of internal disease was not found. Resumen Se describe en 3 gatos esfinge emparentados una erupción maculopapular pruritica con caracteristicas clinicas e histológicas similares a la urticaria pigmentosa en la especie humana. Todos los gatos compartian el mismo abuelo, desarrollaron la enfermedad en edad juvenil y mostraron hallazgos históricos, clinicos e histológicos similares. El examen fisico mostró pápulas y máculas costrosas, eritematosas, parcialmente unidas, generalizadas, bilaterales y simétricas localizadas en tronco, extremidades, cuello y cabeza. Algunas máculas mostraban una pigmentación marronácea oscura. No pudo provocarse dermatografismo en ninguno de los gatos. El examen histológico de las pápulas mostró la presencia de un infiltrado dérmico y subcutáneo perivascular a difuso compuesto por mastocitos bien diferenciados. No se encontró enfermedad sistémica en un animal en el que se evaluó esta posibilidad. [Vitale, C.B., Ihrke, P.J., Olivry, T., Stannard, A.A. Feline urticaria pigmentosa in three related Sphinx cats. (Urticaria pigmentosa felina en 3 gatos esfinge emparentados.) Veterinary Dermatology 1996; 7 : 227–233.] Résumé Les auteurs décrivent chez 3 chats Sphynx apparentés une eruption maculopapuleuse présentant des similitudes cliniques et histologiques avec l'urticaire pigmentaire humaine. Les 3 chats ont le même grandpère, présentent une apparition précoce des symptômes, et, une anamnèse, une clinique et une histologie similaires. L'examen clinique révèle des macules et des papules croûteuses à large distribution bilatérale et symétrique, érythèmateuses, partiellement coalescentes, sur le tronc, les membres, le cou et la tête. Quelques macules montrent une pigmentation brun foncé. La présence d'un dermographisme n'a pu être démontré chez aucun des chats. L'examen histologique des papules révèle la présence d'un infiltrat dermique et sous cutané périvasculaire à diffus de mastocytes bien différenciés. La recherche d'une atteinte systémique chez un des chats n'a pas montré d'atteinte interne. [Vitale, C.B., Ihrke, P.J., Olivry, T., Stannard, A.A. Feline urticaria pigmentosa in three related Sphinx cats. (Urticaire pigmentaire féline chez 3 chats Sphynx apparentés.) Veterinary Dermatology 1996; 7 : 227–233.] Zusammenfassung Es wird über eine juckende makulopapuläre Eruption mit klinischen und histologischen Befunden, die der Urticaria pigmentosa des Menschen ähneln, bei drei verwandten Sphinx-Katzen berichtet. Alle Katzen hatten den selben Großvater, zeigten einen Krankheitsbeginn im Jugendalter und wiesen ähnliche Befunde in der Vorgeschichte, Klinik und Histologie auf. Die klinische Untersuchung zeigte weit verteilte, bilateral symmetrische, erythematöse, teilweise koaleszierende verkrustete Maculae und Papeln am Rumpf, Gliedmaßen, Hais und Kopf. Einige maculae wiesen eine dunkelbraune Pigmentierung auf. Dermatographismus konnte bei keiner der Katzen ausgelöst werden. Die histologische Untersuchung der Papeln zeigte die Anwesenheit eines perivaskulären bis diffusen dermalen und subkutanen Infiltrates von gut differenzierten Mastzellen. Bei einer Katze mit systemischen Erscheinungen konnte die Ursache der inneren Erkrankung nicht gefunden werden. [Vitale, C.B., Ihrke, P.J., Olivry, T., Stannard, A.A. Feline urticaria pigmentosa in three related Sphinx cats (Feline Urticaria pigmentosa bei drei verwandten Sphinx-Katzen). Veterinary Dermatology 1996; 7 : 227–233.]     

High rise syndrome with impalement in three cats

Three cats were presented for management of impalement injuries sustained following falls from second storey windows onto spiked metal railings. Two cats presented with penetrating thoracic wounds and extensive pulmonary parenchymal trauma, while one presented with abdominal impalement and splenic rupture. Following stabilisation, all three cats underwent exploratory surgery. A good outcome was achieved in two of the cats: one with thoracic and one with abdominal penetration. Impalement injury secondary to free fallis a previously unreported variation of 'high rise syndrome' in cats.     

Recurrent localised cutaneous parapoxvirus infection in three cats

CASE HISTORY: Three cats were presented with single proliferative lesions affecting one foot, which failed to heal after medical treatment, and recurred despite surgical resection. PATHOLOGICAL FINDINGS: Histologically, the lesions were proliferative and papillary. There was marked acanthosis, rete peg formation, and compact orthokeratosis, with large numbers of bacteria in the orthokeratotic scale. Some biopsies had multifocal keratinocyte swelling of the stratum granulosum, and amphophilic intracytoplasmic inclusions were present in some of the swollen cells. The dermis consisted of a light fibrous stroma with marked capillary proliferation. Parapoxviruses were detected in the lesions of all cats by electron microscopic examination. PCR analysis detected orf virus (contagious ecthyma virus) in two cats, and orf virus was cultured from one cat. DIAGNOSIS: Parapoxvirus infection in cats. CLINICAL RELEVANCE: Parapoxvirus infection should be considered as a differential diagnosis when dealing with proliferative, non-healing lesions on the feet of cats, especially cats in rural areas. The recovery of orf virus from a cat with typical poxvirus lesions extends the range of species affected by this virus.     

Pneumonia associated with Mycoplasma spp in three cats

Mycoplasma spp were isolated in pure culture from bronchoalveolar lavage specimens from three cats with clinical, cytological and radiographic signs of bron-chopneumonia or suppurative bronchitis. Predisposing factors were not identified in the first case, the second cat had oesophageal hypomotility, while the third cat had been exposed to cigarette smoke and had advanced periodontal disease. Respiratory signs resolved promptly and completely in all cases following antimicrobial therapy directed against mycoplasmas. Mycoplasma spp are possible causes of lower respiratory tract disease in cats and this should be considered when selecting empirical therapy for feline airway disease and pneumonia. In some situations mycoplasmas may behave as primary lower respiratory tract pathogens in cats.     

Hematologic abnormalities preceding myeloid leukemia in three cats.

Cytopenia were recognized in three cats infected with feline leukemia virus. In one cat, marrow blast cells were increased in number, and a diagnosis of aleukemic leukemia was made. The disease progressed slowly for 3 1/2 months before terminating in acute myelomonocytic leukemia, recognized as a blast crisis in blood. In the other two cats, neutropenia and altered granulopoiesis in bone marrow preceded development of myeloid leukemia.     

Horner's syndrome and ipsilateral laryngeal hemiplegia in three cats

Horner's syndrome is described in three cats associated with wounds to the ventrolateral neck. In each case, ipsilateral laryngeal hemiplegia was observed on laryngoscopy. This finding provided strong evidence to support a diagnosis of second order Horner's syndrome due to disruption of the cervical sympathetic trunk, as motor fibres innervating laryngeal abductors also traverse the neck; both as descending fibres within the contiguous cervical vagus and as ascending fibres within the recurrent laryngeal nerve. Notably, the ability to vocalise was unimpaired in all cases and, in two cats, neck wounds were not apparent until the neck had been clipped and closely examined. These findings indicate that assessment of laryngeal function is of value when localising the site of the neural defect responsible for selected cases of second order Horner's syndrome.     

Treatment of cryptococcosis in three cats, using ketoconazole

Ketoconazole was effective in the treatment of cryptococcosis in 3 cats. A dosage of 10 to 15 mg/kg of body weight was given once or twice daily with a meal for 11 to 33 weeks. Fungal cultures and serotesting were used to assess the efficacy of treatment and resolution of active infection. In some of the cats, the treatment was associated with gastrointestinal signs and increased serum liver enzyme activity. Ketoconazole has been used in human beings, dogs, and cats for the treatment of systemic mycoses.     

Comparison between tracheal ratio methods used by three observers at three occasions in English Bulldogs

Background

Tracheal hypoplasia is a congenital condition described in mainly brachycephalic breeds and is one component of the brachycephalic obstructive airway syndrome (BOAS). Two radiographic methods have been described to evaluate the dimensions of the tracheal diameter in dogs and to distinguish between hypoplastic and non-hypoplastic tracheas: the tracheal lumen diameter to thoracic inlet distance ratio (TD/TI) and the ratio between the thoracic tracheal luminal diameter and the width of the proximal third of the third rib (TT/3R). The purpose of this study was to compare these two published radiographic methods between observers, different measuring occasions and to investigate the effect on classification of dogs as having hypoplastic or non-hypoplastic tracheas using four previously published mean ratios as cut-offs (<0.11, <0.127 and <0.144 for the TD/TI and <2.0 for the TT/3R method).Three observers evaluated right and left lateral recumbent radiographs from 56 adult English Bulldogs independently on three different occasions. TD/TI and TT/3R ratios were calculated and correlated between measuring occasions. Kappa, observed, positive, and negative agreements were calculated between observers and measuring occasions. Number of hypoplastic and non-hypoplastic dogs for each method and occasion was determined using <0.11, <0.127 and <0.144 as cut-offs for TD/TI and <2.0 for TT/3R.

Results

Intraobserver agreement varied with kappa between 0.45-0.94 for the TD/TI and 0.20-0.86 for the TT/3R method. Interobserver kappa varied between 0.27-0.70 for the TD/TI method and between 0.05-0.57 for the TT/3R method. There was poor agreement in classifying English Bulldogs as tracheal hypoplastic or non-hypoplastic, depending on measuring method, cut-off value and observer.

Conclusions

The diagnostic value of both the TD/TI and TT/3R methods with such poor agreement is questionable, and significantly impacts their reliability for both clinical evaluation of dogs and use in health screening programs.