IMAGING DIAGNOSIS—CONGENITAL LOBAR EMPHYSEMA IN A DOG

A 14‐week‐old female West Highland White Terrier developed acute dyspnea. Radiographically there was an enlarged, hyperlucent caudal portion of the left cranial lung lobe and a diffuse, severe interstitial‐to‐alveolar pattern in the remaining lung lobes that was accentuated caudodorsally. Computed tomography confirmed the presence of the emphysematous lobe and further showed it to have focal lobar bronchial collapse. Lung lobe resection was performed, and the diagnosis was congenital lobar emphysema secondary to bronchial cartilage hypoplasia.     

Use of computed tomography and minimum intensity projection in the detection of lobar pneumonia mimicking lung lobe torsion in a dog

A 10‐year‐old female spayed Dachshund was referred with progressive coughing for 1 month. The dog was tentatively diagnosed with right middle lung torsion based on pleural effusion, vesicular emphysema, abruptly ending bronchus in consolidated right middle lung, and no contrast enhancement of the affected lobe on radiography and computed tomography (CT). There was no evidence of torsion upon thoracotomy, and histological examination confirmed lobar pneumonia. The CT images were reevaluated using minimum intensity projection and revealed normal bronchial courses. The minimum intensity projection technique can be to assist in evaluation of the bronchial tree for dogs with suspected lung lobe torsion and other pulmonary diseases.     

Surgical correction of congenital lobar emphysema in a dog

Massive lobar emphysema in the middle lobe of the right lung was observed in a dog brought to our clinic with sudden onset of tension pneumothorax, and lobectomy was performed to excise it. Pathological examination resulted in a diagnosis of congenital bronchiectasis associated with bronchial cartilage hypoplasia. Two cases of diagnosis and successful treatment of congenital lobar emphysema have been reported in dogs.     

Spontaneous midlobar lung lobe torsion in a 2-year-old Newfoundland

A 2-year-old, intact male Newfoundland was presented for evaluation of a 1- to 2-day history of coughing, retching, and progressive lethargy. Thoracic radiographs demonstrated right-sided pleural effusion and lobar vesicular emphysema. An exploratory thoracotomy revealed midlobar torsion of the right caudal lung lobe. A partial lung lobectomy was performed, and following surgery, the dog recovered without complications. Lung lobe torsions in dogs typically occur at the hilus of the affected lung lobe. This report documents that midlobar lung lobe torsions occur in dogs and should be considered as a differential diagnosis in cases of lobar vesicular emphysema and pleural effusion.     

RADIOGRAPHIC DIAGNOSIS OF LUNG LOBE TORSION

Clinical data, thoracic radiographs, ultrasonographic exams, and histopathologic reports in 13 dogs and two cats with confirmed lung lobe torsion were reviewed. Age of dogs ranged from 4 months to 11.5 years, (mean of 6.4 years) and several breeds of large and small dogs were represented. Right middle lobe torsion was predominant in large dogs (five of eight large breed dogs) and left cranial lobe torsion was more commonly seen in small dogs (three of five small-breed dogs). Two domestic short-hair cats, 10 and 14 years of age, had right cranial and right middle lobe torsion, respectively. Underlying thoracic disease was found in only five of 15 patients. On thoracic radiographs, increased lobar opacity and pleural effusion were found in all patients (100%). Small dispersed air bubbles were found within the affected lobe of 13 patients (87%). This pattern, which was the result of vesicular emphysema, was variably extensive, and became more evident on follow-up radiographs in five of six dogs. The lobar bronchi could be seen in only eight of 15 patients (54%), and appeared irregular, focally narrowed or blunted in six of the eight patients, and displaced in five of the eight. Other common radiographic findings included mediastinal shift (nine), curved and dorsally displaced trachea (seven), and axial rotation of the carina (seven). Ultrasonography was used in seven patients and considered generally useful, although variable signs were observed.     

COMPUTED TOMOGRAPHIC FEATURES OF LUNG LOBE TORSION

The imaging features of lung lobe torsion in 10 dogs (nine complete, one partial torsion) acquired with a helical single‐slice computed tomography (CT) unit are described. Attenuation values of normal, rotated, and adjacent collapsed lung lobes before and after intravenous contrast medium administration were compared. Affected lung lobes were: left cranial (5), right middle (3), right cranial (1), and left caudal (1). CT findings in nine dogs with complete lung lobe torsion included pleural effusion and an abruptly ending bronchus. In eight of these dogs, enlargement, consolidation, emphysema of the affected lung lobe, and mediastinal shift to the contralateral side were present. Rotated lung lobes did not enhance, whereas adjacent collapsed and aerated lung lobes did (P<0.05). Apnea induced with hyperventilation or breath‐hold is essential to reduce motion artefacts and obtain a diagnostic study.     

Successive torsion of the right middle and left cranial lung lobes in a dog

This case report describes the torsion of two lung lobes in a dog. The animal was first presented for a torsion of the right middle lung lobe. Following the surgical resection of that lobe, the dog suffered another torsion of the left cranial lung lobe (cranial and caudal segments).     

Congenital lobar emphysema and tension pneumothorax in a dog.

Congenital lobar emphysema (CLE) and tension pneumothorax (TPT) are rarely reported in dogs. A case of CLE of the right middle lung lobe predisposing to air trapping, alveolar hyperinflation, and pleural rupture resulting in fatal spontaneous TPT in a 6-month-old mixed breed dog is described. The unique alteration of "bloat line" was observed in this case in addition to compressive atelectasis of all other lung lobes and lack of negative pressure within the thoracic cavity, signifying markedly elevated intrathoracic pressure. Bronchial cartilage hypoplasia and bronchiectasis were confirmed microscopically, which likely led to abnormal dynamic collapse of bronchi during expiration, consequentially leading to increased intrapulmonary pressure, bullous emphysema, and pleural rupture resulting in TPT. TPT consequent to CLE may therefore be considered one of the potential causes of sudden death in young dogs without overt clinical illness.     

Surgical treatment of congenital lobar emphysema in a puppy

Congenital lobar emphysema was found in a three-month-old male springer spaniel. Clinical signs included coughing, progressive dyspnoea and abnormal lung auscultation. Radiographic examination revealed overinflation and hyperlucency of the right middle lung lobe. Following lung lobectomy, clinical signs resolved and the animal had normal exercise tolerance. Previous case reports are reviewed and discussed in relation to human congenital lobar emphysema.     

COMPUTED TOMOGRAPHY BRONCHIAL LUMEN TO PULMONARY ARTERY DIAMETER RATIO IN DOGS WITHOUT CLINICAL PULMONARY DISEASE

Bronchiectasis is diagnosed in humans using multiple computed tomography (CT) criteria, the most important being dilatation of the bronchi. The most widely used criterion for detection of bronchial dilatation is a bronchial lumen to pulmonary artery diameter (bronchoarterial [BA]) ratio >1.0. No studies have been performed to determine the BA ratio in normal dogs. Thoracic CT images of 24 dogs without clinical pulmonary disease were reviewed. The BA ratio of the lobar bronchi of the left cranial (cranial and caudal parts), right cranial, right middle, left caudal, and right caudal lung lobes was measured. The mean of the mean BA ratio for all dogs was 1.45±0.21 (99% confidence interval [CI]=1.34–1.56). The mean of the mean BA ratio as determined by lung lobe was 1.45±0.04 (99% CI=1.41–1.49). The range of individual BA ratios was 0.8–2.0. There was no significant difference in mean BA ratios as a function of lung lobe ( P =0.60). The BA ratio in these clinically normal dogs was consistent and may be a useful tool in evaluating for bronchiectasis on CT images. BA ratios >2.0 were not identified in this population, suggesting a threshold to differentiate normal from abnormal bronchi.     

Usefulness of CT imaging for segmental lung lobe torsion without typical radiographic imaging in a Pomeranian

A 3-year-old, intact female Pomeranian presented with a 1-month history of coughing. Thoracic radiography showed focal infiltration of the left cranial lung lobe and widening of the cranial mediastinum. Subsequent computed tomography revealed torsion of the caudal segment of the left cranial lung lobe, which was confirmed by exploratory thoracotomy. There was no apparent underlying etiology for the condition. To the authors’ knowledge, this is the first report of lung lobe torsion in this breed and the first detailed CT imaging report for segmental lung lobe torsion.     

Endoscopic evaluation of bronchial morphology in rabbits

OBJECTIVE: To evaluate bronchial morphology endoscopically in rabbits and develop a valid nomenclature for the endobronchial branching pattern. ANIMALS: 10 mature New Zealand White rabbits. PROCEDURES: Flexible bronchoscopy was performed in rabbits anesthetized with isoflurane via nasal mask. Airways were systematically evaluated from the larynx to the terminal branches accessible with a 2.5-mm-outer diameter flexible endoscope. Airway branching patterns were identified and assessed for variation among subjects. RESULTS: Airways of all rabbits were readily examined with the 2.5-mm flexible endoscope. Laryngeal structure and function were normal in each rabbit, and airway branching patterns in all rabbits evaluated were identical. At the carina, branching into left and right principal bronchi was evident. The left principal bronchus divided immediately into the left cranial and left caudal lobar bronchi. The left cranial lobe bronchus further divided into dorsal and ventral segmental bronchi. The left caudal lobe bronchus gave rise to branches originating dorsally, ventrally, and medially before continuing caudally. The right principal bronchus divided into the right cranial, right middle, and accessory lobar bronchi and continued distally as the right caudal lobar bronchus. The right cranial lobe bronchus also divided into dorsal and ventral segmental bronchi, and the right caudal lobe bronchus had branches that originated dorsally, ventrally, and medially. CONCLUSIONS AND CLINICAL RELEVANCE: Definition of a standard nomenclature for airway branching in rabbits will allow precise localization of disease in clinical cases and accurate collection of airway samples in clinical and scientific evaluations.     

Congenital lobar emphysema in a kitten

A five‐month‐old ragdoll cat presented with severe respiratory signs, unresponsive to medical therapy. Hyperinflation of the right middle lung lobe was diagnosed with radiography and computed tomography. Lung lobectomy following a median sternotomy led to full recovery. Histopathological analysis revealed lobar emphysema and, based on the animal's age, congenital lobar emphysema was considered the most likely diagnosis.     

Radiographic and computed tomographic evaluation of experimentally induced lung aspiration sites in dogs

This study was performed to radiographically examine the prevalence of aspiration sites and to evaluate their atomical correlation with the bronchial pattens. Ten healthy beagle dogs were repeatedly radiographed, at weekly intervals, in the left and right lateral, ventrodorsal (VD) and dorsoventral (DV) positions. Three mililiters of iohexol distilled with same volume of saline was infused into the tracheal inlet. Which lung lobe was aspirated was decided upon by the presence of a significant alveolar pattern due to the contrast medium. Alveolar patterns were identified at the left (100%) and right cranial lung lobes (77%) with the dogs in dependant lateral recumbency, at the right caudal lung lobe (71%) with the dogs in VD recumbency and at the right middle lung lobe (59%) with the dogs in DV recumbency, respectively. The anatomical correlation was evaluated by performing computed tomography. The right principal bronchus (165.8 ± 1.6°) was more straightly bifurcated than was the left principal bronchus (142.7 ± 1.8°, p < 0.01). In VD position, the right side lung had a greater opertunity to become aspirated. The ventrally positioned right middle lobar bronchial origin was more easily to be aspirated the other laterally positioned ones. We think that these anatomical characteristics can be one of the causes for aspiration pneumonia to occur more frequently in the right side lung.     

Segmental lung lobe torsion in a 7-week-old Pug

Case summary: A 7‐week‐old, intact female Pug was referred with an acute history of expiratory dyspnea, tachypnea, and pyrexia. Radiologic evaluation revealed bilateral pleural effusion and a poorly demarcated area of soft tissue opacity cranial to the heart. The presence of air bronchograms in the cranial lung lobes suggested alveolar parenchymal pathology consistent with pulmonary edema, congestion, or cellular infiltration. Exploratory thoracotomy revealed a segmental torsion of the left cranial lung lobe. The affected lobe was removed and the puppy recovered uneventfully. Unique information: Lung lobe torsion tends to occur more frequently in mature large breed dogs at a mean age of 3 years. The age, breed, and segmental nature of the torsion in the reported case are contrary to most of the previously documented cases of lung lobe torsion. To the authors' knowledge, this is the first report of lung lobe torsion in a 7‐week‐old dog.     

Lung lobe torsion associated with chest wall defects in a dog

An 8-year-old, spayed, female poodle presented with exercise intolerance, lethargy, respiratory distress, retching, hyporexia and diarrhoea. Thoracic radiographs revealed increased opacity in the left cranial thoracic region. The fifth and sixth ribs appeared to be bulging cranially to caudally, and CT and surgical exploration confirmed the presence of a thoracic wall defect in that area. CT showed abrupt occlusion of the bronchus that branches into the left cranial lobe and consolidation of the caudal segment of left cranial lung lobe, which led to the diagnosis of lung lobe torsion. A thoracotomy was performed, the twisted lung lobe was surgically excised, and the defect in the thoracic wall was repaired. Respiratory distress gradually improved after the surgery, and there were no identified complications within the 2-year period following the procedure. Based on our literature search, this is the first reported case of lung lobe torsion caused by a thoracic wall defect in a dog.     

Study of lobation and vascularization of the lungs of wild boar (Sus scrofa)

The purpose of this study was to describe the anatomy of the lungs of wild boars for comparison with those of domestic swine. It was found that the right lung of the wild boar is divided into four lobes: cranial, median, caudal and accessory, whereas the left lung is divided into two lobes: cranial and caudal. In 93.4% of the cases, right pulmonary artery separates into the ascendant, descendant, median, accessory and caudal branches. In 73.3% of the cases, left pulmonary artery separates most frequently to form three branches to the cranial lobe, whereas the median lobe is generally supplied by only one arterial branch. There is a single pattern of bronchial distribution: in the right lung a tracheal bronchus leads to the cranial lobe, where it separates into the cranial and caudal bronchi and there are also bronchi to the median, caudal and accessory lobes. In the left lung, the large bronchus separates to form two branches, one of which further separates to form two branches to the cranial lobe whereas the other forms a single branch to the caudal lobe.     

Congenital lobar emphysema in two dogs

Congenital lobar emphysema is described in two dogs. The condition was characterized by progressive dyspnoea and cyanosis from a very young age. There was marked expiratory effort, and wheezing and crackling were evident on auscultation. Radiographic examination revealed overdistension and emphysema of the right middle lobe with displacement of the heart and mediastinum to the opposite side. The pathology and possible treatments are discussed.     

INTERMITTENT CRANIAL LUNG HERNIATION IN TWO DOGS

Two aged dogs with chronic obstructive airway disease were evaluated because of intermittent swelling of the ventral cervical region. Radiographs made at expiration and caudal positioning of the forelimbs allowed identification of intermittent cervical lung herniation of the left and right cranial lung lobe in both dogs. Pulmonary hyperinflation, increased expiratory effort, and chronic coughing were considered responsible for the lung herniation. Cervical lung hernia should be included in the differential diagnoses of intermittent cervical swelling in dogs with chronic respiratory disorders associated with increased expiratory effort and chronic coughing.