4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Virginia Campbell — Thu, 01 Mar 2012 20:28:34 GMT

[quote user="james herriot lied"]

Are you making sure the 'end quote' bit is before your bit?

[/quote]

There's a point. Thanks.

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

james herriot lied — Thu, 01 Mar 2012 15:38:13 GMT

Are you making sure the 'end quote' bit is before your bit?

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Virginia Campbell — Thu, 01 Mar 2012 15:36:05 GMT

Dunno why my post is all coming up as a quote from a previous post instead of just the bit I quoted from Emma's post in the quote box

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Virginia Campbell — Thu, 01 Mar 2012 15:33:31 GMT

[quote user="Emma Middleton"]

Thank you all for your support and advice on this interesting (and valuable learning experience!) case.

Thanks for posting it and the update - you've just given me a little dose of free online CPD!

[/quote]

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Emma Middleton — Thu, 01 Mar 2012 15:18:13 GMT

[quote user="Kate Richardson"]Out of interest, what were the indications for a CT scan? [/quote]

Kate, from what I can gather, the options of chest drains + antibiotics Vs exploratory thoracotomy were discussed with owner before the CT scan. Once thoracotomy was decided on, a CT was planned before the surgery, presumably to aid in planning the surgery and ensure this was the appropriate course of action.

Thank you all for your support and advice on this interesting (and valuable learning experience!) case.

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Kate Richardson — Thu, 01 Mar 2012 12:18:18 GMT

Thirded! Well done.

Out of interest, what were the indications for a CT scan?

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

james herriot lied — Thu, 01 Mar 2012 11:07:56 GMT

Seconded - referral was obviously the right option all round. Well done, Emma

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Hannah Wynne Richards — Thu, 01 Mar 2012 11:03:54 GMT

Well done Emma Pat yourself on the back

Wynne

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Emma Middleton — Thu, 01 Mar 2012 10:29:08 GMT

Sorry for the delay, but here's the update:

The dog had an ultrasound guided thoracocentesis (pale straw-coloured fluid with numerous degenerate neutrophils) and a CT scan on 25th which showed a small volume of bilateral pleural effusion. There was pleural thickening, atelectasis of some parts of several lung lobes, enlargement of the tracheobronchial lymph node and mild irregular thickening of the right cranial mainstem bronchus.

So after discussing options with the owners he had a thoracoctomy on the 27th - found small amount of turbid fluid similar to that on the chest tap, the left caudal and right accessory lung lobes had a lot of adhesions and had to be removed along with some of the ventral mediastinum. If anyone's interested in the details I can copy and paste them for you - it's a long report!

Recovering well at their hospital on injectable analgesics. Should be discharged in a few days. They concluded a chronic pyothorax. This dog had a work up for shifting lameness last Summer and nothing was diagnosed, but this resolved. This was probably the start of the problem, which didn't show itself as systemic illness until late Dec/Jan.

Fingers crossed he will make a full recovery.

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

james herriot lied — Mon, 27 Feb 2012 19:34:48 GMT

[quote user="Arlo Guthrie"]

the spat between 'james herriot lied'

[/quote]

I think it's only a spat when both sides wish to hold an argument, Arlo.

Where someone goes off half-cocked without properly ascertaining whether there actually is an axe to grind, we'd normally call that a 'James Herriot Lied' style of attack, or JMH-ism for short. But it's nice to know I have some competition now.

I'll be serving Malcolm the cheap wine when he next comes round for his tea, though. What's the latest, Emma?

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Virginia Campbell — Mon, 27 Feb 2012 18:42:12 GMT

[[quote user="Emma Middleton"]

Chris - really appreciate your explanation, especially with the arrows. Shame our xray machine can't do them! I do very few small animal radiographs. I'm good with broken bones!

[/quote]

I third this! Going back to the original picture now to see if I can find the arrowed things without the benefit of the arrows.

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Arlo Guthrie — Mon, 27 Feb 2012 09:28:11 GMT

Not wanting to take over the thread again, just as the hijackers have been escorted off the plane, but it seems to me that the spat between 'james herriot lied' and Malcolm is a good example of a misunderstanding caused by the limitations of the written word.

Quite sure that James herriot lied did not mean the last sentence of his original post as anything more than a general observation, but can see how Malcolm would read it as directed at him, because the first point in the post was addressed to him.

No clever solution to that. These things happen from time to time. Hope no ill feeling on either side

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

katie mountford — Sat, 25 Feb 2012 23:33:06 GMT

Did you notice any differences in lung sounds between dorsal and ventral in this dog? Until I did OOHs work and seemed to see an awful lot of pleural effusion cats in a short space of time I never really appreciated how it can be a really useful but subtle pointer. From your history it doesn't sound like pleural space disease would have necessarily been high up on the list of differentials so if you aren't specifically listening to different lung fields it probably wouldn't have jumped out at you (well it wouldn't have for me anyway!) but you'll often hear very quiet lung sounds ventrally in these cases. I find that is more obvious than trying to appreciate dulled heart sounds (as you have the dorsal lung fields to compare it too!)

For tapping dogs chests I tend to use a 18G 1'' needle attached to a bit of iv tubing with a 3 way tap on the end of that-its much easier to keep the needle still than if you just use a needle/3-way/syringe combo and butterfly caths tend to be too short to reach into the pleural space in dogs. Good call to refer by the way-placing chest drains is scary the first time you do it!

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

nikki — Sat, 25 Feb 2012 19:32:16 GMT

[quote user="robloxley"]

[quote user="Michael Woodhouse"]What are you looking at? [/quote]

There are pleural fissure lines on the DV; on the lateral the ventral lung lobes are scalloped and not extending ventrally as far as normal.

Ultrasound is also great and easy for detecting pleural effusions. In dyspnoeic cats I will reach for that often before the xray.

[/quote]

Second that. I love my ultrasound machine. No need to move the cat around, can take machine to cat and not worry about having to lie it down for an xray. Had a really really dyspnoeic cat on Thursday and was expecting to see fluid but ultrasound actually showed chest full of soft tissue density. No wonder the cat couldn't breathe. Post mortem xray showed no visible gas in the lungs at all. I think if I'd try to lie it down for an xray it might have taken the euthanasia decision out of our hands!

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Christopher Saul — Sat, 25 Feb 2012 18:24:41 GMT

You're really welcome guys It's nice to be of help. Bones is where I slip up Michael! Not to mention I wouldn't have a clue what to do with a cow! That's why this website is so good - we can all share our knowledge and strengths with each other .

Let us know how the dog gets on Emma!

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Emma Middleton — Sat, 25 Feb 2012 17:53:23 GMT

[quote user="Michael Woodhouse"]

Chris - really appreciate your explanation, especially with the arrows. Shame our xray machine can't do them! I do very few small animal radiographs. I'm good with broken bones!

[/quote] I second this. Really helpful. Thanks for taking the time to put the arrows on!

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Michael Woodhouse — Sat, 25 Feb 2012 17:44:12 GMT

Chris - really appreciate your explanation, especially with the arrows. Shame our xray machine can't do them! I do very few small animal radiographs. I'm good with broken bones!

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

james herriot lied — Sat, 25 Feb 2012 15:31:54 GMT

[quote user="Malcolm Ness"]

A rather pompous remark is what I wrote. I can't call you anything because you hide behind a psuedonym. I am prepared to stand behind what I write and I don't understand those who on one hand are happy to publish their opinions but on the other hand won't identify themselves.

[/quote]

Sheesh. As you wish, Mr Ness, as you wish. I'm sure your comments are an accurate reflection of your personality, and wish you well. You're not correct on this one, though.

I don't wish to enter into an argument on this - I was rather enjoying the discussion and was taking no little pleasure in seeing the situation pan out for Emma, and in being able to congratulate her for behaving extremely well and probably saving this dog's life, simply by having the bravery to ask for help in an open and honest manner. She's rather a credit to herself, I think.

It was a lovely little thread, which didn't deserve this hijack. Sorry, Emma - hope your weekend is going OK and let us know how it pans out.

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Christopher Saul — Sat, 25 Feb 2012 15:10:04 GMT

[quote user="Michael Woodhouse"]

What are you looking at?....... What is the 'gas' cranial to the heart?

[/quote]

I take it you mean the gas shadow that I've outlined with the red arrows? I'm not 100% sure as I'm not a radiologist but I think it's the front of the left cranial lung lobe, which extends slightly further cranial than the right and can sort of wrap around the front of the right and appear end-on in lateral views.

In addition there are fissure lines, the most prominent being between the right caudal and right middle lung lobes ( green arrows). The ventral surface of the (on this view right) cranial and middle lung lobes have been completely elevated off the floor of the thorax (blue), and the ventral surface of the cranial lung lobe is scalloped (black), suggesting a reactive effusion e.g. pyothorax

Hope this helps

Chris

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Gillian Mostyn — Sat, 25 Feb 2012 14:02:46 GMT

[quote user="Malcolm Ness"]I don't understand those who on one hand are happy to publish their opinions but on the other hand won't identify themselves.[/quote]

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Malcolm Ness — Sat, 25 Feb 2012 13:18:53 GMT

[quote user="james herriot lied"]Why on earth would you consider that to be directed at you[/quote]

The give-away for me was the inclusion of my name in your opening sentence.

[quote user="james herriot lied"]And you're calling me pompous[/quote]

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

james herriot lied — Sat, 25 Feb 2012 12:52:07 GMT

[quote user="Malcolm Ness"]

[quote user="james herriot lied"]And it's amazing how calm we all are when giving detached second opinions on t'interne[/quote]

A rather pompous remark. Read again what I wrote.

[/quote]

Why on earth would you consider that to be directed at you, Malcolm? My comment was about how relatively straightforward it can be for the rest of us to give advice on cases which we're not currently having to go through the stress of actually dealing with ourselves - and thus, how useful it can be for an isolated young colleague to be able to move her own stress onwards, with benefit to the patient.

So how could you place yourself at the centre of that one, Malcolm?

And you're calling me pompous? (possibly a correct assumption, admittedly, but people in glass houses, mate)

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Clive Ansell — Sat, 25 Feb 2012 12:51:40 GMT

[quote user="Emma Middleton"]

it was my intention to keep the dog hospitalised over the weekend (not send it home) so if it had deteriorated, it could have been dealt with by our OOH hospital.

[/quote]

Why the referral if you have access to your own OOH hospital practice?

By brother once waited 5 days for a chest drain to be placed in an NHS hospital, with the knowledge that a purulent exudate was present. Written up for on a Thursday afternoon, bank holiday weekend, done on the Tuesday am - unbelievable!

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Emma Middleton — Sat, 25 Feb 2012 12:01:13 GMT

BTW the dog is insured and the owners are sensible and were happy to go with what I recommend - so fortunately don't have to deal with the added complicating factor of cost issues! Makes things simpler. I will update you on the final diagnosis and outcome.

Re: 4 yo Springer with pyrexia, inappetance, cough - advice on x-rays please

Emma Middleton — Sat, 25 Feb 2012 11:45:05 GMT

[quote user="nikki"]If you look back at the xray now can you see why we all said pleural effusion? [/quote] Yes - looking at it last night I could see that the lungs almost look like they're floating in fluid, and with the benefit of hindsight, waiting til Monday wouldn't have been the best thing for the dog unless there were major cost issues or something. So I'm glad I posted on here, but to clarify, it was my intention to keep the dog hospitalised over the weekend (not send it home) so if it had deteriorated, it could have been dealt with by our OOH hospital. [quote user="Hannah Wynne Richards"]have you ruled out distemper? [/quote] No, but he is vaccinated and is now at the referral centre ;) [quote user="james herriot lied"]but unfortunately that experience is often gained equally through finding out which patients we shouldn't have sat back with. [/quote] Very true. I usually am overly cautious rather than the other way around, but I have to say I have learned a lot from the discussion on here and managed to do so without compromising the patient, which is a fantastic outcome :)