Case of the Month

• Severe mixed lung pattern of the right middle lung lobe with diffuse vesicular pattern, suspicion of abnormal location of this lung lobe, and mild pleural effusion.  Highly suspicious for a lung lobe torsion of the right middle lung lobe.  Differential: Severe lobar pneumonia, aspiration pneumonia.  Cardiogenic pulmonary edema unlikely due to the inconsistent history.

• Mild generalized cardiomegaly.  Differentials: Age-related normal variant, sedation, bradycardia, cardiopathy (if present likely compensated).

• Computed tomography of the thorax after initial stabilization advised.  

• Echocardiography to be considered if clinically indicated.

• An echocardiography and a computed tomography (CT) of the thorax were performed (follow up CT).

• The echocardiography diagnosed a mild and compensated hypertrophic obstructive cardiomyopathy with a dynamic left ventricular outflow obstruction with questionable clinical relevance at the moment.

• The computed tomography findings are presented in the follow up section (follow up CT).

• Some literature: Spontaneous Lung Lobe Torsion in a Cat ; Clinical characteristics and long-term outcome of lung lobe torsions in cats: a review of 10 cases (2000–2021)

Thorax in 3 projections of a skeletally immature cat in normal body condition.

Musculoskeletal structures within normal limits.
Diaphragm delineable.  Thoracic volume mildly enlarged.
Mediastinum within normal limits.
Mild bilateral pleural effusion, right more severe than left, and accentuated in the region of the right middle lung lobe.
Margins of the right middle lung lobe not clearly delineable with generalized severe increased radiopacity/consolidation of this lung lobe with diffuse vesicular lung pattern and with mild increased volume.  Stem bronchus of the right middle lung lobe not clearly delineable and right middle lung lobe subjectively mildly caudally displaced.  Rest of the pulmonary parenchyma with mild increased unstructured interstitial lung pattern, especially in the right hemithorax.
Cardiac silhouette not completely delineable due to border effacement with the pulmonary changes, but subjectively generalized mildly enlarged.  Pulmonary vessels, aorta, and caudal vena cava within normal limits.
Included cranial aspect of the abdomen with mild distention of the gallbladder likely secondary to the hyporexia and with questionable clinical relevance. Included part of the abdomen otherwise within normal limits.

Severe mixed lung pattern of the right middle lung lobe with diffuse vesicular pattern, suspicion of abnormal location of this lung lobe, and mild pleural effusion.  Highly suspicious for a lung lobe torsion of the right middle lung lobe.  Differential: Severe lobar pneumonia, aspiration pneumonia.  Cardiogenic pulmonary edema unlikely due to the inconsistent history.
Mild generalized cardiomegaly.  Differentials: Age-related normal variant, sedation, bradycardia, cardiopathy (if present likely compensated).

Computed tomography of the thorax after initial stabilization advised. 
Echocardiography to be considered if clinically indicated.