Pyometra in a 5-year-old Persian cat.
Diagnosis and conclusions.

Yesterday, Mr Kane visited my clinic with his beloved 5-year-old Persian female cat named Lily, seeking consultation for increased water intake, depression, abnormal urination, and a noticeable loss of appetite.

Pyometra at the clinic

During the clinical examination, I took Lily's body temperature, revealing a hyperthermia reading of 39.8 degrees Celsius, prompting a deeper dive into her health

Fig 1. Photo of the thermometer at the clinic

Using a stethoscope to check Lily's breathing, I found her respiration fell within the normal range. However, when I listened to Lily's heartbeat using the stethoscope, I noticed an irregular rhythm (cardiac murmurs). A thorough clinical examination revealed sensitivity and discomfort on palpation of Lily's lower abdomen, indicating a potential underlying issue that needs attention.

Fig 2. Photo of Lily at the clinic

After detecting sensitivity during abdominal palpation, I decided to delve deeper into Lily's health story. Opting for a comprehensive approach, I initiated blood sample analysis, ultrasound, and urine tests. The blood work uncovered mild leukocytosis, indicating an elevated white blood cell count, and an increased level of globulins (hyperglobulinemia), pointing to a potential underlying infection.

The urine analysis report indicated a low concentration or gravity of urine. The ultrasound painted a visual narrative, depicting an enlarged uterus, chronic thickening of the uterus walls without pregnancy, which may lead to a cyst forming in the walls of the uterus, and a distended tubular structure filled with anechoic fluids. These findings strongly hinted at pyometra, a serious bacterial infection likely due to hormonal changes (progesterone) during Lily's oestrous periods.

Fig 3. Ultrasound image showing multiple anechoic fluid-filled pockets

An atrioventricular block

As the pieces of the puzzle came together, the urgency of pyometra demanded emergency surgery, but an unexpected irregularity in Lily's heartbeat prompted further investigation. Auscultation, however, revealed an unexpected irregularity in Lily's heartbeat, demanding immediate attention. I have decided to undergo an ECG to conduct a more in-depth investigation into the abnormal heartbeat.

The electrocardiogram (ECG) revealed that the electrical signal is moving slowly through the AV node, creating an increased PR interval (greater than 0.9 seconds), indicating a first-degree atrioventricular block. This information provides important insights into the electrical conduction system of the heart, and further discussions with a cardiologist were necessary to determine the appropriate course of action for managing this condition.

Fig 4. ECG image showing increased PR interval

Remote cardiological consultation

Recognizing the need for specialized insight, I reached out to a veterinary cardiologist through the DRVET.CH app, to navigate Lily's complex medical landscape. Their collaboration became pivotal in deciphering Lily's intertwined health concerns.

The tele-cardiologist carefully checked Lily's heart, finding a hidden issue in the ECG report and blood analysis that added another challenge alongside the urgent pyometra problem. This made the case more complicated, needing a personalized two-step treatment plan. The cardiologist suggested premedication with electrolyte balance and Tab. Atenolo for three days prior to the surgery.

Fig 5. Blood smear showing marked leucocytosis

Pyometra surgery

After Lily's heart rhythm returned to normal following subsequent check-ups, Lily received gas anesthesia with Isoflurane (an anesthetic agent that has a quick recovery time) with a dose rate of 1.0% to 2.5%, paving the way for the crucial surgery to address the pyometra.

Two weeks of dedicated care worked wonders for our furry friend, returning the cat to a vibrant and healthy life. The owner, overwhelmed with gratitude, expressed heartfelt appreciation to our exceptional team. In the end, it wasn't just a cat's recovery but a testament to the power of compassion and expertise coming together in the world of veterinary care. Lily's success story became compelling, and discussed among fellow veterinarians, illustrating the necessity of seeking specialized expertise when facing intricate cases that transcend conventional diagnoses

The impact of remote cardiology consultation

Lilly with first-degree heart block receives regular monitoring through remote consultation. A cardiologist keeps a close eye on Lilly's progress, adjusts medication and offers essential guidance. Remote consultations have been a lifeline for those with heart conditions like Lily's. When it comes to emergencies, quick assessment and diagnosis by cardiologists through these remote sessions mean faster treatment, potentially saving lives. It's not just about managing her care, it's about ensuring Lilly feels supported and empowered in her journey toward better heart health.