Cardiac etiology is the leading cause of feline chylothorax: 35 cases (2006-2022).

Echocardiography should be performed in all cats with chylothorax to identify cardiac disease.

This retrospective study of 35 cats with chylothorax identified cardiac disease as the predominant etiology (57%), followed by idiopathic (31%), neoplasia (9%), and peritoneopericardial diaphragmatic hernia (3%). Cardiac-related chylothorax was characterized by elevated left atrial-to-aortic ratios (median 2.4) compared to other etiologies (<1.4). Neoplastic cases presented in significantly older cats. Median survival times varied substantially by etiology: cardiac 172 days, idiopathic 416 days, neoplastic 38 days, and hernia-related 27 days. Prognostic factors negatively affecting survival regardless of etiology included advanced age and low rectal temperature at presentation. The authors recommend echocardiography for all cats diagnosed with chylothorax given the high prevalence of cardiac disease. Notably, all cats with left atrial-to-aortic ratios exceeding 1.4 had cardiac etiology, and all cats over 14 years presented with neoplastic disease, providing useful diagnostic predictors for clinical practice.

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