Lung lobe torsion associated with chylothorax in a cat

Abstract

A 10.5-year-old domestic shorthair presented with a history of progressive inappetence, lethargy and elevated respiratory rate. Clinical and diagnostic findings confirmed the presence of a chylothorax with evidence of a mass or collapsed lung within the right cranial thorax. Computed tomography, sternotomy and histopathology confirmed the presence of a right middle lung lobe torsion associated with a chylothorax. The torsion was successfully managed with surgical removal of the affected lung lobe, and the patient continues to be asymptomatic 6 months postoperatively.

Successful Surgical Treatment of Idiopathic Chylothorax in a Cat

“…O quilotórax é um tipo de efusão pleural considerado incomum em gatos, poucas informações apontam a frequência destas alterações. A presença de líquido quiloso no tórax pode ocorrer secundariamente a outras afecções que afetem o sistema de drenagem ou de produção do quilo ou ainda ser caracterizado como um transtorno primário do metabolismo dos lipídeos [1,2,4,16]. No paciente descrito, as causas secundárias de quilotórax foram descartadas, tais como traumatismos, neoplasias e doenças cardíacas.…”

Body Cavity Fluids

“…Causes for chylous effusions in the thoracic cavity include cardiovascular disease, neoplasia (e.g., lymphoma, thymoma, and lymphangiosarcoma), heartworm disease, diaphragmatic hernia (Kerpsack et al, 1994), lung torsion, mediastinal fungal granulomas, chronic coughing, vomiting, primary lymphedema, iatrogenic, or idiopathic Fossum et al, 1986a;Fossum et al, 1991;Fossum, 1993;Mclane and Buote, 2011;Meakin et al, 2013;Neath et al, 2000;Schuller et al, 2011;Singh and Brisson, 2010;Small et al, 2008;Waddle and Giger, 1990). Triglyceride-rich chylomicrons are derived from dietary lipids processed in the intestine and transported via lymphatics.…”

Lung

“…[60][61][62] Torsion can occur spontaneously, 60,63 but most reported cases have an underlying respiratory disease identified or suggested, e.g., feline asthma, 64 or it may be associated with pleural effusion, including chylothorax. [60][61][62] Torsion can occur spontaneously, 60,63 but most reported cases have an underlying respiratory disease identified or suggested, e.g., feline asthma, 64 or it may be associated with pleural effusion, including chylothorax.…”

“…16 It has been suggested that lesions of 0.3-0.5 cm are the absolute lower limit for radiographic identification 58 because it can be difficult to differentiate metastatic disease from other pulmonary diseases resulting in a similar radiographic pattern (e.g., pneumonia, hemorrhage, or edema). 61 Although there are only a few case reports in the literature, the prognosis is considered to be good, assuming there is no underlying effusion. Therefore, in order to ensure an accurate diagnosis is always reached, consideration should be given to undertaking ultrasound-guided fine needle aspiration of consolidated areas of lung or nodular lesions.…”

“…11 Clinical signs include lethargy, depression, and gastrointestinal signs but pleural effusions are an uncommon finding. 61,65 The clinical signs of lobar torsion include respiratory difficulty, lethargy and epistaxis. Both scenarios have been reported in cats.…”