Case summary A 5-year-old neutered male domestic shorthair cat was presented for evaluation of chronic bilateral eosinophilic keratoconjunctivitis (EK). The patient had a history of recurrent corneal plaques and conjunctivitis that were initially managed with systemic and topical immunosuppressive therapy. Long-term disease control was limited by poor tolerance of topical ophthalmic medications, resulting in inconsistent treatment and repeated disease recurrence affecting both eyes. Over several years the cat was treated with subconjunctival triamcinolone acetonide, antiviral therapy, and topical megestrol acetate with only partial and temporary improvement. Due to persistent disease and inability to administer long-term topical therapy reliably, bilateral subconjunctival cyclosporine implants were surgically placed. Postoperative management included short-term topical antibiotic therapy. At the 10-week and 7-month postoperative examinations, marked clinical improvement was observed, with resolution of most corneal plaques and substantial reduction in conjunctival inflammation. Relevance and novel information Feline eosinophilic keratoconjunctivitis is a chronic immune-mediated ocular surface disease that typically requires long-term topical immunosuppressive therapy. Successful management may be limited in patients that are resistant to medication administration. This case demonstrates that subconjunctival cyclosporine implants may represent a viable long-acting treatment option for feline EK when topical therapy cannot be consistently administered. To the authors’ knowledge, use of cyclosporine implants for management of feline eosinophilic keratoconjunctivitis has not previously been reported.
Case Summary: A 4-year-old neutered male Turkish Angora cat presented with lethargy, mental dullness and lower urinary tract signs. Hematological and biochemical analyses confirmed hepatic dysfunction. Diagnostic imaging identified portal vein thrombosis (PVT), an extrahepatic portosystemic shunt and collateral vessels surrounding the PVT. Additionally, partial splenic rotation and intermittent colonic displacement were identified. Primary hepatic disease, a common cause of PVT, could not be excluded in this patient, and visceral positional abnormalities were considered to have played a significant role in the development of PVT. Initial treatment consisted of anticoagulant therapy with rivaroxaban and symptomatic management of hepatic dysfunction and secondary complications. Following initiation of therapy, the patient maintained clinically stable with resolution of clinical signs despite persistent imaging evidence of PVT. Relevance and Novel Information: This is the first report in veterinary medicine to identify partial splenic rotation and intermittent colonic displacement as possible causes of PVT. Furthermore, this case demonstrates that a favorable clinical outcome may be achieved through conservative medical management of PVT secondary to abdominal visceral positional abnormalities.
An eight-year-old, indoor, male neutered Oriental mix cat was presented with acute bilateral pelvic limb lameness without preceding trauma. The cat had received oral alendronate for 4.5 years for the management of idiopathic hypercalcaemia. Radiographs revealed bilateral, closed, comminuted proximal tibial and fibular fractures with cortical sclerosis. Staged bilateral open reduction and internal fixation were performed using orthogonal locking compression plates. Alendronate therapy was discontinued, and the cat remained normocalcaemic during eight months of follow-up. Despite robust stabilisation, traumatic re-fracture of the right tibia occurred following inadequate confinement, necessitating revision fixation with longer implants and the addition of allogeneic demineralised bone matrix (DBM). Delayed union and marked callus formation were observed in the left tibia, consistent with suppressed bone remodelling secondary to chronic alendronate therapy. In contrast, the revised right tibial fracture, treated with adjunctive DBM, demonstrated accelerated healing. Radiographic monitoring demonstrated osseous union without further complications or evidence of additional fractures, illustrating that favourable outcomes are achievable in cats with bilateral bisphosphonate-associated insufficiency fractures when appropriately managed. This report represents the second documented case of bisphosphonate-associated fractures in a cat managed surgically with extensive follow-up. It is the first to describe bilateral tibial fracture repair and the use of adjunctive DBM for bisphosphonate-associated fractures. It highlights that favourable outcomes are achievable in these cases through orthogonal plating combined with adjunctive DBM, and discontinued bisphosphonate therapy to reduce future fracture risk. This report also supports serial radiographic monitoring, particularly within five years of treatment initiation.
Case summary A 2-year-old male neutered domestic shorthair cat was referred one month after medical management of extrahepatic biliary tract obstruction (EHBTO) for progressive lethargy and hyperbilirubinemia. Abdominal ultrasonography identified a 10mm obstructive common bile duct mass. The cat underwent common bile duct mass resection, choledochoduodenostomy and oesophagostomy tube placement, complicated by transient cardiac arrest. Histopathology confirmed biliary adenocarcinoma. Ongoing toceranib phosphate (toceranib) (2.44mg/kg PO Monday, Wednesday, Friday; 10mg PO Monday, Wednesday, Friday; Zoetis) was initiated 11 days postoperatively. Monitoring consisted of haematology, serum biochemistry, thoracic radiography, and abdominal ultrasonography. Follow‑up abdominal ultrasonography at 6 weeks, 14 weeks, and 10.5 months documented a pyloric mass, absence of ultrasonographic evidence of the pyloric lesion, and diffuse hepatic progression, respectively. Cytology of the pyloric mass and hepatic lesions confirmed carcinoma. Despite progression, the cat remained clinically well with normal serum total bilirubin, and continued toceranib postoperatively for 18 months. Relevance and novel information This report presents the first documented management of feline common bile duct adenocarcinoma combining surgical resection and oral toceranib, with objective assessment of treatment response. Toceranib therapy was ongoing 7.5 months after ultrasonographic disease progression, and the cat remained alive at that time, achieving a survival duration far exceeding previously reported median survival times for treated feline biliary carcinoma. Toceranib was well tolerated, with adverse effects limited to antiemetic-responsive nausea.
Case Summary A 12-year-old neutered female, domestic shorthair cat was referred for further investigation into acute onset of increased upper respiratory noise of one month duration. On physical examination, inspiratory stertor was present with mild increased respiratory effort and airflow was reduced from the left nasal passage. Computed tomography identified a caudal nasal/rostral nasopharyngeal mass. A rostral staphylectomy was performed to remove the lesion and histopathological analysis confirmed salivary gland hyperplasia . Ten months post-operatively the owner reported the cat had a good quality of life and absence of the upper respiratory noise. Relevance and novel information To the authors’ knowledge this is the first description of nasopharyngeal salivary gland hyperplasia in a cat. Although uncommon, it should be recognised as a potential differential diagnosis for nasopharyngeal mass-like lesions in feline patients.
Case summary: An 11-year-old neutered male domestic shorthair cat was referred for diabetes mellitus and recurrent episodes of respiratory distress. Physical examination identified an abdominal mass, while routine laboratory testing was unremarkable. Cardiac evaluation revealed cardiomyopathy with a hypertrophic phenotype. Thoracic and abdominal computed tomography identified a heterogeneous mass (5.6 cm) in the right caudal abdominal region, with normal-appearing adrenal glands. Urinary normetanephrine-to-creatinine and metanephrine-to-creatinine ratios were markedly increased (3164 µg/g and 271 µg/g, respectively), representing 51-fold and 15-fold increases compared with 13 clinically healthy control cats, strongly supporting the suspicion of a functional extra-adrenal paraganglioma. Following phenoxybenzamine treatment, exploratory laparotomy was performed. Due to cardiovascular instability, characterized by tachycardia and hypertension, tumor resection was not feasible; however, incisional biopsy samples were successfully obtained. Immunohistochemical findings confirmed the diagnosis of a neuroendocrine tumor, with immunoreactivity for chromogranin A and neuron-specific enolase. The absence of immunoreactivity for pan-cytokeratin (AE1/AE3) and the presence of S100 protein staining in sustentacular cells were consistent with an extra-adrenal paraganglioma. This is the first reported functional extra-adrenal paraganglioma in a cat with biochemical confirmation of catecholamine excess based on urinary metanephrine- and normetanephrine-to-creatinine ratios. Relevance and novel information: This case highlights the diagnostic utility of urinary metanephrine-to-creatinine ratios as a non-invasive tool for detecting catecholamine excess in cats. It also underscores the importance of considering paraganglioma in cats with episodic respiratory distress, hypertrophic phenotype cardiomyopathy, and the presence of an extra-adrenal mass.
Case summary A 10-year-old, castrated male domestic shorthair cat presented with stertor and severe respiratory distress caused by intratracheal masses occluding the majority of the tracheal lumen. Conventional endoscopic forceps biopsy yielded small tissue fragments, which were insufficient for a definitive histopathological diagnosis. Given the perceived high risk of tracheal resection and anastomosis, bronchoscopic cryotherapy with a 1.1 mm, flexible cryoprobe was performed for cryobiopsy and cryo-debulking. The masses occluded 80–90% of the lumen and were completely removed with cryotherapy, with immediate clinical improvement and decreased airway resistance (279 to 31 cmH 2 O/l/s). Haemorrhage was mild and controllable, and recovery was uneventful. Histopathology revealed tracheal myxosarcoma, a neoplasm not previously described in the feline trachea. The cat remained free of clinical signs for 7 weeks, after which clinical signs recurred, with radiographic evidence of regrowth. Pulmonary function testing suggested no substantial ventilatory compromise compared with preoperative findings; therefore, continued observation was chosen given the early recurrence. Three months after the initial intervention, bronchoscopy was repeated owing to gradually worsening clinical signs and confirmed tumour regrowth occluding approximately 50% of the lumen. A second cryotherapy session again achieved complete debulking and rapid resolution of signs. Relevance and novel information This report documents the first described tracheal myxosarcoma in a cat and demonstrates that bronchoscopic cryobiopsy can overcome the limitations of forceps biopsy while providing concurrent, airway-sparing palliative debulking. Bronchoscopic cryotherapy could serve as a feasible, minimally invasive diagnostic and therapeutic intervention for intraluminal tracheal masses in cats.
Case series summary A 7 year-old neutered male Domestic Shorthair cat was presented with a firm, painless mass palpated over the right iliac region. CT imaging revealed a well-demarcated monostotic lesion within the right iliac wing, composed of fat and soft tissue attenuation. The lesion caused cortical thinning, irregularity, and partial interruption, without any periosteal reaction or surrounding inflammation, findings suggestive of a benign process. Based on these imaging features and the lesion’s anatomical location, a partial iliectomy with preservation of the pelvic limb was performed. The mass was excised en bloc. Histopathological evaluation confirmed the diagnosis of intraosseous myelolipoma, characterized by a well-delineated proliferation of mature adipose tissue intermingled with trilineage hematopoietic elements (myeloid, erythroid, and megakaryocytic), without cytological atypia or malignant features. At the 15-day and 2-month follow-ups, the cat walked normally and had returned to its usual activities. Limb function remained intact. Relevance and novel information Intraosseous myelolipomas are exceptionally rare in both human and veterinary medicine, and to the authors’ knowledge, this is the first case described in a feline patient. Diagnosis requires advanced imaging and histopathological confirmation. Surgical excision by partial iliectomy enabled complete removal of the lesion while preserving limb function, resulting in favourable short-term clinical outcome. This case expands the range of differential diagnoses for feline pelvic bone lesions and highlights the feasibility of conservative, limb-sparing surgical techniques in select cases.
Case summary This case report describes the clinical presentation, diagnostic findings and clinicopathologic features consistent with developmental lung disease (DLD) and pulmonary hypertension (PH) in a 3-month-old Sphynx Munchkin kitten. The kitten was originally referred for episodes of respiratory distress that was unresponsive to medical management, consisting of diuretics, antibiotics and corticosteroids. Echocardiography was consistent with a high probability of PH of a non-cardiac etiology. Baseline blood work, thoracic radiographs, thoracic CT with triphasic angiography and a bronchoalveolar lavage were performed. Thoracic CT revealed diffuse ground-glass opacity with bronchiolectasis and distention of the pulmonary artery and branches. The bronchoalveolar lavage identified an equal distribution of non-degenerative neutrophils and macrophages, with erythrophagocytosis and no overt neoplastic cells or infectious organisms identified. The kitten was humanely euthanized due to the lack of an identifiable treatable etiology and poor prognosis. Histopathological findings were most consistent with DLD with diffuse acinar underdevelopment and vascular changes including pulmonary capillary hemangiomatosis. These findings have not been previously reported in the feline DLD literature. Relevance and novel information There is a paucity of literature describing DLD and its potential to cause PH in cats. A comprehensive diagnostic evaluation, ultimately including histologic examination, is needed to reach a diagnosis of DLD. The presence of PH in a young kitten without any identifiable primary cardiac or respiratory cause, pulmonary thromboembolism or cardiac parasites should lead to a DLD being considered.
Case summary A 2.5-year-old intact female British Shorthair cat was referred for cardiology evaluation due to intermittent panting and a heart murmur identified on cardiac auscultation before elective surgery. Physical examination revealed a left parasternal grade II/VI systolic murmur without arrhythmia. Thoracic radiographs showed cardiomegaly without pulmonary infiltration. The echocardiography was prompted by auscultation, history, and radiological findings. Transthoracic echocardiography demonstrated marked right atrial enlargement and eccentric hypertrophy of the right ventricle. Echocardiography revealed a partial atrioventricular septal defect characterised by a large ostium primum defect (0.79 cm) and an anterior mitral valve cleft, resulting in a left-to-right shunt (estimated Qp/Qs ≈ 2.2). Doppler interrogation of the left pulmonary vein entering the lateral wall of the left atrium demonstrated focal turbulence and increased peak velocity (1.08 m/s), corresponding to a pressure gradient of approximately 4.7 mmHg, findings consistent with suspected unilateral pulmonary vein stenosis. Tricuspid regurgitation velocity (2.2 m/s) did not reflect increased afterload. Elective surgery was postponed owing to uncertainty regarding peri-anaesthetic haemodynamic risk. Medical treatment with enalapril and clopidogrel was initiated. At 9-month follow-up, the cat remained clinically stable and echocardiographic findings were unchanged. Relevance and novel information Pulmonary vein stenosis is rarely reported in cats. This report describes the concurrent presence of partial atrioventricular septal defect and suspected unilateral pulmonary vein stenosis. These findings highlight the detection of a congenital heart defect in a young cat, despite the low-grade murmur.
Case summary A 16-year-old, spayed female domestic shorthair cat was referred to the Schwarzman Animal Medical Center for evaluation of chronic, progressive eosinophilia accompanied by vomiting and weight loss despite normal appetite. Blood smear evaluation revealed immature eosinophils with dysplastic features and occasional giant forms. Abdominal ultrasound identified small-intestinal thickening, a hepatopathy and splenomegaly. Screening for feline leukemia virus, feline immunodeficiency virus and heartworm infection were negative. Chronic eosinophilic leukemia was suspected, although hypereosinophilic syndrome could not be ruled out. At the time of referral, the cat was receiving prednisolone and chlorambucil for suspected small cell gastrointestinal lymphoma, but showed persistent clinical signs and progressive eosinophilia. Chlorambucil was discontinued and toceranib was initiated alongside prednisolone. No adverse effects attributable to toceranib were observed. A partial response, defined as resolution of clinical signs and a 30% reduction in circulating eosinophils, was observed on day 39. A subsequent progression-free survival interval of 4 weeks was achieved. Progressive disease developed on day 75, and given declining quality of life, euthanasia was thereby elected on day 89. Relevance and novel information This case report is the first to describe the use of toceranib to treat suspected chronic eosinophilic leukemia, a rare and poorly documented disease process in cats. This novel therapeutic approach is the first publication of a partial response and stable disease in the treatment of suspected chronic eosinophilic leukemia in a cat.
This report describes a 9-year-old, neutered female domestic shorthair cat presenting with a 7-day history of anorexia and previous chronic constipation. Clinical examination revealed abdominal distension and discomfort. Radiographic and ultrasonographic imaging showed severe, generalized gaseous distension of the entire gastrointestinal tract without evidence of mechanical obstruction. An exploratory celiotomy confirmed severe, non-obstructive dilation of the stomach and intestines, with aperistalsis of the ileum and large intestine. Histopathological analysis of intestinal biopsies revealed neuritis and necrosis of the myenteric plexus, along with the presence of protozoan trophozoites consistent with Entamoeba histolytica. These findings led to a diagnosis of intestinal pseudo-obstruction secondary to amebiasis-associated ganglionitis. Treatment was initiated with pyridostigmine, an acetylcholinesterase inhibitor, and metronidazole. The cat responded favorably, with resolution of clinical signs and normalization of defecation. This case documents a rare instance of intestinal pseudo-obstruction in a cat, uniquely associating it with amebiasis and demonstrating a successful therapeutic outcome with pyridostigmine.
Case series summary Two rescued juvenile cats with unilateral severe shoulder deformities (SDs) suspected to be secondary to septic arthritis were referred for further management. Comprehensive diagnostic evaluations confirmed SD with suspected septic arthritis in both cases. Because of the poor prognosis for preserving shoulder joint function, shoulder arthrodesis was performed to relieve pain and restore forelimb weightbearing ability. At 6 and 8 years postoperatively, both cats exhibited normal motor function in the affected limbs, no signs of lameness and maintained a good quality of life. No evidence of osteomyelitis or implant failure was noted. These findings suggest that arthrodesis may be a viable and effective long-term treatment option for irreparable shoulder joint disorders in cats. Relevance and novel information Shoulder joint injuries and disorders are less common in cats than in dogs, and only a limited number of reports exist in the small animal orthopaedic literature. In clinical practice, SD in small animals is rarely documented, with few references regarding its aetiology and pathophysiology. This report presents two cases of SD in rescued cats, demonstrating that shoulder arthrodesis can be an effective treatment for irreparable feline shoulder joint disorders. To the best of our knowledge, this is the first report to describe long-term clinical and radiographic outcomes of shoulder arthrodesis in cats with SD.
Case summary This report describes a 14-year-and-9-month-old, male neutered cat with a primary adrenal tumour secreting aldosterone with pulmonary metastases, alongside concurrent hyperthyroidism and congestive heart failure. The cat presented with hyporexia and muscular weakness, including marked cervical ventroflexion. Hypokalaemia, hypertension, marked hyperaldosteronaemia and presence of a left-sided adrenal mass were consistent with primary hyperaldosteronism, and pulmonary nodules were detectable radiographically. Congestive heart failure and poor quality of life resulted in euthanasia. Microscopic examination identified an adrenocortical carcinoma, and the histological morphology and immunohistochemical labelling was similar between the primary tumour and pulmonary nodules. Relevance and novel information Primary hyperaldosteronism is an underdiagnosed condition of cats, causing hypertension and hypokalaemia. Excessive aldosterone is secreted by the adrenal glands and may be caused by tumours. Around half of aldosterone-secreting tumours in cats are malignant, although distant metastases have only been reported once previously. This is the first report of radiographically evident pulmonary metastases from an aldosterone-secreting adrenal tumour confirmed by immunohistochemical labelling.
Case summary A 13-year-old neutered female domestic shorthair cat was referred for weight loss, polyphagia, polyuria, polydipsia and intermittent vomiting. Blood work demonstrated diabetes mellitus; abdominal ultrasonography revealed a hypoechoic, thickened pancreas with two large fluid-filled cavities within the body and right limb. Cytology of the aspirated fluid indicated suppurative inflammation with bacterial infection, which cultured Pasteurella multocida . Medical management for diabetes mellitus and pancreatic abscessation was initiated. After approximately 4 months of antimicrobial therapy and five percutaneous drainages, clinical signs improved; nevertheless, serial abdominal ultrasonography demonstrated persistent pancreatic abscessation, while repeated cultures and antibiograms documented progressively resistant bacterial infections. The condition culminated in abscess rupture and septic peritonitis, prompting surgical drainage and omentalisation. Histopathological examination of the pancreatic parenchyma revealed severe lymphoplasmacytic pancreatitis with glandular atrophy, while evaluation of the pancreatic tissue associated with the abscess demonstrated a suspected pancreatic exocrine neoplasm, most compatible with a well-differentiated adenocarcinoma. Relevance and novel information This case highlights the need for earlier consideration of surgical intervention in cases of recurrent pancreatic abscessation and underscores the importance of including concurrent pancreatic neoplasia as a differential diagnosis in chronic, non-resolving presentations.
Case summary A 1-year-old, male castrated domestic shorthair cat presented for chronic mobility decline and muscle stiffness, first noted at 3 months of age, and persistently elevated serum creatine kinase levels (>19,000–53,000 IU/l). Clinical examination revealed macroglossia and selective hypertrophy of cervical and appendicular muscles. Neurologic evaluation indicated a myopathic gait without pain or neurologic deficits. Muscle biopsy was supportive of muscular dystrophy (MD) and immunohistochemistry demonstrated loss of the sarcoglycan complex with complete absence of all tested sarcoglycan proteins, consistent with a diagnosis of sarcoglycan-deficient MD. These findings contrast with prior feline reports that were mostly limited to reduction or absence of beta-sarcoglycan on immunostaining without overt clinical evidence of MD. A follow-up echocardiogram revealed mild to moderate right ventricular changes without indications for treatment. At 2 months after diagnosis, the patient remained clinically static, suggesting a relatively slow progression despite absent sarcoglycan expression. Relevance and novel information This case represents the first reported feline sarcoglycanopathy characterized by the absence of all tested sarcoglycan subunits on immunohistochemistry and concurrent presentation of classic Duchenne-like MD signs, including macroglossia and muscular hypertrophy. It expands the phenotypic spectrum of muscular dystrophies in cats, underscoring parallels to limb-girdle muscular dystrophies in humans and dogs. Given the cat’s static clinical course and diagnostic overlap with dystrophinopathies, this case suggests sarcoglycan-deficient MD in cats may present with a broader spectrum of severity than previously appreciated. The findings support the potential utility of feline sarcoglycanopathies, when phenotypically consistent with forms appreciated in other species, as spontaneous animal models for comparative medical research.
Case summary:A 1-year-old, male neutered Persian cat presented to the emergency room with acute, severe wheezing and coughing after the introduction of a new kitten to the household. The patient progressed to hypoxemic respiratory failure consistent with acute respiratory distress syndrome (ARDS) and required mechanical ventilation. RT-PCR testing from a conjunctival and deep pharyngeal swab confirmed feline calicivirus infection. Because of refractory hypoxemia and declining lung compliance (2.4 ml/cmH2O), novel therapy with intratracheal porcine surfactant (Curosurf) was attempted. A dose of 1.5 ml/kg was administered over 60 s. After administration, pulmonary compliance improved to 3.1 ml/cmH2O. The patient was weaned from the ventilator on day 10; however, severe laryngeal swelling necessitated a temporary tracheostomy. The patient died on day 15 from tracheal stenosis and obstruction of the stoma site by granulation tissue. Relevance and novel information:To the authors' knowledge, this is the first report describing the development of ARDS from calicivirus pneumonia and the use of porcine surfactant in the treatment of ARDS in a cat. The administration of surfactant resulted in objective improvements in lung compliance.
Case summary A 3-year-old, spayed female domestic shorthair cat was presented for acute onset cough and dyspnoea. Thoracic radiography revealed a radiopaque foreign body proximally in the right caudal main bronchus. Initial attempts at endoscopic retrieval using a flexible bronchoscope were unsuccessful, as the foreign body migrated progressively distally into the right caudal lobe bronchus, precluding bronchoscopic removal. The cat subsequently underwent a right fifth intercostal-space lateral thoracotomy. A primary bronchotomy was performed to retrieve a small stone, and the bronchus was closed with a single-layer, simple interrupted pattern, using monofilament suture. Postoperative management included analgesia, antibiotics and restricted activity. The cat recovered uneventfully. At a 15-day follow-up, clinical signs had resolved and the cat remained in good general condition. Relevance and novel information Tracheobronchial foreign bodies are uncommon in feline patients, and reports describing primary bronchotomy for their removal are limited in dogs and non-existent in cats. Although bronchoscopic extraction is generally favoured because of its minimally invasive nature, this case illustrates a scenario in which surgical intervention is indicated, particularly when endoscopic access is compromised by distal migration of the foreign body or a narrow bronchial lumen. This report details the surgical approach, intraoperative management and postoperative care after primary bronchotomy in a cat. The findings provide practical guidance for veterinary surgeons confronted with similar cases and contribute to the scarce literature on surgical management of bronchial foreign bodies in cats.
Case summary A 3-year-old, female spayed domestic shorthair with 7 months of pyogranulomatous panniculitis was referred after culture isolation of Actinomyces species. Despite initial improvement, clinical resolution was not achieved with the dosage and duration of clindamycin therapy previously reported as adequate for actinomycosis. Surgical resection with antibiotic impregnated calcium sulfate carrier material for local delivery of ampicillin-sulbactam was pursued. The patient developed severe hypercalcemia (21.6 mg/dl, reference interval 7.8–11.3) after surgery, resolving after 7 days of 0.9% saline diuresis and bisphosphonate therapy. Mycobacterium abscessus was isolated from tissue culture. After 5 months of clarithromycin therapy, clinical resolution of mycobacteriosis panniculitis was achieved. Relevance and novel information This case documents the management of a potential complication of calcium sulfate carrier material, a local antibiotic delivery material that is increasingly used for chronic soft and osseous tissue infection management. This case documents the management of a medically refractory case of infectious feline panniculitis specifically as a result of complex bacterial culture interpretation specific to rapid-growing non-tuberculosis mycobacterium.
A 9-year-old intact female domestic shorthair cat was evaluated for lethargy, vaginal discharge and intermittent perineal swelling that resolved after urination. Ultrasonography revealed severe uterine enlargement consistent with pyometra. During ovariohysterectomy, the urinary bladder was found retroflexed into the pelvic canal and manually repositioned. Despite initial improvement, perineal swelling recurred. Computed tomography confirmed persistent urinary bladder retroflexion in the absence of perineal hernia, pelvic trauma or pelvic canal mass. Exploratory celiotomy demonstrated complete absence of the ventral and left lateral vesical ligaments, providing a structural explanation for the recurrent displacement. The bladder was surgically stabilized with an incisional cystopexy, resulting in an uneventful recovery and no recurrence over 7 years. Urinary bladder retroflexion is exceptionally rare in cats and has been described only in association with pelvic disruption or perineal hernia. This case is the first to describe bladder retroflexion in a cat independent of pelvic diaphragm failure and instead driven by severe uterine distension from pyometra. The case introduces a previously unrecognized pathophysiological mechanism in which chronic uterine enlargement exerts caudal traction on the bladder, potentially compromising vesical ligament integrity and permitting retroflexion. These findings expand current understanding of factors influencing bladder positioning in cats and demonstrate that reproductive tract pathology alone can lead to bladder malposition. Long-term resolution following incisional cystopexy underscores the effectiveness of surgical stabilization when bladder support structures are deficient. This case broadens the differential diagnosis for perineal swelling in female cats and highlights pyometra-induced uterine distension as an under-recognized cause of urinary bladder displacement.
