Pneumonia diagnosed by FNA of consolidated lung in a 7 year old FS German Shepherd Dog

Case Study

Pneumonia diagnosed by FNA of consolidated lung in a 7 year old FS German Shepherd Dog

A 7-year-old FS German Shepherd with history of treatment for undiagnosed illness was presented for evaluation of considerable weight loss, weakness, lethargy, coughing up bile, anorexia, not urinating and not defecating. Current therapy was prednisone, sucralfate, and tramadol. Abnormalities on physical examination were weakness and labored breathing. Abnormalities on blood chemistry were moderately elevated ALP activity, mildly elevated ALT activity, and mild hyperglycemia.

A 7-year-old FS German Shepherd with history of treatment for undiagnosed illness was presented for evaluation of considerable weight loss, weakness, lethargy, coughing up bile, anorexia, not urinating and not defecating. Current therapy was prednisone, sucralfate, and tramadol. Abnormalities on physical examination were weakness and labored breathing. Abnormalities on blood chemistry were moderately elevated ALP activity, mildly elevated ALT activity, and mild hyperglycemia. The patient was treated with IV fluids, Baytril, dexamethasone, and atropine and subsequently transferred to a referral facility for further diagnostics. On survey thoracic radiographs, bilateral pulmonary congestion was present. The only pertinent finding on survey abdominal radiographs was severe hip dysplasia. Tracheal wash was performed and a thyroid profile submitted. The patient was treated with Nutri-Cal, aminophylline, Previcox, Clavamox, and eventual Cerenia as the Clavamox resulted in vomiting. The patient was presented a few days later for trouble swallowing and was treated Metacam and atropine, and discharged with Orbax.

DX

Pneumonia

Sonographic Differential Diagnosis

Lobar pneumonia or possible lung carcinoma.

Image Interpretation

Multiple lung consolidations were noted in this patient in the left ventral and minor in the right medial region. The lesions do not appear overtly resectable.

Outcome

The patient was recommended for bronchodilators and broad spectrum antibiotics but was euthanized seven days after the ultrasound was performed.

Comments

Assessment of the abdomen sonographically to detect any potential primary neoplasia would have been appropriate as metastatic lung neoplasia can present in similar fashion even if cytology was consistent with inflammatory disease. Core lung biopsy could have been performed as well but the sampling window was challenging and declined by owner for financial reasons.

Clinical Differential Diagnosis

Pulmonary disease – pneumonia (bacterial/fungal, aspiration),neoplasia, hypersensitivity, edema.

Sampling

US-guided FNA cytology from the lung revealed significant mixed inflammation with neutrophilic predominance suggestive of pneumonia.

Patient Information

Patient Name : Bella A
Gender : Female, Spayed
Species : Canine
Type of Imaging : Ultrasound
Book : yes
Status : Complete
Liz Wuz Here : Yes
Code : 10_00017

Clinical Signs

  • Anorexia
  • Lethargy
  • Not defecating
  • Not Urinating
  • Vomiting
  • Weakness
  • Weight loss

History

  • Dyspnea
  • Steroid therapy
  • Tramadol therapy
  • Weakness

Exam Finding

  • Respiratory Distress
  • Weakness

Images

LungConsolidation

Blood Chemistry

  • Alkaline Phosphatase (SAP), High
  • ALT (SGPT), High
  • Glucose, High

Clinical Signs

  • Anorexia
  • Lethargy
  • Not defecating
  • Not Urinating
  • Vomiting
  • Weakness
  • Weight loss
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