Running head: NASOPHARYNGEAL POLYP IN A CAT

Respiratory Emergency
Nasopharyngeal Polyp in a Cat
Sarra Borne Lord
Tarleton State University

NASOPHARYNGEAL POLYP IN A CAT

Respiratory Emergency
Nasopharyngeal Polyp in a Cat
One upper respiratory disease that can lead to an emergency in cats is nasopharyngeal
polyps. Some cats develop a stalk in the back of their throat which is usually secondary to
chronic upper respiratory infections. These polyps may originate in the middle ear or the
Eustachian tube. Nasopharyngeal polyps are benign, but they can grow to a size that causes
obstruction of the nasopharynx (Keuhn, Taylor, Dyer, & Hauptman, 2011). Post-removal
complications can include Horners syndrome (which may be temporary or may persist), head
tilt, and mild facial palsy (usually temporary) (Wolf, 2010)
Patient Signalment and History
Runt is a 7 month old, intact male, DSH kitten who was referred for severe stertor or
possible upper airway obstruction. Owners have the queen and two siblings and stated that he
was the runt of the litter. He has had chronic upper respiratory infections and has been treated
with antibiotics. He has never eaten well and has been developmentally delayed. Owners report
that he snores while sleeping and occasionally open mouth breathes. He tires more easily than
the other kittens. There has been no sign of an URI infection in the past couple of months but he
is still having difficulty breathing. They have noticed that Runt will have abdominal
involvement while breathing. The rDVM commented about seeing throat expanding while
breathing.

Radiographs were taken by the rDVM, the original images were not presented, but a

copy of the radiologists report was available. It noted a soft tissue opaque structure in the region
of the soft palate consistent with a soft tissue mass or less likely foreign material. However, this
may also be artifact from positioning. The radiologist recommended a CT scan of the skull and
thorax, and upper airway examination as the next steps.

NASOPHARYNGEAL POLYP IN A CAT

Physical Exam. Temperature: 99.3, P: 160, R: 32, Weight: 2.1 kg, 4.63 lb, 0.16 m2.
Mental status: bright, alert and responsive. BCS: 2.5/5. Mucous membranes: pink. Ears: normal.
Eyes: normal. Oral Cavity: only brief exam tolerated, foul odor from mouth. Stertorous sounds.
Thoracic Auscultation: purring. Cardiac evaluation: normal rate and rhythm. Femoral pulses:
good. Abdominal Palpation: no obvious abnormalities. Musculoskeletal: small size. Lymph
nodes: normal. Skin: normal. Genitalia: intact male, both testicles descended.
Laboratory Findings. A CBC and serum chemistry panel including electrolytes was
performed to assess Runts organ function prior to initiating further treatment or diagnostics. All
were within normal limits for a cat of his age. These results are reproduced in Table 1.
Diagnostic plan. A CT exam of Runts head and chest was offered and declined by the
clients due to cost. The next option was an anesthetized oropharyngeal exam, +/- bronchoscopy
depending on initial findings. This plan was accepted.
Runt was sedated with butorphanol 0.2 mg/kg SC, an IV catheter was placed in his right
cephalic vein and isotonic fluids were initiated at a surgical rate of 3 ml/kg. Runt was then
masked down with sevoflurane. Upon fully opening Runts mouth to intubate it was noticed that
his soft palate was bulging and a pink-red fleshy mass was showing over the caudal margin. A 3
mm endotracheal tube was placed and sevoflurane was continued at 3.5%.

Figure 0- 1: Runt Nasopharyngeal Polyp; Photos courtesy of Dr. E Pickens, VMS of DFW

NASOPHARYNGEAL POLYP IN A CAT

Procedure. A spay hook was used to pull the soft palate rostrally to expose the
maximum length of the mass. After a quick surgical consult, a hemostat was used to grab the
base of the mass and remove it. Minor hemorrhage occurred, but was stopped with gauze pads
packing of the oropharynx. The mass was 2.6 cm in length.
Upon recovery from anesthesia, Runt exhibited signs compatible with Horners
syndrome; his left pupil was dilated, right pupil was mitotic, and right third eyelid was raised.
Diagnosis. Nasopharyngeal mass confirmed via histopathology. Histopathology report
Post-operative Horners syndrome.
Recommendations and comments. Runt recovered from his procedure without
complication of hemorrhage, but he developed Horners syndrome. Horners syndrome is a
common neurological disorder of the eye and facial muscles caused by dysfunction or damage to
the sympathetic nervous system that supplies the eye. This was a result of removing the
nasopharyngeal polyp that likely originated from the epithelium of the middle ear and had
probable facial nerve involvement. Typically the changes resulting from Horners syndrome are
temporary (mismatched pupils, raised third eyelid) but permanent changes are possible. Polyps
can reoccur if a stalk of tissue is left behind during the removal. If new signs develop a CT of
his skull may indicate if he requires surgery to remove remnants of tissue from his ear canal.
Buprenorphine 0.015 mg/kg transmucosally every eight hours was dispensed for pain
control as needed for 3-5 days. Phenylephrine 2.5 % eye drops; one drop each eye every 8 -12
hours was dispensed for the Horners syndrome.
Five days post-procedure the owners reported by telephone that Runt was doing much
better and that his breathing had greatly improved. He still had signs of Horner's syndrome but
they were also greatly improved.

NASOPHARYNGEAL POLYP IN A CAT

5
References

Keuhn, N., Taylor, S., Dyer, N., & Hauptman, J. (2011, July). Nasopharyngeal polyps in cats.
Retrieved February 13, 2015, from Merck Manuals.com:
http://www.merckmanuals.com/pethealth/cat_disorders_and_diseases/lung_and_airway_
disorders_of_cats/nasopharyngeal_polyps_in_cats.html
Pickens, E. (2014, December 09). Digital photo: Runt nasopharyngeal polyp.
Wolf, A. (2010). Gingivitis, stomatitis, and other oral lesions in cats. Cincinnati Veterinary
Medical Association, (pp. 1-4).

NASOPHARYNGEAL POLYP IN A CAT

6
Tables

Table 1
Laboratory Values
Test
WBC
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
Hematocrit
RBC
Hemoglobin
Reticulocytes
Platelets

Result
16.17
7.4
5.38
1.86
1.49
0.04
32.7
8.68
11.8
28.6
616

Reference Range
5.5 19.5 K/uL
2.5 - 12.5 K/uL
0.4 6.8 K/uL
0.15 1.7 K/uL
0.1 0.79 K/uL
0 0.1 K/uL
30 45%
5 10 M/uL
9 15.1 g/dL
3 - 50 K/uL
176 600 K/uL

Albumin
Alkaline Phosphatase
ALT
Amylase
BUN
Calcium
Cholesterol
Creatinine
Globulin
Glucose
Phosphorus
Total Bilirubin
Total Protein

2.7
194
34
580
17
10.3
131
0.7
4.9
103
7.3
0.1
7.6

2.2 4 g/dL
14 111 U/L
12 130 U/L
500 1500 U/L
16 -36 mg/dL
7.8 11.3 mg/dL
65 225 mg/dL
0.8 2.4 mg/dL
2.8 5.1 g/dL
74 159 mg/dL
3.1 7.5 mg/dL
0 -0.9 mg/dL
5.7 8.9 g/dL

Sodium
Potassium
Chloride

158
4.4
114

150 165 mmol/L

3.5 5.8 mmol/L
112 129 mmol/L

Note: The mild increase in eosinophils may be directly related to the nasopharyngeal polyp, as its make-up
consisted largely of eosinophilic cells and degenerated neutrophils. Histopathologically the mass was described as
an inflammatory nasal polyp with glandular cystic dilation containing columnar epithelial cells and filled with
mucinous/eosinophilic and/or large numbers of degenerate neutrophils.