Page 111 - Problem-Based Feline Medicine

7 – THE COUGHING CAT 103

Cervical trachea collapse produces inspiratory dyspnea, Clinical signs
while intrathoracic tracheal or bronchial collapse will
Deep productive cough, may be soft and ineffective.
lead to mostly expiratory dyspnea.
Inspiratory and expiratory dyspnea, often with open-
Generally occurs secondary to trauma or to compres-
mouth breathing.
sion caused by an extraluminal mass.
Adventitial breath sounds, including crackles, wheezes,
Diagnosis snaps and pops.
Radiographs may show attenuation of the tracheal or History of signs consistent with bacterial, fungal, viral,
bronchial lumina. Fluoroscopy may be more sensitive mycoplasmal and Chlamydophila felis pneumonitis.
for dynamic collapse.
Constitutional signs include lethargy, anorexia, weight
Tracheobronchoscopy is valuable in both diagnosing loss, fever and ill thrift.
and grading the severity of the collapse.

Differential diagnosis Diagnosis
Tracheitis from feline rhinotracheitis virus is generally Thoracic radiography shows alveolar densities (focal
associated with other upper respiratory tract signs. or generalized) and possible areas of complete consoli-
dation. Hilar lymphadenopathy supports fungal or
Laryngeal paralysis or edema, tracheal foreign body
mycobacterial pneumonia.
and tracheobronchial neoplasm can be differentiated
endoscopically. Hematology often shows neutrophilia with or without a
left shift or signs of toxicity. Low-grade, non-respon-
Small airway disease (feline asthma/bronchitis com-
sive anemia and monocytosis may support chronicity.
plex) can worsen upper airway collapse, but generally
diagnosis is based on radiographic peribronchiolar pat- Cytology and culture of lung samples may be
tern and airway inflammation on lung wash cytology. obtained via percutaneous lung aspiration, transtracheal
wash, or bronchoscopic lavage. Fungal, aerobic and
Treatment anaerobic bacterial cultures are generally submitted.

Medical treatment is indicated if the collapsing seg- Serology may aid in the diagnosis of cryptococcal
ment is short and minimally attenuated, and consists pneumonia.
primarily of antitussive therapy (butorphanol 1 mg/cat
PO q 6–12 h prn).

Surgical therapy may be indicated with severe collapse Differential diagnosis
due to trauma. This generally requires referral to a spe-
Chronic small airway disease (feline asthma/bronchi-
cialist with experience in airway surgery.
tis), PIE and lymphomatoid granulomatosis, and pul-
Weight loss and avoidance of neck collars can be very monary neoplasia, either primary or metastatic disease,
beneficial in affected cats. may mimic pneumonia.
Small airway disease tends to have peribronchiolar
PNEUMONIA
infiltrates compared to the alveolar pattern of pneu-
monia. Also, although asthmatic cats may be
Classical signs
severely dyspneic, systemic signs of fever, or neu-
● Moist, productive cough. trophilic leukocytosis are rare.
● Fever or hypothermia may be present.
PIE, granulomas or neoplasms tend to have a nodu-
● Fetid halitosis.
lar or interstitial density on radiographs, but biopsy
● Adventitial lung sounds are common.
results are required to distinguish these diseases.
See main reference on page 64 for details (The Each of the infectious pneumonias can have overlap-
Dyspneic or Tachypneic Cat). ping features.