Help with thoracic rads please!

Re: Help with thoracic rads please!

Will McMullan — Thu, 02 Oct 2014 16:49:23 GMT

Thanks for all the input. I should have said, coagulation times were all WNL. Coomb's test just came back -ve. Melaena only started today, and has gone downhill overnight, now very weak and wobbly on HL. I think her owner may opt to PTS now unfortunately.

How reliable are the idexx lungworm snap tests by the way? The figures I've found online are 98% sensitive and 99.4% specific, which I would normally be pretty happy with. Has anyone seen cases that have had -ve snap tests that they are certain had lungworm? We have never seen a lungworm case in this area and this dog has never travelled, even in the UK.

Re: Help with thoracic rads please!

Mike Martin — Thu, 02 Oct 2014 16:15:59 GMT

Metastatic neoplasia. Nice rads.

Re: Help with thoracic rads please!

Dalya Livy — Thu, 02 Oct 2014 12:44:32 GMT

Totally agree Martin, perhaps I worded my earlier post poorly - what I meant was that on the first set of bloods the platelets were 145 (well, 142) and if the dog was bleeding at the time then thrombocytopaenia should not have been the culprit. At this stage, with platelets under 50, it may well be a contributor.

Re: Help with thoracic rads please!

Martin Atkinson — Thu, 02 Oct 2014 12:15:14 GMT

[quote user="Dalya Livy"]Platelet count of 145 should not cause spontaneous bleeding[/quote]It was 45 on the second count, admittedly not as low as they can be with IMT but worrying nonetheless.

Re: Help with thoracic rads please!

ruths — Thu, 02 Oct 2014 10:59:06 GMT

Yes- I agree that there is either consumption of platelets ( bleeding) or destruction of platelets (IMT) is leading to the drop in platelets. It's not spontaneous bleeding DUE to low platelets (yet) I think coags is the next place to go- you don't have a full profile on why this dog is bleeding somewhere yet. Are there any other areas of haemorrhage- retinal? Mms? Skin? Good luck!

Re: Help with thoracic rads please!

Dalya Livy — Thu, 02 Oct 2014 10:32:23 GMT

Although at first glance it looks military, I'd agree it's more of a reticular bronchointerstitial pattern. Platelet count of 145 should not cause spontaneous bleeding, so if the dog was bleeding at that stage I'd suspect platelets (and HCT) are decreasing as a consequence of ongoing haemorrhage.

Lungworm would definitely still be heading the list, and I'd use both Advocate and fenbendazole. Agree with above - I'd add doxycycline in case of Ehrlichia, and check coags if possible/add VIt K. Any chance of travel somewhere where she could have picked up a fungal disease? Is she pyrexic? Neoplasia is possible, but not a winning situation obviously, so I'd probably treat the treatable and cross my fingers. Supportive care if O can afford it - oxygen, bronchodilators (how does the heart sound?).

For what it's worth, I had an older dog with almost identical presentation and barely any lung to breathe with, turned out to be lungworm (on Baermann few days post presentation), made a full recovery. One case study is always a good evidence base :)

Re: Help with thoracic rads please!

Mark Hedberg — Thu, 02 Oct 2014 09:48:58 GMT

The platelets are very low in my opinion - any history of ticks or travel? Idexx do a snap test for vector borne diseases; I know it's unlikely in the UK but I've seen tick borne disease in other countries and thrombocytopenia is always something that rings alarm bells with me.

Re: Help with thoracic rads please!

ruths — Wed, 01 Oct 2014 23:31:57 GMT

That is a bronchio interstitial pattern. There are big donuts all over. I'd go with tx vs lungworm- tho the lung pattern really doesn't fit - and tx for IMT but maybe do coags too- don't want to miss rodenticide poising

Re: Help with thoracic rads please!

Robin Grimmer — Wed, 01 Oct 2014 22:52:50 GMT

I think this is more a miliary pattern that looks more neoplastic, particularly the one from yesterday. If it was just haemorrhage I would expect a more alveolar pattern with air bronchograms. I think the anaemia and thrombocytopenia are more likely due to the blood loss from haemoptysis. The dog could also be swallowing a lot of blood and passing it out in the digestive tract. Is malaena present? I think the prognosis is poor for this one.

Re: Help with thoracic rads please!

Martin Atkinson — Wed, 01 Oct 2014 17:20:24 GMT

I was concerned on the first lateral that there was an anterior thoracic mass, this doesn't appear on the second one (I presume they are both right laterals? Maybe a left lateral may shed more light), but the lesion don't look neoplastic to me. The right ventricle is enlarged and the big reduction in HCT and PLT count is very worrying. I would revisit lungworm and give this dog some fenbendazole regardless of your -ve SNAP and do a Baermanns faecal test. Maybe your Coombes will tell you something but I'd be thinking thrombocytopaenia rather than AIHA.

If money is tight I'd stick it on high doses of preds and get the Panacur in there with some antibiotic cover. If its some horrid neoplastic condition they won't be able to afford to pay for further investigation/therapy anyway from the sound of it.

Re: Help with thoracic rads please!

Will McMullan — Wed, 01 Oct 2014 16:26:53 GMT

The radiographs titled 2 and 3 are actually from the day she initially presented and the other lateral is from yesterday. Just to confuse y'all.