Respiratory tract cases Flashcards
Case 1, Billy
Make a problem list
Make a differential diagnosis list
Make a diagnostic plan
Problem list:
cough
increased resp sounds and clicking on expiration
overweight
Case 1, Billy
Make a problem list
Make a differential diagnosis list
Make a diagnostic plan
Make a differential diagnosis list:
tracheal collapse
canine infectious respiratory disease
complex
AB resistant bacterial tracheobronchitis?
neoplasia
heart disease
heart worm / lung worm
chronic bronchitis
Eosinophilic bronchopneumopathy
Canine idiopathic pulmonary fibrosis
Case 1, Billy
Make a problem list
Make a differential diagnosis list
Make a diagnostic plan
Make a diagnostic plan:
xrays with cervical trachea in
bloods: hematology, CRP at minimum
consider arterial blood gases
analyze fecal sample: both flotation and Baermann
bronchoscopy if needed
Case 1, Billy
What do you see in thoracic radiographs?
A. Alveolar opacity in the right middle lung lobe
B. Increased bronchial opacity and moderate cardiomegaly
C. Mild pleural effusion
D. Something else, what?
D. Something else, what? tracheal collapse.
Case 1, Billy
* Bronchoalveolar lavage cytology normal and no bacterial growth
What is your diagnosis?
How do you treat Billy?
What is your diagnosis?
>50% tracheal collapse and bronchomalacia?
How do you treat Billy?
Y-harness, weight loss
Oral prednisolone for short courses only, fluticasone inhalation for long-term
theophylline though No effect on large airways but reduces smaller-airway spasm which lowers intrathoracic pressure and the tendency of larger airways to collapse.
intratracheal stent if owner is willing
Case 2, consultation call from a colleague.
He asks:
”The dog has been in an accident and has bled quite a lot blood to pleural cavity. It is doing pretty ok at the moment.
How much blood should I remove from the pleural cavity? The dog weighs 20kg.”
A. Remove as much blood as possible to make the breathing easier.
Case 3, Nana.
Make a problem list!
sneezing and nasal discharge (resolved with AB)
mild fever
6 week cough
heart rate 138/min
T 39.0
increased breathing sounds on auscultation
CRP 28 mg/l
Case 3, Nana
What do you see in the radioraphs?
A. Mild alveolar pattern
B. Mild pleural effusion
C. Mild vascular pattern
D. Mild bronchointerstitial pattern
D. Mild bronchointerstitial pattern
Case 3, Nana
* You suggest bronchoscopy with BAL but the owner denies it.
How do you treat Nana and why?
A. Corticosteroid treatment trial with oral prednisolone, antibiotics were tried already!
B. Doxycycline for 2 weeks
C. Inhaled fluticasone and inhaled bronchodilator
D. Follow up, no other treatment, maybe a cough suppressant if the owner is bothered by the cough.
B. Doxycycline for 2 weeks
Case 4, Evi.
Make a problem list!
Respiratory rate 70/min
heart rate 250/min
Breathing shallowly and mouth open
lungs silent on auscultation
Case 4, Evi
In addition to giving the cat oxygen and sedating it slightly with butorphanol, what else should you do and why?
A. The cat is having bronchoconstriction, give fast acting corticosteroids and bronchodilator
B. Take radiographs of the lung otherwise you don’t know how to proceed
C. Perform thoracocentesis in case the cat has pneumothorax
D. Perform thoracic ultrasound to see if there is free gas in pleural cavity
C. Perform thoracocentesis in case the cat has pneumothorax
Case 5, Mica.
What do you see in the radiographs?
A. Alveolar opacity
B. Bronchial opacity
C. Bronchiectasis and ground glass opacity
D. Cardiomegaly and vascular pattern
B. Bronchial opacity
Case 5, Mica.
What do you think about these arterial blood gas findings?
hypoxemia
increased alveolar arterial oxygen gradient (Normal <15-20 mmHg)
increased base excess (Alactic base excess (ABE)) indicating buffering/compensation has happened despite PaCO2 being WNL
Bronchoalveolar lavage fluid cytology.
What do you see?
A. degenerated neutrophils, intracellular
bacteria
B. eosinophils, neutrophils, alveolar
macrophages
C. plasma cells, epithelial cells, eosinophils
D. neutrophils, lymphocytes, basophils
B. eosinophils (black arrow), neutrophils (red), alveolar macrophages (greenn)
What is your opinion about the bronchoalveolar lavage fluid analysis?
highly cellular
suspiciously low macrophage number
neutrophilia
eosinophilia
lymphopenia
Case 7, Rambo.
You manage to take one lateral thoracic radiograph before the cat gets mad at you. What do you see?
Write your answer, no clues given!
pleural effusion likely due to undiagnosed heart disease or neoplasia that we can’t discern due to fluid
Case 7, Rambo.
What is the type of this effusion fluid?
Non-septic Inflammatory effusion
Case 8, Milli
- You give oxygen and sedate the cat with butorphanol.
Although the cat is dyspneic, you decide to take a radiograph.
What do you see?
diffuse bronchial pattern
increased opacity, maybe in atelectasis caudal lung field
gastric aerophagia
