– 4 year MN Collie cross with history of a cough that started about 1 week
– rDVM placed pet on a compounded cocktail of pred and tetracycline which helped the cough
– pet presented today tachypneic
– chest rads showed pleural effusion; thoracocentesis approx. 2.5 L of turbid, floculent fluid pink/tan in colour; pet remained tachypneic despite fluid removal
– in house cytology neutrophils, no bacteria seen
– bloodwork: moderate neutrophilia
– 4 year MN Collie cross with history of a cough that started about 1 week
– rDVM placed pet on a compounded cocktail of pred and tetracycline which helped the cough
– pet presented today tachypneic
– chest rads showed pleural effusion; thoracocentesis approx. 2.5 L of turbid, floculent fluid pink/tan in colour; pet remained tachypneic despite fluid removal
– in house cytology neutrophils, no bacteria seen
– bloodwork: moderate neutrophilia
Chest ultrasound: echogenic pleural effusion and lung hepatization seen in right and left lung lobes; highly irregular lung lobe surface seen in the right middle lung lobe region with multiple hyperechoic foci gas pockets. Was not able to use colour Doppler due to tachypnea
Differentials? pyothorax and pneumonia, lung lobe torsion, neoplasia?
Comments
Would expect bacteria on
Would expect bacteria on cytology with a pyothorax. Other differentials would be lung abscessation, foreign body, fungal disease; all of which can give a para-pneumonic pleural effusion. Are you able to aspirate the affected lung lobe? May need a CT scan.
Pet was referred so possibly
Pet was referred so possibly will get CT
Pet was referred so possibly
Pet was referred so possibly will get CT
Only pathologies that resolve
Only pathologies that resolve on this scenario is from cracking the chest which is what i would do and not even wait for the CT because of the potential for lung lobe torsion. On occasion LLT are not bloody and may have the t-duct involved if milky pink.
Lung necrosis, fungal and neoplasia are my other diffs.
With that level of dyspnea I would screen the abdomen sonographically for related lesions and go to sx for exlap t-otomy if clean.
Here are 2 LLT cases from the archive not saying thats what it is but in that age if not fungal then LLT has to be in consideration… then neoplasia.
http://sonopath.com/members/case-studies/cases/lung-lobe-torsion-6-year-old-mn-collie-dog
http://sonopath.com/members/case-studies/cases/lung-lobe-torsion-2-year-old-fs-pug
As an update. This pet
As an update. This pet underwent a thoracotomy and a pre-op and post op CT scan. The post CT scan report:
Conclusions: 1. Mild mediastinal widening with pneumohydromediastinum. 2. Mild pneumohydrothorax. 3. Focal area of marked increased attenuation, right cranial lung lobe. 4. Bilateral mild increase attenuation, caudal lung lobes. 5. Multifocal pulmonary nodules. 6. Previous sternotomy. 7. Static moderate left sided subcutaneous emphysema. 8. Static periosteal reaction, 9th rib on the right. 9. Bilateral thoracostomy tubes
10. Right jugular catheter. 11. Incidental C7 transitional vertebrae
The differential diagnosis for the mediastinal widening continue to include mediastinitis, edema, or neoplasia. The differential diagnosis for the area of marked increased attenuation in the right cranial lung lobe include focal area of severe atelectasis, granuloma, abscess, or neoplasia. The differential diagnosis for the pulmonary nodules include granulomas, abscess, hematogenous pneumonia or metastatic neoplasia. The primary differential diagnosis for the increased attenuation at the periphery of the caudal lung lobes is atelectasis. There continues to be no evidence of a foreign body on this study. Shawn Mackenzie, DVM, DVSc, DipACVR
At surgery 70% of thickened nodular mediastinum was removed along with abundant fibrinous material. Some lung atelectasis was noted and the pleural surface was covered in finbrinous nodules. The chest was drained, flushed and two chest tube splaced. Culture of the fluid and removed tissue showed Pasteurella Canis. Histopath is still pending. No FB’s seen.
The pet was managed intensively in ICU and is now home and doing really well.