Diseases of the lungs in dogs and cats

Question 1

Diagnostic imaging

Answer 1

X-ray - LL, VD, DV. Look for bronchial, interstitial, alveolar and nodular pattern. May see bronchitis, edema, pneumonia, hemorrhage, granuloma.
Ultrasound: FNA or thoracocentesis
CT: neoplasia, abscess, pulmonary fibrosis, bronchiectasis
Bronchoscopy: direct visualization (edema, inflam, FB, ulcer, tumor)
BAL for cyto, bacto etc.

Question 2

Diseases of the small airways

Answer 2

Canine chronic bronchitis, bronichiestasis, feline lower air way disease, feline asthma, airway FB, bronchial neoplasia

Question 3

CS: daily cough for more than 2 months. Productive or non-productive. Exercise intolerance, tracheal sensitivity, inspiratory crackles, expiratory wheezes, prolonged expiration with push at end, increased vagal tone +/- sinus arrythmia. Bronchoscopy: hyperemic mucous memb, mucoid or purulent secretions, fibrous nodules on mucosa

Answer 3

Canine chronic bronchitis (cause unknown, but most likely smoke)
Inflammation -> fibrosis and mucous production -> further airway inflammation

Question 4

Treatment canine chronic bronchitis

Answer 4

Controlled but can never be cured.
Anti-inflammatories: Prednisolone
Bronchodilators: terbutaline, theophylline
Antitussive (if inflammation is treated, if not mucous can be trapped): Codeine
Antibiotic (if BAL and microbiology is +): doxycycline for mycoplasma.
Adjuntive treatment: clean areas, harness instead of collar

Question 5

History of chronic productive cough, loud bronchial sounds, +/- nasal discharge, hemoptysis (coughing blood)

Answer 5

Bronchiectasis (irreversible dilation of large airways, bronchi, with accumulation of pulmonary secretions). Cocker spaniel. Response to long standing inflammation (CCB)

Question 6

Treatment brochiectasis

Answer 6

Lobectomy (if lobar bronchiectasis). Antibiotic based on culture, bronchodilators (terbutaline, theophylline), NOT COUGH SUPPRESSANT (antitussive)

Question 7

Chronic cough, paroxysmal, dry “hacking” cough, open mouth breathing, prolonged expiration

Answer 7

Feline Asthma/feline bronchial disease.

Question 8

Acute or chronic cough, dry + unproductive. Cyanosis and recurrent airway infection that partially responds to AB

Answer 8

Airway foreign body (due to laryngeal paralysis, dental procedures, plant, food or teeth)

Question 9

Coughing, obstructive breathing pattern (loud respiration). Harsh wheezing sound on auscultation

Answer 9

Bronchial neoplasia. Treatment: lobectomy.

Question 10

Bacteria causing bacterial pneumonia

Answer 10

e.coli, klebsiella, bordatella, pasturella, mycoplasma and pseudomonas

Question 11

Lethargy
Fever
Dyspnea
Acute or chronic cough
Exercise intolerance
Mucopurulent nasal discharge
Hemolysis
Increased lung sounds and crackles or wheezes

Answer 11

Bacterial pneumonia

Question 12

Hematology: Increased WBC
Radiography: Diffuse or focal alveolar pattern, bronchiectasis, megaespohagus, mass

Answer 12

Bacterial pneumonia

Question 13

Treatment bacterial pneumonia

Answer 13

AB based on culture
Bronchodilator (theophylline)
Lobectomy in case of focal pneumonia or abscess
Saline nebulization

Question 14

Virus causing bronchopneumonia

Answer 14

1. Morbillivirus (distemper)
2. Canine influenza + parainfluenza virus
3. Canine+feline Herpes virus
4. Canine resp. coronavirus
5. Feline coronavirus (FIP)
6. Calcivirus (Fe)

Question 15

Mucopurulent oculo-nasal discharge
Fever
Lethargy
50% neurological signs
Thickened skin on paw pad and nose

Answer 15

Distemper (morbillivirus).
Pathogenesis: exposure + inhal. -> replication in macrophages + tonsils -> viremia -> several tissues (lung, bowel, skin, CNS) -> bronchopneumonia, enteritis, encephalitis, hard pad nose

Question 16

Treatment Canine distemper infection

Answer 16

AB
Bronchodilators (theophylline)
Fluid
If seizure: diazepam, phenobarbital

Question 17

Cough
Tachypnea
Acute onset of respiratory distress
Fever
Lethargy
Shock
Cats: wheezes (bronchospasms)

Answer 17

Aspiration pneumonia (aspiration of food, fluid or gastric content resulting in pulmonary inflammation)

Question 18

Causes of aspiration pneumonia

Answer 18

Megaesophagus
Laryngeal and pharyngeal dysfunction
Anasthesia
Neuromuscular disease

Question 19

Nasal discharge (mucopurulent or serous
Crackling sounds
Increased lung sounds (or normal auscultation)
History of: coughing, gagging, dyspnea, lethargy and anorexia
Blood test: eosinophilia
Bronchoscopy: green-yellow mucous, mucosal thickening

Answer 19

Eosinophilic bronchopneumonia (= inflammatory disease of unknown etiology - hypersensitivity to an environment or endogenous antigen)

Question 20

Dyspnea, cyanosis, coughing
Auscultation: crackles heard on inspiration and end-expiration (dorsocaudal lung fields), heart: +/- murmur, arrythmia, tachycardia. Murmur without sinus tachycardia (-> pulmonary disease)

Answer 20

Pulmonary edema

Question 21

Causes of pulmonary edema

Answer 21

1. Left sided heart failure (incr. vascular hydrostatic pressure)
2. Vasculitits, ARDS (incr. vascular permability)
3. Hypoalbuminemia (decr. plasma oncotic pressure)
4. Upper airway obstruction (decr. transpulmonary pressure)

Question 22

Treatment eosinophilic bronchopneumonia

Answer 22

Glucocorticoids + allergy/hyposensitivity testing

Question 23

Treatment pulmonary edema

Answer 23

Diuretics (furosemide), oxygen therapy, sedatives (acepromazine)

Question 24

Singed hair, smell of smoke, loss of consciousness, upper airway stridor (laryngeal edema), ocular and nasal discharge. Some patients only show signs after 24 hours: ARDS, infection, laryngeal edema

Answer 24

Smoke inhalation (=direct injury to airways from heat, particulate matter and toxic gases)

Question 25

Treatment smoke inhalation

Answer 25

Observation for at least 24-48 hours, tracheostomy (laryngeal edema), oxygen cage, bronchodilators, antibiotics (after culture), analgesics, corticosteroids

Question 26

Respiratory distress, tachypnea, cough, hypotension, dyspnea, fever, lethargy

Answer 26

Lung lobe torsion (deep chested dogs, cause: idiopathic, pleural effusion, surgery, trauma)

Question 27

Extreme anxiety, tachycardia, cyanosis, crackles (end-inspiration, expiration), wheezes

Answer 27

Acute Respiratory Distress Syndrome (ARDS) = acute hypoxemic respiratory failure due to lung injury and increased pulmonary capillary permeability. Usually secondary to sepsis, pancreatitis, aspiration, shock or microbial pneumonia

Question 28

Treatment ARDS

Answer 28

O2, fluid, furosemide, control of blood gas. Prognosis is poor

Question 29

Dyspnea, exercise intolerance, +/- cough, cyanosis, crackles

Answer 29

Pulmonary fibrosos = interstitial lung disease: alveolar septal fibrosis, interstitial fibrosis, epithelial hyperplasia and focal calcification. Affect terrier. No effective treatment. Xray: diffuse interstitial pattern

Question 30

Sudden onset of respiratory distress, tachypnea and cyanosis

Answer 30

Pulmonary thromboembolism = abnormal gas exchange, pulmonary infarction

Question 31

Causes pulmonary thromboembolism

Answer 31

Usually secondary to: heartworm disease, immune-mediated hemolytic anemia, neoplasia, DIC, hyperadrenocorticism (cushing), protein loosing-enteropathy and nephropathy

Question 32

Diagnosis and treatment pulmonary embolism

Answer 32

Pulmonary angiography, antithrombin 3, blood gas, radiography and echocardiography. Treatment: thrombolytic therapy and underlaying disease.

Question 33

Chronic cough, exercise intolerance, respiratory distress, dyspnea, weight loss and anorexia

Answer 33

Pulmonary neoplasia (most often metastatic - carcinoma, osteosarcoma).