Jimmy Needs Lung Surgery

 Jimmy will need lung surgery to remove a nodule "in the right caudel intercostal space in the 6th IC space ventrally (between the 6 and 7 ribs). Well circumscribed, mildly irregular nodule approximately 10cm in the caudal aspect of the right middle lung lobe, near the pleural surface and adjacent to the cardiac silhouette." [CT report.] They suspect cancer because it is rare that a nodule is in the lungs-for cat or human-and not be cancerous. The recent CT did not find cancer in the rest of the body for now. The nodule will be removed with the half of the lung lobe and will be tested for cancer and if needed, chemo might be warranted. We expect to schedule this for the first week of April.

He had an updated ultrasound in February and there are more lesions/nodules on his liver, which have been there for the last few years. But some have grown. We then had xrays taken to check his chest and a nodule was discovered.  A CT in early March revealed that the nodule has grown in a year-from a speck on the March 2024 xray, to a 2 cm "curvilinear vessel" from his April 2024 CT (for the lump on his shoulder that was removed last May) to now a nearly 10cm object. 

We do not want to put him through lung surgery. But if we do not do it now while it is small, it will grow too large to easily remove through the ribs without cracking open his chest, which is what we do not want to do. If we wait too long, it will grow to put pressure on his pulmonary system, creating breathing issues, creating CHF, putting pressure on his heart, causing it to be weak. He has developed a mild heart issue now as it is: 

"The echocardiogram showed that he has developed a mild degree of left atrial dilation. He also had intermittent irregularity of his cardiac rhythm due to premature beats called APCs. There is no evidence of cardiomyopathy, but these abnormalities indicate that his heart is under some stress. This could stem from hypertension or even from an underlying cancerous process. He is not currently at risk for congestive heart failure and cardiac medications are not indicated. He can still be considered an acceptable candidate for anesthesia, if needed."

So, now is a good time while he is a good candidate. BUT the recovery process is difficult and he'll be home THE NEXT DAY. They do not keep them-not this hospital. I will try to arrange home visits with his vet or a visiting vet. I will also need help taking the girls for twice weekly fluids for the first week or so at least. He is supposed to have BED REST for two weeks. So, he and I will be hold up in the small guest bedroom that I continue to use to stay with the cats because it is easy to get to them, the bed is very low-and we have soft stairs to the bed-and the cat does not have far to walk to eat and use the litter box. Stitches will be removed after two weeks. 

His CT also found mildly enlarged sternal nodes-too difficult to remove to test and could be signs of future cancer but no one is concerned at this time. The nodules on his liver did not present as cancer which is a good sign. And the CT showed he has mild arthritis in his spine-not unusual for a 16 year old boy. There was a mild nodule on his kidney but not cancerous and not unusual for a senior cat. 

Below are images of lung information and Jimmy's xrays. 

Jimmy xrays

2024 Updates

I have not had the time nor inclination to make blog posts since the last one of May 2024. I thought I had kept up with this but no. I have posted items to the cat Facebook pages, however.

There has been a lot going on. As of March 23, 2025, Jimmy and Elizabeth and Roxanne are still with us.

Roxanne and Elizabeth developed CKD. 

Elizabeth developed it in March 2024 and we struggled through most of 2024 with stabilizing her issues. She would not eat. We used cyprohepatidine and mirtazapine and Mirataz ear gel to stimulate her eating. When she was feeling sick, neither medication would work to make her eat. The Mirataz ear gel did not really work well but it did greatly irritate her ears. They became red, dry, scaly and we had to stop using it by the end of the summer. We began hand feeding her and continue to do so as needed. We struggled to keep her weight above 11 lbs. I put her on numerous supplements and vitamins as I did for Myrna Loy for her heart and for kidney support (see Vitamins and Supplements and Goop mixture here at the blog in word searches, Medication tab, etc.) The vet started her on once a week fluids from March to June. Then we began twice a week fluids. We also put her on Zenequin antibiotics because the fall ultrasound showed that her kidneys were inflamed. Finally, by November, she began to eat something on her own, and 1/4 of Mirtazapine pill helped her begin to eat on her own. Blood work from the fall and currently shows slight improvement in kidney blood values. She is more of a CKD stage 2/3 than stage 3/4 now. She continued to do well until late January when she stopped eating on her own. We fed her by hand four times a day-40ml per time because only 30ml or so makes it into her mouth. Her weight remained stable. In March she began eating something on her own and began responding again to Mirtazapine which helps her eat enough on her own that we hand feed her 20ml four times a day-as long as her weight remains over 11.10 lbs. I give her 1/4 Mirtazapine once a week. It tends to wind her up a bit but eventually she settles down and eats. We do not want her to lose weight and fat and muscle mass. We have seen cats before lose weight and get below 10lbs and get very sick and go into end stages of life, and pass away once they begin to lose fat and muscle mass. She is also on Zenequin (originally Baytril which she did not tolerate)-first for one month, then two weeks on, and two weeks off. This was recommended for her inflamed kidneys and gastro issues. Elizabeth has a leaky tricuspid valve that appeared in 2024 and we continue to monitor. But she has no CHF or HCM issues. 

Roxanne: She has had a difficult few months. She was showing early signs of something-CKD stage 1; gastro issues; she had been tested positive for FIV in 2023 but subsequent tests in 2024 showed no infection. We ran the ELISA and PCR tests three different times. She saw the internist at a hospital in October because of questionable blood values, possible FIV, and how she seemed run down at home. 

(Hospital report:)

"DIAGNOSIS:
1. Chronic hyporexia, vomiting, lethargy, weight loss r/o chronic inflammatory enteropathy, IBD, small cell GI

lymphoma, infectious (toxoplasmosis, less likely fungal, other), less likley EPI

• Diffuse small intestinal muscularis thickening

2. Low normal to mild neutropenia r/o individual variant, spurious, contributing FIV, less likley immune mediated,

   consumptive

3. Biliary cystadenomas

4. Chronic kidney disease (stage 2)

• Left pyelectasia (3.2 mm)-suspect CKD, less likely pyelonephritis, partial obstruction

5. Discordant FIV positive results

6. Focal thickening base of L interventricular septum (heart murmur

   "She was seen 7/3/24 for weight loss and hyporexia, with an ongoing history of intermittent vomiting that would respond to cerenia. CBC was normal (Neut 3976). Chemistry showed azotemia (Creat 2.3, BUN 33, SDMA 17, otherwise normal (P 4.2, K 4, Alb 3.3, Glob 4.7, ALT 29, gluc 88, choles 244, spec cpl 1.3 ug/dL, T4 2.3 ug/dL). UA cysto USG 1.028, pH 6.5, 30 mg/dl protein, no glucose, ketones, bili, quite sedi. BP was normal (130-162). Baytril was prescribed for one month though lead to anorexia after about two weeks and was stopped, then appetite returned after also receiving an unmeasured amount of mirtazapine.

...9/11 she was seen for report blood work and was noted that she overall was doing better than the prior month, with main concerns including intermittent hyporexia, lethargy, and weight loss. CBC showed mild neutropenia 2147, lymphopenia 8742, WBC 3.2, otherwise normal. Chemistry showed creat 2.1, SDMA 17, otherwise normal including T4 2.4 ug/dL. Owner requested aldosterone level due to concerns with prior pets which was low 90 pmol/L (194-388) with normal K 4.8.

She is struggling with lethargy and inappetance, though that has improved somewhat. Owner is providing supplements to address her high potassium (see above). Owner is handfeeding...This week she has needed hand feeding at night, her appetite is intermittently decreased. She is fed in the morning and she will graze all day, then offered at night time, usually hand fed, and food is always available overnight. If she doesn't eat her breakfast than the hand feeding will start. She comes right away to the bowl, but walks away. Owner had tried Cyproheptadine but didn't see much response for appetite stimulation. The mirtazapine isn't working as dramatically for her as it does their other cat. Her weight is stable (around 10.6 lbs). She used to vomit frequently, but owner started her Cerenia 1/2 tab SID almost a year ago and vomiting has resolved.

...CONCLUSION:

Biliary cystadenomas. Chronic kidney remodeling. Left pyelectasia associated with pyelonephritis or CKD. Ureteral distention was not visible to evaluate for a ureteral calculus. Abdominal radiographs could be performed to evaluate for a ureteral calculus not visible sonographically (Radiographic images are not available to me).Altered small intestinal wall layering. Rule out IBD, neoplasia.

... ASSESSMENT: Based upon Roxanne's chronic gastrointestinal localizing signs it is suspected that she has primary intestinal disease...revealed stable biliary cystadenomas, chronic kidney remodeling, mild dilation of the left renal pelvis, and diffuse small intestinal muscularis thickening. The renal pelvis (outflow of kidney) dilation is suspected to be secondary to chronic kidney disease (CKD), though can be seen with infection, and is less likely secondary to partial obstruction and given the degree as well as lack of ureteral dilation.

...It is common for cats to have intermittently mildly decreased to low normal neutrophil counts that doesn't necessarily represent pathology. Severely decreased neutrophil counts can be seen secondary to overwhelming infection and immune mediated conditions, as well as primary bone marrow disease. Roxanne's neutrophil count has not been low enough for this and may be within her normal fluctuation, though if she does have FIV this could be a contributing factor...we have submitted toxoplasmosis levels (which can rarely cause decreased neutrophils and can infect the GI tract) as well as a GI panel (to assess for decreased vitamins supporting a malabsorptive process, pancreatitis, or issues producing digestive enzymes), both are pending...

That being said with her chronic GI signs and intestinal thickening primary intestinal disease is likely. The most common processes are chronic inflammatory enteropathy or small cell GI lymphoma. The causes of chronic enteropathy are not well known but are suspected to be a result of an abnormal response by the body to certain intestinal bacterial (uncommon) or dietary antigens/proteins (common), or immune driven inflammation (common). Treatment often employs diet (hydrolyzed, novel) and for some steroids or immunomodulatory medication and supplements if deficiencies are present based on the GI panel. While small cell GI lymphoma is cancerous, it is typically a slower advancing process, causes signs, blood work changes (often none), low B12, and intestinal thickening very similar to inflammatory bowel disease. However this process can only be distinguished from chronic enteropathy based on biopsies +/- additional tests performed on biopsy samples. Cats with therapy for small cell GI lymphoma (which in part overlap with inflammatory disease), if they have a positive response often have a median survival time (50% do better, 50% less) of ~2 years. Treatment mainly involves steroids and (generally oral) chemotherapy if tolerated..."

RESULT:
Roxanne was given steroids for her gastro issues and seemed to do well on steroids in October and into November. She began eating a lot due to steroids and drinking a lot. Then she began to drink excessively into November and getting her chest wet (from putting herself into the water bowl) and began to seem tired and was not moving around the house as much as normal. Then she began to not eat as well as she had been and her weight began to slowly drop. There were many signs that she was not doing well. In early December I took her to the vet for blood work updates. Her formerly NORMAL blood work was sky high off the charts, showing CKD stage FOUR and diabetes, and internal damage. Her body could no longer handle the steroids and the steroids had damaged her kidneys.

Glucose: 403-September was 93, normal high is 175.

Creatinine: 1.9-normal is below 1.6.

BUN: 44-normal is below 35.

Cholesterol: 504-normal below 276.

Triglycerides: 3308-normal is below 90.

Urine had glucose and protein indicating that the kidneys could not filter properly and items were spilling into the bloodwork, and that her body had so much glucose that it was not being filtered by the kidneys but spilling over. 

We quickly titrated the steroids down for the next two weeks. I increased her fiber source to help absorb the cholesterol and triglycerides (high cholesterol and triglycerides are due to kidney/liver/diabetes/steroids.) And I increased the fish oil which was also recommended to help. 

We fed her Royal Canin glycol balance diabetic food as well as Hill's KD and other renal diets until February when her glucose levels appeared normal again. Now she is fed renal diets only.

When she stopped eating in January, we began hand feeding her four times a day-and continue to do so. Hill's KD is easily syringed up to hand feed.

She began receiving fluids twice a week with Elizabeth and continues.

She was also put on Zenequin (could not tolerate Baytril) and received it for a month, then two weeks on and two weeks off. She continues to follow this regime.

Finally, in March her blood work improved and she now seems to be at CKD stage one. BUT she will not eat on her own. She still seems lethargic at times. She does not always choose to roam the house as she used to prior to steroids making her ill in late November.  We can only continue hand feeding, giving supplements, etc. and monitoring. Her latest gastro ultrasound shows no issues. 

VARIOUS OTHER ISSUES:

Ears-all three have had ear issues. We use Tresaderm or Animax. I use this when the ears feel hot or look hot, when the cat reacts by shaking their head when petted, or is found scratching at them. Since the girls are in enough, the vet has checked their  ears often. There are no mites in any of the three AND we use Revolution (Revolution Plus, also) for monthly flea/tick/worm/mites protection. 

All three have had eye issues. We use Tobramycin for conjunctivitis, running eyes, redness and irritation. 

AS FOR JIMMY STEWART: that will be a separate post update. 

Elizabeth

Jimmy

Roxanne

Jimmy's Lump Seems to be NON CANCEROUS Lipoma

Pathology Report:

"Jimmy Stewart's mass is thought to represent an angiolipoma. Angiolipomas are a variant of a lipoma.
Lipomas are benign connective tissue tumors composed of histologically normal adipose tissue. It has been
postulated that lipomas may represent regions of nodular hyperplasia or altered lipocyte metabolism
rather than true neoplasia. Because lipomas have no defined microscopic borders, gross inspection at the
time of surgery is often a better indicator of completeness of resection than microscopic examination.
Development of multiple lipomas is common, and close observation for additional masses would be prudent.
Surgical excision is typically curative.

 A vascular derived neoplasm was considered, but is less favored at this time. Additional recuts and
 re-trims to further characterize the lesion are pending...

  HISTOPATHOLOGIC DESCRIPTION:
  The specimen consists of multilobulated nodules of well-differentiated adipocytes supported by modest
  bands of fibrocollagenous tissue that occasionally are partially encapsulating the nodules. There are
  multifocal random branching vascular structures within this mass that are interspersed among lobules of
  mature adipocytes. Individual adipocytes have abundant cytoplasmic lipid and small compressed nuclei.
  Mitoses are not seen. Inflammation is not present..."

Jimmy CT Shows Lung Issues/Stomach Hernia, etc. Skin Lump Well Defined

There's so much going on here. I've not had a chance to stop and write-between cats, house issues, garden, personal, etc.

Lizzie-doesn't want to eat, isn't feeling well lately, was in for blood work and scans in April and has approaching CKD. We are feeding her renal foods, fluids, extra vitamins, etc. And Mirtazapine once a week and very little of it BECAUSE of the complications long term use had on Katharine (see posts December/January.) But we are hand feeding her daily three times a day and her weight is stable at 11.3 lbs. Some days she eats well on her own but not all. I want her to stay over 11 lbs because when they get down to 10 or less, they become weak, with less fat and muscles which is what we saw with Katharine.

Jimmy-as I posted in March, had two biopsies of his back lump and the second one came up possibly cancer. We had a CT in early May and THAT report came up with---a possible lung issue AND a stomach hernia and other issues. The lump? Smaller than in March and well defined and NOT spreading. SO-the CT specialist thinks it's likely not cancer but needs to be removed and tested to know for sure. We were supposed to remove it this week BUT NO ONE CAN TELL ME ABOUT THE CT REPORT and if anything is serious. The vet hospital sends them out so there's NO ONE to talk to. Our state's vet school is without a rad/onc/CT/MRI specialist since February so no one there can discuss it with me. No one else in the area will read someone else's CT unless MY VET sends it to them. AND MY VET hasn't yet despite me requesting it a week ago; AND the surgeon to remove the skin lump still hasn't called me to discuss the CT report and if there's an issue to resolve before he has surgery. His cardiologist said she can't see anything of concern on the xrays from March and feels the CT report is too vague and to continue removing the skin lump to test for cancer. BUT if the lung issue is concerning, then he can't have surgery or daily intubation for radiation treatment on the lump area if it is cancer.

I'm worried about either waiting to find out more about the lung-but where, when, who??-or risking surgery now and having something go wrong. Or waiting to remove the lump and what if it's cancer but not ACTING like cancer? And then waiting spreads it?

The CT report:

"Thoracic CT-
In the right caudal lung lobe ventrally there is an irregularly marginated, ovoid soft tissue attenuating structure, measuring approximately 2.9 x 3 mm. (VERY SMALL) This is closely associated with vessels and an airway. On the dorsal reformatted image, this appears to be associated with a curved vessel. This structure is less discrete and poorly defined on series 2, the initial scan.
There is patchy groundglass appearance within the left cranial and right mid ventral pulmonary parenchyma.

...On the second scan, the pylorus of the stomach is displaced into the caudal thorax and there is esophageal distention. There is adjacent poorly defined soft tissue attenuating material, not identified on the initial scan.

...Sternal lymph nodes are mildly enlarged with homogenous enhancement...

CONCLUSIONS:
Solitary ovoid pulmonary structure. Given that there is only 1 structure, this could represent a granuloma or neoplastic nodule, however, on the dorsal reformatted image, this has a curvilinear appearance, therefore, this also could represent a curvilinear vessel which has a nodular appearance on the transverse images.
Mild sternal lymphadenopathy.
Chronic lower airway changes. (WHAT?? Serious?)
Sliding hiatal hernia."

Jimmy

Elizabeth

Discussed Necropsy with Pathology-Getting Tox Screen

I talked to the pathologist who did Katharine’s necropsy. There’s no one specific thing that happened that led to her death. Except her pancreas wasn’t doing well. Two weeks before everything seemed OK and stable. There are a lot of things we cannot see with ultrasound, x-rays or bloodwork. You can only see them once there’s a necropsy, and you see them under the microscope. The same thing with her heart. She had lesions in her heart, the myocardial fibers disarray that they described in the necropsy means that she had lesions. This disrupts the heart’s signaling that helps it beat properly. The heart got worse with the stress from whatever was going on with her liver and pancreas that led to her death. And what happened to the heart probably created the clots that they found in the vessels of her lungs. So she died of liver and pancreas failing that upset the heart that led to clots in the lungs that meant she couldn’t properly breathe. It was a cascading effect. But what caused it initially maybe the pancreas. Which means that no matter what you do to protect them, if the pancreas gets upset, it will lead to a cat’s death. We saw this with Baby. 

There is no reason that they found in the brain for the neurological issues that she had. I can only describe it as if she had Parkinson’s disease. She had this odd twitching that was going on in her face for the last couple of months and her front right leg would shake or vibrate, depending on how she was sitting or sleeping.

They are doing a tox screen. That will take two weeks. 

Katharine's Vet Gives Me the Cause of Her Death

The necropsy doesn't offer a definitive cause of death. I posted the necropsy in the previous post.

And there are things not addressed. I'll have to call them Monday. But her vet read the report and said she died of (which is not listed as a cause in the report but she surmised the cause by the descriptions in the report:)

(DIC) "Disseminated intravascular coagulation (DIC) is a hematological syndrome characterized by the activation of intravascular coagulation resulting in excessive fibrin formation and simultaneous consumption of coagulation factors and platelets resulting in severe hemorrhaging."

She had too many clots (fibrin) in her blood vessels and organs, and especially in her lungs leading to blood loss and oxygen loss because nothing could circulate; this causes damage to all organs. This led to further organ failure including heart, lungs, liver, pancreas, kidneys. And even the thyroid showed inflammation responses to the process.

We knew she had mild CKD and her blood values had been high normal and stable TWO WEEKS before her seizure. Her cardiology report TWO WEEKS prior said that her heart disease HCM was moderate and stable from last September's checkup. Her liver and pancreas had made her sick in December, and we believe she had been getting sick since November. We had been hand feeding her all through December and January and she had seemed stable the week before she had her seizure.

Her vet believes the last seizure was caused by the underdiagnosed liver and pancreas disease (even though blood work TWO WEEKS before showed mildly elevated results and her ultrasound showed mild issues with both organs.) Apparently, severity of liver and pancreas disease cannot be accurately detected until they blow up, which is what happened after her seizure.

So, seizure caused the dominoes to fall; or the game of Jenga was being played internally and something became elevated/declined to function properly and caused her seizure which then increased the decline of her organs.

Her vet says that she was dying Saturday night/Sunday morning and that the reason she couldn't breathe wasn't because of the small amount of fluid in her lungs at death but because of the clots and lack of oxygen in her body that made breathing impossible.

I'm glad she was home when she died, that I had her bundled up in bed with me and my arm wrapped around her.

This is Katharine a few months ago, doing what she loved to do-climb up onto me, cuddle up against my head, then CHOMP DOWN on my hair.

Katharine Died Feb. 4, 2024

I hadn't realized that I had not posted her death. She died of respiratory failure. She had fluid in her lungs and however that worked, her heart stopped. We were going to give her oxygen and take her to the ER but she died before we could leave the house. 

Katharine Hepburn 

She had gone to the ER after her seizure January 27; then to the vet hospital January 28. She was there until Wednesday Jan. 31 when she came home. She was weak, couldn't-and never did-cry or make a sound. She could barely walk. The hospital said they didn't know why and that was that. We nursed her, fed her, and she could use the litter box but wouldn't eat on her own. She finally drank water Friday. But Saturday she was breathing heavily. The ER withdrew fluid from her pleural cavity-pleural effusion-but could not account for cause. She went back that evening at 9 pm but they said there was more fluid but not enough to risk removing because it was too close to the heart. Her breathing worsened over night. I should have taken her back about 2 a.m. when her breathing rate was 48 and she had this vague expression and did not easily respond to touch or speech. I had her bundled up in a blanket next to the radiator because the ER said her body temperature was dropping. She woke me at 5:30 trying to move and I picked her up and put her into bed with me. She did not try to move. She seemed to be unaware of me. She was still breathing heavily. She woke me at 6:30 with sharp, shallow sounds but still unconscious. I should have taken her then to the ER. I hesitated. I don't know why. Then it slowed about 7:15. That's when I got my husband and we were helping her when she stopped breathing. I will never again let that happen. Yes, she was likely dying but not being able to breathe must have been uncomfortable.  

We took her body for a necropsy later in the day. We received the report today, February 23, 2024. The report is inconclusive. Many things were wrong but nothing to account for the pleural effusion. No heart attack. No brain tumor. No accounting for weakness or neurological issues she had been having. No real reason for liver failure. Or why her heart stopped. She had 30ml of fluid in the pleural cavity-two tablespoons. That would have made breathing hard. But not enough to stop breathing-or so vets believe. 

We are going to request a tox screen as the pathologist suggested. And I'll speak to them next week about any other tests. 

NECROPSY

Gross Description

A 4.1kg spayed female cat was necropsied on 2/5/2024. Autolysis was mild. The animal had moderate amounts of subcutaneous and visceral fat, and had an overall body condition score of 6/9. Scant red-tinged fluid stained the fur around the left nares. The abdomen and left forelimb were shaved, and there was a small puncture wound over the left cephalic vein consistent with venipuncture. There was also a shaved region over the left side of thorax with needle puncture along with mild associated subcutaneous dark red hemorrhage. There were approximately 30ml of transparent, red tinged fluid ni pleural cavity. The lungs were diffusely mottled shades of dark red. The heart weighed 17g and the left and right ventricular free wals respectively measured 8mm and 3mm in thickness. There was a slightly enhanced reticular pattern. The left thyroid gland was dark purple, and enlarged measuring 2cm x 1cm x Icm; there were 3mm in diameter fluid filled cysts at the cranial and caudal ends. There were 3 blue, 1cm in diameter, spherical capsules in the stomach contents. No other significant lesions were observed.

Comments

Overall, the described changes are mild and likely incidental, or are related to clinical treatment or diagnostic procedures. The enlargement of the left thyroid gland may suggest thyroid hyperplasia or a benign tumor. No lesions to suggest any other specific underlying disease process were observed. 

Microscopic Description

Representative routinely stained sections of brain, heart, lung, spleen, liver, kidney, tongue, esophagus, stomach, intestines, pancreas, urinary bladder, adrenal gland, thyroid gland, haired skin, lymph node and bone marrow were examined. Autolysis was mild.

In the left ventriculum of the heart, the cardiomyocytes were often arranged in abnormally intersecting patterns and there was variation in myofiber size. Multifocally, the myocardium was replaced by moderate amounts of fibrosis. In the lung sections, the small pulmonary vessels were occluded by fibrin thrombi.

In the liver sections, there were mild multifocal centrilobular areas of hepatocellular necrosis, characterized by loss of cellular details with retention of the architecture or loss of hepatocytes and replacement by hemorrhage. There was moderate Ito cell hyperplasia. In the pancreas, there was mild focal infiltrates of degenerate neutrophils in the pancreatic parenchyma. The peripancreatic adipose tissue was extensively replaced by amorphous basophilic to amphophilic material mixed with degenerated neutrophils, consistent with saponification.

Multifocally in the kidney section, there were mild infiltrates of lymphocytes and plasma cells in the interstitium. Rare thickened Bowman's capsules were observed. The thyroid gland were moderately hyperplastic and there was a large cyst which contained high amounts of homogeneous eosinophilic fluid in the center of the thyroid. No other significant lesions

were observed.

Morphologic Diagnosis(es)

Heart: Moderate multifocal myocardial fibrosis and myocardial disarray

Liver: Mild acute multifocal centrilobular hepatocellular necrosis

Pancreas: Mild acute neutrophilic pancreatitis with severe peripancreatic fat necrosis

Lung: Mild pulmonary thromboembolism

Thyroid gland: Moderate hyperplasia with cyst

Comments

The findings in the heart are most consistent with hypertrophic cardiomyopathy (HCM), which is the most common type of cardiac disease in cats and is a common cause of sudden death. The changes in the liver may be secondary to the cardiac condition but given the centrilobular pattern, a toxic insult cannot be completely ruled out. 

The fibrin thrombi in the lung can be secondary to the heart condition or pancreatitis which can lead to disseminated intravascular coagulation (DIC). This cat also had thyroid gland hyperplasia, but this is likely non-functional and considered as an incidental finding. The findings in the kidneys are mild and likely an incidental finding as well. No further

testing is currently pending.