case_images: PMC11141230_01
case_images: Composite echocardiographic images in a Chartreux cat referred for heart murmur, exercise intolerance and open-mouth breathing during exercise. (a) Right parasternal, four-chamber view optimised for the right chambers showing right atrial enlargement with atrial septal bowing toward the left atrium and right ventricular hypertrophy. (b) Right parasternal five-chamber view, colour Doppler image showing findings compatible with systolic anterior motion of the mitral valve (mitral regurgitation and left ventricular outflow tract turbulence). (c) M-mode image taken from the right parasternal short-axis view at the papillary muscles level. Significant right ventricular dilation and hypertrophy were noted, with paradoxical septal motion and reduced left ventricular internal diameters. (d) Pulsed-wave Doppler flow taken at the pulmonary valve: laminar flow with fast acceleration time and longer ejection time (aorta-like flow profile). (e) Left parasternal apical view optimised for the right chambers. Colour Doppler flow showing the presence of tricuspid regurgitation. (f) Continuous-wave Doppler flow from tricuspid regurgitation jet identifying severe tricuspid regurgitation (4.5 m/s). These findings were compatible with high probability of severe pulmonary hypertension
case_images: 10.1177_20551169241249003-fig1.jpg
case_images: PMC11141230_01_10.1177_20551169241249003-fig1.jpg
case_images: fig1-20551169241249003
case_images: No intracardiac shunts were noted (Figure 1).
case_images: Thoracic radiographs, performed in lateral (right) and ventrodorsal (left) views at the time of presentation, showing severe generalised cardiomegaly without notable changes in lung parenchyma and/or pulmonary vessels
case_images: 10.1177_20551169241249003-fig2.jpg
case_images: PMC11141230_01_10.1177_20551169241249003-fig2.jpg
case_images: fig2-20551169241249003
case_images: A severe generalised increase in the size of the cardiac silhouette was observed without obvious pulmonary vascular changes (Figure 2).
case_images: Composite image showing relevant CT findings. (a) The lung parenchyma in a pulmonary window. (b) Severe cardiomegaly, in a pulmonary window, with the presence of ground-glass opacity (GGO). The degree of GGO was likely attributable to primary lung disease, but unlikely to justify the severe right-sided cardiomegaly and reported clinical signs. (c) Severe generalised cardiomegaly, in a soft tissue window, mainly involving the right atrium and ventricle. (d) The pulmonary trunk, in a soft tissue window. Although there are currently no standard measurements applicable to cats, the pulmonary trunk to aorta ratio measured normal (1.1).
case_images: 10.1177_20551169241249003-fig3.jpg
case_images: PMC11141230_01_10.1177_20551169241249003-fig3.jpg
case_images: fig3-20551169241249003
case_images: The main findings were severe generalised cardiomegaly (mainly affecting the right chambers), diffuse ground-glass opacity in the lung parenchyma, some parenchymal bands and subpleural interstitial thickening associated with mild bronchiolectasis (Figure 3).
case_images: Relevant gross pathology findings: (a) prominent right-sided cardiomegaly with dilated right auricle, right ventricular dilation and normal pulmonary trunk; (b) lung lobes, fixed in formalin, with diffuse mottled areas in all lung lobes; and (c) macroscopic appearance of the liver, which appears enlarged with fibrin deposition and foci of neovascularisation
case_images: 10.1177_20551169241249003-fig4.jpg
case_images: PMC11141230_01_10.1177_20551169241249003-fig4.jpg
case_images: fig4-20551169241249003
case_images: The lungs were affected by diffuse lung pathology (Figure 4).
case_images: Lung histopathology. The alveoli are markedly dilated in the uncollapsed portions of the lung. Alveolar haemorrhage was identified in many alveoli but was considered artefactual. (a) Low magnification showing the lung alveolar parenchyma is diffusely affected. Individual alveolar diameter is equivalent to or larger than adjacent terminal bronchioles. (b) High magnification slide showing alveolar parenchyma enlargement. Bronchi and bronchioles had prominent smooth muscle bundles, occasionally surrounded by prominent lymphofollicular aggregates (bronchus-associated lymphoid tissue hyperplasia) and often contained large numbers of foamy alveolar macrophages and eosinophilic cellular debris
case_images: 10.1177_20551169241249003-fig5.jpg
case_images: PMC11141230_01_10.1177_20551169241249003-fig5.jpg
case_images: fig5-20551169241249003
case_images: All lobes were characterised by markedly enlarged alveolar spaces and airway abnormalities reflecting abnormal development of both conducting airways and alveoli (Figure 5).