Pulmonary diseases

Question 1

What are Ddx for inspiratory dyspnoea?

Answer 1

• Laryngeal paralysis
• Laryngeal neoplasia
• Tracheal mass / stenosis

Question 2

What are Ddx for expiratory dyspnoea?

Answer 2

• Dynamic airway collapse
• Feline asthma

Question 3

What are Ddx for inspiratory + expiratory dyspnoea?

Answer 3

• Pulmonary parenchymal disease (Pneumonia; pulmonary oedema; Idiopathic pulmonary fibrosis IPF)
• Pleural effusions
• Pneumothorax
• Pulmonary thromboembolism

Question 4

When doing a clinical exam what should be done?

Answer 4

• Mucus membrane colour (cyanosis?)
• Auscultate heart and lung field
• Assess thoracic compressibility (cats)
• Percussion
• Effect of body position on dyspnoea?
• Watch ribs from above (no movement in tension pneumothorax, any flail segments?)
• Normal respiration or paradoxical?

Question 5

When is aspiration pneumonia seen in SA?

Answer 5

• Megaoesophagus
• Laryngeal paralysis after tie-back surgery

Question 6

What does ventral / caudodorsal distribution suggest with pneumonia?

Answer 6

• Ventral = suggest airway disease / aspiration
• Caudodorsal = suggest haematogenous spread

Question 7

What is Pnneumocystis carinii? Tx?

Answer 7

• Yeast like fungus
• Cavalier King Charles puppies have immunoglobulin deficiency and may present with dyspnoea due to PC pneumonia
• Tx = Only responds to TMP sulphonamides

Question 8

What is Angiostrongylus vasorum? What does it cause?

Answer 8

• “French heart worm” infestation.
• In pulmonary vessels
• Causes respiratory signs: cough, shortness of breath, hypoxaemia, exercise intolerance.
• Can also cause coagulopathies, neurological signs etc

Question 9

How is angiostrongylosis diagnosed?

Answer 9

• Faecal baermann
• Rectal swab, smeared onto slide
• SNAP test

Question 10

What are other pulmonary conditions resulting in dyspnoea?

Answer 10

• Cardiac disease
• Pulmonary neoplasia / metastatic neoplasia - need 3 x-ray views (R-lat, L-lat + DV)

Question 11

When would you do FNA of lung mass?

Answer 11

• Only if next to chest wall - ultrasound guided
• otherwise = risk of pneumothorax

Question 12

Where can bronchogenic carcinoma metastasize to?

Answer 12

• Extremities = digits

Question 13

What pulmonary condition is common in westies?

Answer 13

• Idiopathic pulmonary fibrosis

Question 14

What is seen with idiopathic pulmonary fibrosis?

Answer 14

• Slow, insidious progression
• Dogs have inspiratory and expiratory dyspnoea, rapid, shallow breathing, can develop rectus abdominus hypertrophy and become cyanotic on minimal exertion.
• Characteristic “crackles” like cellophane on lung field auscultation
• Become severely disabled
• May be similar to diffuse fibrosing alveolitis in humans

Question 15

What is treatment of idiopathic pulmonary fibrosis?

Answer 15

• Symptomatic support
• Restrict exercise + excitement
• Give o2 (expensive)
• Bronchodilators
• Mycophenolate

Question 16

What is Paraquat poisoning?

Answer 16

• Herbicide
• Severe pneumotoxin
• Results in severe dyspnoea (initially with minimal radiographic findings).
• Initial alveolitis progresses to severe pulmonary fibrosis
• Very poor / hopeless prognosis

Question 17

Pulmonary thromboembolism is usually due to an underlying systemic disease, what can these be?

Answer 17

• IMHA
• Protein losing conditions (especially nephropathy)
• Hyperadrenocorticism (Cushing’s disease)
• Pancreatitis
• Sepsis
  *D.I.C

Question 18

How is suspected pulmonary thromboembolism treated?

Answer 18

• Oxygen supplementation
• Sedation / anxiolytic
• Treat underlying disease
• Antiplatelet medication (clopridogrel)
• Anticoagulation tx to prevent further episodes

Question 19

What is ARDS (Acute Respiratory Distress Syndrome)?

Answer 19

• In life, a form of non-cardiogenic pulmonary oedema. Respiratory distress with alveolar infiltrates on radiographs.
• Various initiating factors, especially pneumonia,
  electrocution, smoke inhalation, near drowning,
  trauma, sepsis, DIC.