Possible inhaled grass seeds

RE: Possible inhaled grass seeds

Anthony Dennison — Mon, 24 Jul 2017 11:44:26 GMT

I've seen 1 airway foreign body before. At university (a full ear of corn) - they tried to get it out with a scope but it wasn't budging. The surgeons were debating on on which thoracotomy approach to take when Ed Hall walked in, told them to put the dog on antibiotics and anti-inflammatories for 48 hours and let the ear go a little mushy. It came out on first attempt on the 2nd scope.

RE: Possible inhaled grass seeds

Evelyn Barbour-Hill — Sat, 22 Jul 2017 15:15:11 GMT

[quote user="patrick murphy"]

slight tangent but my wee bronchoscope from the auctions cost £28, they are out there, although not perfect.

[/quote]

That's a bargain by any criteria.

RE: Possible inhaled grass seeds

patrick murphy — Sat, 22 Jul 2017 15:11:28 GMT

slight tangent but my wee bronchoscope from the auctions cost £28, they are out there, although not perfect.

RE: Possible inhaled grass seeds

Evelyn Barbour-Hill — Sat, 22 Jul 2017 14:56:35 GMT

[quote user="Anthony Todd"]

Just asking:

Are they easy to find on bronchoscopy?

Is it easy to do? What about the endo tube?

Do they ever disappear into the bronchioles?

ie do you always find them?

Do you really need to refer?

Never done one [hope I didn't miss a FB....]

[/quote]

Just answering...

Often. It varies. Things tend to lodge as soon as the passage gets tight. Many things seem to stop at the carina for a while, which is fortunate.

How easy it is to do depends upon how skilled you have become. Navigation is the difficult thing. Which is why one is relieved when the little beggar is still at the carina. Even when you can see the thing plain as a pikestaff, retrieving it can be difficult. The more different retrieval thingies you have in your kit the better.

The flexible scope goes down inside the endotracheal tube. I use a right-angle connector between tube and oxygen tubing, which has an extra port with a stopper – you know the things – that the scope goes down. In a cat though I have to take the tube out and pass the scope – there's enough room round it for the cat to breathe, although you mustn't take too long about it. I do have a 0.9mm scope that would go down a cat's endotracheal tube, but it's not steerable so is not terribly useful.

Disappear into the bronchioles? I expect so.

Do you always find them? Probably not. All one can say is that sometimes you don't find anything.

I answer as a self-taught endoscopist. I'm quite prepared to be slapped down by others.

RE: Possible inhaled grass seeds

Anthony Todd — Sat, 22 Jul 2017 14:14:47 GMT

[quote user="Robin Grimmer"]I would always attempt one first of all, provided I had the equipment.[/quote]

Thanks Robin.

Rather what I expected and I think even I would have a look in a puzzling coughing dog.

RE: Possible inhaled grass seeds

Iain McAllister — Sat, 22 Jul 2017 13:16:51 GMT

[quote user="Rob Davis"]

I would personally be happy to give this a few days to see what happened. If the coughing is persistent then would advise bronchoscopy (obviously warning the owner that it may not reveal anything and negative findings wouldn't totally rule out FB in unexplored area). Even if there is a grass seed in the airway, it is possible that it could be coughed out by the dog, and a short delay is unlikely to be critical.

[/quote]

Pretty much what I've done - we have no bronchoscope here so it would mean referral - having a look see on Monday...thanks for the replies and good to know there is no such thing as a stupid question lol

RE: Possible inhaled grass seeds

Robin Grimmer — Sat, 22 Jul 2017 13:15:41 GMT

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]I had one memorable case of a wheat seed bronchial FB[/quote]

Just asking:

Are they easy to find on bronchoscopy?

Is it easy to do? What about the endo tube?

Do they ever disappear into the bronchioles?

ie do you always find them?

Do you really need to refer?

Never done one [hope I didn't miss a FB....]

[/quote]

In answer to your questions:

It was only the one case I've ever had, hence was memorable.

It was relatively easy to find. It was a huge clump, possibly 2-3cm across, so completely blocking a main stem bronchus.

It was difficult to do, possibly due to the large size it was difficult to grasp. As I remember, it took several attempts - the first few just getting small pieces until I got the whole mass.

I don't know about disappearing in to the bronchioles, possibly a smaller FB, but it was clear this one was going nowhere.

The ET tube is a good question. AFAIR, I extubated and topped up with propofol while I removed the FB, so was a bit dicey, especially as at least one lung lobe was occluded by the FB!

I would always attempt one first of all, provided I had the equipment.

RE: Possible inhaled grass seeds

Robin Grimmer — Sat, 22 Jul 2017 13:08:55 GMT

[quote user="Rob Davis"]

[/quote]

I agree with this approach in this case. I would be happy to give a few days wait and see, but my case was a bit different as it was 2 weeks after the event and cough had persisted since then.

RE: Possible inhaled grass seeds

Anthony Todd — Sat, 22 Jul 2017 12:21:12 GMT

[quote user="Robin Grimmer"]I had one memorable case of a wheat seed bronchial FB[/quote]

Just asking:

Are they easy to find on bronchoscopy?

Is it easy to do? What about the endo tube?

Do they ever disappear into the bronchioles?

ie do you always find them?

Do you really need to refer?

Never done one [hope I didn't miss a FB....]

RE: Possible inhaled grass seeds

Rob Davis — Sat, 22 Jul 2017 12:16:32 GMT

RE: Possible inhaled grass seeds

Robin Grimmer — Sat, 22 Jul 2017 12:09:53 GMT

I had one memorable case of a wheat seed bronchial FB - also in an ESS that had been running through wheat fields (and we know from Theresa May that is a naughty thing to do! ) This had been present for 2 weeks though. As well as the cough, there was an obvious density present on x-ray. I scoped it and although a bit fiddly I managed to retrieve the FB, which was a huge clump of wheat seeds.

I would have gone straight for a GA in this dog, so you could get decent x-rays and scope if necessary. Agree with Evelyn's comments, if they're being cost phobic about x-rays, then how come bronchoscopy and referral?

RE: Possible inhaled grass seeds

Clive Ansell — Sat, 22 Jul 2017 11:52:21 GMT

[quote user="Anthony Todd"]

[quote user="Clive Ansell"]I'm struggling to understand why Iain's OP has been given one star? it is a perfectly reasonable and sensible question, and a good interesting topic for general discussion.[/quote]

Me too!! When are you going to end these anonymous unqualified unreasoned one stars Arlo???

How was the migrating grass seed diagnosed and found, by the way; doubt if an early Xray would help much??

[/quote]

Unsure of all the detail, being a locum and no longer at the practice.

Radiographs of chest and a swab were taken early on, and I believe a diagnosis of bacterial pneumonia was initially made, with no visible evidence of a grass awn or other foreign body, or of cardiac or pericardial enlargement at the time. Despite an initial improvement, the dog eventually deteriorated and collapsed and was referred. I think, but not 100% sure, a diagnosis was made via CT or MRI imaging.

In this case there was no history to suggest an inhaled grass awn, or a cough even.

RE: Possible inhaled grass seeds

Anthony Todd — Sat, 22 Jul 2017 09:35:10 GMT

[quote user="Glen McIntosh"]Anyways, grass seed was removed and all ok.[/quote]

Sounds like scoping is the first thing to do if an inhaled grass-seed is suspected.

Are they easy to find?

[quote user="Glen McIntosh"]some other causes of cough though.[/quote]

Will there be much on Xray in a sudden onset "cough" without pretty serious associated signs surely???

RE: Possible inhaled grass seeds

Glen McIntosh — Sat, 22 Jul 2017 03:19:52 GMT

Seems like a perfectly reasonable question to me as well and one I would like to hear opinions on.

I had a grass seed in the lung case about 7 or 8 years ago. I remember it because it was the same night I had my first (and so far only, touch wood) RCVS complaint - not about the grass seed case, it was a house visit request that occured while I was scoping the grass seed case under GA.

Anyways, grass seed was removed and all ok.

But I can't remember why I suspected grass seed inhalation and why I ended up scoping it, I had never done bronchoscopy before or since. The RCVS case became the focus of memories from that night.

I guess I would base my decisions a lot on the temporal association between the onset of cough and the running in the grass fields.

Did the cough start immeadiately after running in the field. If so then yes, I would be recommending referral and even consider disclaimer if owner declined to follow that advice.

If not, say it started a few hours later, then I would discuss the possible potential devestating sequale, offer referral but would also be happy to wait and see, if coughing persists or other symptoms develop then refer.

I think you are right Anthony, early xray probably won't help diagnose grass seed, but would help rule out some other causes of cough though.

RE: Possible inhaled grass seeds

Anthony Todd — Fri, 21 Jul 2017 23:01:08 GMT

Me too!! When are you going to end these anonymous unqualified unreasoned one stars Arlo???

How was the migrating grass seed diagnosed and found, by the way; doubt if an early Xray would help much??

RE: Possible inhaled grass seeds

Clive Ansell — Fri, 21 Jul 2017 20:09:02 GMT

I'm struggling to understand why Iain's OP has been given one star? it is a perfectly reasonable and sensible question, and a good interesting topic for general discussion.

I would advice bronchoscopy as soon as really. Chances are no awn will be present or found, but the consequences of a pulmonary foreign body could be severe.

I was involved with a case about 3 years ago; also a springer spaniel, that presented initially with a raspy chest and pyrexia, no cough. responded well to antibiotics. This was repeated and on the 3rd or even 4th occasion the dog presented collapsed and was eventually referred. It was found to have a grass awn that had migrated to the pericardium, presumably inhaled originally. Made a full recovery after surgery.

RE: Possible inhaled grass seeds

Evelyn Barbour-Hill — Fri, 21 Jul 2017 19:43:45 GMT

[quote user="Iain McAllister"]Would you refer for bronchoscopy immediately in these cases or treat and wait and see - o a little cost phobic so didn't get the opportunity to take rads[/quote]

I may be being a bit stupid, but if he doesn't want to fork out for radiography why would he fork out for bronchoscopy, especially if it's a referral?

I'd do any bronchoscopy myself, but with what urgency would depend upon my degree of suspicion, and on owner preferences too.

I see no reason in your case not to treat medically and see what happens.