Strange lungs and dyspnoea - JRT

Re: Strange lungs and dyspnoea - JRT

Anthony Dennison — Thu, 26 Sep 2013 22:36:26 GMT

Just as an aside, I had a case with similar looking radiographs (albeit in a Labrador), that turned out to have histiocytic carcinoma....

Re: Strange lungs and dyspnoea - JRT

Bob Russell — Thu, 26 Sep 2013 11:42:24 GMT

Quite correctly clinical outcomes for cases discussed here remain unknown.

Guilty as charged so will give an update.

As soon as this dog went on to cephalexin (co-amox did little) the cough disappeared and the breathing went back to near normal. Follow up X-rays still show abnormalities they are significantly clearer.

I am fairly convinced the FB differential is top of the list but the owners are reluctant to follow up as the dog is doing so well!

Re: Strange lungs and dyspnoea - JRT

Malcolm Ness — Wed, 17 Jul 2013 21:54:16 GMT

[quote user="Anthony Dennison"]leave it a couple of days on steroids and antibiotics and let it get a little mushy[/quote]

I think Bob said it has been symptomatic for 6 mths plus already. In our practice the most common lung FBs are blackthorn twigs - they tend not to go mushy in my experience though we can often remove them with a scope.

Lung tumours are often like this in the caudal lobes but the most common is a bronchial carcinoma and these are usually in much older dogs so I can't really add anything useful to this discussion.

Re: Strange lungs and dyspnoea - JRT

Anthony Dennison — Wed, 17 Jul 2013 17:07:03 GMT

+1 for the lung FB.

At university we had a weimeraner (sp?) admitted after he inhaled a whole ear of corn. We tried to remove it with forceps through a bronchoscope but it wouldn't budge. The surgeons were closing in and looking to do a thoracotomy until the senior medic came in, had a look and said 'nah wait, leave it a couple of days on steroids and antibiotics and let it get a little mushy, it'll come with just a scope then'. And he wasn't wrong!

Re: Strange lungs and dyspnoea - JRT

sandpiper — Wed, 17 Jul 2013 15:52:52 GMT

Cheers! I see things get pretty 'robust' on here from time to time.. :)

Re: Strange lungs and dyspnoea - JRT

Bob Russell — Tue, 16 Jul 2013 13:51:41 GMT

Not quite Voldemort but saves the thread heading off in a very different direction and that infection provokes quite heated debate!

If nobody has said it, welcome to the forum!!

Re: Strange lungs and dyspnoea - JRT

sandpiper — Tue, 16 Jul 2013 12:42:12 GMT

[quote user="mariette asselbergs"]Ahhhhhhhhh, didn't you know bovine TB comes from badgers, not from cows.......? [/quote]

[quote user="Bob Russell"]the infection that cannot be named [/quote]

Oops, am somewhat new to the forum - apologies for letting the cat, or JRT out of the bag! TB = Voldemort of the veterinary world..

Re: Strange lungs and dyspnoea - JRT

Bob Russell — Tue, 16 Jul 2013 10:07:18 GMT

We are all in trouble if this is the infection that cannot be named because most of the cattle in the area roam freely across the New Forest.

Two months on broad spectrum antibiotics made no difference at all!

Re: Strange lungs and dyspnoea - JRT

mariette asselbergs — Tue, 16 Jul 2013 09:32:43 GMT

"roamed fields, on which cows had been grazed"

Ahhhhhhhhh, didn't you know bovine TB comes from badgers, not from cows.......?

Mariette

Re: Strange lungs and dyspnoea - JRT

james herriot lied — Tue, 16 Jul 2013 08:50:51 GMT

[quote user="sandpiper"]

and special culture proved to be Mycobacterium bovis

[/quote]

Sssssshhhhhhh.

Those of us in mixed practice are already avoiding that one.

To be fair, we generally see cats with superficial lesions also - and with the time elapsed since the start of treatment, perhaps less likely now. But it's always a good one for rural areas and scraggy cats.

The contrast material in the gut helps to rule out herniation of gut, certainly - but a splash of omnipaque into the abdomen can help to detail hernias which don't contain gut; although in this case the mixed radio-opacity would make me think that if it's not gut, it's certainly not liver - so much less likely to be a hole in the diaphragm. This one's in the lung and of the lung.

+3 (4?) for mentioning that it aint going to be cheap, and surgery probably the only cure at this point.

Re: Strange lungs and dyspnoea - JRT

sandpiper — Mon, 15 Jul 2013 22:45:20 GMT

I had a youngish female neutered cat last year (don't recall details) who roamed fields, on which cows had been grazed.. had chest xray that broadly looked quite similar and we thought was likely neoplasia or fungal lung disease.. But, also had a couple of peripheral nodules (and iris changes) that on histopath, ZN stain and special culture proved to be Mycobacterium bovis

Re: Strange lungs and dyspnoea - JRT

Miriam Lodewyks — Mon, 15 Jul 2013 22:25:45 GMT

I second (or 3rd) the inhaled FB - grass seed? Think it's unlikely there'll be a "cheap solution"... It'll either continue to breathe or it won't.

Re: Strange lungs and dyspnoea - JRT

Utlendigur — Mon, 15 Jul 2013 22:20:48 GMT

[quote user="John Flynn"]

1) inhaled FB and lobar pneumonia

2) primary lung neoplasm

3) Other (yea, I don't know, maybe lung lobe torsion or something...)

If ultrasound and BAL and endoscopy are all non-starters, then I'd either try FNA of the relevant part of lung and spray it on a slide looking for something inflammatory or neoplastic (you might surprise yourself), or I'd try an empirical choice of antibiotics and see if there is any clinical improvement.

[/quote]

What he said

My first thought was inhaled FB + pneumonia/consolidation, especially considering the age and breed (having regularly watched my own JRT thrashing through undergrowth at high speed, seemingly oblivious to thorns, brambles etc) . If it was that, I do wonder how much improvement would be possible though, given the extent of the xray changes and duration, with medical treatment. Looks like it is going to need a lung lobectomy.

Re: Strange lungs and dyspnoea - JRT

Evelyn Barbour-Hill — Mon, 15 Jul 2013 22:12:10 GMT

Endoscopy might also give some information. Do you have any neighbours handy with an endoscope?

Re: Strange lungs and dyspnoea - JRT

Virginia Campbell — Mon, 15 Jul 2013 22:05:22 GMT

[quote user="Bob Russell"]belonging to the chap that tops my fields and cuts the hedges![/quote]

re inhaled FB...does dog go to work with him?

Re: Strange lungs and dyspnoea - JRT

John Flynn — Mon, 15 Jul 2013 21:55:47 GMT

That last image is quite straight DV with spine and sternum overlying quite well I think.

You have mediastinal shift away from the caudal right lung lobe and the cardiac silhouette is also shifted away from what I can tell.

I'm probably sufficiently satisfied that this isn't diaphragmatic herniation.

So we have a primarily lobar opacity, of increased size, in the right middle(/caudal) lung lobe then I think?

I'm going to stick my neck out with a differential list:

1) inhaled FB and lobar pneumonia

2) primary lung neoplasm

3) Other (yea, I don't know, maybe lung lobe torsion or something...)

Re: Strange lungs and dyspnoea - JRT

Bob Russell — Mon, 15 Jul 2013 18:01:01 GMT

I had convinced myself that this was a diaphragmatic hernia and provisionally planned to open her up but now am far from convinced this is a good idea. She has been on various treatments for well over 6 months now!

Not better nor worse but a farm dog with an owner that was being practical about costs!

The left should be the one with the left marker so need to flip it on the machine. These are stored on a disc so not sure how to flip them as jpegs!

No episode of pyrexia noted. Started with another practice November from memory!

HR 170bpm not muffled!

Re: Strange lungs and dyspnoea - JRT

Bob Russell — Mon, 15 Jul 2013 17:56:46 GMT

[quote user="james herriot lied"]

Should say that I can't see the images in a larger format, so can't comment on subtle patterns.

Hmm. Many things spring to mind, although I think the BYTs (Bright Young Things) will be along shortly with some big words and grand descriptions. Plus one for likely neoplasia - but if funds are truly limited, you could do worse than a quick slug of high-I contrast agent down the gullet, followed by xray, and then if necessary a quick intrabdominal squirt of the same, followed by inverted juggle and another xray. Would help to rule out herniations, and can be done conscious.

As would a quick scan poking forwards from the back of the costal arch: doesn't look like you're going to meet a massive acoustic interface on the right side, and it could give some decent info on architecture of tissue, possibly even help with a FNA if there seems to be a solid mass extending to the boundary. Again, without need for GA.

[/quote]

Sorry for the unconventional left v's rt on the stored images!

Re: Strange lungs and dyspnoea - JRT

John Flynn — Mon, 15 Jul 2013 17:49:30 GMT

[quote user="Bob Russell"]would welcome opinions and happy to answer questions![/quote]

Q1: which side of the DV view is left and which is right - I'm rubbish at telling such things?

Q2: time scale and onset of dyspnoea?

Q3: Any history of pyrexia or other indicators of inflammatory disease?

Q4: What is the resting heart rate (should be audible through the clear side of the lungs whichever that one is)? Any arrhythmias / murmurs? Does the heart sound muffled even on that side?

From the DV, I can't see this being pulmonary oedema from CHF as the distribution looks unilateral to me, so I'd stop the furosemide.

I would also like to see some separation between the heart and diaphragm to be sure, and think this could be achieved by checking with ultrasound as suggested.

The primary lesion appears to be in one of the caudal lung lobes, with opacity also present in the ipsilateral cranial lung lobe. I would try to do a unilateral bronchoalveolar lavage if feasible and safe by lying the dog with the affected lung side down and letting gravity assist (unless I was endoscoping).

I wouldn't jump to neoplasia in such a young dog, though I think it's possible. Perhaps an inhaled FB could be on the differential list as well?

Re: Strange lungs and dyspnoea - JRT

james herriot lied — Mon, 15 Jul 2013 17:12:20 GMT

Should say that I can't see the images in a larger format, so can't comment on subtle patterns.

Re: Strange lungs and dyspnoea - JRT

James Laidlaw — Mon, 15 Jul 2013 16:36:31 GMT

Looks nodular - especially on the DV. I'd be thinking neoplasia until I could rule it out...

Cardiac silhouette not visible and not much aerated lung visible on the R side. Any history of trauma/herniation?