Pneumonia?

Re: Pneumonia?

Anthony Dennison — Thu, 26 Sep 2013 23:08:04 GMT

Thought I should bring this thread to a close:

The owners went away for 10 days and left the dog with their daughter. They picked her up yesterday, and she is hardly eating, vomiting and v lethargic. I am going out to them to put her to sleep tomorrow.

Eugh. Considering how well she was at diagnosis I thought she may beat the averages, but it seems not. Another case with a poor outcome, seems to have happened a lot lately, don't like not winning

Re: Pneumonia?

Stephen Courtney — Fri, 13 Sep 2013 22:40:38 GMT

There is nothing you could have done differently at the beginning. but i can't recall seeing a Horners case with other clinical signs that wasn't actually neoplasia. I've had a spate of forelimb lamenesses that come back with Horners and odd gair defecits a week or two later.....sinking feelings...

Re: Pneumonia?

Mark Hedberg — Fri, 13 Sep 2013 16:34:45 GMT

[quote user="Anthony Dennison"]

Just spoken to the owner, they've been told that it's a histiocytic carcinoma, survival time of 2 weeks to a few months maximum.

Eagerly awaiting the report now, feel guilty that I didn't investigate this sooner, perhaps something could have been done before it became too widespread.

[/quote]

I would doubt that myself - once it got bad enough to start coughing, the carcinoma would have been seriously widespread. And before the dog started coughing, would they have come in for a check? More than likely the dog had been slowly slowing down over time as this thing spread, and the owners probably attributed it to 'old age' or 'just feeling her bones' or 'a spot of arthritis'.

Sorry you've had a rough time with this; we are our own worst critic in this profession.

Hope you have a decent weekend!

Re: Pneumonia?

Anthony Dennison — Fri, 13 Sep 2013 15:48:59 GMT

Just spoken to the owner, they've been told that it's a histiocytic carcinoma, survival time of 2 weeks to a few months maximum.

Eagerly awaiting the report now, feel guilty that I didn't investigate this sooner, perhaps something could have been done before it became too widespread.

Re: Pneumonia?

Anthony Dennison — Thu, 12 Sep 2013 13:31:32 GMT

I passed the radiograph images on to a local cardiologist, who was very concerned about the soft tissue densities. I've referred her to Liverpool for further investigation and treatment, appointment tomorrow. Think I've reached my limit with what I can do!

Re: Pneumonia?

John Flynn — Thu, 12 Sep 2013 12:11:35 GMT

Horners on same side as swelling over shoulder I'm guessing...

Could do phenylephrine response test to check that is consistent with sympathetic lesion at this location but probably unecessary effort.

Re: Pneumonia?

Christina Smith — Thu, 12 Sep 2013 11:30:28 GMT

+1 for FB. I am afraid

Re: Pneumonia?

Anthony Dennison — Thu, 12 Sep 2013 09:13:11 GMT

Kennel Cough first, Horners came second.

Re: Pneumonia?

Utlendigur — Wed, 11 Sep 2013 22:17:09 GMT

[quote user="John Flynn"]My guess is loads of macrophages in that serosanguinous fluid aspirated consistent with a FB (could have been inhaled and not tracking through thorax or could have been penetrating wound).[/quote]

Or, any history of a stick injury?

Did the horner's coincide with the "kennel cough"?

Re: Pneumonia?

Anthony Dennison — Wed, 11 Sep 2013 20:39:42 GMT

Sorry, was put on to TMPS when first presented with Horner's and pyrexia.

Re: Pneumonia?

Anthony Dennison — Wed, 11 Sep 2013 20:38:17 GMT

Not sure if this has worked, will try another way if not. Apologies for the poor quality, we did put left and right markers on the plate but they don't seem to have come up! The lateral is a Left lateral view, note the tract over shoulder blade?

Re: Pneumonia?

John Flynn — Wed, 11 Sep 2013 20:13:22 GMT

My guess is loads of macrophages in that serosanguinous fluid aspirated consistent with a FB (could have been inhaled and not tracking through thorax or could have been penetrating wound).

Will wait for the xrays, but sounds tricky and if is FB then often no easy solution...

Antibiotic-wise any empirical choice is probably fine unless not working and then BAL or transtracheal wash ideally to get culture... but if FB, then abs won't make it go away...

If I was going empirical I'd maybe elect TMPS pending culture, but I know some will say that these cases a fluoroquinolone is appropriate as pneumonia can be life-threatening and something like veraflox that also supposedly covers anaerobes may have a place...

I loved florfenicol when I did cattle/sheep. ANyone used this in dogs?

Re: Pneumonia?

Michael Woodhouse — Wed, 11 Sep 2013 20:11:39 GMT

Seems a rather weird choice swapping one tetracycline for another.

Migrating foreign body could tie up both the lump and the lungs.