PMC6376519_01
Right lateral thoracic radiograph depicting normal thorax at initial presentation to the primary veterinarian despite acute dyspnea
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Thoracic radiographs at that time were unremarkable (Figure 1).
Right lateral thoracic radiograph performed 14 days after initial presentation to the primary veterinarian depicting moderate caudoventrally located pleural effusion
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The following day the cat became severely dyspneic, and thoracic radiographs revealed moderate right-sided pleural effusion (Figure 2).
Abdominal ultrasound image depicting tubular structure ventral to and, questionably, arising from the right liver
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A small hypoechoic structure with irregular margins that contacted the diaphragm was identified, ventral to the right side of the liver (Figure 3).
Thoracic ultrasound image depicting a hyperechoic structure in right caudal thorax, in contact with the diaphragm. There is moderate pleural effusion ventral to the structure
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A hyperechoic structure was identified in the right caudal thorax in contact with the diaphragm, symmetrical to the hypoechoic abdominal structure (Figure 4).
Sagittal view of thoracoabdominal CT scan depicting open communication between the fluid-filled abdominal structure and the thorax via a defect in the diaphragm
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This revealed a fluid-dense tubular structure extending from ventral to the liver, through the diaphragm, into the thorax, and directly communicating with the pleural space (Figure 5).
Necropsy image. Visceral surface of the liver with abscessed tissue at left connecting deflated gall bladder and diaphragm
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A necropsy was performed, which identified a cholecystopleural fistula arising from the apex of the gall bladder (Figure 6) with multifocal abscesses and cellular necrosis, and severe acute fibrinous pleuritis.