Lung ultrasonography findings in dogs with various underlying causes of cough

Jessica L. Ward 1Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011.

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Gregory R. Lisciandro 3Hill Country Veterinary Specialists, Spicewood, TX 78669.

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Wendy A. Ware 1Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011.

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Kristina G. Miles 1Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011.

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Austin K. Viall 2Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, IA 50011.

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Teresa C. DeFrancesco 4Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.

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Abstract

OBJECTIVE

To characterize lung ultrasonography (LUS) findings in dogs with a primary clinical complaint of cough.

ANIMALS

100 client-owned coughing dogs.

PROCEDURES

A standardized LUS examination was performed for all dogs to quantify the number of B lines and identify subpleural abnormalities at 4 sites on each hemithorax. The final clinical diagnosis (reference standard) was determined by medical record review, and sensitivity and specificity of LUS for the diagnosis of selected causes of cough was determined.

RESULTS

Common underlying causes of cough included dynamic airway collapse (n = 37), cardiogenic pulmonary edema (CPE; 12), and bronchitis (10). Compared with dogs with other causes of cough, dogs with bacterial pneumonia (n = 7) were more likely to have subpleural shred signs, whereas dogs with pulmonary neoplasia (4) were more likely to have subpleural nodule signs. Dogs with CPE had higher total B-line scores and higher numbers of LUS sites strongly positive for B lines (> 3 B lines/site) than other dogs. The LUS criteria of total B-line score ≥ 10 and presence of ≥ 2 sites strongly positive for B lines were each 92% sensitive and 94% specific for CPE diagnosis. Notably, 18% (16/88) of dogs with noncardiac causes of cough had been treated previously with diuretics because of prior CPE misdiagnosis.

CONCLUSIONS AND CLINICAL RELEVANCE

LUS profiles in dogs with cough differed by the underlying cause. In dogs with a clinical history of cough, this imaging modality could be diagnostically useful, particularly to help exclude the possibility of underlying CPE.

Abstract

OBJECTIVE

To characterize lung ultrasonography (LUS) findings in dogs with a primary clinical complaint of cough.

ANIMALS

100 client-owned coughing dogs.

PROCEDURES

A standardized LUS examination was performed for all dogs to quantify the number of B lines and identify subpleural abnormalities at 4 sites on each hemithorax. The final clinical diagnosis (reference standard) was determined by medical record review, and sensitivity and specificity of LUS for the diagnosis of selected causes of cough was determined.

RESULTS

Common underlying causes of cough included dynamic airway collapse (n = 37), cardiogenic pulmonary edema (CPE; 12), and bronchitis (10). Compared with dogs with other causes of cough, dogs with bacterial pneumonia (n = 7) were more likely to have subpleural shred signs, whereas dogs with pulmonary neoplasia (4) were more likely to have subpleural nodule signs. Dogs with CPE had higher total B-line scores and higher numbers of LUS sites strongly positive for B lines (> 3 B lines/site) than other dogs. The LUS criteria of total B-line score ≥ 10 and presence of ≥ 2 sites strongly positive for B lines were each 92% sensitive and 94% specific for CPE diagnosis. Notably, 18% (16/88) of dogs with noncardiac causes of cough had been treated previously with diuretics because of prior CPE misdiagnosis.

CONCLUSIONS AND CLINICAL RELEVANCE

LUS profiles in dogs with cough differed by the underlying cause. In dogs with a clinical history of cough, this imaging modality could be diagnostically useful, particularly to help exclude the possibility of underlying CPE.

  • 1. Canning BJ. Anatomy and neurophysiology of the cough reflex. Chest 2006;129:33S47S.

  • 2. Ferasin L. Coughing. In: Ettinger SJ, Feldman EC, Cote E, eds. Textbook of veterinary internal medicine. 8th ed. St Louis: Elsevier, 2017;107111.

    • Search Google Scholar
    • Export Citation
  • 3. Ware WA. Cough. In: Ware WA, ed. Cardiovascular diseases in small animal medicine. London: Manson Publishing, 2011;101105.

  • 4. Fox PR. The history. In: Fox P, Sisson D, Moise N, eds. Textbook of canine and feline cardiology. 2nd ed. London: Saunders, 1999;4145.

    • Search Google Scholar
    • Export Citation
  • 5. Mazzone SB. An overview of the sensory receptors regulating cough. Cough 2005;1:2.

  • 6. Widdicombe J. Airway receptors. Respir Physiol 2001;125:315.

  • 7. Ferasin L, Crews L, Biller DS, et al. Risk factors for coughing in dogs with naturally acquired myxomatous mitral valve disease. J Vet Intern Med 2013;27:286292.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8. Guglielmini C, Diana A, Pietra M, et al. Use of the vertebral heart score in coughing dogs with chronic degenerative mitral valve disease. J Vet Med Sci 2009;71:913.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9. Singh MK, Johnson LR, Kittleson MD, et al. Bronchomalacia in dogs with myxomatous mitral valve degeneration. J Vet Intern Med 2012;26:312319.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10. Tart KM, Babski DM, Lee JA. Potential risks, prognostic indicators, and diagnostic and treatment modalities affecting survival in dogs with presumptive aspiration pneumonia: 125 cases (2005–2008). J Vet Emerg Crit Care (San Antonio) 2010;20:319329.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11. Atkins C, Bonagura J, Ettinger S, et al. ACVIM consensus statement guidelines for the diagnosis and treatment of canine chronic valvular heart disease. J Vet Intern Med 2009;23:11421150.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12. Mantis P, Lamb CR, Boswood A. Assessment of the accuracy of thoracic radiography in the diagnosis of canine chronic bronchitis. J Small Anim Pract 1998;39:518520.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13. Johnson LR, Singh MK, Pollard RE. Agreement among radiographs, fluoroscopy and bronchoscopy in documentation of airway collapse in dogs. J Vet Intern Med 2015;29:16191626.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14. Armbrust LJ, Biller DS, Bamford A, et al. Comparison of three-view thoracic radiography and computed tomography for detection of pulmonary nodules in dogs with neoplasia. J Am Vet Med Assoc 2012;240:10881094.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15. Lichtenstein D, Mézière GA, Biderman P, et al. The comet-tail artifact: an ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med 1997;156:16401646.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16. Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012;38:577591.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17. Baad M, Lu ZF, Reiser I, et al. Clinical significance of US artifacts. Radiographics 2017;37:14081423.

  • 18. Al Deeb M, Barbic S, Featherstone R, et al. Point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema in patients presenting with acute dyspnea: a systematic review and meta-analysis. Acad Emerg Med 2014;21:843852.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19. Hassdenteufel E, Henrich E, Hildebrandt N, et al. Assessment of circulating N-terminal pro B-type natriuretic peptide concentration to differentiate between cardiac from noncardiac causes of pleural effusion in cats. J Vet Emerg Crit Care (San Antonio) 2013;23:416422.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20. Lisciandro GR, Fosgate GT, Fulton RM. Frequency and number of ultrasound lung rockets (B-lines) using a regionally based lung ultrasound examination named Vet BLUE (veterinary bedside lung ultrasound exam) in dogs with radiographically normal lung findings. Vet Radiol Ultrasound 2014;55:315322.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21. Ward JL, Lisciandro GR, Keene BW, et al. Accuracy of point-of-care lung ultrasonography for the diagnosis of cardiogenic pulmonary edema in dogs and cats with acute dyspnea. J Am Vet Med Assoc 2017;250:666675.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22. Lee PM, Tofts RP, Kory P. Lung ultrasound interpretation. In: Soni NJ, Arntfield R, Kory P, eds. Point-of-care ultrasound. Philadelphia: Elsevier, 2015;5969.

    • Search Google Scholar
    • Export Citation
  • 23. Pereda MA, Chavez MA, Hooper-Miele CC, et al. Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis. Pediatrics 2015;135:714722.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24. Chavez MA, Shams N, Ellington LE, et al. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir Res 2014;15:5059.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25. Lisciandro GR. The Vet BLUE lung scan. In: Lisciandro GR, ed. Focused ultrasound techniques for the small animal practitioner. Ames, Iowa: Wiley Blackwell, 2014;166187.

    • Search Google Scholar
    • Export Citation
  • 26. Hansson K, Häggström J, Kvart C, et al. Left atrial to aortic root indices using two-dimensional and M-mode echocardiography in Cavalier King Charles Spaniels with and without left atrial enlargement. Vet Radiol Ultrasound 2002;43:568575.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27. Gargani L. Lung ultrasound: a new tool for the cardiologist. Cardiovasc Ultrasound 2011;9: 6.

  • 28. Lichtenstein D. Should lung ultrasonography be more widely used in the assessment of acute respiratory disease? Expert Rev Respir Med 2010;4:533538.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29. Rademacher N, Pariaut R, Pate J, et al. Transthoracic lung ultrasound in normal dogs and dogs with cardiogenic pulmonary edema: a pilot study. Vet Radiol Ultrasound 2014;55:447452.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30. Vezzosi T, Mannucci T, Pistoresi A, et al. Assessment of lung ultrasound B-lines in dogs with different stages of chronic valvular heart disease. J Vet Intern Med 2017;31:700704.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31. Agricola E, Bove T, Oppizzi M, et al. Ultrasound comet-tail images: a marker of pulmonary edema. Chest 2005;127:16901695.

  • 32. Gadbois J, Anjou M, Dunn M. Radiographic abnormalities in cats with feline bronchial disease and intra- and interobserver variability in radiographic interpretation: 40 cases (1999–2006). J Am Vet Med Assoc 2009;234:367375.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33. Mathis G, Blank W, Reissig A, et al. Thoracic ultrasound for diagnosing pulmonary embolism: a prospective multicenter study of 352 patients. Chest 2005;128:15311538.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34. Cortellaro F, Ceriani E, Spinelli M, et al. Lung ultrasound for monitoring cardiogenic pulmonary edema. Intern Emerg Med 2017;12:10111017.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35. Schober KE, Hart T, Stern J. Detection of congestive heart failure in dogs by Doppler echocardiography. J Vet Intern Med 2010;24:13581368.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36. Oyama MA, Sisson DD, Bulmer BJ, et al. Echocardiographic estimation of mean left atrial pressure in a canine model of acute mitral valve insufficiency. J Vet Intern Med 2004;18:667672.

    • Crossref
    • Search Google Scholar
    • Export Citation

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