Decortication, thoracic omentalization, and pericardiectomy for treatment of severe fibrosing pleuritis in a cat

CASE DESCRIPTION A 5-year-old spayed female domestic shorthair cat was evaluated because of an acute onset of dyspnea and open-mouthed breathing. CLINICAL FINDINGS Thoracic radiography revealed pleural effusion and signs consistent with restrictive pleuritis, and results of preoperative CT were consistent with diffuse, severe restrictive pleuritis, bilateral pleural effusion, and pulmonary atelectasis. Thoracocentesis yielded a red, turbid fluid that was identified as chylous effusion with chronic inflammation. TREATMENT AND OUTCOME Exploratory thoracotomy revealed diffuse, severe fibrous adhesions between the mediastinum, heart, lung lobes, and thoracic wall, with a thick fibrous capsule enveloping all lung lobes. Surgical treatment consisted of complete pleural decortication, pericardiectomy, and thoracic omentalization. The cat remained hospitalized for 6 days, receiving oxygen supplementation, multimodal analgesia, and supportive care. Long-term home care consisted of prednisolone administration, rutin supplementation, and provision of a low-fat diet. At recheck examinations 3-, 7-, and 20-weeks postoperatively, the cat remained tachypneic, but was otherwise clinically normal without dyspnea or respiratory distress. Follow-up thoracic radiography revealed improved pulmonary expansion, decreased pleural effusion, and resolved pneumothorax. CLINICAL RELEVANCE Surgical management of fibrosing pleuritis secondary to idiopathic chylothorax in cats has historically resulted in poor outcomes. This report details the first successful use of complete decortication in the surgical management of severe fibrosing pleuritis in a cat.

Left Pulmonary Artery Coarctation Associated with Pneumonia and Pulmonary Hypertension in a Cat

A five-month-old European shorthair female kitten was referred because of recurrent episodes of respiratory distress. Results of physical examination, thoracic radiography, and echocardiography led to a presumptive diagnosis of severe precapillary pulmonary hypertension (PH) and interstitial pneumonia associated with right-sided cardiac remodeling. The cat rapidly died because of respiratory insufficiency. Pulmonary and cardiovascular pathological findings evidenced left pulmonary artery coarctation, severe right-sided cardiac hypertrophy, and bilateral pneumonia. This is the first report of pulmonary artery coarctation associated with pneumonia and PH in a cat.

Utilizing smartphone-based electrocardiography and thoracic radiography to evaluate cardiac function and morphology in geriatric Sika deer (Cervus nippon)

OBJECTIVE To describe qualitative and quantitative cardiothoracic values in geriatric Sika deer (Cervus nippon) using digital radiography, 6-lead ECG (sECG), and smartphone-based ECG (aECG). ANIMALS 10 healthy geriatric Sika deer (9 females and 1 male). PROCEDURES Deer were chemically immobilized, thoracic radiographs were obtained, and inhalant anesthesia was initiated. An sECG and aECG were simultaneously recorded for each animal using the same ECG specifications. Results were compared between devices. RESULTS Radiographically, no deer had any cardiopulmonary abnormalities. Median (range) values for the most important cardiac measurements were 170 (153–193) mm for cardiac height, 135 (122–146) mm for cardiac width, 9 (8–9) for vertebral heart score, and 99 (69–124) mm for cardiosternal contact. All deer had a normal sinus rhythm with no pathological arrhythmias noted. A significant difference between sECG and aECG was identified for minimum heart rate (49 vs 51 beats/min, respectively), P wave duration (0.05 vs 0.03 seconds), P wave amplitude (0.28 vs 0.10 mV), PR interval (0.15 vs 0.12 seconds), and QT interval (0.39 vs 0.30 seconds). CLINICAL RELEVANCE Thoracic radiographs were suitable to evaluate basic cardiothoracic morphology in Sika deer. The aECG was useful for assessing heart rate and rhythm but, compared with sECG, proved no substitute for evaluating duration and amplitude of ECG waveforms.

Giant pulmonary hydatid cyst in children

Hydatid disease is still endemic in Tunisia. It is mostly seen in young people less than 40 years and children are affected in one third of cases. The lungs are the predominant location in children. Our study aims to define the particularities of children PHC's (pulmonary hydatic cyst) management, the characteristics of giant cyst and to study predictive factors of complications. We included retrospectively 105 children with PHC followed between 1999 and 2019. Patients were aged less than 16 years with surgically confirmed diagnosis of PHC. Two groups of cysts were defined: giant cysts which were 10 cm across or more, and no giant cysts.The sex-ratio was 1,38 with a mean age of 10.5±3 years. The symptomatology was dominated by cough (59%), thoracic pain (51%) and hemoptysis (46%). Giant cysts were observed in 24 (22.9%) patients. Dyspnea (29% vs 5% p<0.001) and thoracic pain (88% vs .41% p<0.001) were significantly more frequently reported in giant cysts. Eighty-six patients had a single cyst (83%) and 19 had multiple cysts (17%). Giant cysts accounted for 22,9% (24 cases). Thoracic ultrasonography was diagnostic in 77.4%. The thoracic CT scan was performed in 27 children with inaccessible cysts in thoracic ultrasonography or in diagnostic doubt.Patients were all treated surgically. Surgical procedures consisted of cystectomy (59%), pericystectomy (18%) and pulmonary resection when parenchyma was destroyed (23%). Parenchymal resection was more often performed in complicated cysts (27% vs 20% p>0.05) and in giant cysts (41% vs 18% p<0.05). A two-stage thoracotomy was performed in the 4 patients with bilateral cysts. Thirteen patients presented immediate post-operative complications which occurred more frequently in complicated and giant cysts. Hospital stay was longer in complicated cysts (16±9 days vs 7±3 days; p<0.001) and in giant cysts (14±9 days vs 11±8 days; p>0.05). In endemic regions, the diagnosis of PHC in children should be based on the combination of thoracic radiography and ultrasonography which are effective, not costly, safe and accessible. Complicated and giant PHC cause lung damage leading to extensive parenchymal resection. They are more associated with post-operative complications prolonging hospital stay and increasing expenses.

Lessons from the COVID-19 Pandemic on the Use of Artificial Intelligence in Digital Radiology: The Submission of a Survey to Investigate the Opinion of Insiders

The development of artificial intelligence (AI) during the COVID-19 pandemic is there for all to see, and has undoubtedly mainly concerned the activities of digital radiology. Nevertheless, the strong perception in the research and clinical application environment is that AI in radiology is like a hammer in search of a nail. Notable developments and opportunities do not seem to be combined, now, in the time of the COVID-19 pandemic, with a stable, effective, and concrete use in clinical routine; the use of AI often seems limited to use in research applications. This study considers the future perceived integration of AI with digital radiology after the COVID-19 pandemic and proposes a methodology that, by means of a wide interaction of the involved actors, allows a positioning exercise for acceptance evaluation using a general purpose electronic survey. The methodology was tested on a first category of professionals, the medical radiology technicians (MRT), and allowed to (i) collect their impressions on the issue in a structured way, and (ii) collect their suggestions and their comments in order to create a specific tool for this professional figure to be used in scientific societies. This study is useful for the stakeholders in the field, and yielded several noteworthy observations, among them (iii) the perception of great development in thoracic radiography and CT, but a loss of opportunity in integration with non-radiological technologies; (iv) the belief that it is appropriate to invest in training and infrastructure dedicated to AI; and (v) the widespread idea that AI can become a strong complementary tool to human activity. From a general point of view, the study is a clear invitation to face the last yard of AI in digital radiology, a last yard that depends a lot on the opinion and the ability to accept these technologies by the operators of digital radiology.

Chest computed tomographic findings of patients with COVID-19-related pneumonia

Background In December 2019, pneumonia cases of unknown cause were announced in Wuhan, China. The causative agent of pneumonia was identified as coronavirus 2 (SARS-CoV-2), and the disease was named coronavirus disease 2019 (COVID-19). Purpose To evaluate the usefulness of computed thoracic tomography (CT) and postero anterior (PA) thoracic radiography in patients with COVID-19. Material and Methods Between March and June 2020, the patients who arrived at our hospital with suspicion of COVID-19 were retrospectively analyzed. Thorax CT findings of the 281 patients (142 females and 139 males; age range 3–91 years) with positive PCR tests were evaluated. Lesions in the lung parenchyma were examined according to their number, localization, and distribution. PA chest radiograms were classified into two groups, positive and negative for the lung parenchymal lesions. Results Of the total 281 patients with PCR-positive COVID-19, CT examinations were normal in 107 (38.1%), and positive CT findings for pneumonia were found in 174 patients (61.9%). Bilateral involvement was observed in 100 (57.5%) of the 174 patients with positive CT findings, and unilateral involvement was observed in 74 (42.5%) of them. According to the localization of the lesions, peripheral subpleural distribution occurred in 160 of the 174 patients (91.9). The most common lesion was the ground glass opacities (GGO). In 77 of 281 PCR-positive patients (27.4), pulmonary lesions were found on PA chest radiograms. Conclusion The presence of bilateral posterior subpleural GGO, nodule, and consolidation in thoracic CT are significant in terms of COVID-19 pneumonia.

Concurrent Hiatal Hernia and Megaesophagus Secondary to a Nasopharyngeal Polyp in a 6-month-old Cat

Background: Nasopharyngeal polyps are benign and inflammatory masses assumed to arise from the middle ear or the eustachian tube with extension into the pharynx. The most common clinical signs associated with nasopharyngeal polyps include respiratory stertor, dyspnea, and otic discharge Neurological signs, including head tilt, facial nerve paralysis, and ataxia, might indicate concurrent involvement of the middle or inner ear. The objective of the current study is to describe a case of a feline nasopharyngeal polyp with a concurrent hiatal hernia and megaesophagus, both spontaneously resolved after removal of the polyp.Case: A 6-month-old, intact, female, domestic shorthair cat presented for evaluation of lethargy, anorexia, and upper respiratory signs, such as stridor, stertor, and dyspnea. A thoracic radiography revealed esophageal dilation caudal to the cardiac silhouette, suggestive of megaesophagus with gaseous filtration. An esophagram confirmed a hiatal hernia and megaesophagus. Computed tomography revealed a nasopharyngeal mass adjacent to the soft palate and a soft-tissue density in the right tympanic bulla. A tentative diagnosis of a nasopharyngeal polyp was made. After the ventral bulla osteotomy, the nasopharyngeal mass was removed by a gentle traction avulsion technique. Six days after the surgery, hiatal hernia and megaesophagus were spontaneously resolved. Based on histopathologic exam, the mass was found to be an inflammatory nasopharyngeal polyp. Two months after surgery, the owner reported that the patient’s condition had returned to baseline with a good appetite, and the thoracic radiography was within normal limit. Six months after the surgery, the owner reported the patient was completely recovered from the upper airway obstruction signs.Discussion: For successful treatment of a nasopharyngeal polyp, traction avulsion of the polyp with or without a ventral bulla osteotomy is recommended. However, in patients with otitis media, a ventral bulla osteotomy followed by traction avulsion of the polyp is recommended in order to reduce the rate of polyp recurrence. Common clinical signs of a nasopharyngeal polyp are stertor, stridor, dyspnea, dysphagia, and open-mouth breathing, which are identified in a chronic upper airway obstruction. A hiatal hernia secondary to a nasopharyngeal polyp has not been reported so far. However, a relationship between chronic upper airway obstruction and hiatal hernias has been proposed previously. Moreover, hiatal hernia resolved spontaneously after removal of the nasopharyngeal polyp suggests that the occurrence of the hiatal hernia was secondary to the nasopharyngeal polyp. In addition to the hiatal hernia, megaesophagus was also identified in the present case. Megaesophagus secondary to a chronic upper airway obstruction from a nasopharyngeal obstruction has been reported. However, megaesophagus is also thought to occur secondary to hiatal hernias. Therefore, in the current study, it is unclear whether the megaesophagus was solely a result of the obstructive nature of the nasopharyngeal polyp or a combination of the hiatal hernia and the nasopharyngeal polyp. In conclusion, any cat with clinical signs of an upper airway obstruction and a concurrent hiatal hernia and megaesophagus should be thoroughly investigated for a nasopharyngeal polyp, as well as other gastrointestinal and systemic causes. Furthermore, this case suggests that the prognosis for a concurrent hiatal hernia and megaesophagus is good in cats if the nasopharyngeal polyp is properly removed.Keywords: cat, hiatal hernia, megaesophagus, nasopharyngeal polyp

Tracheal Adenocarcinoma in a Cat

Background: Primary tracheal adenocarcinoma is a rare neoplasm in cats. The clinical signs often are indicative of upper airway obstruction accompanied with dyspnea, stridor, wheezing, exercise intolerance, and cough. The severity of the clinical signs is related to the size of the mass and consequently, the proportion of the tracheal lumen that is obstructed. The diagnosis is made using thoracic radiography and tracheobronchoscopy by collecting fragments for histopathological analysis and removing the mass. The present study aimed to report the case of a cat with tracheal adenocarcinoma.Case: A 17-year-old Persian female cat presented with clinical signs of dyspnea and progressive weight loss. Emergency therapy was started with bronchodilators, antibiotics, and corticosteroids, but there was no response to treatment. Complementary blood and imaging tests were performed. Thoracic radiography revealed soft tissue opacity overlying the dorsal trachea from the third to the fourth rib, bronchial pattern, and pulmonary hyperinflation. Tracheoscopy showed an irregular intraluminal thoracic trachea mass, occluded by approximately 95% of the airway lumen. The mass was biopsied multiple times with endoscopic cup biopsy forceps, followed by removal of approximately 50% of the mass lesion with an endoscopic wire snare. The patient was in intensive care, and since her clinical condition worsened 48 h after the endoscopic procedure, euthanasia was performed. Necropsy revealed a remanescent mass located in the trachea lumen 8 x 3 mm and a nodule in the right caudal pulmonary lobe with 8 mm of diameter . Histological examination showed epitelian cuboidal neoplastic cells with acinar patterns. Only a few mitosis and moderate anysocitosis were observed. The final diagnosis was primary tracheal adenocarcinoma with pulmonary metastasis.Discussion: The initial oxygen therapy associated with bronchodilators and antibiotics can be explained by the history of asthma. Tracheal tumors in cats are considered to be rare, which makes the diagnosis challenging. The suspicion of tracheal neoplasia was only raised after radiographic examination, but it was not possible to state whether it was intra- or extratracheal. The bronchial pattern reported herein can be observed both in inflammatory diseases such as asthma and bronchitis as well as aging-related diseases in animals. Pulmonary hyperinflation, with a caudal displacement of the diaphragm, is seen in bronchial diseases and in cases of tracheal neoplasms, with the latter justified by the retention of air in the pulmonary lobes. Dehydration and weight loss in the animal are justified by severe dyspnea, which makes it difficult to consume food and water. The tracheoscopy procedure was essential to confirm intraluminal tracheal neoplasia with almost complete lumen obstruction. An attempt was made to remove the neoplasms with polypectomy endoscopic forceps. However, because 95% of the trachea was obstructed, the manipulation led to local edema and bleeding, which promoted complete obstruction of the air passage to the lungs. The obstruction impaired the patient's oxygenation, justifying procedure suspension. The instability and worsening of the clinical picture persisted in the subsequent days, which prevented further intervention, culminating in the animal's euthanasia. Adenocarcinoma, in the present case, was in the advanced stage, evidenced by the presence of pulmonary metastasis. Dyspnea severity was related to neoplasm size, proportion of tracheal lumen obstruction, and presence of pulmonary metastasis. The tumor size associated with the presence of metastasis was a determining factor for the classification of neoplasia in the advanced stage, making more invasive interventions impossible and worsening the patient prognosis.