Aortic mineralization in a cat︓ A case report
Chiaki Morita, MVS１, Yusuke Yamashita, BVS２, Takayoshi Miyabayashi, BVS, MS,PhD, Dipl. ACVR１
１︓iVEAT Fukuoka Veterinary Specialty Practice, 2︓Aoi Animal Hospital
History
A 9-year-old, neutered male, American shorthair cat had resection of a bladdermass (urothelial carcinoma) at a university hospital and was discharged after
three days. The following day, after subcutaneous fluid administration at a
primary veterinary clinic, the patient developed dyspnea and diagnosed withpleural effusion, pulmonary edema and cardiomyopathy. Pleural drainage andcardiac treatment (Pimobendan and ACE inhibitor) were initiated. Seven days
later, the patient came to Aoi Animal Hospital for a second opinion.
Clinicopathological findings
The results of complete blood count and blood chemistry tests were within anormal limit except for a high SNAP NT-proBNP value.
The blood pressure was a high end of normal (138 mmHg; normal value is<140mmHg).
Radiographic and CT imaging findings
Radiographic findings
The right lateral view showed mineralization of vascular wall from the aortic rootto the abdominal aorta (Figure 1a). In the ventrodorsal (VD) and dorsoventral
views, the left ventricular wall was attached to the thoracic wall, and cardiac
enlargement was observed (Fig. 1b). In the VD view, the left kidney was 1.7
times and the right kidney was 2.5 times of the length of the second lumbar
vertebral body (Fig. 1b).
Computed Tomography (CT) imaging findings
Mineralization was seen from the aortic root to the abdominal aorta.
appeared enlarged (Figure 2a).

The heart

Multi-phased, non-selective, intravenous contrast studies were performed. Theinterventricular septum and the papillary muscle appeared thickened (Figure 2c).
Discussion
In cats, aortic mineralization on thoracic radiographs was rare.1-4 Two reports
showed the cause of aortic mineralization: arteriosclerosis and metastatic
calcification due to chronic renal failure. 1,2
In dogs, aortic mineralization was also rare (21/3443), and it was considered to
be no clinical significance.4

In humans, however, the incidence of aortic mineralization on thoracic
radiographs was 1.9% in men and 2.6% in women (the ages of 30 and 89). 5,6
Furthermore, in humans, aortic mineralization was associated witharteriosclerosis, chronic renal failure, aging and cardiovascular disease.6-9
The following is to discuss the pathogenesis of the aortic mineralization in thiscase.
First, in humans, arteriosclerosis is the most common cause of aortic
mineralization.10 The risk factors of arteriosclerotic damage include hypertension,dyslipidemia, and diabetes mellitus.11 In this case, dyslipidemia, and diabetes
mellitus were negative because of blood test results. In this patient, the bloodpressure was within a normal range, but the value was in the high end.12 Thus,
hypertension cannot be completely ruled out.
Second, metastatic calcification due to chronic renal failure was less likely in thispatient. Although the patient had the left renal atrophy in the imaging and he
was suspected the impaired renal function, his serum calcium levels, urea
nitrogen, and creatinine were normal on the blood test. And there appeared to
be normal renal excretory function on contrast-enhanced CT imaging.
Third, aging cause degenerative changes and dystrophic calcification. Aging
factor cannot be ruled out. However, considering the prevalence of cats, itcouldnʼt be single cause of aortic calcification.
Fourth, in human reports, aortic calcification is associated with cardiovasculardiseases.6,13 Aortic calcification can cause adverse effects on vascularcompliance, vasomotion, and plaque stability.14 Aortic stiffness including aortic
calcification correlates with left ventricular afterload.13 In addition,
cardiomyopathy can cause turbulence and reduced perfusion of blood in the aorta,
which may have resulted in the aortic mineralization in this case.15,16
Finally, this patient had urothelial carcinoma of the bladder in the past. The
aortic calcification might have occurred due to the presence of carcinoma. Focus
on the molecular biological aspects, osteopontin is a multifunctional glycoproteinthat is involved in cardiovascular disease, cancer, and biomineralization (theprocess by which organisms produce minerals).17 In humans, studies haveshown that overexpression of osteopontin promotes carcinogenesis, progression,and metastasis of multiple malignant tumors.18 Notably, in humans, increased
osteopontin expression has been observed in urothelial carcinoma in bladder.19
There was no report that examined osteopontin in cats.
It is suspected that both cardiac disease and urothelial carcinoma are related toaortic mineralization in this case.

Conclusion
When aortic mineralization is observed in cats, it should be examined thatchronic renal failure and underlying disease that triggers arteriosclerosis. It also
has to check the cardiac disease, because there may be a loss of aortic elasticity
and increased afterload. Molecular biological mechanisms should be the subjectof future research.

Figures and captionsFigure１a

Figure１b1a. Right lateral thoracic and cranial abdomen radiograph (cropped).
Mineralization of the aortic root to abdominal aorta is seen (arrows).
1b. Ventrodorsal thoracic and cranial abdomen radiograph (cropped). The
cardiac shadow is wide and appears enlarged. The left kidney appears smaller
than normal (arrow).

Figure 2a

Figure２b

Figure２c2a. Sagittal plain CT image. Mineralization is seen from the aortic arch toabdominal aorta. 2b. Dorsal CT image of the right and left kidneys in the portal
venous phase. There is a difference in size between the left and right kidneys, butthere appears to be no abnormal renal excretory function. 2c. Dorsal CT imageof thoracic in the portal phase. It shows cardiac enlargement and mineralization of
the aortic root (arrow).

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