Pulmonary Lymphomatoid Granulomatosis in Seven Dogs (1976–1987)

Seven dogs with pulmonary lymphomatoid granulomatosis were reviewed. The disease occurred in six large-breed and one small-breed dogs. The dogs were five to 14 years old (mean, 8.4; median, 7), and four of seven dogs were males. Three dogs had been previously treated with adulticide therapy for canine dirofilariasis. Clinical histories included a progressive respiratory disease characterized by varying degrees of cough, dyspnea, exercise intolerance, and weight loss. Thoracic radiographic features included hilar lymphadenopathy, pulmonary masses of varying sizes, and mixed pulmonary patterns of lobar consolidation with ill-defined interstitial and alveolar pulmonary infiltrates. Cardiovascular changes compatible with chronic dirofilariasis were present in three dogs. The clinical course was usually progressive and fatal. The survival time ranged from six days to four years (mean, 12.5 mos; median, 3 mos). Gross and histologic features included mass lesions with areas of necrosis that replaced normal pulmonary architecture. Cytologically, these lesions were characterized by infiltration with pleomorphic, angioinvasive mononuclear cells that often resulted in vascular obliteration. The infiltrating cells resembled large lymphoid cells that possessed large hyperchromatic nuclei and small amounts of cytoplasm. Systemic lymphoid neoplasia with peripheral lymphadenopathy was diagnosed in two dogs. In both cases, lymph-node cytology was similar to the cellular infiltrates found in the lungs and consistent with a diagnosis of lymphomatoid granulomatosis. These features are compared with previously reported cases of canine lymphomatoid granulomatosis and those features identified in a similar disease described in man.     

RADIOGRAPHY REVIEW: THE INTERSTITIAL PATTERN OF PULMONARY DISEASE

The interstitium supports and surrounds the blood vessels, lymph vessels, bronchi, and alveoli. One of the most common interstitial lung patterns is that of multiple, variably sized distinct nodules. Pulmonary granulomas, abscesses, and neoplasms usually have this radiographic appearance. Other interstitial patterns result from the summation of multiple areas of diseased perivascular and peribronchial interstitial tissue and/or alveolar septa. Diseases characterized by this unstructured increase in pulmonary density include pulmonary fibrosis, early dirofilariasis, interstitial edema, viral pneumonia, and certain types of metastatic neoplasia.     

THE RADIOGRAPHIC APPEARANCE OF PULMONARY HISTOPLASMOSIS IN THE CAT

A retrospective study of 18 cats with pulmonary histoplasmosis was conducted to evaluate radiographic patterns of disease and to determine age, breed, and sex distributions. All cats had active disease confirmed by biopsy/aspiration cytology (lung, bone marrow, peripheral lymph nodes, pleural fluid) or necropsy examination. Cats 3 years of age or less had the highest incidence of disease; females outnumbered males 2 to 1. Radiographically, most cats had an interstitial pattern which appeared as a fine, diffuse or linear pattern, or as a more distinct nodular pattern. An alveolar pattern was an uncommon radiographic finding. Tracheobronchial lymphadenopathy and calcified lymph nodes or pulmonary parenchymal lesions were not identified in these cats.     

THORACIC BLASTOMYCOSIS: A REVIEW OF ITS RADIOGRAPHIC MANIFESTATIONS IN 40 DOGS

Thoracic radiographs of 40 dogs with confirmed blastomycosis were reviewed to determine the incidence of the associated radiographic signs. The predominant patterns of disease were determined in each dog and were as follows: nodular interstitial densities, 13 dogs; a mixed lung pattern not localized to any particular part of the lung, ten dogs; a bronchointerstitial pattern, five dogs; a nonspecific hazy interstitial pattern, four dogs; a mixed alveolar and interstitial density, two dogs; a cavitary lesion, one dog. The lungs appeared normal in four dogs. Concurrent findings included eight dogs with thoracic lymphadenopathy, two dogs with pneumomediastinum, and one dog with pleural effusion. None of the lesions appeared mineralized.     

PULMONARY ACTINOMYCOSIS IN A DOG

A six-year-old spayed female mixed-breed dog was evaluated for coughing, dyspnea, exercise intolerance, and intermittent fever of four month's duration. Extensive alveolar, interstitial, and peribroncial infiltration was observed throughout the lung fields, Pulmonary actinomycosis was diagnosed by isolation of Actinomyces from anaerobic cuture of a transtracheal aspirate. Therapy for Actinomycs resulted in clinical remission; however, radiographic evidence of a severe pulmonary pathologic condition remained 45 days after the initiation of therapy. The dog was asymptomatic for pulmonary disease two years following treatment.     

Alveolar lung diseases in small animals and their radiographic diagnosis

A systematic approach to the diagnosis of disseminated lung disease is more accurate and comprehensive than one based on the memorization of the appearance of each disease. The patterns of disseminated diseases are based on the pathophysiological changes. They are: alveolar, interstitial, bronchial, vascular and mixed. Each pattern has its own characteristics and list of causes.
The alveolar pattern is the most common in small animals. Pathogenesis and radiographic characteristics of the pattern, and the ways in which diseases cause it, are described.
Differential diagnosis, using clinical and radiographic findings, is discussed.     

Radiographic appearance of pulmonary metastases from transitional cell carcinoma of the bladder and urethra of the dog

Eleven cases of histologically proven transitional cell carcinoma of the bladder or urethra of the dog were selected for evaluation and characterization of the varied radiographic appearances of the lungs. In the 8 dogs with metastases, those appearances included radiographically normal pulmonary parenchyma, a semidense, diffuse, lacelike haze referred to as interstitial opacity, nodular interstitial opacity, and consolidations. One affected dog had hilar lymphadenopathy. In the 3 dogs without pulmonary metastases, the radiographic appearance was either normal pulmonary parenchyma or increased unstructured interstitial opacity. Of all dogs in the study, 6 had a radiographic appearance of increased unstructured interstitial opacity. Four of those 6 had histologically proven metastases in the peribronchiolar lymphatics or alveolar capillaries. Dyspnea was not identified in any of the affected dogs. The radiographic appearance for 3 of the 8 dogs with pulmonary metastases was misinterpreted as opacity compatible with age. The radiographic appearance for 1 of the 3 dogs without pulmonary metastases was misinterpreted as highly suspect for metastases.     

Chronic idiopathic pulmonary fibrosis in five dogs

Five dogs presented with chronic and progressive pulmonary illness characterized by progressive dyspnea, exercise intolerance, and significant inspiratory crackles on auscultation. Radiographically, there was a widespread and diffuse interstitial lung pattern with varying degrees of bronchial involvement. Histopathological changes included thickened alveolar septa, interstitial fibrosis, and pneumocyte hyperplasia. Based on the clinical, radiographic, and histopathological changes, a diagnosis of idiopathic pulmonary fibrosis was made. Idiopathic pulmonary fibrosis is a chronic disease characterized by inflammation and fibrosis of the pulmonary interstitium and peripheral airspaces, which has been poorly characterized in the dog.     

Treatment of canine dirofilariasis: pulmonary thromboembolism caused by thiacetarsamide--microscopic changes

Light and scanning electron microscopies were used to study the pulmonary embolism occurring in Dirofilaria immitis-infected dogs after treatment with thiacetarsamide. Lesions in control dogs (nontreated) which had been infected for 4 weeks with 9 Dirofilaria immitis adults were compared with lesions occurring in infected dogs at 2 weeks and at 4 weeks after they were treated with the adulticide. Extensive thromboembolism occurred in the caudal lobar pulmonary arteries of dogs at posttreatment weeks 2 and 4. Complicated villous proliferations were present at posttreatment week 2. The characteristic myointimal proliferation of dirofilariasis showed resolution in the large pulmonary arteries of the dogs at week 4. However, the caudal lobar pulmonary arterial and lung lesions were more severe in the later group. The pathophysiology of adulticide-induced thromboembolism and associated lung parenchymal changes were discussed.     

Bronchoalveolar lavage affects computed tomographic and radiographic characteristics of the lungs in healthy dogs

Bronchoalveolar lavage is a common diagnostic test for dogs with suspected pulmonary disease, however there is no published information on whether this procedure could affect the imaging characteristics of the lungs. Aims of this prospective experimental study were to describe computed tomography (CT) and radiographic features of the lungs after bronchoalveolar lavage in a sample of healthy dogs. Thoracic CT and radiographic images of eight healthy Beagles were acquired at the following time points: before bronchoalveolar lavage, immediately following bronchoalveolar lavage, and at 2, 4, 8, 12, and 24 h following bronchoalveolar lavage. Lung consolidation or interstitial patterns were seen in CT and radiographic images immediately after the procedure. Radiographic lung patterns resolved within 2 h and CT patterns resolved within 24 h. Resolution of the CT pulmonary patterns in the ventral areas of the lungs was delayed compared to the dorsal areas. Mean CT imaging scores differed over time (P < 0.001), while mean radiographic imaging scores did not differ over time. This study suggests that thoracic radiography and CT imaging assessments should precede bronchoalveolar lavage procedures if possible, or be performed at least 24 h afterward.     

RETROSPECTIVE ASSESSMENT OF THORACIC RADIOGRAPHIC FINDINGS IN METASTATIC CANINE HEMANGIOSARCOMA

Twenty-one dogs with histopathologically confirmed hemangiosarcoma were evaluated by thoracic radiography for metastatic disease. All dogs had histopathologic examinations of the lungs within two weeks of thoracic radiography. Fourteen dogs had histopathologic evidence of pulmonary hemangiosarcoma; metastatic disease was detected radiographically in eleven of these dogs. The most common radiographic pattern was that of poorly defined small coalescing nodules (8 dogs); other radiographic patterns included well-circumscribed nodules (3 dogs) and alveolar infiltrates secondary to hemorrhage (2 dogs). Differential diagnoses for diffuse, poorly defined, coalescing pulmonary opacities should include hemangiosarcoma in addition to edema, lymphoma, systemic mycoses, fibrosis, allergy, toxicosis, and carcinomas.     

Diffuse alveolar injury in two dogs

Proliferative interstitial pneumonia of undetermined cause was diagnosed in 2 dogs. The clinical signs in both dogs consisted primarily of acute onset, rapid breathing, and raspy lung sounds. Radiography revealed a diffuse increase in pulmonary alveolar density. In both dogs, the primary pathologic process was diffuse alveolar pneumocyte injury, and the pulmonary lesions were similar. Proliferation of type II pneumocytes (some of which were atypical mononucleated, and others multinucleated) was a prominent feature of the interstitial pneumonia. Because of the atypical features of some pneumocytes in such cases, biopsy findings may suggest a neoplastic process. Proliferative interstitial pneumonia should be included in the differential diagnosis of a diffuse pulmonary disease that is poorly responsive to medical treatment.     

THORACIC COMPUTED TOMOGRAPHY,ANGIOGRAPHIC COMPUTED TOMOGRAPHY,AND PATHOLOGY FINDINGS IN SIX CATS EXPERIMENTALLY INFECTED WITH AELUROSTRONGYLUS ABSTRUSUS

Aelurostrongylus abstrusus infection is common in endemic areas and may cause severe respiratory clinical signs. Computed tomography (CT) is an important tool to diagnose pulmonary disease, because it allows detection of small lesions and discrimination of superimposed structures. The purpose of this study was to characterize by CT and angiographic CT the pulmonary lesions in six cats before, and 48 and 81 days after inoculation with 100 or 800 A. abstrusus infective larvae. Histological examination of the accessory lung lobe was performed to determine the microscopic, pathomorphologic correlate of the CT findings. The predominant CT lesion consisted of multiple nodules of varying size distributed throughout the lungs, severity depending on infectious dose. The histological correlate of the nodular lesions was multifocal dense granulomatous to mixed inflammatory cell infiltrates, including eosinophils distributed in the parenchyma and obliterating the alveoli. Marked, multifocal, dose‐dependent thickening of the bronchi and adjacent interstitial changes blurred the margins of the outer serosal surface of the bronchi and vessels. Histologically, this was due to peribronchial mixed cell inflammation. During the course of infection some of the nodular and peribronchial changes were replaced by areas of ground‐glass opacity. In addition to providing detailed depiction of pulmonary lesions resulting from an infectious cause and clearly defining lesions with respect to time and severity of infection, CT allowed quantitative assessment of bronchial thickness and lymph node size during the course of disease. Findings indicated that CT characteristics of this disease are consistent with pathologic findings.     

RADIOGRAPHY REVIEW: THE VASCULAR AND BRONCHIAL PATTERNS OF PULMONARY DISEASE

Pulmonary blood vessels account for the majority of radiographically visible structures in normal lung. The vascular pattern of pulmonary disease is characterized by changes in vessel size, shape, contour. Changes in size can be classified as hypo vasularity (decreased size) or hyper vascularity (increased size). The pulmonary arteries and veins may be affected separately or simultaneously. In normal lung, the bronchial structures peripheral to the hilar area are not seen clearly. The bronchial pattern of pulmonary disease is characterized by alteractions in bronchial wall thickness and dinsity, or in bronchial lumen diameter. Mixtures of the four lung patterns, i.e. , alveolar, interstitial, bronchial, and vascular, occur frequently. The lung radiographic pattern in an individual animal depends not only on the disease process present, but also on the stage of the disease during which they are radiographed.     

RADIOGRAPHIC AND HISTOPATHOLOGIC CHARACTERISTICS OF PULMONARY FIBROSIS IN NINE CATS

Pulmonary fibrosis is a progressive fatal interstitial lung disease that is often idiopathic, occurs in multiple species, and may be caused by a number of inciting factors. The purpose of this retrospective, multicenter study was to describe the radiographic and histopathologic characteristics of idiopathic and induced pulmonary fibrosis in a group of cats. Cats with thoracic radiographs and histopathologically confirmed pulmonary fibrosis were recruited using the American College of Veterinary Radiology list serve. A board‐certified veterinary radiologist and diagnostic imaging intern reviewed radiographs and recorded characteristics by consensus. Findings from additional imaging modalities were also recorded when available. All histopathology samples were re‐reviewed by a veterinary pathology resident. A total of nine cats met inclusion criteria. All patients had a broad range of radiographic characteristics that included broncho‐interstitial pattern, alveolar pattern, pulmonary masses, pulmonary bullae, pleural effusion, and cardiomegaly. Cats with available echocardiographic studies had characteristics that included right ventricular dilation and hypertrophy and pulmonary arterial hypertension interpreted to be secondary to primary lung disease. Cats with available CT studies had characteristics that included focally increased soft tissue attenuation, masses, and ventral consolidation that exhibited no improvement with dorsal versus ventral recumbency. Histopathology showed pulmonary fibrosis, type II pneumocyte hyperplasia, and smooth muscle hypertrophy in all patients. Epithelial metaplasia was present only in one patient. Findings from the current study indicated that cats with pulmonary fibrosis have highly variable radiographic characteristics and that these characteristics may mimic other diseases such as asthma, pneumonia, pulmonary edema, or neoplasia.     

Exercise-induced pulmonary haemorrhage in the horse: results of a detailed clinical, post mortem and imaging study. III. Subgross findings in lungs subjected to latex perfusions of the bronchial and pulmonary arteries

Latex was injected under pressure into bronchial and pulmonary arteries of the inflated lungs of Thoroughbreds and transverse sections taken to calculate the area of lesions resulting from exercise-induced pulmonary haemorrhage. Extensive areas of dense brown haemosiderin varying from 0 to 45 per cent of total lung volume were identified, predominantly in the dorsocaudal lungfields. Bronchial arterial proliferation appeared to have replaced the pulmonary supply in affected areas of the lung. Closely associated with the staining and bronchial arterialisation, there was widespread small airway disease. The most severely affected bronchioles contained thick gelatinous or mucous exudate or mucoid plugs and had grossly thickened walls. These lesions suggest that the source of haemorrhage in exercise-induced pulmonary haemorrhage is from alveolar capillaries anomalously supplied by the bronchial arterial circulation through the development of pathological shunts. Small airway disease is suggested as being of major importance in the pathogenesis of the disease and may have led to the initial proliferation of the bronchial circulation.     

MULTIDETECTOR‐ROW COMPUTED TOMOGRAPHY PATTERNS OF BRONCHOESPHAGEAL ARTERY HYPERTROPHY AND SYSTEMIC‐TO‐PULMONARY FISTULA IN DOGS

Anomalies involving arterial branches in the lungs are one of the causes of hemoptysis in humans and dogs. Congenital and acquired patterns of bronchoesophageal artery hypertrophy have been reported in humans based on CT characteristics. The purpose of this retrospective study was to describe clinical, echocardiographic, and multidetector computed tomography features of bronchoesophageal artery hypertrophy and systemic‐to‐pulmonary arterial communications in a sample of 14 dogs. Two main vascular patterns were identified in dogs that resembled congenital and acquired conditions reported in humans. Pattern 1 appeared as an aberrant origin of the right bronchoesophageal artery, normal origin of the left one, and enlargement of both the bronchial and esophageal branches that formed a dense network terminating in a pulmonary artery through an orifice. Pattern 2 appeared as a normal origin of both right and left bronchoesophageal arteries, with an enlarged and tortuous course along the bronchi to the periphery of the lung, where they communicated with subsegmental pulmonary arteries. Dogs having Pattern 1 also had paraesophageal and esophageal varices, with the latter being confirmed by videoendoscopy examination. Authors conclude that dogs with Pattern 1 should be differentiated from dogs with other congenital vascular systemic‐to‐pulmonary connections. Dogs having Pattern 2 should be evaluated for underlying pleural or pulmonary diseases. Bronchoesophageal artery hypertrophy can be accompanied by esophageal venous engorgement and should be included in the differential diagnosis for esophageal and paraesophageal varices in dogs.     

Pulmonary manifestations of heartworm disease

The clinical signs associated with heartworm disease are the result of changes in the pulmonary arterial system. These clinical signs are the result of either pulmonary hypertension or lung parenchymal disease associated with vascular changes. An increase in pulmonary arterial pressure produces an increase in right ventricular afterload, which may lead to exercise intolerance, syncope, and right-sided congestive heart failure. Coughing, dyspnea, and hemoptysis are the results of pulmonary parenchymal disease.     

Radiographic findings in dogs with pulmonary blastomycosis: 125 cases (1989-2006)

OBJECTIVE: To identify radiographic patterns in dogs with pulmonary blastomycosis and radiographic factors associated with outcome. DESIGN: Retrospective case series. ANIMALS: 125 dogs with pulmonary blastomycosis. PROCEDURES: Medical records were reviewed, and for each lung lobe, the primary radiographic pattern and percentage of lobar involvement at the time of initial examination were recorded. RESULTS: 79 dogs survived, 38 died, and 8 were euthanized without treatment. The initial radiographic pattern was variable and not significantly associated with outcome. Mean half-time for radiographic resolution of pulmonary infiltrates was 41.4 days for all patterns except masses, for which mean half-time to resolution was 90.8 days. Transient radiographic worsening was seen in 20 of 87 (23%) dogs but was not associated with a poor prognosis. Pulmonary bullae were seen in 20 (16%) dogs, most often in association with an alveolar pattern. Accuracy of using percentage of right caudal lung lobe involvement ( 20%) to predict outcome was 74.4%; accuracy of using number of affected lobes (< 4 vs >or= 4) to predict outcome was 65.8%. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that a nonuniform distribution of pulmonary infiltrates was equally as likely as a diffuse nodular interstitial pattern in dogs with pulmonary blastomycosis. On the basis of half-time for resolution of pulmonary infiltrates, follow-up radiography should be performed no more often than every 4 to 6 weeks in clinically stable patients. Transient radiographic worsening that occurred during the initial weeks of treatment was not associated with a poorer prognosis.     

Lung Injury Leading to Respiratory Distress Syndrome in Young Dalmatian Dogs

A progressive pulmonary disease resulting in severe respiratory failure and death in an average of 3 weeks was diagnosed in 11 young Dalmatian dogs. The dogs were from 4 litters, all genetically related by a common ancestor. The initial clinical signs were tachypnea and noisy respiration. Respiratory distress developed shortly before death and was characterized by strenuous and rapid respirations, along with cyanosis and vomiting. On blood gas analysis, there were severe arterial hypoxemia, hypercapma, and marked alveolar-arterial oxygen difference. Radiographically, a diffuse pattern of alveolar, interstitial, and peribronchial densities was observed in the lungs. Most dogs developed pneumomediastinum and gastroesophageal intussusception in the terminal phase of the disease. There was no response to treatment with antibiotics, corticosteroids, diuretics, or oxygen. At necropsy, the lungs were wet, heavy, and relatively airless. Absence of 1 kidney in 2 dogs and severe internal hydrocephalus in 2 dogs were additional necropsy findings. Pulmonary histopathology included metaplasia and atypia of the alveolar and bronchiolar epithelium, a nonpurulent inflammatory reaction characterized mainly by mononuclear cells and macrophages, eosinophilic hyaline membrane formation, and focal pulmonary fibrosis. The histological manifestations were typical of acute lung injury. Clinically, the findings were consistent with adult respiratory distress syndrome (ARDS), except for the relatively long course. No known risk factors for ARDS, such as trauma, toxin exposure, infection, or endotoxemia could be identified. The relationship of the other abnormalities (ie, renal aplasia, hydrocephalus) to the pulmonary disease also remains obscure. An inherited defect is suspected, because segregation analysis of the 4 litters suggests autosomal recessive inheritance.