3 month-old, Male Intact, DSH, Feline

This case was recently presented in one of our virtual diagnostic imaging sessions.

If you attended the session, you may remember this case. We thought it was so interesting, we’d share it here for the CaseConnexx Community!

History:

Presented for difficulty defecating as well as being much smaller and more lethargic than his littermates. The owners noted that he is about 2-3x smaller than the other kittens. He doesn’t play or act normally.

On exam, his deciduous teeth were not erupted with the exception of the maxillary canines. His abdomen was bloated and painful with a large amount of firm stool palpated in the colon.

Blood glucose normal, T4 < 0.4. Thyroid panel pending. Gave a warm water enema, small amount of SC fluids, and recommended starting on lactuose and levothyroxine for suspected congenital hypothyroidism.

Images:

Findings:

Peritoneal serosal detail is poor, consistent with the patient’s young age. The distal descending colon is moderately dilated with formed and subjectively desiccated fecal material. The proximal colon is also distended with gas and feces. A large gas-filled viscus also containing formed soft tissue opaque material in the left cranial abdomen is suspected to be the fundus. Severe dilation of the proximal descending colon cannot be entirely excluded. Visible small intestine is normal in diameter and predominantly gas-filled. The liver is normal in size. The spleen, kidneys and urinary bladder are not distinctly seen.

There is absent mineralization of the proximal and distal femoral epiphyses, proximal tibial epiphyses, patellae and vertebral endplates. The long bone cortices are considered normal in thickness. There is no evidence of soft tissue swelling in the included pelvic limbs.

Conclusions:

  1. There is evidence of marked constipation. This is a known side effect of congenital hypothyroidism in feline patients. Concurrent congenital colonic hypomotility/megacolon cannot be excluded.
  2. As mentioned, the dilated gas-filled structure containing formed soft tissue opaque material in the left cranial abdomen is likely the fundus containing partially digested food. Severe dilation of the proximal descending colon is considered less likely. No evidence of gastrointestinal obstructive pathology is identified.
  3. There is evidence of delayed skeletal maturation based on this patient’s estimated age. The lack of vertebral endplate and long bone epiphyseal mineralization would be consistent with congenital hypothyroidism.

Recommendations:

Continued medical management of constipation and suspected congenital hypothyroidism is considered appropriate. Repeat radiographs of the abdomen following approximately 12 hours of fasting are suggested to reevaluate GI contents. A complete upper GI contrast study may be considered to evaluate gastrointestinal motility.

Resources:

  1. K Bojanic et al. Congenital Hypothyroidism of Dogs and Cats: A Review. New Zealand Veterinary Journal 2011 May; 59 (3): 115-22
  2. S Szabo et al. What’s your Diagnosis? Congenital Hypothyroidism. Journal of the American Veterinary Medical Association. 2007 Jan 1; 230 (1): 29-30.

Photo by Matthew Larkin on Unsplash

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