What Is Your Diagnosis?

Ellen D. Siedlecki Metropolitan Veterinary Hospital, 1053 S Cleveland-Massillon Rd, Akron, OH, 44321.

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Rance M. Gamblin Metropolitan Veterinary Hospital, 1053 S Cleveland-Massillon Rd, Akron, OH, 44321.

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Bennet Fagin Metropolitan Veterinary Hospital, 1053 S Cleveland-Massillon Rd, Akron, OH, 44321.

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History

A 4-year-old 4.1-kg (9-lb) neutered male domestic shorthair cat was evaluated for noisy breathing and nasal discharge from the left naris of 1 month's duration that began after an episode of vomiting. After the episode, the cat had sneezed frequently and periodically breathed with its mouth open. The owner reported that blood was occasionally seen coming from the left naris and that the cat's appetite had decreased. Treatment with antimicrobials, anti-inflammatory medications, and antihistamines did not resolve the clinical signs and the owner was referred for further evaluation of the cat.

Abnormal physical examination findings included decreased airflow through the left naris, compared with the right; abnormal sounds in the nasal passages; and discharge from the left naris. Radiographs of the skull were obtained during general anesthesia (Figure 1).

Figure 1—
Figure 1—

Lateral (A) and ventrodorsal (open mouth; B) radiographic views of the skull and rostrocaudal (C) radiographic view of the frontal sinuses of a 4-year-old cat evaluated for noisy breathing and nasal discharge from the left naris of 1 month's duration that began after an episode of vomiting.

Citation: Journal of the American Veterinary Medical Association 228, 8; 10.2460/javma.228.8.1195

Determine whether additional imaging studies are required, or make your diagnosis from Figure 1—then turn the page

Radiographic Findings and Interpretation

A soft tissue opacity is evident in the left side of the nasal cavity on the ventrodorsal open-mouth radiographic view (Figure 2). No radiographic signs of bone lysis are seen. The tympanic bullae are mildly thick, but the tympanic cavities and frontal sinuses are radiographically unremarkable. Differential diagnoses included nasopharyngeal polyp, granuloma (fungal), exudate (mucus), blood clot, foreign body, or neoplasia.1

Figure 2—
Figure 2—

Same radiographic views as in Figure 1. On the lateral radiographic view, notice that the tympanic bullae are mildly thick (black arrows); the opacity of the tympanic cavity is considered normal. On the ventrodorsal radiographic view, a soft tissue opacity (black arrowheads), which mildly obscures the nasal conchae, can be seen in the left side of the nasal cavity. On the rostrocaudal radiographic view, a soft tissue opacity is evident in the left nasal passage (white arrow).

Citation: Journal of the American Veterinary Medical Association 228, 8; 10.2460/javma.228.8.1195

Comments

In the cat of this report, the relevance of bulla disease was not determined. Rhinoscopy was performed by use of rigid and flexible rhinoscopes. Evaluation of the left nostril revealed a large amount of mucus and hair. Rhinoscopy of the nasopharynx revealed a mass of hair on the left side of the nasal choanae. The mass was removed, and the nasal cavity was flushed with saline (0.9% NaCl) solution. The cat recovered from general anesthesia without complications. Dexamethasone sodium phosphate (3 mg, SC) was given to minimize inflammation in the nasopharynx caused by the foreign material and induced by the rhinoscopic procedure. Three days later, the owner reported that the cat was doing well, had no nasal discharge, but sneezed occasionally. Four months later, the owner reported that the clinical signs had resolved.

During radiographic evaluation of the nasal cavity and paranasal sinuses, the extent and location of the lesion; presence of bone lysis in the nasal concha, septum, and facial bones; and any mass effect that deforms features of the nose, face, orbit, or sinuses should be considered.1 Nasal foreign bodies, mild infections, or inflammation typically causes nondestructive rhinopathy. Destructive rhinopathic lesions, resulting in a soft tissue mass effect and facial bone lysis, can develop in cats with chronic, severe infections such as Cryptococcus neoformans. Neoplasia, such as adenocarcinoma and lymphoma, is more likely to cause facial bone destruction.2–4 Compared with radiography, other diagnostic imaging methods, such as computed tomography or magnetic resonance imaging, may give a clearer assessment of pathologic lesions. Other common pharyngeal masses in cats, such as nasopharyngeal polyps, should be differentiated from foreign bodies.1

To the authors' knowledge, hairballs as nasal foreign bodies in cats have not been reported. They may truly be rare, or cats may spontaneously expel them. Nasopharyngeal foreign bodies should be added to the differential diagnosis list as a cause of nondestructive rhinopathic lesions in cats.

  • 1

    Myer W. Cranial vault and associated structures: nasal cavity and paranasal sinuses. In: Thrall D, ed. Textbook of veterinary diagnostic radiology. 3nd ed. Philadelphia: WB Saunders Co, 1998;5153, 5964.

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  • 2

    O'Brien RT, Evans SM, Wortman JA, et al. Radiographic findings in cats with intranasal neoplasia or chronic rhinitis: 29 cases (19821988). J Am Vet Med Assoc 1996;208:385389.

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  • 3

    Wilson DW, Dungworth DL. Tumors of the respiratory tract. In: Meuten DJ, ed.Tumors in domestic animals. 4th ed. Ames, Iowa: Iowa State University Press, 2002;365399.

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  • 4

    Lana S, Withrow SJ. Tumors of the respiratory system. In: Withrow SJ, MacEwen EG, eds. Small animal clinical oncology. 3nd ed. Philadelphia: WB Saunders Co, 2001;370373.

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