Veterinary Medicine - September 2008 - (Page 498)

A challenging case PEER-REVIEWED 2A & 2B. Lateral and ventrodorsal thoracoabdominal radiographs obtained immediately after the cat’s thoracic duct ligation and partial pericardiectomy revealed mild pleural effusion. Hemoclips are seen in the cranial mediastinum where the thymic cyst was excised and in the caudodorsal thorax where the thoracic duct was ligated. The implanted access port is seen on the left side of the thorax with a chest tube attached. mild pericardial hemorrhage and focal granulomatous in ammation associated with lipid debris. The pathologist commented that the pattern of mild lymphocytic in ammation within the pericardial or mediastinal tissues was typical of the in ammatory reaction associated with chylothorax in cats. The focal granulomatous in ammation was due to an accumulation of macrophages distended with lipid debris, presumably engulfed lipid associated with chylothorax. Discharge and follow-up The cat was hospitalized for three more days, and we continued to drain 50 ml/ day of serosanguineous pleural uid. The cefazolin was discontinued one day after surgery, and the cat was started on cefpodoxime proxetil (7.6 mg/kg orally every 24 hours). Because of concern of a possible infection based on seeing neutrophils in the pleural uid, enro oxacin (3.4 mg/kg orally every 24 hours) was also started one day after surgery for broader spectrum antibiotic coverage. The fentanyl patch was removed. The cat appeared clinically stable despite having continued pleural effusion, so we discharged it with enro oxacin (3.4 mg/kg orally every 24 hours) and cefpodoxime (7.6 mg/kg orally every 24 hours) for 14 days. The chest tube was secured in the subcutaneous region of the left thorax and did not have external exposure. We instructed the owner to aseptically prepare the skin over the port and insert a needle into the port to drain the effusion once daily or as needed depending on the amount of uid obtained and whether the cat exhibited dyspnea. On recheck examination three days later, the owner reported that the cat was asymptomatic. The owner expressed anxiety about using the chest tube and had not attempted to drain the chest while the cat was home. Also, the owner was concerned that it was too bulky. We informed the owner that the port was causing no appreciable discomfort during the examination that day. The owner continued to express resistance to using the chest tube and requested it be removed, so we anesthetized the cat, drained 25 ml of serosanguineous uid, and removed the chest tube with a short surgical procedure. The cat received intravenous lactated Ringer’s solution (14 ml/hr) for six hours and morphine (0.01 mg/kg) subcutaneously once immediately postoperatively. It was discharged about eight hours after surgery with the recom- mendation to continue the enro oxacin and cefpodoxime. Over the next few weeks, the owner brought the cat to our clinic intermittently for thoracentesis; 160, 200, and 100 ml of uid was aspirated the rst, second, and fourth week after chest tube removal, respectively. After each thoracentesis, carprofen (2.2 mg/kg) was administered subcutaneously. The effusion continued, but the rate appeared to decrease dramatically in the 12 months after the thoracic duct ligation and partial pericardiectomy. About 12 months after the thoracic duct ligation and partial pericardiectomy, the cat weighed 17.6 lb (8 kg), had a body condition score of 7 out of 9, and was eupneic, and thoracic auscultation results were unremarkable. The rechecks have become less frequent, and the most recent thoracic radiographs, which were taken 20 months after the thoracic duct ligation and partial pericardiectomy, showed a possible scant amount of pleural effusion on the lateral view (Figures 3A & 3B). Follow-up complete blood count, serum chemistry pro le, and urinalysis results have been unremarkable. A heartworm antigen and antibody test were performed, and the results were negative. Clinically, the cat is doing well. 498 September 2008 VETERINARY MEDICINE

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Veterinary Medicine - September 2008 Contents Leading Off Practical Matters Idea Exchange A Challengin Case: Thymic Cyst and Recurrent Chylothorax in a Cat 10 Life-Threatening Behavior Myths CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - September 2008

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