POCUS Found Pneumothorax in 5 of 14 High-Rise Cats. Radiographs Caught Three.

Five cats had pneumothorax on ultrasound; thoracic radiographs identified three. The miss happened in cats with normal vitals.

POCUS Found Pneumothorax in 5 of 14 High-Rise Cats. Radiographs Caught Three.

Photo: Yue WU · Unsplash

Point-of-care ultrasound identified pneumothorax in five of 14 cats that fell from height, but thoracic radiographs identified it in only three of those five.

What the study found

In 14 cats presenting after falls from 1-9 stories, pleural and lung ultrasound (PLUS) identified pneumothorax in five cats based on loss of lung sliding (5/5), presence of lung point (5/5), and presence of asynchronous curtain signs (2/5). Of those five cats, thoracic radiographs identified pneumothorax in three. PLUS also identified coalescent B-lines in six cats and ventral lung consolidation in one. Of the five cats with coalescent B-lines on PLUS, three had unremarkable thoracic radiographs and two had findings consistent with pulmonary contusions. Mean respiratory rate was 53 (±23)/min; two of 14 cats were in respiratory distress. Those two cats presented with bilateral pneumothorax and asynchronous curtain signs. Twelve cats survived to discharge; two were euthanized due to poor prognosis or financial constraints.

How the study was built

This was a retrospective descriptive study of 14 cats that fell from height and presented to a university hospital. The study describes POCUS findings, abdominal POCUS and pleural and lung ultrasound examinations, alongside clinical findings and radiographic results. A combination of limb (n = 7), abdominal (n = 5), and thoracic (n = 9) radiographs were obtained. Abdominal POCUS was unremarkable in all cats. Mean animal trauma triage score was 2 (±2). This is observational data from a single institution with a small sample; it describes what POCUS found in these cats, not what it would find in a larger population or what the imaging discrepancies mean clinically.

The number, and its error bars

In this retrospective study of 14 cats that fell from heights of 1-9 stories, pneumothorax was observed in five cats on point-of-care ultrasound (POCUS) examination. Of these five cats with pneumothorax identified on pleural and lung ultrasound (PLUS), three had pneumothorax identified on thoracic radiographs. Coalescent B-lines were observed in six cats on PLUS; of these, two had findings consistent with pulmonary contusions on radiographs while three had unremarkable thoracic radiographs. Fractures were identified in six cats on limb and pelvic radiographs. The abstract reports these counts without confidence intervals or p-values.

What the authors say it cannot tell you

The abstract doesn't state limitations. That itself is a limitation, the reader doesn't know what the authors considered the study's boundaries, what confounders they flagged, or what population this generalizes to. A 14-cat sample from one hospital is descriptive, not definitive.

Who paid for it

The abstract doesn't state funding sources or conflicts of interest.

What this means for your practice

VeterinaryPracticeNow's read, not the study's. Everything in this section is our editorial interpretation for practice owners. The study does not claim any of it.

If you're seeing high-rise cats and you're relying on thoracic radiographs alone to rule out pneumothorax, this study says there's a gap. The cats PLUS caught and radiographs missed weren't in respiratory distress, only two of the full cohort were, and normal vitals and a low trauma score didn't predict imaging findings.

The operational question is whether you've got POCUS capability in-house or whether you're referring for imaging. If you're already doing abdominal POCUS on trauma cases, adding PLUS is a skill investment, not a capital one. If you're not, the study doesn't tell you what the miss rate costs in outcomes, only that the miss exists.

If you're weighing POCUS training or trying to justify the time investment to a partner, subscribe to VeterinaryPracticeNow.

The two cats euthanized were euthanized for prognosis or financial reasons, and the study doesn't break out whether missed pneumothorax on radiographs was associated with either decision. Twelve of the cohort survived to discharge. The imaging gap is real; whether it changes your protocol depends on what you're already equipped to do and what the alternative costs in referral time or client spend.

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Source: Journal of Veterinary Emergency and Critical Care (Wiley)

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