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Dr. Salkin, please continue..so do you think the pleural…

Dr. Salkin, please continue..so do...
Dr. Salkin, please continue..so do you think the pleural effusion might have caused collapse? I meant to say, doesn't pneunomnia usually cause edema?
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9/15/2017
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 33,761
Experience: University of California at Davis graduate veterinarian with 45 years of experience.
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Yes, that's the most likely reason for its collapse. No, pneumonias need not cause edema but certainly can. For example, a bronchopneumonia isn't likely to cause edema while an interstitial pneumonia (involving the alveolae) will.

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Customer reply replied 8 months ago
based on those xrays, you don't think it seems like pneunomnia was present? Was there any way to fix this issue?

I didn't see penumonia in those X-rays. The only manner in which to address a collapsed lung is to successfully treat the underlying condition that caused the collapse. That wasn't possible with FIP.

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Customer reply replied 8 months ago
Is that the best way to usually diagnose pneunomnia, is xrays? Pneunomnia is usually throughout entire lungs, esp. if it would have made her that sick? I saw on their treatment sheet how they heard increased lung sounds the longer she was there in hospital. Leter, I will forward you the xrays that were taken 2 weeks prior to these ones, and I would like you to see the comparison.

Yes. No, pneumonias can be focal or generalized, lobar (involving just one lung lobe) or regional. I'll watch for the other X-rays.

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Customer reply replied 8 months ago
If pneunomnia can be lobar, then why do you feel that this most likely wasn't pneunomnia?

Because there was no pneumonia found in her necropsy.

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Customer reply replied 8 months ago
But if you were treating her, and you saw this xray, do you feel that pneunomnia is possible?

No, but an abscess could look like that and so I'd prescribe an antibiotic until I knew more about my patient.

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Customer reply replied 8 months ago
there were giving 100 mg of unasyn 3 times a day for 3-4 days..would that have improved that if it was the case? what is done on necropsy to see pneunomnia, test the lung tissue for bacteria? Pneunomnia usually doesn't cause effusion and swollen lymphnodes in the abdomen?

That was a good choice of antibiotics. Yes, I would have expected to see improvement in that time frame if there were an infection susceptible to that antibiotic. The necropsy revealed that there wasn't; hence, no response to the antibiotic. Yes, histopathology confirms or denies the presence of pneumonia which you already know. There's no mechanism for a pneumonia to cause abdominal changes and so a systemic infection such as FIP which can effect both the thoracic and abdominal cavities needs to be expected.

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Customer reply replied 8 months ago
pneunomnia doest usually cause effusion? I concerned that weren't paying attention to lungs for necropsy, so Im not convinced it was covered there.
Customer reply replied 8 months ago
here is what the radiologist wrote for these xrays..what do you thinkFindings
Two electronically transmitted images including right lateral and ventrodorsal thoracic radiographs are provided for review, acquired June 1, 2017.
The cardiac silhouette is moderately enlarged and based on the visible margins, rounded. There is a low volume of pleural fluid obscuring portions of the cardiac silhouette and causing wide pleural fissure lines as well as rounding and retraction of lung lobe margins. There is increased opacity in the area of the right middle lung lobe and caudal subsegment of the left cranial lung lobe consistent with atelectasis or less likely consolidation of other cause.
The hepatic silhouette is moderately enlarged and has rounded irregular margins. Abdominal serosal detail is relatively good
Conclusion
Cardiomegaly consistent with cardiomyopathy and/or pericardial effusion. Low volume pleural effusion. Atelectasis or less likely consolidation of other cause (pneumonia, neoplasia, hemorrhage) involving portions of the left cranial and right middle lung lobes.
Marked hepatomegaly with irregular margins consistent with hepatic cysts and/or neoplasia, granulomas or less likely abscessation.

Correct. They paid attention to the lungs. To wit: "Atelectasis or less likely consolidation of other cause (pneumonia, neoplasia, hemorrhage) involving portions of the left cranial and right middle lung lobes."

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Customer reply replied 8 months ago
no, that wasn't the necropsy comments, that was the radiologist interpreting the xrays when she was still there..what does Atelectasis or less likely consolidation of other cause (pneumonia, neoplasia, hemorrhage) involving portions of the left cranial and right middle lung lobes." mean?

A complete necropsy involves sectioning of the lungs. Atelectasis is a fancy term for complete or partial collapse of a lung or a section (lobe) of a lung. A pulmonary consolidation is a region of (normally compressible) lung tissue that has filled with liquid, a condition marked by induration (swelling or hardening of normally soft tissue) of a normally aerated lung. ... Simply, it is defined as alveolar space that contains liquid instead of gas. Consolidation can be caused by infection, cancer, or hemorrhage.

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Customer reply replied 8 months ago
is he saying its partial collapse and pneunomnia is less likely and do you agree?

Yes, I agree.

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Customer reply replied 8 months ago
but isn't atelectsasis just generalized? is ther usually not collapse involved with pneunomnia? do you feel that with the effusion and swollen mesenteric lymphnodes this was something else besides pneunomnia? what about pyothorax as a possibility? would bacteria have shown up in testing of effusion if it was pyothorax?

Atelectasis can involve a small portion of a lung lobe or the entire lobe. No, there's isn't usually collapse invovled with pneumonia. There wasn't a pneumonia and, yes, there was something else - FIP. There was no evidence of pyothorax in the necropy and, yes, bacteria would have been easily found if pyothorax did exist. I feel like I'm enabling you and am guilty about it. You've dwelled on this for over two months now and this can't be healthy for you.

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Customer reply replied 8 months ago
You are not enabling me, this is helpful. so there is a difference between atelectasis and consolidation? Cancer could be both?

Yes, please review the definitions of each as found in my post timestamped 11:47 (my time). Yes, a cancer can be found in either case.

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Customer reply replied 8 months ago
Ok, but pneunomnia is usually not both cases? I thought if there is edema from it, that could collapse it? If they say atelectasis, then they aren't really saying what caused it, just that its collapsed?

No, pneumonia is only one of many possible causes of these conditions but if there were a pneumonia the edema from the pneumonia could cause either or both conditions. Correct, atelectasis is a histopathologic finding. It doesn't tell us the cause in of itself.

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Customer reply replied 8 months ago
Im sorry, when you said no, are you referring to my first question that pneunomnia doesn't usually fall into both cases of atelectasis and consolidation, similar to cancer?

No, I'm saying that pneumonia doesn't necessarily cause atelectasis or consolidation. A solid tumor, however, will appear as consolidation in an X-ray.

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Customer reply replied 8 months ago
Im confused I thought that pnenomnia doesn't cause collapse therefore no atelectasis, and cancer could be be both atelectasis or consolidation?

Both pneumonia and cancers can cause collapse (atelectasis) and/or consolidation.

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Customer reply replied 8 months ago
but you said pneunomnia doesn't usually cause collapse?

Correct. I didn't say that it couldn't cause collapse, however.

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Customer reply replied 8 months ago
here is xrays from 2 weeks prior..

They reveal an effusion but not the atelectasis.

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Customer reply replied 8 months ago
this is the one where the radiologist said mild asthma

I wouldn't be able to confirm that in those films but I don't argue with specialists.

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Customer reply replied 8 months ago
this is what he wrote for this one..what do you think..you see effusion in this one?FindingsTwo electronically transmitted digital images including ventrodorsal and right lateral thoracic radiographs are provided for review, acquired May 17, 2017.The cardiac silhouette is mildly enlarged and slightly rounded. There is a prominent wedge-shaped soft- tissue opacity in the area of the right middle lung lobe visible on the VD view, most likely a collapsed right middle lung lobe. There are mild bronchial changes throughout the remainder of the lungs. The pulmonary vessels are normal.The hepatic silhouette is moderately enlarged and appears more rounded and irregular along the right caudal lateral margins. The stomach is displaced caudally and dorsally and slightly to the left. The stomach contains a small amount of gas consistent with fasting or anorexia.There are multiple narrowed intervertebral disc spaces in the cervical thoracic and cranial lumbar regions with very mild spondylosis deformans at multiple sites.ConclusionMild cardiomegaly consistent with cardiomyopathy such as secondary to hyperthyroidism. Bronchial changes and collapse right middle lung lobe consistent with mild chronic asthma. Hepatomegaly consistent with the history of hepatic cystic disease and or mass lesions.Mild degenerative spinal changes.           
Take a look around.


Which one? I don't see an X-ray.

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Customer reply replied 8 months ago
no sorry, there wasn't an xray, just his writeup..what do you think of it? you saw effusion in the ones I sent before?
Customer reply replied 8 months ago
that was his writeup for the xrays I posted before..you saw effusion there but no atelectasis? I don't get why he mentions some lung lobe collapse consistent with mild asthma..do you feel then that she didn't have the atelectasis at that time but the increased effusion caused it 2 weeks later?

There appeared to be a small amount of free fluid under the heart. The radiologist, however, didn't think so. In "4." I can see the middle lung collapse I missed earlier. It's much smaller than in the previous films I looked at. This is why I'm not a specialist radiologist.

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Customer reply replied 8 months ago
what do you think?
Customer reply replied 8 months ago
do you think it looks like pneumonia? how can it be asthma?

Did you see my post timestamped 4:38 PM (my time)?

I don't see a pneumonia. The radiologist thought that the changes in the lungs could represent mild asthma. Who am I to argue?

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Customer reply replied 8 months ago
do you think this was early pneunomnia they didn't cath perhaps and it just got worse? does it look like the same thing as weeks later just not as bad? I really feel that this might have been pneunomnia that wasn't caught..Im just not sure why the abdomen nodes were enlarged. could pneunmnia lower immune system and then trigger FIP?
Customer reply replied 8 months ago
but collapse usually doesn't mea asthma, right?

It can occur in asthmatics but isn't pathognomonic (specifically indicative) of asthma.

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Customer reply replied 8 months ago
what do you mean, theres ore explanations for it then just astma?

Correct. We've already discussed the possible causes of a collapsed lung lobe.

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Customer reply replied 8 months ago
do you think this was early pneunomnia they didn't cath perhaps and it just got worse? does it look like the same thing as weeks later just not as bad? I really feel that this might have been pneunomnia that wasn't caught..Im just not sure why the abdomen nodes were enlarged. could pneunmnia lower immune system and then trigger FIP??

No. That would have been found in her necropsy. FIP enlarged the abdominal lymph nodes.

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Customer reply replied 8 months ago
do you think that the FIP may have caused the pneumonia?
Customer reply replied 8 months ago
it cant be coincidence she had this lung collapse and then the effusion happened..she was having breating issues..and they did ultrasound 2 weeks prior and didn't see the lymph nodes at that time..does that mean anyting?

There was no pneumonia.

The effusion preceded the lung collapse.

It just means that the lymph nodes had enlarged by 2 weeks after the ultrasound.

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Customer reply replied 8 months ago
but we saw lung collapse there and no effusion, so how can we can say it preceded it?

Did I get the timing wrong? Mea culpa. I'll back up.

There was no pneumonia.

I have to assume that the radiologist conjectured that the collapse was related to asthma.

It just means that the lymph nodes had enlarged by 2 weeks after the ultrasound.

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Customer reply replied 8 months ago
but how can the lymph nodes not become enlarged yet with FIP but there is all of these lung issues beforehand?

The degree of lymphadenopathy will vary with the severity of the infection in a particular location.

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Customer reply replied 8 months ago
but the ultrasound 2 weeks prior saw no lymphnodes at all...was there fluid in the lungs, on the latter xrays(the original ones I sent first)

A lot can happen in two weeks. I don't recall what the radiologist said about the latter x-rays. I believe that you still have that report, however.

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Hi,
I'm just following up on our conversation about your pet. How is everything going?
Dr. Michael Salkin
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Customer reply replied 8 months ago
I am asking what you saw on xrays not what radilogist wrote..can FIP cause edema? they kept commenting she had increased lungs sounds, and worry that was pnenomnia? If if seemed like there was no edema, just atelectasis, could pneunomnia get that worse over a few days?

"Listen" to what the radiologist had to say. He/she is a lot smarter than I when it comes to reading films. Pulmonary edema isn't expected with FIP. The vasculitis caused by that virus causes effusions in body cavities instead. I don't know why you keep harping on pneumonia. Pneumonia wasn't seen. A collapsed lung lobe was seen and the lungfields may have indicated mild ansthma.

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Customer reply replied 8 months ago
because they kept saying how she had increased lungs sounds, which would mean edemea, right? If she had pneunomnia, would she have had a temperature? She did in ER which I know can happen with FIP, too, but that morning ishe only had 101.8 whci is normal. She had pneunomnia for a couple weeks wouldn't she have had a temeperature all along?

It can indicate edema but also other lung disorders. Fever may or may not be present with pneumonias; for example, people with walking pneumonia can feel well and not know they're quite ill.

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Customer reply replied 7 months ago
why do you feel it was not pneunomnia? based on the xrays you saw, ?

I've already answered this and so I'll opt out as I've offered up all I have.

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
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Satisfied Customers: 33,761
Experience: University of California at Davis graduate veterinarian with 45 years of experience.
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