Presentation
Presented with cough of several years duration.
Patient Data
On thoracic radiographs, there is collapse of the right middle lung lobe, with evidence of the lobar sign on this lateral projection. The trachea is diffusely small in size, and the wall appears thickened. There is a diffuse bronchial pattern with areas of alveolar pattern.
The CT images show that there is severe thickening of the lobar bronchi to the cranial lobes, and also of the proximal portions of the mainstem bronchi. The right cranial lobar bronchus is bronchiectatic, and a large intraluminal soft tissue occlusion is identified peripherally. Multiple other peripheral airways reveal intraluminal soft tissue accumulation. The right middle lobe is collapsed. There are multifocal patchy areas of interstitial and peribronchial infiltrates throughout all lung lobes, but most severe within the caudal lobes.
Case Discussion
Chronic feline lower airway inflammatory disease with bronchiectasis and tracheal collapse.
Bronchoscopy showed moderate to severe tracheal erosions just distal to the larynx. There was extremely thickened mucosa throughout the entire trachea with a redundant tracheal membrane. Grade 1/4 tracheal collapse was seen throughout its length. Marked mucus accumulation was seen in the mid region of the trachea with a slight stenosis at the level of the thoracic inlet. Bronchoscopy also revealed severe blunting at the carina. Many airways could not be entered because of mucus plugging or stenosis, and bronchiectasis could not be directly visualized.
BAL of 2 sites revealed increased cellularity (1700-1800 cells) with increased numbers/percentages of neutrophils (5-15%). BAL cultures for aerobic, anaerobic, and Mycoplasma species were negative.
The bronchiectasis indicates that the airway disease is chronic and irreversible, and will probably predispose the cat to recurrent pneumonia. Treatment plans include nebulization and antibiotics as needed.
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