Dear Jonathan D, Johnson Lynelle R
William R Pritchard Veterinary Medical Teaching Hospital, University of California, One Shields Avenue, Davis, California 95616, USA.
J Feline Med Surg. 2013 Nov;15(11):1019-27. doi: 10.1177/1098612X13508253.
Respiratory endoscopy is a useful diagnostic tool to evaluate the airways for the presence of mass lesions or foreign material while allowing for sample collection for cytologic and microbiologic assessment. While bronchial disease (eosinophilic or neutrophilic) is the most common lower respiratory disease identified in cats, infectious, anomalous and neoplastic conditions can clinically mimic inflammatory bronchial disease. Diagnostic imaging is unable to define the etiology for clinical signs of cough, tachypnea or respiratory difficulty, necessitating visual evaluation and collection of airway samples. Endoscopy allows intervention that can be life-saving and also confirmation of disease, which is important given that life-long medication is likely to be required for management of inflammatory airway disease.
Cats with either airway or pulmonary disease benefit from laryngoscopy, tracheoscopy and bronchoscopy to determine an etiologic diagnosis. In the best situation, animals that require these procedures present early in the course of disease before clinical decompensation precludes anesthetic intervention. However, in some instances, these tests must be performed in unstable cats, which heightens the risk of the procedure. Cats that do not respond to empiric medical therapy can also benefit from bronchoscopic evaluation.
Due to the small size of feline airways and the tendency for cats to develop laryngospasm, passage of endoscopic equipment can be difficult. Bronchoconstriction can lead to hemoglobin desaturation with oxygen and respiratory compromise.
This article reviews published studies and case reports pertaining to the diagnostic approach to feline respiratory disease, focusing specifically on endoscopic examination of the lower airways in cats. It also discusses appropriate case selection, equipment, endoscopic techniques and visual findings based primarily on the authors' experiences.
呼吸内镜检查是一种有用的诊断工具，可用于评估气道中是否存在肿块病变或异物，同时还能采集样本进行细胞学和微生物学评估。虽然支气管疾病（嗜酸性或嗜中性）是猫中最常见的下呼吸道疾病，但感染性、先天性和肿瘤性疾病在临床上可能会模仿炎症性支气管疾病。诊断成像无法确定咳嗽、呼吸急促或呼吸困难等临床症状的病因，因此需要进行视觉评估并采集气道样本。内镜检查不仅可以进行可能挽救生命的干预，还能确诊疾病，鉴于炎症性气道疾病的管理可能需要终身用药，这一点很重要。
患有气道或肺部疾病的猫可从喉镜检查、气管镜检查和支气管镜检查中受益，以确定病因诊断。在最佳情况下，需要进行这些检查的动物在疾病早期就会就诊，此时临床失代偿尚未排除麻醉干预的可能性。然而，在某些情况下，这些检查必须在不稳定的猫身上进行，这会增加手术风险。对经验性药物治疗无反应的猫也可从支气管镜评估中受益。
由于猫气道较小且猫容易发生喉痉挛，内镜设备的插入可能会很困难。支气管收缩可导致血红蛋白氧饱和度下降和呼吸功能不全。
本文回顾了已发表的有关猫呼吸道疾病诊断方法的研究和病例报告，特别关注猫下呼吸道的内镜检查。它还主要根据作者的经验讨论了合适的病例选择、设备、内镜技术和视觉发现。
