Journal of Feline Medicine and Surgery Open Reports最新文献

Case summary: An 8-year-old female neutered domestic shorthair cat was referred for further investigations of lethargy, polyuria, polydipsia, hyporexia and weight loss. One month prior, the cat had been diagnosed with normotensive and non-proteinuric chronic kidney disease and a single small well-defined splenic nodule thought to represent a benign process. Specialist abdominal ultrasonography documented changes suggestive of pyelonephritis alongside a solitary splenic mass (2 cm in size). Follow-up imaging 4 weeks later showed progression of the splenic mass (3.5 cm) and a novel marked anaemia. Splenectomy and histopathology were performed, which confirmed a diagnosis of splenic haemangiosarcoma. The cat was started on metronomic thalidomide (5 mg/kg PO q24h; BOVA) 16 days postoperatively. The cat re-presented to the referring veterinary practice 169 days after splenectomy (153 days after starting metronomic thalidomide) owing to lethargy and hyporexia. Abdominal ultrasound identified a solitary hepatic mass and free peritoneal fluid; the cat was subsequently euthanased without further investigations.

Relevance and novel information: This is the first published case report documenting the management of splenic haemangiosarcoma in a cat with splenectomy and metronomic thalidomide. Our observations indicate that survival time falls in line with other chemotherapeutic protocols and that thalidomide side effects were limited to mild polyphagia and moderate sedation, which was tolerated well if the drug was administered in the evening.

Case series summary: Three adult cats were successfully treated for severe anaemia caused by a bleeding hard palate ulcer with a temporary palatal guard. Each cat required a blood transfusion and underwent surgical implantation of a customised temporary guard to protect the hard palate mucosa from ongoing irritation. The palatal guards were made from radiographic film in two cases and an acetate sheet in the third. Cats received varied concurrent treatments in conjunction with surgery, including amoxicillin/clavulanate or doxycycline, cyclosporine and prednisolone. Complete resolution of the hard palate ulceration and anaemia was observed in all three cases.

Relevance and novel information: Excessive licking can lead to mucosal erosion of the hard palate, delayed healing and severe haemorrhage. When a palatine ulcer is refractory to medical management or the anaemia is severe, surgical intervention may be required. Techniques previously described include electrocautery, horizontal mattress sutures and ligation of the palatine artery combined with a bipedicle mucoperiosteal flap. These techniques typically require advanced surgical skills or access to specific equipment, may involve repeat surgeries to correctly isolate the palatine artery, and may leave a secondary wound that could prolong anorexia or risk becoming a new site of haemorrhage. Placement of a temporary customised palatal guard is a novel surgical technique for the treatment of bleeding palatine ulcers that does not require isolation of the palatine artery, involves minimal tissue handling, provides immediate control of oral pain, encourages immediate return to appetence and prevents ongoing trauma to the area during healing.

Case summary: A 1-year-old intact female domestic shorthair cat presented for evaluation of worsening respiratory distress and tachypnoea. The cat had been diagnosed with spontaneous pneumothorax 4 days earlier by the primary clinician and treated with therapeutic thoracocentesis. On physical examination, the patient exhibited decreased lung sounds, tachypnoea and increased breathing effort. Recurrent spontaneous pneumothorax was confirmed via thoracic radiography, and therapeutic thoracocentesis was repeated. Lung ultrasound performed after thoracocentesis revealed lung consolidation, pulmonary nodules and multiple cyst-like lesions with irregularly thickened echogenic walls and anechoic centres. Repeat thoracic radiography showed a diffuse moderate bronchointerstitial pattern with multifocal soft tissue nodules. A thorough faecal examination revealed ova resembling those of Paragonimus species, and subsequent molecular analysis confirmed Paragonimus westermani. The cat was initially treated with fenbendazole alone, which resulted in limited improvement and recurrent spontaneous pneumothorax. A second course of fenbendazole combined with praziquantel led to clinical improvement. The cat remained free of clinical signs and was doing well, with no identifiable lung nodules on thoracic radiography 2 years after diagnosis.

Relevance and novel information: This report describes a novel cyst-like lung ultrasound finding characterised by an irregularly thickened echogenic wall and anechoic centre, associated with P westermani infection in a cat presenting with recurrent spontaneous pneumothorax. The report also highlights a successful treatment approach resulting in long-term resolution. The identification of this novel lung ultrasound finding can facilitate early diagnosis and treatment of Paragonimus species infection in cats, especially for those presenting with respiratory distress and pneumothorax.

Case summary: A 1-year-old spayed female mixed-breed cat presented with chronic large bowel diarrhoea. The cat was treated with various antibiotics, prednisolone and dietary supplements without significant improvement. Endoscopic examination revealed an irregular colonic mucosa with multifocal erosion and haemorrhage. Impression smears of the colonic mucosa contained large numbers of unicellular round-to-oval organisms and macrophages. Histologically, granulomatous inflammation with numerous organisms was observed in the lamina propria of the colonic mucosa. The organisms had a cell wall and internal segmentation, which were positive on periodic acid-Schiff and Grocott's methenamine silver staining. Immunohistochemically, CD204-positive macrophages had accumulated in the lesions. Ultrastructural examination revealed dense bodies and starch granules, and the absence of chloroplasts in the cytoplasm of the organisms. PCR and a sequence analysis detected the Prototheca bovis 18S rRNA gene in formalin-fixed, paraffin-embedded colonic mucosa tissue. Based on these findings, the cat was diagnosed with granulomatous colitis associated with P bovis infection.

Relevance and novel information: This first report of feline intestinal protothecosis suggests that Prototheca species infection should be considered in the differential diagnosis of cats with treatment-resistant chronic large bowel diarrhoea.

Case summary: A 7-year-old female spayed domestic shorthair cat presented with respiratory distress. Initial diagnostics revealed a large cystic mass in the mediastinum and moderate hyperglobulinaemia. Additional abnormalities were ruled out through thoracic and abdominal CT. The mass was surgically removed, and antibiotic treatment was started based on cytological findings of intralesional bacteria. Histopathology and microbiology confirmed a severe inflammatory reaction pattern compatible with feline eosinophilic sclerosing fibroplasia (FESF) associated with Staphylococcus aureus. After surgery and antibiotic therapy, clinical signs and related abnormalities fully resolved. At the time of writing, 24 months postoperatively, the patient shows no evidence of relapse.

Relevance and novel information: FESF, initially described as an inflammatory condition affecting the gastrointestinal tract, has also been anecdotally reported in other locations, including the retroperitoneum, retropharyngeal region and mediastinum. This report is the second to document a mediastinal presentation without concurrent abdominal involvement, and the first to achieve long-term remission without the use of immunosuppressants. It supports the hypothesis that FESF may represent a characteristic pattern of inflammation secondary to a range of triggers rather than a distinct disease process, indicating that treatment should probably target the specific underlying cause.

Case summary: A 2-month-old kitten was presented for ataxia and depressed mental status after implantation of a pet identification microchip. Radiographs were taken immediately by the referring veterinarian and showed a longitudinal metallic foreign body (electronic microchip) within the cervical vertebral canal at the craniocervical junction. A CT examination 2 days after the incident showed cranial migration of the microchip ventrally to the caudal brainstem. Ventral basioccipital craniectomy was immediately performed to retrieve the microchip by a ventral approach to the caudal brainstem. Postoperative recovery was uneventful and the cat was discharged 2 days later. At the 2-week follow-up, neurological examination of the cat was normal. No long-term complications were reported.

Relevance and novel information: This case report describes the intradural migration of a microchip and surgical removal via ventral basioccipital craniectomy.

Case summary: Feline megaesophagus (ME) is a rare failure of esophageal motility leading to regurgitation, weight loss and sometimes death in cats. It has been identified secondarily to neurologic and neuromuscular disorders, mechanical obstruction of the esophagus (eg, vascular ring anomalies, esophageal stricture) and upper airway obstruction among others; when no cause is found, it is considered idiopathic. Videofluoroscopic swallow studies (VFSSs), especially using an unrestrained free-feeding protocol, are underutilized for comprehensive evaluation of cats with regurgitation, including identifying the etiology of ME. In this case report, a 3-month-old male intact domestic shorthair cat with a history of regurgitation since weaning and radiographic evidence of ME had VFSS features compatible with a functional obstruction of the lower esophageal sphincter (LES) consistent with LES achalasia-like syndrome. Medical management with sildenafil failed to improve clinical signs, and surgical correction of LES achalasia using a Heller myotomy and Dor fundoplication was declined. As a result of caregiver compassion fatigue from persistent regurgitation, euthanasia was elected.

Relevance and novel information: Videofluoroscopic documentation of functional obstruction of the LES (ie, LES achalasia-like syndrome) can identify a novel etiology of feline ME. Free-feeding unrestrained VFSS protocols are recommended to allow physiologic assessment of swallowing disorders with no higher risk of aspiration than eating and drinking at home. Recognition of LES achalasia-like syndrome may lead to further study of directed treatments targeting the functional obstruction as has been carried out in humans and dogs.

Case summary: An 8-month-old male castrated domestic shorthair cat was presented for acute stranguria, pollakiuria and vocalization. The patient was diagnosed with urethral obstruction and hospitalized for medical management. At 36 h after discharge, the cat started passing severely hemorrhagic urine and was diagnosed with a uroperitoneum and uroretroperitoneum. An abdominal ultrasound and fluoroscopic retrograde positive contrast cystourethrogram did not identify a source of urinary tract rupture. An exploratory laparotomy revealed urine leakage from both kidneys, with evidence of rupture involving both the renal pelvis and parenchyma. It is suspected that sterile pyelonephritis and renal hemorrhage resulted in bilateral ureteral obstruction, and subsequent uroretroperitoneum, extending to cause uroperitoneum. Left ureteronephrectomy and right subcutaneous ureteral bypass placement was offered as a salvage procedure; however, euthanasia was elected intraoperatively because of a poor prognosis.

Relevance and novel information: Renal pelvic and parenchymal rupture is a poorly reported cause of uroabdomen in the cat. Furthermore, although severe renal hemorrhage has not been described in cats, it may lead to bilateral ureteral obstruction and uroabdomen.

Case summary: A 4-year-old spayed female domestic shorthair cat was presented for evaluation of multiple abdominal masses and hyperglobulinemia. Thoracic radiographs and abdominal ultrasonography revealed a cranial abdominal mass with extension through the aortic hiatus of the diaphragm and into the caudodorsal mediastinum. A diagnosis of feline eosinophilic sclerosing fibroplasia (FESF) with intralesional methicillin-resistant Staphylococcus aureus (MRSA) was obtained based on necropsy results.

Relevance and novel information: To the authors' knowledge, this case report is the first to describe extension of a primary FESF lesion through the diaphragm and is the first confirmed case of intralesional MRSA in an FESF lesion. In addition, this case is one of a growing number of reports of FESF lesions that do not involve the gastrointestinal tract. This case further contributes to the growing evidence that FESF should be considered as a differential diagnosis, in addition to neoplasia, feline infectious peritonitis or abscessation, in cats with masses, especially when there is concurrent hyperglobulinemia, a low albumin:globulin ratio and/or eosinophilia. This case also highlights the importance of considering this differential for masses outside the abdominal cavity, those involving both the chest and the abdomen, and those that do not involve the gastrointestinal tract.

Case summary: An 8-year-old castrated male mixed-breed cat was presented with recurrent vomiting, weight loss and abdominal distension. Blood work revealed hyperbilirubinaemia and elevated liver enzyme activities. Abdominal ultrasound and CT showed marked dilation and obstruction of the common bile duct (CBD) due to chronic cholecystitis and cholangiohepatitis. The cat was diagnosed with CBD obstruction secondary to chronic cholecystitis and cholangiohepatitis and was initially treated with antibiotics and prednisolone. Surgical intervention was performed because of complete CBD obstruction and worsening icterus that was unresponsive to medical management. A choledochoduodenostomy was performed using a simple side-to-side anastomosis between the CBD and the duodenum. The patient recovered uneventfully after surgery without significant complications. At the last follow-up, 6 months postoperatively, the cat remained clinically stable.

Relevance and novel information: There is limited information on choledochoduodenostomy in cats. This is the first veterinary report describing a simple side-to-side anastomosis between the CBD and the duodenum to resolve severe extrahepatic biliary obstruction secondary to chronic cholangitis and cholecystitis. As a result of the dilation and thickening of the CBD wall, this technique was feasible. This case study lacks information on long-term prognosis and continued monitoring is important.