Any suggestions for pleural effusion problem?

[Linny]

My cat, Tigger has pleural effusion, but my vets have not been able to discover the root cause. Tigger first experienced this in June 2001, at just under four years of age. A chest x-ray showed fluid around his lungs. The fluid pulled from his chest was clear. His blood was tested for possible causes including viral infections such as feline leukemia, thyroid problems etc., but all the tests were negative. FIP was also ruled out due to age and lack of exposure. Tigger exhibited no symptoms of illness other than rapid breathing and some lethargy. Tigger was placed on Lasix to help remove the fluid. Although no heart murmur was detected, the vets felt that the only other probable cause was cardiomyopathy. Within 2 ½ weeks of diagnosis and initiation of treatment with Lasix, another x-ray showed that the fluid around his lungs was almost completely gone. Tigger’s breathing was much better and he was no longer lethargic. Tigger was then examined at Virginia Tech’s College of Veterinary Medicine where he was given an extensive echocardiogram. The cardiologist stated that his heart was perfect and they could find no cause related to his heart. Several other specialists at VT reviewed Tigger’s medical data and could provide no diagnosis. At the doctors’ recommendation, we gave him Lasix for one more week after his trip to Virginia Tech and then discontinued treatment. His breathing continued to be normal for nearly two years.

Tigger was taken to the vet for routine vaccination on 2/27/03. Since taking him for his vaccinations, I had noticed that his breathing appeared to be a little faster than normal. One afternoon, Tigger started breathing “heavily” (more rapid and harder than usual even when sleeping). I took him to the vet on 3/27/03 and he once again had pleural effusion (fluid is clear). As before, there were no other symptoms. The vet removed approximately 150 cc of clear fluid and Tigger was placed on the Lasix (1/4 of a 12.5 mg tablet, twice per day). Tigger weighs 8 ½ pounds, and is now approaching 6 years of age. After three weeks of treatment, Tigger still had fluid around his lungs. On 4/17/03, another 250 cc of fluid was removed, and Tigger was placed on Enacard (1 mg tablet, once per day) in addition to the Lasix. The vets thought that he may have high blood pressure, causing the effusion, and are hoping that the enacard will reduce the effusion. For the first couple of weeks, Tigger did very well, but then his breathing rate increased again. Tigger again had to have 300 cc fluid removed on 5/8/03. (He was off the medicine for about 5 days during this three weeks due to my husband and I being out of town.) Tigger has been eating well, and is active. Even the night before having 300 cc of fluid removed, he was very playful and feisty. The vets have not been able to determine the root cause of the effusion. Tigger appears to be normal except for the breathing rate increase and getting “winded” more quickly during play as the fluid builds.
Has anyone experienced anything like this, and do you have any suggestions as to cause and other types of treatment?

Thank you.

[davet]

near a vet school i sure would get him there...i seriously doubt there are manyveterinary pulmonists out in the field...can't say any more then good luck and hope it is rectified

[Traci]

I'm thinking chylothorax or a previous injury possibility. Although in chylothorax, the fluid would most likely be milky white or even contain blood. Sometimes it is idiopathic and treatment wouldn't include much more than what you're currently adding. I'm assuming your vets have ruled out bacterial infections?

I agree with Davet, get him back to VTech and recheck with a new ECG, a doppler check (for hypertension) and consider an ultrasound to rule out right or left-sided heart enlargement.

[Linny]

Thanks to Traci and davet for your comments. VTech is about 2 1/2 hours away and is a VERY stressful trip for Tigger. We really don't want to do that again if we don't have to, but it may come to that. The echocardiogram/ultrasound in his 2001 episode was very thorough (they did it in three different modes) and showed that his heart was perfectly normal. The vet is indeed calling this idiopathic. I'm taking Tigger back soon for another chest tap and plan to ask the vet about infections and about testing the fluid again (it hasn't been tested during this episode). It was tested in 2001 and did not reveal much other than that it was NOT chylous.

Will post again soon.

Thanks,

Linny