What Is Your Diagnosis?

Joao E de Brito Galvao Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.

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Rebecca Ball Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.

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Aimee Kidder Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.

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Mieke Baan Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.

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Stephen J. Birchard Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.

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Wm. Tod Drost Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.

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History

A 3-year-old castrated male Pekingese was evaluated at the veterinary teaching hospital because of coughing and suspected pneumonia. Coughing began acutely 3 months earlier. At that time, the dog began treatment with antimicrobials, antitussives, bronchodilators, and anti-inflammatory drugs. Thoracic radiographs had been obtained 3 months apart; radiographic findings revealed evidence of pneumonia that was resolving. However, once administration of antimicrobials was discontinued, coughing episodes had become more frequent.

At the time of initial admission to the veterinary teaching hospital, results of physical examination were unremarkable, with the exception of the presence of referred upper airway sounds and occasional coughing. Thoracic radiographs were obtained and revealed a linear to oblong soft tissue opacity in the ventral aspect of the left caudal lung lobe. Bronchoscopy was performed and revealed that the left main stem bronchus was filled with mucopurulent material. Findings on cytologic examination of bronchoalveolar lavage fluid were consistent with septic suppurative inflammation; bacterial culture of the fluid yielded Escherichia coli and Pasteurella multocida. On the basis of results of antibacterial susceptibility testing, treatment with azithromycin and enrofloxacin was begun.

Two months later, thoracic radiography was repeated and revealed continual radiographic improvement. The owner was instructed to continue administration of antimicrobials for 1 month and to bring the dog back for re-evaluation. However, the dog was evaluated 2 months later. Coughing episodes had become more frequent during the preceding 2 to 3 weeks; administration of antimicrobials had been discontinued for 4 weeks. Thoracic radiographs were obtained (Figure 1).

Figure 1—
Figure 1—

Left lateral (A), right lateral (B), and ventrodorsal (C) radiographic views of the thorax of a 3-year-old castrated male Pekingese evaluated because of episodes of coughing that repeatedly became more frequent when antimicrobial treatment was discontinued.

Citation: Journal of the American Veterinary Medical Association 240, 1; 10.2460/javma.240.1.37

Determine whether additional imaging studies are required, or make your diagnosis from Figure 1—then turn the page

Radiographic Findings and Interpretation

A focal, ill-defined soft tissue opacity is evident on the ventrodorsal view of the thorax (Figure 2), superimposed over the left eighth rib. This soft tissue opacity in the left caudal lung lobe is less pronounced than on previous radiographs. On the right lateral view, an irregularly marginated, tubular soft tissue opacity is superimposed on the caudal aspect of the cardiac silhouette. The soft tissue opacity is at the junction of the caudal subsegment of the left cranial and left caudal lung lobes. The radiographic diagnosis is fluid-filled bronchus with focal pneumonia and pneumonitis. The potential causes for the fluid-filled bronchus include bronchitis, a bronchial plug, and bronchial foreign body.

Figure 2—
Figure 2—

Same right lateral and ventrodorsal radiographic images as in Figure 1. A focal, ill-defined soft tissue opacity is present on the ventrodorsal image (arrows) superimposed over the left eighth rib. This soft tissue opacity in the left caudal lung lobe was less pronounced than on previous radiographs. On the right lateral image, an irregularly marginated, tubular soft tissue opacity is superimposed on the caudal aspect of the cardiac silhouette. This is at the junction of the caudal subsegment of the left cranial and left caudal lung lobes (arrows).

Citation: Journal of the American Veterinary Medical Association 240, 1; 10.2460/javma.240.1.37

Because of persistent radiographic abnormalities and clinical signs, thoracic computed tomography (CT) was performed (Figure 3). In a precontrast, reconstructed oblique view of the left caudal lung lobe, bronchial wall thickening and a soft tissue attenuating structure in the peribronchial interstitium and within the bronchus were evident. The soft tissue density followed the path of a bronchus from the dorsocranial to ventrocaudal aspect of the lung.

Figure 3—
Figure 3—

Computed tomographic precontrast, reconstructed oblique (diagonal line; insert A) image of the left caudal lung lobe (B) made at the level of the eight rib. An 8-slice, multidetector CT scanner was used. The reconstructed image was made by use of a lung algorithm and displayed in a lung window. Notice the bronchial wall thickening and an increase in soft tissue density in the peribronchial interstitium and within the bronchus. The soft tissue attenuating structure follows the path of the bronchus from the dorsocranial to ventrocaudal aspect of the lung (arrows). Additionally, a 1.0 × 1.2-cm soft tissue density nodule is present within the pulmonary parenchyma at the ventrolateral aspect of the left caudal lung lobe (arrowheads). L = Left. R = Right.

Citation: Journal of the American Veterinary Medical Association 240, 1; 10.2460/javma.240.1.37

On CT imaging, a 1.0 × 1.2-cm, contrast-enhancing, soft tissue attenuating structure was present within the pulmonary parenchyma at the ventrolateral aspect of the left caudal lung lobe. Contrast enhancement of this nodule was observed after IV injection of iohexol (images not shown). Differential diagnosis for the pulmonary nodule included granuloma, inhaled foreign body with pneumonia and an abscess, or, less likely, neoplasia.

Comments

Because of findings on thoracic radiography and CT as well as the lack of sustained clinical improvement following medical treatment, a thoracotomy and left caudal lung lobe lobectomy were performed. After the left caudal lung lobe was removed, it was dissected. A 3.0-cm-long wooden stick was found traveling through the entire length of the lung lobe. A focal abscess was also identified, which was associated with the wooden stick. The dog recovered well from surgery, and coughing episodes completely subsided thereafter.

In the dog of this report, radiographic and CT evidence of a soft tissue structure was caused by the presence of the wooden stick within the bronchus. In addition, a 1.0 × 1.2-cm nodule was identified by use of CT that was consistent with the focal abscess found at surgery in association with the wooden stick. For this dog, thoracic CT provided a more sensitive diagnostic procedure than did thoracic radiography for evaluation of a wooden stick foreign body. Bronchial foreign bodies have been described in dogs.1,2 Although not true for the dog of the present report, bronchial foreign bodies most often lodge in the right bronchus and affect the right caudal lung lobe.2,3

  • 1.

    Venker-van Haagen AJ, Vroom MW, Heijn A, et al. Bronchoscopy in small animal clinics: an analysis of the results of 228 bronchoscopies. J Am Anim Hosp Assoc 1985; 21: 521526.

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  • 2.

    Brownlie SE. A retrospective study of diagnosis in 109 cases of canine lower respiratory disease. J Small Anim Pract 1990; 31: 371376.

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  • 3.

    Schultz RM, Zwingenberger A. Radiographic, computed tomographic, and ultrasonographic findings with migrating intrathoracic grass awns in dogs and cats. Vet Radiol Ultrasound 2008; 49: 249255.

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