Fatal hemoptysis after bronchoscopic biopsy in a dog

An 8‐year‐old 24.6 kg mixed breed dog underwent bronchoscopy for evaluation of a persistent progressive cough. Bronchoscopy documented a markedly thick and irregular, cobblestone appearance of the mucosa. A bronchoscopic biopsy was obtained; immediately after the biopsy, a large amount of hemorrhage poured from the endotracheal tube. Multiple efforts to control the hemorrhage were unsuccessful and the dog suffered a cardiopulmonary arrest and could not be revived. A necropsy was performed, which was significant for pallor, evidence of prior heartworm disease, prominent bronchial arteries, and erosion of the submucosal vessels at the site of the biopsy. The cause of death was hemorrhage associated with transbronchial biopsy of an enlarged bronchial artery associated with heartworm disease. This report describes a rare complication of a routine diagnostic procedure.     

Successful management of saltwater submersion injury in a dog using mechanical ventilation

Objective– To describe successful management of saltwater near-drowning in a dog using mechanical ventilation. Case Summary– A 7-year-old spayed female Golden Retriever weighing 37 kg was referred for mechanical ventilation after saltwater submersion injury. The dog had a history of rare seizures characterized by pre-ictal agitation. On the morning of the event, the dog became agitated and ran toward Puget Sound. The owners discovered the dog unconscious in approximately 25.4 cm (10 in) of water, with her head submerged. The owners estimated that the dog was submerged for approximately 30 seconds. The dog was presented immediately to the nearest emergency facility where initial diagnostic testing and treatment included venous blood gases, nasal oxygen, and IV fluids. The dog was dyspneic despite nasal oxygen administration and was referred for mechanical ventilation. Upon arrival the patient was cyanotic with an arterial partial pressure of oxygen of 38 mm Hg (reference interval 85–100 mm Hg) and oxygenation saturation of 62% (reference interval >95%). Thoracic radiographs were taken and revealed severe, bilateral pulmonary infiltrates. The patient was ventilated for 70 hours and was discharged 4 days later. Complications included pneumonia and phlebitis at the site of a cephalic IV catheter. Follow up thoracic radiographs 10 days after discharge were within normal limits and the owners report a full recovery at 1 year. New or Unique Information Provided– Submersion injury can result in acute respiratory distress syndrome in dogs. Mechanical ventilation provided critical support during pulmonary recovery in this dog.     

Medical and surgical management of severe barium aspiration in a dog

Objective– To describe the medical and surgical management of a unique case of barium sulfate aspiration pneumonia in a dog. Case Summary– A 5‐year‐old spayed female black Labrador Retriever weighing 33 kg was presented for evaluation of barium aspiration pneumonia. Approximately 200 mL of barium had been instilled into the caudal lung lobes via an improperly placed orogastric tube. Right caudal, right middle, and accessory lung lobectomies were performed, and the dog was managed intensively for 19 days in the hospital. New or Unique Information Provided– This is the first report of a complete diagnostic work‐up including bronchoscopy, bronchoalveolar lavage, culture, thoracotomy, and pulmonary histopathology for severe barium sulfate aspiration in a dog with an excellent outcome.     

Successful management of severe hypoventilation and hypercapnia in an alpaca (Vicugna pacos) with short‐term mechanical ventilation

Objective – To describe the successful management of an alpaca with severe hypoventilation and hypercapnia, suspected to be secondary to an anesthesia‐related event. Case Summary – A 3‐year‐old, female alpaca underwent a routine eye enucleation under general anesthesia after traumatic globe perforation. Severe hypoventilation and associated hypercapnia developed postoperatively resulting in a severe primary respiratory acidosis. The awake alpaca was supported with positive‐pressure ventilation for approximately 20 hours before successful weaning. Recovery to hospital discharge occurred over the subsequent 5 days with the alpaca regaining apparently normal respiratory function. New or Unique Information Provided – To the knowledge of the authors, this is the first report describing positive‐pressure ventilation of an alpaca in the veterinary literature. In this case of severe hypoventilation, ventilatory support was essential to the positive outcome. As South American camelids continue to increase in popularity there may be an increased demand for high‐quality and sophisticated veterinary care for these animals. Mechanical ventilation can be used to help restore and maintain normal PO₂, PCO₂, and respiratory acid‐base status in alpacas with ventilatory dysfunction.     

A study of experimental acute lung injury in pigs on zero end-expiratory pressure

OBJECTIVES: Tidal expiratory flow limitation (EFL) has been reported in humans with acute lung injury (ALI) and assumed to be associated with small airway closure. Detection of EFL is important because by selecting positive end-expiratory pressure at such a level that EFL is no longer present in the tidal breath, the repeated opening and closure of small airways can be prevented. The objective of this study was to investigate the occurrence of EFL in two experimental models of ALI. ANIMALS: Ten female piglets. METHODS: Animals were anaesthetized, tracheotomized and mechanically ventilated on zero end-expiratory pressure. Acute lung injury was induced by oleic acid (OA) (n = 5) or saline lavage (SL) (n = 5). Tidal EFL was assessed by the negative expiratory pressure test. Lung and chest wall mechanics were partitioned using an oesophageal balloon. Resistance and static elastance were assessed by a rapid airway occlusion technique at baseline ventilatory settings. RESULTS: There was no EFL at any time before and after ALI in both models. This may be due to an increased elastance which promoted higher expiratory flow after ALI and to a decreased chest wall to lung static elastance ratio which could favour small airways patency. The similar increase in total lung resistance, in the two models, after ALI was mostly due to an increased airway resistance in the OA model and to the lung tissue resistance in the SL model. CONCLUSIONS AND CLINICAL RELEVANCE: Tidal EFL was not detected in experimental ALI. This finding casts some doubt about the usefulness of some experimental models of ALI to mimic some reported findings in human ALI.     

Acute respiratory distress syndrome in dogs and cats: a review of clinical findings and pathophysiology

Objective: To review the clinical and pathophysiologic aspects of acute respiratory distress syndrome (ARDS) in dogs and cats. Data sources: Data from human and veterinary literature were reviewed through Medline and CAB as well as manual search of references listed in articles pertaining to acute lung injury (ALI)/ARDS. Human data synthesis: Since the term ARDS was first coined in 1967, there has been a abundance of literature pertaining to this devastating syndrome in human medicine. More complete understanding of the complex interactions between inflammatory cells, soluble mediators (e.g., tumor necrosis factor, interleukin (IL)‐6, IL‐8, platelet activating factor) and the clinical patient has provided for timely recognition and mechanistically based protective strategies decreasing morbidity and mortality in human patients with ARDS. Veterinary data synthesis: Although little is known, ARDS is becoming a more commonly recognized sequela in small animals. Initial case reports and retrospective studies have provided basic clinical characterization of ARDS in dogs and cats. Additionally, information from experimental models has expanded our understanding of the inflammatory mechanisms involved. It appears that the inflammatory processes and pathologic changes associated with ARDS are similar in dogs, cats, and humans. Conclusions: Unfortunately, current mortality rates for ARDS in small animals are close to 100%. As our capability to treat patients with advanced life‐threatening disease increases, it is vital that we develop a familiarity with the pathogenesis of ARDS. Understanding the complex inflammatory interactions is essential for determining effective preventative and management strategies as well as designing novel therapies for veterinary patients.     

Development of a radioimmunoassay for thyroxine in canines using polyethylene glycol

Metropolitan Clinical Laboratories, 687 West 8th Avenue, Vancouver, British Columbia, Canada Since the normal circulating level of thyroxine is so much lower in canines and other species than it is in humans, the authors suggest that it is impractical to use systems designed for thyroxine detection in human sera on their veterinary patients. Their newly developed, simple yet sensitive radioimmunoassay is presented here and further outlined in the accompanying table. Successfully performed on 500 canine patients, this radioimmunoassay features the use of T(4) standards prepared with T(4)-free serum, I(125) thyroxine with a very high specific activity, and specific antiserum for thyroxine, previously titered to give 50% binding of radioactive T(4) in the test system. Polyethylene glycol is used to separate the bound and free radioactive T(4), resulting in a procedure which can be performed rapidly at room temperature.     

一例泰迪犬冠状病毒感染伴发急性肺水肿的病理诊断报告

某宠物主人送检1只4月龄泰迪犬,初步确诊为冠状病毒感染,于输液过程中突然死亡。剖检可见整个肺脏呈深红色,肺叶边缘呈粉红色,切面深红色,支气管断端有大量红色液体渗出;剖开气管可见其浆膜面呈暗红色,腔内充满红色清亮液体;心脏左右心室扩张,质地柔软,心尖钝圆,呈心力衰竭心。对各个脏器取材进行病理组织学观察,主要病变表现为肺脏弥漫性淤血、水肿,心肌纤维局部溶解坏死。诊断该犬因感染冠状病毒后初次洗澡应激加重病情,并且随着大量静脉输液导致或加剧急性肺水肿发生,最终造成该犬急性死亡。对该病例进行了系统地病理剖检和组织病理学观察,为犬科动物和其他动物发生类似病症提供一定的参考。     

Serum concentrations of cardiac troponin I and cardiac troponin T in dogs with class IV congestive heart failure due to mitral valve disease

Objective: The objective of this study was to evaluate the incidence of circulating detectable serum levels of cardiac troponin I (CTnI) and circulating detectable serum levels of cardiac troponin T (CTnT) in dogs with class IV congestive heart failure (CHF) due to mitral valve disease (MVD) at admission. An additional study aim was to determine if detectable troponin levels correlated with the magnitude of several clinical parameters. Design: Prospective clinical investigation. Setting: Small animal emergency and critical care referral hospital. Interventions: Blood was collected before emergency treatment from 15 dogs presenting in class IV CHF due to MVD. Measurements: Serum concentrations of CTnI, CTnT at presentation. Main results: Six dogs (40%) had a detectable CTnI (median 0.24, range 0.12–0.31 ng/mL), and the remainder were less than 0.1 ng/mL and deemed non‐detectable. The one dog (7%) that had a detectable CTnT (0.02 ng/mL) also had a detectable CTnI (0.23 ng/mL). There was no statistical difference in survival to discharge between dogs with non‐detectable troponin levels and those with detectable troponin levels; however, dogs with detectable troponin levels had shorter overall survival times. Dogs with a detectable level of CTnI had a median survival of 67.5 days (range 1–390 days), and dogs with a non‐detectable level of CTnI had a median survival time of 390 days (range 20–912 days) (P=0.02). Conclusion: This study suggests that CTnI can be detected at admission in the blood of 40% of dogs with class IV CHF due to MVD. Dogs with non‐detectable levels of cardiac troponins had a significantly longer overall survival time. The encouraging results of this small pilot study warrant further investigation.