PMC5362853_01
Three-view thoracic radiographs of a 9-year-old male neutered cat taken 3 weeks following the onset of lethargy, coughing and an episode of dyspnea. (a) Ventrodorsal, (b) left lateral and (c) right lateral radiographic projections. Note the severe diffuse, mixed bronchial-to-structured interstitial (miliary-to-nodular) pattern with peribronchial cuffing in all lung lobes. Note also the mild alveolar opacity present throughout the caudodorsal lung fields. The pulmonary pattern causes border effacement of the caudal pulmonary lobar vasculature, great vessels and, to a lesser degree, the caudal border of the cardiac silhouette, especially on the lateral projections. Note the normal extrapulmonary and extrathoracic structures
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Peribronchial cuffing was evident, with multifocal areas of poorly defined alveolar disease (especially in the perihilar and caudal dorsal lung fields) (Figure 1).
Transabdominal thoracic sonography of the same cat shown in Figure 1, performed immediately following thoracic radiographic evaluation. Images depict the diaphragmatic hepatic view of the caudal lung fields. (a) The right caudal lung field. The liver and gall bladder (GB) are to the right of the diaphragm (arrows). Note the multiple (>3), hyperechoic B-lines (comet tail artifacts) emanating to the left of the image into the distal field from the pleuropulmonary-diaphragmatic junction. These are indicative of consolidated lung fields and mixed interstitial pulmonary pathology within the right caudal lung field. (b) Similar images as (a) of the right caudal lung field. The gall bladder is not within the image field of view. Note a larger nodule (arrowhead) and 'shred' sign (denoted by the white 'V'). In all sonographic images, the margins of the pleura are irregular. In real time, multifocal, intermittent 'shred' signs were noted. A shred sign is consistent with alveolar parenchymal disease in contact with aerated sections of lung producing irregular sonographic borders. (c) The left caudal lung field. Note that findings within the left caudal lung lobe were similar to that of the right. Falciform fat (labeled 'falc fat') and the liver are to the right of the pleuropulmonary-diaphragmatic interface (arrows)
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Thoracic sonography revealed many B-lines (comet tail artifact, a subtype of reverberation artifact) with intermittent, well-defined, small (2-3 mm), hypoechoic nodules, intermittent irregular pleural margins and multifocal, intermittent, variously sized (2-4 mm) 'shred' signs (Figure 2).
Cytologic sample obtained via pulmonary ultrasound-guided fine-needle aspirate containing Aelurostrongylus abstrusus larva. Just to the right of the center of the image is a large, curved, basophilic larva with a kinked tail (far right) and non-rhabditiform esophagus (left) extending approximately half of the length of the parasite, consistent with a stage 1 A abstrusus larva. The background consists of blood and proteinaceous debris interspersed with occasional non-degenerate neutrophils and alveolar macrophages. Modified Wright's stain
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Some of these larvae possessed distinctly notched tails (Figure 3).
Cytologic sample obtained by way of ultrasound-guided pulmonary fine-needle aspiration showing A abstrusus ova. At the center of the image is a large, oval egg containing numerous basophilic-staining blastomeres surrounded by abundant non-degenerate neutrophils and alveolar macrophages (characterized by their abundant, vacuolated cytoplasm) on a background of blood and proteinaceous debris. Modified Wright's stain
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Also present were multiple oval structures measuring approximately 80 mum x 70 mum, with a frothy interior, containing numerous round basophilic structures consistent with blastomeres (Figure 4).
Two-view thoracic radiographs taken 6 weeks following the diagnosis and medical management of Aelurostrongylus abstrusus. Note the degree of improvement of the previously described mixed pulmonary pattern compared with Figure 1. A mild, diffuse mixed bronchial and unstructured interstitial pattern persists within the right caudodorsal and accessory lung fields. Consideration was given to resolving verminous pneumonia with excellent clinical response to medical management with mild residual pulmonary parenchymal pathology and/or fibrosis. No clinical signs were apparent at the time of imaging
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A residual, but much improved, mild-to-moderate, mixed bronchial and unstructured interstitial pulmonary pattern persisted within the right caudal dorsal and accessory lung lobes (Figure 5).