Bertie is an adorable, wide eyed, five year old neutered British Shorthair who presented to Animal Emergency Service Hawthorn East with respiratory distress last month. His story highlights the importance of collaboration between primary care, emergency and specialist teams in achieving the best possible outcome for patients.
Respiratory Distress Leads to a Concerning Discovery
Bertie first presented to his primary care veterinarian after his owners noticed respiratory distress and an increased effort at home. On examination, he had a body condition score of 4/9, muffled heart sounds on auscultation, and a paradoxical respiratory pattern, all signs that warranted further investigation.
His veterinary team performed a TFAST examination and thoracic radiographs, which revealed a bilateral pleural effusion and a heterogeneous mass along the left thoracic wall. No obvious cardiac abnormalities were identified.
Recognising the severity of Bertie's condition, his primary care veterinarian promptly stabilised him by performing a thoracocentesis, removing 200 mL of serosanguinous fluid from his chest. This significantly improved his breathing and allowed for referral to Animal Emergency Service (AES) Hawthorn East for advanced diagnostics and ongoing care.
Stabilisation and Advanced Imaging at AES
Red Arrows = Mass
Blue * = Pleural Effusion
Upon arrival at AES, Bertie was managed with oxygen therapy, careful sedation when required, and repeat thoracocentesis to minimise respiratory effort and reduce the risk of fatigue.
Once he was stable enough to undergo general anaesthesia, a CT scan of the thorax was performed, confirming a large soft tissue mass occupying the left cranioventral mediastinum.
To further characterise the mass, ultrasound guided fine needle aspirates were collected and submitted for cytological analysis, along with samples of the pleural effusion. The fluid was identified as a protein rich transudate with minor haemorrhage, consistent with a space occupying lesion affecting normal vascular flow and permeability.
Cytology from the mass was suspicious for a lymphocyte predominant thymoma and did not display characteristics typically associated with lymphoma. As Bertie continued to accumulate pleural fluid, a chest drain was placed to provide ongoing management while treatment options were considered.
A Collaborative Approach to Patient Care
With a likely diagnosis established and a favourable long-term prognosis associated with thymoma, the next step in Bertie's care was surgical treatment.
Fortunately, Melbourne Animal Referral Services (MARS) specialist team was available to conduct Bertie's surgery, so his case was discussed directly between teams, ensuring continuity of care and a smooth transition from emergency stabilisation and diagnostics to surgical assessment.
Following discussions regarding prognosis and treatment options, Bertie's owners elected to proceed with surgery.
Surgical Removal of the Mass
The MARS surgical team performed a midline sternotomy to remove the mass. The procedure was successful, and Bertie recovered smoothly without complications.
The excised mass and cranial mediastinal lymph nodes were submitted for histopathology. Results indicated that the mass was most consistent with a thymoma, although further classification with immunohistochemistry has been recommended.
Importantly, there was no evidence of neoplastic spread to the sampled mediastinal lymph nodes, providing encouraging news for Bertie's long term outlook.
From Respiratory Distress to Home Within 24 Hours
Just 24 hours after surgery, Bertie was able to return home to continue his recovery with his family.
His case is a wonderful example of how collaboration between a vigilant primary care veterinarian, the emergency and critical care team at AES, and the specialist surgeons at MARS can provide patients with timely, coordinated care when it matters most.
We are delighted that Bertie is now recovering at home and wish him many happy, healthy years ahead.
Learn more about AES Hawthorn East
For more information about how AES Hawthorn East operates, visit their location page or check out this blog on their Open Hospital Concept.
