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Leo Norris Acc # 137382

Leo Norris Acc # 137382. Trisha J Oura 8/16/2010. Leo Norris. 8 yo MN DSH Presented to NCSU ER for acute onset RF lameness and pain x 24 hours Open mouth breathing, T = 99.6F, HR = 216 bpm II/VI systolic heart murmur, L heart base RF = no motor, cool to touch. Initial Diagnostics.

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Leo Norris Acc # 137382

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  1. Leo NorrisAcc # 137382 Trisha J Oura 8/16/2010

  2. Leo Norris • 8 yo MN DSH • Presented to NCSU ER for acute onset RF lameness and pain x 24 hours • Open mouth breathing, T = 99.6F, HR = 216 bpm • II/VI systolic heart murmur, L heart base • RF = no motor, cool to touch

  3. Initial Diagnostics • Thoracic radiographs • Echocardiogram

  4. Results • Thoracic radiographs: • Multiple pulmonary nodules and larger cavitated pulmonary mass (left caudal lung lobe), diffuse mild bronchial pattern, mild right cranial lobar artery enlargement, normal cardiac silhouette • Echo: • Trace MR, mild LA enlargement, no evidence of thrombus • AUS: • Degenerative renal changes, cystoliths, pancreatic cysts

  5. Results • FNA of pulmonary mass • Epithelial proliferation consistent with carcinoma, mixed inflammation • Cytologically consistent with neoplasia; cannot rule out dysplastic population secondary to inflammation (but unlikely)

  6. Feline Arterial Thromboembolism • 1st reported in 1930 (distal aortic thrombus) • 1955 = case series of 9 cats • 1960 = estimated prevalence of 1/142 new feline admissions at Upenn • 2001 = 1/175 feline admissions at U of MN

  7. Feline ATE • Thrombus formation: Altered endothelial surface Altered blood flow Altered blood composition

  8. Thrombus Review • Altered endothelial surface/blood flow • Collagen, vWF, TF exposure can initiate thrombus formation • LA enlargement = stasis • Degree of LAE may correlate with increased risk of ATE • Altered blood composition • Protein loss (AT loss) • Platelet hypercoagulability with HCM? • Congenital thrombogenicity? • 1 thrombus predisposes to future thrombi

  9. Risk Factors for ATE 127 cats presenting with ATE (1992-2001)

  10. Risk Factors • Cardiac • Up to 41% of cats with HCM have evidence of thrombus formation at necropsy • Neoplasia • Particularly pulmonary carcinoma • Tumor emboli vs. hypercoagulable state from neoplasia • Hyperthyroidism • Directly hypercoagulable • Secondary cardiac disease

  11. ATE with Neoplasia • Tumor embolization = rarely reported in humans • Usually associated with primary or secondary pulmonary neoplasia • Common ATE sites: cerebral artery, aortic bifurcation, common femoral artery • Poorly documented in cats • Retrospective JAAHA paper = 100 cats with ATE • 2 had pulmonary masses, 3 had consolidation in caudodorsal lung lobes (none had heart disease)

  12. Case Report • 14 yo MN Abyssinian with acute onset R carpal hyperextension, pallor, cool footpads • 3 mos prior to presentation = cough • 1 mo prior to presentation: radiographs = cavitated pulmonary mass (L caudal) • Eventually progressed to LH pain/discoloration, firm gastrocnemius • Amputation due to gangrenous limb

  13. Clinical Signs, Treatment, Prognosis 5 P’s! Pulselessness Pain Pallor Paresis Poikilothermia • Clinical signs: • Treatment: • Treat the underlying disease • Analgesia • Improve systemic perfusion (with care!) • Thrombolytics? (TPA, SK) • Anticoagulants: LMW Heparin, aspirin, clopidogrel (Plavix) • Prognosis • Survival to discharge ~ 22-29% • Poor prognostic indicators: T<98.9F, bradycardia, more than 1 limb affected, lack of motor function • CHF does not have significant effect on ultimate survival, but does effect MST (77d vs. 223 d)

  14. Leo’s Outcome • Seen by oncology for carboplatin • On plavix, meloxicam (anti-angiogenicNSAID) • Doing better, regaining forelimb function • Due for a follow-up with oncology this week (per client communication)… • As of 11:45am 8/15 • Represented to ER for acute onset worsening of RF signs, vocalizing, open-mouth breathing • Euthanasia with necropsy

  15. References • Laste NJ, NK Harpster. A retrospective study of 100 cases of feline distal aortic thromboembolism:1977-1993. JAAHA. 1995;31:492-500. • Smith SA, AH Tobias. Feline arterial thromboembolism: an update. Vet Clin Small Anim. 2004;34:1245-1271. • Sykes JE. Ischemic neuromyopathy due to periopheral arterial embolization of an adenocarcinoma in a cat. J Fel Med Surg. 2003;5:353-356.

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