Page 268 - Feline Cardiology

Chapter 19: Congestive Heart Failure 275

A C Congestive Heart Failure

B D
Figure 19.10. Thoracic radiographs of a cat with severe restrictive cardiomyopathy and concurrent severe pulmonary edema and pleu-
ral effusion. Thoracic radiographs including right lateral (A) and dorsoventral (B) projections of this severely dyspneic cat show heavy
alveolar pulmonary infiltrates and mild pleural effusion that obscure the cardiac silhouette. Repeat thoracic radiographs one day after
aggressive diuretic therapy show improved and mild to moderate pulmonary edema and nearly resolved pleural effusion (C) and (D).
Cardiomegaly and left atrial dilation are now visible.

mulates in the perihilar region, which may be obscured pulmonary pattern (Benigni et al. 2009). Cardiogenic
by superimposed structures including pulmonary vas- pulmonary edema was never present in just a single lung
culature and the left atrium. Pulmonary edema is often lobe, which may help distinguish heart failure from some
asymmetrical (78%) rather than bilaterally symmetrical cases of bronchopneumonia or aspiration pneumonia.
(22%) (Benigni et al. 2009). Because there is greater Although often present in heart failure (71% of cats in
pulmonary mass and blood flow to the right lung lobes, 1 study), pulmonary venous distension may not be
there may be greater edema formation in the right lung present in cats that are dehydrated or receiving diuretics
lobes. To further obscure the differentiation of heart (Benigni et al. 2009). Often both pulmonary arteries and
failure versus primary respiratory disease, 61% of cats pulmonary veins are distended in congestive heart
with cardiogenic pulmonary edema also had a bronchial failure. Heart failure should never be ruled out based on