Case of the Month – January 2013

This January sees Malcolm as our case of the Month!  A very brave cat whose sudden loss of miaow was very nearly fatal. As you can see from the photographs Malcolm is a very smart cat.  At just over seven years old he enjoys a happy country life, hunting mice, enjoying his food and generally getting fuss from his family. Normally quite vocal, it was noted that his miaow had suddenly changed in volume to more of a croak and then within a day had gone completely.  Worse still his usual good appetite was waning. A visit to Oak Barn confirmed a high temperature and his sub-mandibular lymph nodes (his external ‘tonsils’ on the outside of his neck) were enlarged.  A provisional diagnosis of laryngitis was made and antibiotics and an anti-inflammatory non-steroidal to reduce his temperature and make him more comfortable were given. However within 24 hours he was no better and returned to the surgery.  By this point his breathing was incredibly noisy and he sounded like an old man constantly snoring.   He was admitted for further investigation – we suspected that he might have a polyp or a grass blade stuck at the back of the throat which are both simple problems to fix. Under general anaesthesia we found an enormous pink swelling on the left hand side of his throat which was squashing his larynx and making it difficult for him to breathe as you can see below.

Photo of Malcolm's Throat

As you can see from the x-rays in the gallery below this mass was extensive running from the base of his tongue to beyond his hyoid apparatus (the bony part of your voice box).  Unusually there was no swelling on the outside of his neck or any evidence of trauma or abscess.  It was only possible to pass the smallest of breathing tubes to protect his airway (endotracheal tube).  Normally we would use a 4.5 size tube for a cat of Malcolm’s size but in this case we could only just squeeze a size 2 tube past this large swelling. The tissue was completely solid, with no evidence of an abscess, so a biopsy was taken and a courier came straight away to take it to the lab for histopathology.  The throat was flushed and we started intravenous anti-inflammatories (a cortisone injection), intravenous diuretics and two different types of intravenous antibiotics. There was no further swelling visible after the biopsy was taken so after discussion with the owners it was decided to wake Malcolm up, but first his neck was clipped and prepared for a possible emergency tracheotomy if he woke and could not breathe. Thankfully Malcolm recovered from his anaesthetic well with the support of an oxygen chamber.  This is a special kennel in which we enrich the atmosphere with a continual supply of oxygen, much like an incubator – in doing so the body needs to breathe less frequently to maintain oxygen levels and fewer breaths per minute allows for less work and irritation on an already swollen larynx. The lab result returned quickly as a an area of pyogranulomatous inflammation with no sign of neoplasia.  Effectively a mound of infected tissue that has not developed into an abscess but has no sign of cancer associated with it. Over the next few days Malcolm improved with his broad spectrum intravenous antibiotics.  Interestingly the lab never managed to culture the infection responsible for this.  Frustratingly this can be quite common – often these bugs grow very happily in living tissue but on an agar plate in a lab can be reluctant! Within a week Malcolm’s miaow returned and his hair began to grow quickly where he had been shaved.  Malcolm has now finished his antibiotics and is back to his usual self.  This is one of those occasions where it would be nice if our patients could talk to us and tell us how this happened!  We must assume that he had a penetrating injury (possibly a bone from hunting) that led to the infection but we will never know.  There is a small chance there could be a foreign body responsible for this case but as yet thankfully there has been no recurrence and Malcolm is his usual lovable talkative self!