Coughing dog

RE: Coughing dog

Julie Innes — Fri, 22 Feb 2019 08:50:30 GMT

Comiserations, Thomas. our patient died at home with his owner last week.

Why is it the nice owners with nice dogs always get horrible things?

RE: Coughing dog

Thomas Johnson — Fri, 22 Feb 2019 08:44:15 GMT

I did a home visit and euthanased him yesterday morning, he was losing weight, getting weaker and had increased respiratory effort. It was very sad, the owner is in the midst of sorting all her husband's things after he passed away a few months ago, she was obviously very upset at losing her dog as well, but she knew she had to make the decision and wasn't going to delay doing it for her own sake.

RE: Coughing dog

Julie Innes — Wed, 13 Feb 2019 08:48:09 GMT

[quote user="Thomas Johnson"]I spoke to the referral centre yesterday and histopathology on the liver masses has come back as haemangiosarcoma, they've started palliative treatment with prednisolone which has made him brighter and got him eating again, but I don't think it will be long before we're seeing him for euthanasia.[/quote]

Our patient is also on the PBD (pred before death) route

RE: Coughing dog

Thomas Johnson — Wed, 13 Feb 2019 08:39:59 GMT

I spoke to the referral centre yesterday and histopathology on the liver masses has come back as haemangiosarcoma, they've started palliative treatment with prednisolone which has made him brighter and got him eating again, but I don't think it will be long before we're seeing him for euthanasia.

RE: Coughing dog

Bob Russell — Fri, 08 Feb 2019 13:14:49 GMT

It is almost guaranteed that in cases where it is a really nice dog, really nice owner or one very dependent on the emotional support of a pet, the news will be bad!

Nasty dogs, nasty owners will get away with it.

Not sure if the colleges give a lecture on sod's law? They should!

RE: Coughing dog

Thomas Johnson — Fri, 08 Feb 2019 12:42:48 GMT

[quote user="Julie Innes"]

I was thinking about this case, Thomas, as we have a very similar one on the go at the moment, although referral isn't an option. Wee old man, it was his wife's dog, the only thing he has .

[/quote]

My case is unfortunately very similar, the owner's husband died a few months ago. I've just had a chat to the owner and she's understandably devastated. The dog is still at the referral centre and they have taken samples to determine the type of neoplasia and treatment options.

RE: Coughing dog

Julie Innes — Fri, 08 Feb 2019 08:55:34 GMT

I was thinking about this case, Thomas, as we have a very similar one on the go at the moment, although referral isn't an option. Wee old man, it was his wife's dog, the only thing he has .

RE: Coughing dog

Thomas Johnson — Fri, 08 Feb 2019 08:23:44 GMT

The clotting times were normal, and I've just had the CT report through from the referral centre:

Diagnostic interpretation: Throughout the pulmonary parenchyma, there are numerous, variably sized, well-delineated soft tissue nodules (fig. 1). The vertebrae, thoracic boundaries and the visible part of the forelimbs are normal. The cranial mediastinal and tracheobronchial lymph nodes are slightly prominent. The cardiovascular structures are within normal limits, in pre-contrast images. In the visible part of the cranial abdomen, the liver has irregular margins and shows multiple, hypoattenuating nodules (fig. 2, lef). Similarly, hypoattenuating nodules can be seen in the visible part of the splenic parenchyma (fig. 2, right).

Conclusions:  Multiple pulmonary nodules – consider metastatic pulmonary neoplasia, most likely  Multiple hypoattenuating hepatic and splenic nodules (consider disseminated neoplasia, such as round-cell tumour, and metastases; nodular hyperplasia and extramedullary haematopoiesis cannot be excluded completely)  Mild cranial mediastinal and tracheobronchial lymphadenomegaly (reactive or metastatic) Additional comments: The cause of the cough is the pulmonary condition; for this the most likely diagnosis is metastatic neoplasia; if the patient has travelled abroad, there is a slim chance that the nodules are granulomas (granulomatous pneumonia, mainly fungal; this should be considered if there are signs of systemic fungal disease). Both the liver and the spleen seem affected by a disseminated disease; lymphoma, histiocytic sarcoma, and metastatic disease are the possible differentials. Ultrasound-guided hepatic and splenic fine-needle aspirates are recommended; if the results indicate metastatic neoplasia, a primary tumour elsewhere should be searched for (prostatic or thyroid neoplasia, or primary bone tumour).

RE: Coughing dog

Thomas Johnson — Wed, 06 Feb 2019 09:52:09 GMT

Thank you all for your advice. I have seen him back today and taken blood for a coagulation profile, I have also started him on a treatment trial with Panacur in case the Angio Detect was a false negative (the sensitivity is about 85%) or in case it is oslerus osleri (though from what I've read that seems unlikely). I have also referred him as we don't have an endoscope. The owner is a smoker so that does add to the concerns for neoplasia.

I will let you all know how he gets on.

RE: Coughing dog

Rach — Tue, 05 Feb 2019 12:24:09 GMT

Another one who would be concerned about neoplasia. Was it a tracheal wash or BAL that the cytology came from? If a tracheal wash, consider a BAL as the pathology looks to be in the lung tissue rather than the trachea. Also the cranial mediastinum looks wide to me, you have nothing to loose by putting the ultrasound probe over its chest (and maybe it’s abdomen to look for evidence of a primary elsewhere?). I know it’s not classic ‘cannonballs’ but would still be a possibility in my book and potentially gives you an alternative route of finding a diagnosis, potentially without having to repeat the GA.

RE: Coughing dog

Jenny Harris — Mon, 04 Feb 2019 16:48:38 GMT

I would be a bit worried about neoplasia, especially with haemoptysis. I would probably treat for lungworm anyway and consider a faecal baermann, scope and BAL. Toxo titres?

RE: Coughing dog

Miriam Lodewyks — Mon, 04 Feb 2019 16:34:47 GMT

Does the dog live with smokers?

I agree heart looks rounder than it should be (subjective, I know).

Oslerus is a good call, as is COPD and neoplasia.

Not exactly helpful, but think you've got to rule out infectious components, then trial steroids...

RE: Coughing dog

Anthony Dennison — Mon, 04 Feb 2019 15:44:15 GMT

Wow those are some horrible looking radiographs! Trachea seems dorsally displaced, I get a VHS of 10 but there does seem to be increased sternal contact with the heart, possibly an enlarged left atrium?

Haematology was normal, have you checked a coagulation profile? Although the Angiostrongylus snap test came back negative, how common is Oslerus osleri? Is it possible to run a lungworm snap test on the tracheal wash fluid?

I'd be considering bronchoscopy to get a direct image of what ever is going on down there. Or consider echocardiography to check there isn't any abnormal heart structure.