Test 3: 43 non infectious pulmonary disease

Question 1

5 common small animal lung diseases that are not pneumonia

Answer 1

• Pulmonary contusions
• Allergic airway diseas
• Non-cardiogenic pulmonary edema
• Pulmonary thromboembolism
• Pulmonary interstitial fibrosis

Question 2

common causes of pulmonary contusions

Answer 2

Compression-decompression injury → HBC, High rise syndrome, kicks, abuse, shock waves

Question 3

clinical signs of pulmonary contusion

Answer 3

• Acute/severe respiratory distress/tachypnea OR may develop progressively over 24-48 hours
• Other signs of trauma- thoracic limb fractures, abrasions, pneumothorax, rib fractures, pleural effusion, diaphragm rupture, arrhythmias, pericardial effusion
• Auscultation: normal or increased breath sounds; crackles and/or wheezes: May worsen over a 24-hour period, Can be asymmetric/unilateral or generalized, Can be difficult to interpret around other thoracic pathology
• Hemoptysis is uncommon in small animals (compared to humans)

Question 4

diagnosis of pulmonary contusion

Answer 4

B lines on ultrasound

Thoracic radiographs: patchy/diffuse interstitial or alveolar lung infiltrates; localized or generalized

CT

Question 5

treatment of pulmonary contusion

Answer 5

O2
intubation if severe
pain meds

antibiotics not used unless pneumonia devleops

prognosis: usually resolves in 10-14 days

Question 6

DDX for allergic airway disease

Answer 6

Parasitic allergic airway disease
Eosinophilic bronchopneumopathy
Feline asthma

Question 7

clinical signs of allergic airway disease

Answer 7

Range from asymptomatic, chronic disease (>2 months) or acute crisis
* Cough, crackles, wheeze, respiratory distress
* Expect lung hyperinflation thickened bronchi/bronchioles
* Lower airway inflammation– mucosal edema, airway smooth muscle hypertrophy, airway constriction, excessive production of airway secretions

Question 8

what are some parasites that can cause allergic airway disease

Answer 8

Migrating parasites:
§ Toxocara canis (roundworms)
§ Ancylostoma caninum (hookworms)
§ Strongyloides stercoralis (pinworms)

Primary lung parasites:
§ Paragonimus kellicotti (lung fluke)
§ Aelurosrongylus abstrus (cat lungworm)
§ Capillaria aerophile
§ Filaroides hirthi (dog lungworm)

Dirofilaria immitis: antimicrofilarial antibodies trap microfilaria in pulmonary
capillaries

Question 9

diagnosis of parasitic allergic airway disease

Answer 9

Fecal testing + Baermann
heartworm testing
CBC (↑eosin)
Xray: interstitial infiltrates, bronchial thickening, alveolar consolidation

Question 10

treatment of parasitic allergic airway disease

Answer 10

Anthelminthic medications +/- corticosteroids

Question 11

EBP allergic airway disease is more common in

Answer 11

younger well conditioned Siberian Huskies, Alaskan Malamutes with yellow green nasal discharge

Hypersensitivity with eosinophilic infiltration of lung/mucosa

Question 12

diagnosis of EBP allergic airway disease

Answer 12

CBC- peripheral eosinophils seen in 60% of cases
Thoracic radiographs: diffuse bronchointerstitial pattern
Often alveolar infiltrates from secondary pneumonia
Bronchoscopy: yellow-green mucous, thick airways
Cytology- >50% eosinophils in 87% of cases

Question 13

treatment of EBP allergic airway disease

Answer 13

Glucocorticoids – often lifelong

Perform culture and sensitivity – treat for infectious pneumonia if present!!

“Eosinophilic pneumonia of undetermined origin”
Hypersensitivity with eosinophilic infiltration of lung/mucosa in younger well conditioned dogs with yellow- green nasal discharge

Question 14

feline asthma is a type — hypersensitivity reaction to aeroallergens

Answer 14

1

leads to reversible bronchoconstriction →inflammation/bronchitis with thick airways and mucous production

Question 15

feline asthma usually occurs in —

Answer 15

young adult/middle aged, well conditioned cat with a chronic cough

Question 16

clinical signs of feline asthma

Answer 16

Episodic bronchoconstriction leads to increased end-expiratory volume/air trapping, increased work of breathing, and respiratory fatigue

Leads to inflammation/bronchitis with thick airways and mucous production

Crackles/wheeze on auscultation

Question 17

diagnosis of feline asthma

Answer 17

• CBC: rarely see a circulating eosinophilia
• Thoracic radiographs: diffuse bronchial or bronchointerstitial pattern; lung lobe collapse can be seen secondary to mucous plugging
• Cytology- eosinophilia, may be neutrophilia

Question 18

treatment of feline asthma

Answer 18

Remove allergens- air fresheners, cigarette smoke, dust exposure

Steroids and bronchodilators →oral or inhaled

Question 19

young- middle age cat with crackles/wheezing

Answer 19

Feline asthma

diffuse bronchial or bronchointerstitial pattern (donuts); lung lobe collapse can be seen secondary to mucous plugging

bronchoconstriction →Leads to inflammation/bronchitis with thick airways and mucous production

Question 20

Accumulation of extravascular fluid within pulmonary parenchyma or alveoli with a normal pulmonary capillary wedge
pressure

Answer 20

non cardiogenic pulmonary edema

Increased permeability from damaged microvascular barrier and alveolar epithelium

Question 21

DDX for Non-Cardiogenic Pulmonary Edema

Answer 21

Neurogenic pulmonary edema
Negative pressure pulmonary edema
ALI/ARDS

Question 22

explain neurogenic pulmonary edema

Answer 22

Following acute neurologic event (trauma, seizures), increase in intracranial pressure causes surge in catecholamines, increasing vascular resistance and causes alveolar capillary leakage

Mechanisms are poorly understood but are often acute in onset and resolve within 48 hours.

Question 23

explain Negative pressure pulmonary edema

Answer 23

Choking, strangulation, near-drowning causes acute intra-thoracic negative pressure, increasing cardiac afterload and similar catecholamine surge and alveolar capillary leakage

Mechanisms are poorly understood but are often acute in onset and resolve within 48 hours.

Question 24

ALI →ARDS

Answer 24

Inflammation leads to vasculitis, increased permeability, and inflammatory cell infiltration/protein rich fluid leakage into lungs

secondary to severe systemic disease such as sepsis or pancreatitis

Question 25

clinical signs of ALI or ARDS

Answer 25

Severe dyspnea, bilateral pulmonary infiltrates, crackles, hemoptysis, and ventilatory failure
§ Ventilation is often required
§ Prognosis is guarded

secondary to severe systemic disease (sepsis, trauma)
inflammation leads to vasculitis and leakage of protein rich fluid into the lungs

Question 26

diagnosis of non-cardiogenic pulmonary edema

Answer 26

History- strangled, drowning, seizures, trauma

Auscultation- dorsocaudal crackles

Bedside thoracic ultrasound: evidence of “B-lines”

Thoracic radiographs: alveolar pattern- typically dorsocaudal but variable

Question 27

— can cause pulmonary thromboembolism

Answer 27

thrombi, fat, septic emoboli,
metastatic neoplasia, or parasites

Question 28

diagnosis of pulmonary thromboembolism

Answer 28

difficult!!

Coagulation testing →FDP/D-Dimer may be high
Thoracic radiographs: often normal, rarely evidence of poorly perfused areas
CT Angiogram: gold standard

Question 29

treatment of pulmonary thromboembolism

Answer 29

Supportive care: oxygen!
Identify and treat underlying disease
+/- Thrombolytic therapy

Question 30

inflammation and scarring resulting from deranged pulmonary remodeling

Answer 30

pulmonary interstitial fibrosis

Question 31

obstruction of pulmonary vasculature by thrombi, fat, septic emoboli,
metastatic neoplasia, or parasites

Answer 31

pulmonary thromboembolism

Question 32

clinical signs of pulmonary interstitial fibrosis

Answer 32

Common in West Highland White Terriers (also seen in other terriers, cats)

Slow progression of signs- dyspnea, cyanosis, syncope, cough

Loud, coarse, inspiratory crackles

Question 33

diagnosis of pulmonary interstitial fibrosis

Answer 33

Thoracic radiographs: often non-specific, diffuse interstitial pattern

CT: may support radiographic findings

Cytology: usually low population of inflammatory cells

Lung biopsy: definitive diagnosis

common in westies

Question 34

treatment of pulmonary interstital fibrosis

Answer 34

Glucocorticoids
Bronchodilators

Prognosis is often guarded, with eventual progression to respiratory failure