Chronic granulomatous pneumonia and lung rupture secondary to aspiration of activated charcoal in a French Bulldog

A 4‐year‐old, spayed female French Bulldog was presented for respiratory distress and suspected aspiration pneumonia after oral administration of activated charcoal for possible ingestion of a suspected toxic dose of trazodone. The patient had a moderate volume of pleural effusion, which contained free and intracellular black particulate matter consistent with charcoal. Due to presumed charcoal aspiration with subsequent lung rupture, the right middle and right caudal lung lobes were surgically removed. Histology revealed abundant black debris consistent with charcoal and severe granulomatous inflammation. Based on the clinical, gross, and histologic findings, a diagnosis of severe, chronic, locally extensive, aspiration pneumonia and lung rupture with secondary pleuritis and mediastinitis due to charcoal aspiration was made. Aspiration pneumonia is the main complication of activated charcoal administration, which can incite extensive, granulomatous inflammation in the respiratory tract. To the authors’ knowledge, this is the first report describing the cytologic and histologic findings associated with inadvertent charcoal aspiration in a veterinary species.     

Hemorrhagic bile pleuritis and peritonitis secondary to traumatic common bile duct rupture,diaphragmatic tear,and rupture of the spleen in a dog

Objective– To describe the diagnosis and successful treatment of bile pleuritis and peritonitis secondary to traumatic rupture of the common bile duct and a diaphragmatic tear in a young dog. Case Summary– A 1‐year‐old German Shepherd dog was referred for evaluation of vomiting and icterus 4 days after being hit by a car. Thoracic radiographs, thoracic and abdominal ultrasonographic examinations, thoraco‐ and abdominocentesis, and positive contrast celiogram indicated hemorrhagic pleuritis and peritonitis, left dorsal diaphragmatic tear, and rupture and infarct of the spleen. Surgical exploration of the abdomen confirmed these findings in addition to a circumferential tear of the common bile duct, leading to a diagnosis of hemorrhagic bile pleuritis and peritonitis. Aerobic and anaerobic bacterial culture of the abdominal fluid yielded no growth. Surgical correction of the traumatic injuries was achieved via common bile duct anastomosis, cholecystojejunostomy, repair of the diaphragm, and splenectomy. The dog developed postoperative signs consistent with aspiration pneumonia but was successfully treated and discharged from the hospital. Clinical signs and laboratory abnormalities resolved and the dog was alive and healthy 8 months after discharge. New or Unique Information Provided– Bile pleuritis is rare in dogs and cats and is usually associated with penetrating, not blunt, abdominal trauma. Multiple organ injury in cases of traumatic bile duct rupture is uncommon; in this dog, rupture of the common bile duct was accompanied by rupture of the diaphragm and spleen.     

Video‐Assisted Thoracoscopic Resection of Noninvasive Thymomas Using One‐Lung Ventilation in Two Dogs

Objective— To report the technique and outcome of video‐assisted thoracoscopic surgery (VATS) for resection of cranial mediastinal thymoma in 2 dogs. Study Design— Case report. Animals— Eleven‐year‐old Labrador Retrievers (n=2). Methods— Two dogs had VATS resection of thymoma. Preoperative computed tomography (CT) scans revealed well‐circumscribed cranial mediastinal masses with dimensions of 4.5 cm × 4.2 cm × 3.7 cm and 2.1 cm × 2.1 cm × 4.1 cm (at the time of resection) without CT evidence of vascular invasion. One‐lung ventilation (OLV) was achieved using a bronchoscopically placed double‐lumen endobronchial tube. A 3‐portal technique was used for VATS access to the thorax. Thymomas were dissected from the tissues of the cranial mediastinum with the aid of a harmonic scalpel and retrieved in specimen retrieval bags. Results— Two cranial mediastinal thymomas were resected successfully, with their capsules intact, using a VATS technique. One dog developed aspiration pneumonia postoperatively which resolved with treatment and remains healthy 18 months postoperatively with no radiographic evidence of tumor recurrence. The second dog was diagnosed with myasthenia gravis, megaesophagus, and aspiration pneumonia preoperatively and despite recovering well from the procedure had a second episode of aspiration pneumonia 5 days postoperatively and was euthanatized. Conclusions— VATS resection of modestly sized noninvasive thymoma is possible in dogs. Careful case selection and preoperative imaging are the keys. Clinical Relevance— Thoracoscopic resection of modestly sized mediastinal masses forms part of an increasingly expansive set of indications for minimally invasive surgery in select veterinary patients.     

IMAGING DIAGNOSIS—DUODENOBILIARY REFLUX OF BARIUM SULFATE DURING ESOPHAGOGASTROGRAPHY IN A DOG

A 4‐year‐old Australian cattle dog presented for regurgitation, 2 months after duodenal resection and anastomosis for a perforated duodenal ulcer. Duodenobiliary reflux of barium sulfate suspension was detected during fluoroscopic esophagogastrography. Follow‐up radiography 2 hours later demonstrated persistence of the barium in the gallbladder and biliary tree. Ultrasonography showed an open sphincter of Oddi but no other morphological abnormalities with the gallbladder or biliary system. No side effects or bloodwork abnormalities were noted. This is the first case report of duodenobiliary reflux of barium in a dog. The pathophysiology of this phenomenon and its incidence and significance in human medicine are discussed.     

Eosinophilic pulmonary granulomatosis in a young dog with prolonged remission after treatment

A two‐year‐old Jack Russell terrier was presented for evaluation of chronic cough and exercise intolerance. Previous treatment with antibiotics and glucocorticoids had only partially ameliorated the clinical signs. During investigation, hypoxaemia, peripheral eosinophilia and an eosinophilic bronchoalveolar lavage fluid were noted. Thoracic radiographs revealed two ovoid clearly delineated soft‐tissue opacities, one in the caudal segment of the left cranial lung lobe (diameter 26 mm) and the other in the right cranial lung lobe (diameter 20 mm). These findings were verified by computed tomography, which identified an additional smaller lesion (diameter 16 mm) dorsally in the right caudal lobe. Ultrasound‐guided fine‐needle aspiration samples confirmed the diagnosis of eosinophilic pulmonary granulomatosis and treatment with prednisolone and azathioprine was initiated. Within 1 month, granulomas were no longer detectable radiographically. All medication was discontinued after 7 months and currently, after 2·5 years, the dog remains free of clinical signs. To the authors’ knowledge this is the first case report to describe prolonged remission from idiopathic canine eosinophilic pulmonary granulomatosis.     

Muscular dystrophy due to a sarcoglycan deficiency in a female Dobermann dog

A four‐month‐old female Dobermann presented with myalgia, dysphagia, progressive weakness and loss of body condition. Diagnostic evaluation at nine months of age revealed markedly elevated serum creatine kinase activity, electromyographic abnormalities and histological evidence of chronic‐active muscle necrosis. Imaging confirmed dysphagia and aspiration pneumonia. Muscular dystrophy was suspected and immunohistochemical staining of muscle cryosections demonstrated reduced sarcoglycans. Treatment consisted of gastrostomy, and over the next 5 months the dog gained weight, despite continued loss of muscle mass. The dog died at 14 months of age after developing clinical signs of aspiration pneumonia. To the authors’ knowledge, this is the first report of muscular dystrophy in a Dobermann and only the second detailed report of a canine sarcoglycanopathy. Supportive care resulted in an acceptable quality of life for 10 months after clinical signs were first observed.     

Surgical treatment of right-sided renal lymphoma with invasion of the caudal vena cava

An eight-year-old, male castrated basset hound presenting with a three-month history of lethargy was examined. Diagnostic tests including radiography and ultrasonography showed a right-sided renal mass. A 99mTc diethylenetriamine penta-acetic acid scan demonstrated that this kidney was non-functional. At surgery, invasion of the caudal vena cava was found, and the renal segment of the vena cava and the right kidney were resected. The left renal vein was anastomosed to the more proximal vena cava using a polytetrafluoroethylene graft, and the dog recovered well. Two days postsurgery, the dog suffered an acute episode of aspiration pneumonia and was euthanased. The renal mass was diagnosed as lymphoma on histopathology.     

Pulmonary lipoma in a dog

An eight‐year‐old, neutered, male German short‐haired pointer was presented for a chronic cough and an intrathoracic mass. Computed tomography revealed a mass with low attenuation in the right caudal lung lobe that invaded the principal bronchi. The mass was removed by right caudal and accessory lung lobectomy. The histopathological diagnosis was pulmonary lipoma. The clinical signs resolved following surgery. There was no evidence of recurrence or de novo lesions on computed tomography performed 12 months post‐surgery. To the authors’ knowledge, this is the first report of a pulmonary lipoma in a dog.     

IMAGING DIAGNOSIS—NUCLEAR SCINTIGRAPHIC,RADIOLOGICAL, AND PATHOLOGIC CHARACTERISTICS OF METASTATIC PILOMATRICOMA IN A DOG

A 6‐year‐old castrated Goldendoodle dog was presented for left‐sided lameness of 3 weeks’ duration. Focal, moderate to marked increased ^99mTc‐methylene diphosphonate (^99mTc‐MDP) uptake was detected in the right caudal lung lobe, caudal angle of the left scapula, and the distal aspect of the left femur with whole body bone phase scintigraphy. Radiographs identified a well‐circumscribed, oval‐shaped soft tissue opaque mass in the right caudal lung lobe; a suspect oval‐shaped osteolytic lesion in the proximal third of the left scapula; and an osteolytic lesion in the distal aspect of the left femur. Metastatic pilomatricoma was confirmed histologically at all three sites.     

Lipoid pneumonia in a rough collie dog

The incidence of lipoid pneumonia in dogs is not known and confirmed cases do not appear to have been reported. Three forms of lipoid pneumonia are recognised in mammalian species; exogenous lipoid pneumonia (ELP), endogenous lipoid pneumonia (EnLP), and post-obstructive endogenous lipoid pneumonia (PEnLP). All forms share similar microscopic characteristics of fat accumulation in the cytoplasm of alveolar macrophages and are otherwise clinically indistinct from other forms of pneumonia. A case of lipoid pneumonia in a seven-year-old rough collie dog which was presented with recurrent bronchopneumonia over several months is reported here. Diagnosis was made from biopsy of resected lung tissue and from detection of fat-containing vacuoles in macrophages obtained by bronchoalveolar lavage. ELP could not be differentiated from PEnLP in this dog, but a complete recovery followed removal of the affected right accessory and caudal lung lobes.     

IMAGING DIAGNOSIS—TRANSESOPHAGEAL ULTRASOUND‐GUIDED REMOVAL OF A MIGRATING GRASS AWN FOREIGN BODY IN A DOG

A 3‐year‐old English Setter dog was presented for an acute onset of coughing. Tracheobronchoscopic examination allowed localization and removal of one grass awn foreign body. A second migrated grass awn was suspected to be present in the left caudal lung lobe. Transesophageal ultrasound revealed an area of pulmonary consolidation in the dorsomedial portion of left caudal lobe and a linear hyperechoic structure consistent with a grass awn foreign body within the area of consolidation. Transesophageal ultrasonography was also used to provide anatomical landmarks that facilitated successful thoracoscopic removal of the foreign body.     

The pathogenesis of paraesophageal empyema in dogs and constancy of radiographic and computed tomography signs are linked to involvement of the mediastinal serous cavity

The mediastinal serous cavity is a normal anatomic space in the caudal mediastinum. Aims of this anatomic and case series study were to describe the signs of pathologic expansion of the mediastinal serous cavity observed during computed tomography (CT), review the underlying anatomy, perform a literature review, and evaluate the medical records of several dogs with mediastinal serous cavity empyema (paraesophageal empyema). The mesothelial lined mediastinal serous cavity is a cranial extension of the omental bursa, separated from the peritoneal cavity by the diaphragm, in the dorsal part of the caudal mediastinum, to the right of the esophagus, between the heart base and diaphragm. In five adult, large‐breed dogs with surgically and histologically confirmed paraesophageal empyema, macroscopic plant material was found at surgery in two dogs, adherence to adjacent lung was present in three different dogs, accessory lobectomy was performed in two dogs with subacute‐chronic pyogranulomatous pneumonia, and one dog had concurrent pyothorax and mediastinitis, but none had esophageal abnormalities. This study expands our understanding of the pathogenesis and basis for the imaging appearance of paraesophageal empyema in dogs by clarifying the underlying anatomic structures that direct development of this condition. The term empyema accurately describes this condition because the purulent material accumulates within an existing body cavity. The study also provides initial evidence that the development of paraesophageal empyema might be due to local extension of lung disease, such as foreign body migration or pneumonia. Computed tomography was helpful for diagnosis, assessing size, and determining the spread of disease.     

Radiography for the diagnosis of spirocercosis in apparently healthy dogs, St. Kitts, West Indies

Fifty apparently healthy island dogs presenting to the Ross University School of Veterinary Medicine (RUSVM), St. Kitts, West Indies for neutering were used in this prospective study. Twelve of the dogs (24%) were diagnosed with spirocercosis based on a positive fecal analysis and characteristic lesions seen during esophagoscopy. Routine thoracic survey radiographs revealed changes previously reported with spirocercosis in 10/12 (sensitivity = 83%) infected dogs, but in none of the uninfected dogs (38/38; specificity = 100%). The most common radiographic changes were an increased fluid density within the caudal dorsal thorax on the lateral view and a widening and/or bulging of the caudal mediastinum on the dorsoventral view. After oral administration of barium sulfate, barium retention or a tortuous esophagus was visible in all infected dogs (12/12; sensitivity 100%) and in one uninfected dog (1/38; specificity 97%). The results show spirocercosis is common on St. Kitts and that radiographs are as dependable as fecal analysis and/or endoscopy in diagnosing the condition.     

An anatomical and clinical review of cricopharyngeal achalasia in the dog

Cricopharyngeal achalasia is a rare cause of dysphagia in the dog. However it must be differentiated from other causes of dysphagia as it is treatable with surgery. It is a disruption of the cricopharyngeal phase of the oropharyngeal phase of deglutition. There appears to be an incoordination in the swallowing process between the relaxation of the rostral, middle pharyngeal muscles and the caudal pharyngeal muscles. It is seen as a primary condition in young animals presenting soon after weaning onto solid food. The dogs appear clinically healthy unless there is secondary aspiration pneumonia or emaciation. These dogs may present as respiratory emergencies and require intensive support and treatment prior to corrective surgery. The diagnosis is made on videofluoroscopy. The condition carries a good prognosis for cure with surgical myectomy of the cricopharyngeal muscle and the thyropharyngeal muscle, which make up the upper oesophageal sphincter. Temporary relief prior to surgery can be achieved by injection of the cricopharyngeal muscle with botulism toxin. Surgical treatment for dysphagia secondary to an underlying neurological, neuromuscular or pharyngeal weakness carries a guarded prognosis and will make aspiration pneumonia worse.     

Diagnosis and successful treatment of a caudal lingual abscess in a geriatric dog

A 13-year-old, intact male, golden retriever was presented for glossomegaly. A diagnosis of a caudal lingual abscess was made by fine needle aspiration under general anesthesia. The dog showed marked clinical improvement following abscess drainage. Lingual abscesses should be included as a differential diagnosis in any dog with an unexplained acute glossomegaly.     

Radionuclides in lung diagnostics: A new approach

Summary

With a ^99mTc‐labelled aerosol an inhalation (ventilation) image of the lungs was obtained. A lung perfusion image was obtained with ^99mTc‐labelled macro‐aggregates. The data from the gamma camera were stored in a computer and the inhalation‐perfusion (I/P) ratio was calculated for the total lung as well as for one half another selected region, and a local (pixel) area. In the anaesthetised dog in sternal recumbency, the I/P ratio decreased from the cranial to the caudal lung regions. Hence in the dog gravity is not the only determinant of the I/P ratio distribution, as it is assumed to be in man. Position and anaesthesia appeared to influence the distribution of I/P ratios within the lung.     

What is your diagnosis? Particulate material in peritoneal fluid from a dog

9-year-old castrated male Greyhound dog was presented for evaluation of vomiting and lethargy of 1-week duration. On physical examination, the dog was febrile and dehydrated with a tense abdomen and petechial hemorrhages. Clinicopathologic abnormalities included relative polycythemia, mild lymphopenia with reactive lymphocytes, hypoalbuminemia, hypocholesterolemia, hyperbilirubinemia, increased ALP, mild hypokalemia, hyperamylasemia, hyperlipasemia, increased D-dimer concentration, and hyperfibrinogenemia. Cytologic evaluation of peritoneal fluid revealed marked suppurative inflammation with intracellular barium sulfate particles. The day before presentation, the referring veterinarian had administered oral barium sulfate in an upper gastrointestinal contrast study. Radiographs revealed free contrast material in the peritoneal cavity, consistent with gastrointestinal perforation, and leakage of contrast material. Abdominal exploratory surgery revealed a mid-jejunal perforation and a hepatic nodule. Histopathologic diagnosis of the jejunal and liver lesions was T-cell lymphoma. The patient recovered well postoperatively and received chemotherapy for treatment of lymphoma. Most commercial barium sulfate preparations contain relatively uniform, weakly birefringent, pale yellow particles <1 microm in diameter. Because barium sulfate is found occasionally in clinical specimens, cytopathologists should be familiar with its cytologic appearance.     

Rauwolfia serpentina toxicity in a dog

Objective– To describe the clinical manifestations and treatment of Rauwolfia serpentina toxicity in a dog. Case Summary– A 9‐month‐old intact male mixed breed dog was presented following ingestion of an antihypertensive medication containing alkaloids from R. serpentina. R. serpentina alkaloids cause depletion of the biologic amines: norepinephrine, dopamine, and serotonin. The dog experienced hypotension, mental depression, bradycardia, diarrhea, bronchoconstriction, and gastrointestinal ulceration similar to the adverse effects reported in humans. The dog was released from the hospital after 4 days of supportive care. New Information Provided– This is the first case of accidental R. serpentina toxicity in a dog reported in the literature. This case had a good clinical outcome with supportive care and monitoring of all the subsequent adverse effects.     

COMPUTED TOMOGRAPHIC CHARACTERISTICS OF EOSINOPHILIC PULMONARY GRANULOMATOSIS IN FIVE DOGS

Canine pulmonary eosinophilic granulomatosis is a rare inflammatory pulmonary disease characterized by formation of eosinophilic granulomas that tend to obliterate the normal pulmonary architecture. The purpose of this retrospective study was to describe the CT characteristics of confirmed idiopathic pulmonary eosinophilic granulomatosis in a group of dogs. Five dogs met inclusion criteria. All patients were young adult dogs of variable breeds. No dog had concurrent occult heartworm disease. Computed tomographic characteristics most commonly included pulmonary masses and nodules of variable size, and lesions were most commonly located in the caudal lung lobes. Four dogs had large pulmonary masses with or without additional nodules and one dog had nodular lesions disseminated throughout the entire lung parenchyma. All large eosinophilic granulomas were smoothly margined, heterogeneous pulmonary masses displaying heterogeneous contrast enhancement. A honeycomb‐like enhancement pattern was observed in all but one mass and consisted of multiple hyperattenuating rims delineating central hypoattenuating areas, suggestive of bronchiectatic lung with peripheral enhancing airway walls and fluid‐filled, necrotic bronchial lumen. One dog had evidence of tracheobronchial lymphadenopathy. Findings indicated that canine eosinophilic pulmonary granulomatosis should be included as a differential diagnosis for dogs with CT characteristics of multiple pulmonary masses and/or nodules in caudal lung lobes, and a honeycomb‐like enhancement pattern in masses after intravenous administration of iodinated contrast medium.     

Autoimmune myasthenia gravis and dysautonomia in a dog

A two-year-old male entire border collie dog was evaluated for a short history of mixed bowel diarrhoea, coughing, vomiting and stranguria. Physical examination revealed dyspnoea with increased ventral lung sounds and a flaccidly distended bladder. Neurological examination revealed poor pupillary light reflexes, an absent gag reflex and a poor anal tone. Thoracic radiography was consistent with megaoesophagus and aspiration pneumonia. Clinicopathological testing revealed an elevated muscular nicotinic acetylcholine receptor antibody titre. The dog was euthanased because of clinical deterioration. Cerebrospinal fluid (CSF) collected immediately post-mortem revealed macrophagic pleocytosis. Post-mortem histopathological examination was consistent with dysautonomia. This is the first report of coexisting autoimmune myasthenia gravis and dysautonomia in a non-human species. The concomitant diseases may suggest a common immunopathological aetiology.