Figure 1A: A right lateral thoracic radiograph demonstrating a diffuse interstitial to alveolar pattern with bronchial thickening.
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Thoracic radiographic findings included dense interstitial opacities throughout all lung fields, a moderate amount of bronchial
thickening, and an alveolar infiltrate within the ventral lung fields (Figures 1A & 1B). Because of the severe mixed pulmonary pattern, we suspected a chronic inflammatory lung disease. Abdominal radiographic
findings included a large amount of free gas in the peritoneal space, which enhanced the visibility of the serosal margins
of all abdominal structures (Figures 2A & 2B). Our primary differential diagnosis for the pneumoperitoneum was a gastrointestinal perforation because of the absence of
a penetrating abdominal wound on physical examination, so we treated the case as a surgical emergency.
Surgery and further diagnostic testing
The abdomen was prepared for abdominocentesis, and 735 ml free air was removed with a butterfly catheter attached to a syringe
by a three-way stopcock. The patient was subsequently premedicated with butorphanol tartrate and diazepam, followed by isoflurane
mask induction for an exploratory celiotomy. Intravenous fluid support consisted of 5 ml/hr of a balanced electrolyte solution
(Normosol-R—Abbott Laboratories) with 5% dextrose added and polymerized bovine hemoglobin solution (Oxyglobin—Biopure; 75
ml over two hours) to maintain adequate perfusion and tissue oxygenation.
Figure 1B: A ventrodorsal thoracic radiograph demonstrating a diffuse interstitial to alveolar pattern with bronchial thickening.
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We found a 1-cm perforation in the cardia of the stomach (Figure 3). Intraoperative cytologic examination of a sample of the affected area revealed normal gastric epithelium. The gastric mucosa
surrounding the perforation was grossly normal. We resected a full-thickness 1-x-4-cm area surrounding the defect and submitted
it for histologic examination. We saw no other abnormalities intraoperatively throughout the abdomen, and the defect and abdomen
were closed in a standard manner. The gastric mucosa was later found to be normal in all biopsy sections.
Because of the radiographically severe respiratory disease, we performed a transtracheal wash through the endotracheal tube
immediately after the surgery and before extubation. Five milliliters of sterile saline was injected twice through a sterile
catheter. The recovered fluid was centrifuged, and cytologic examination revealed moderate numbers of normal ciliated columnar
epithelial cells. No microorganisms or inflammatory cells were noted.
Figure 2A: An abdominal radiograph showing a large volume of free gas within the peritoneal space, enhancing the visibility
of the serosal surfaces of the abdominal organs.
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Postoperatively, the patient had a severely decreased packed cell volume of 9%, so we performed a transfusion (based on a
prior crossmatch) consisting of 25 ml packed red blood cells. Cefazolin sodium (50 mg intravenously t.i.d.) was administered
during surgery and was continued along with enrofloxacin (11 mg intravenously b.i.d.) to achieve broad-spectrum antibiotic
coverage. We continued clindamycin administration (25 mg orally b.i.d.) because of possible T. gondii infection.
The cat seemed to improve over the next 12 hours, but within 24 hours its condition declined. It became depressed and weak,
and its temperature increased from 99.5 F to 102.6 F (37.5 C to 39.2 C). We performed a diagnostic peritoneal lavage by infusing
22 ml/kg warm isotonic fluid into the abdomen. Recovered fluid contained mature neutrophils and occasional macrophages, which
we attributed to the celiotomy performed the previous day. The cat became progressively more depressed, and its breathing
was labored, so we transferred the cat to an oxygen cage maintained at a 40% oxygen concentration. The cat subsequently developed
respiratory arrest followed shortly by cardiac arrest. Cardiopulmonary resuscitation was unsuccessful, and the cat died.
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