Case Study

RAD – Bronchopneumonia with bacterial, viral or parasitic etiology in a 13 year old MN Jack Russell Terrier

This 13 year old MN Jack Russell Terrier presented for coughing and abdominal distention. History of elevated liver enzymes.

DX

Mixed interstitial-alveolar lung pattern of the right caudal and middle lung lobes  Moderate caudo-dorsal bronchointerstitial pattern (R>L)  Mild cardiomegaly with left and right side involvement with no evidence of congestive heart failure  Possible subcutaneous soft tissue mass cranio-ventral to the first sternebra

Image Interpretation

Rads of the thorax –

Cranio-ventral to the first sternebra in the lateral view there is a rounded, well-defined, homogeneous, soft tissue opacity structure superimposed with the subcutaneous tissue.

Mild generalized cardiomegaly (VHS 11 normal range 9.7 +/- 0.5). Loss of the caudal cardiac waist is noted and the ventro-cranial margin is rounded in the lateral view.

The bronchial tree presents mild generalized wall thickening. Multiple thin bronchial ring shadows are visible throughout the periphery of all lung lobes emphasizing the dorso-caudal lung field.

The background opacity of the caudodorsal lung field appears to be increased with marked reduced visibility of the pulmonary vasculature and the CVC in the left lateral view. There is a severe lung opacification with air bronchograms visible in the right caudal and right middle lung lobe in the V-D view.

Outcome

Obesity and exspiration contribute to the impression of increased lung opacity. However there is the impression of a predominantly bronchointerstitial rightsided and caudodorsal pulmonary infiltrate which is not cardiogenic in origin.
Mainly inflammatory processes (bronchopneumonia) with bacterial, viral or parasitic aetiology should be considered. An allergic cause – such as pulmonary infiltrates with eosinophils – should be considered less likely. The findings are not typical for a neoplastic infiltrate.
An endoscopic examination with BAL, blood-work and a faecal examination (rule out lung worm infection) would be ideal for further definition. As further investigation, ultrasound of the right caudal and middle lung lobe with guided sampling should be considered.
Anemia, bradycardia and fever may result in mild generalized cardiomegaly. Age related bilateral atrio-ventricular endocardiosis is considered less likely. An echocardiography may be considered in case of a systolic heart murmur.
The possible subcutaneous lesion should be rechecked clinically.