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Radiographic case study: A coughing Siberian Husky

Clinical history:

This is an 8 year old, male neutered, Siberian Husky dog with a history of a productive cough (mucoid, frothy discharge) and raspy breathing of 6 years duration. The cough was unresponsive to non steroidal anti inflammatory drugs and mucolytics. A broncho alveolar lavage (BAL) was performed and very thick yellow mucoid fluid was retrieved. The results are pending.

Radiographs were performed. Scroll down to view them:






Diagnostic Interpretation:

THORAX:

All of the visible bronchi do not taper normally (white arrowheads) and there is diffuse thickening and increased opacity of the bronchial walls. There is increased opacity of the ventral lung fields bilaterally, greater on the right, that partially to completely obscures the pulmonary vasculature, consistent with an alveolar pattern (white oval). This pattern is most apparent superimposed with the heart. The oesophagus is mildly gas distended. The cardiovascular structures and pleural space are normal. The included abdomen and musculoskeletal structures are normal.




Conclusions:

Diffuse bronchiectasis with mineralization/thickening of the bronchial walls is consistent with chronic bronchitis (inflammatory, allergic, infectious or parasitic aetiologies). Pneumonia of the ventral lung fields is likely due to decreased clearance secondary to bronchial disease and possible secondary infection.


Additional comments:

Huskies in particular are predisposed to eosinophilic bronchopneumopathy, which is the most likely cause of the severe bronchial disease in this patient. This can be secondary to parastic causes (lungworms, heartworms), so testing for those can also be considered. The bronchiectasis is unfortunately irreversible and a cause for recurrent pneumonia.


Update and BAL results:

(WASME) Wash Cytology

SAMPLE: BAL fluid

Gross description: Yellow and turbid thick fluid with some solid material.

DESCRIPTION

Two squash preparations are examined and are highly cellular with good preservation. Cells are composed predominantly of degenerate neutrophils and eosinophils which are intermixed with lower numbers of alveolar macrophages and occasional mast cells. Low numbers of clustered and individualised ciliated columnar epithelial cells are also seen. The background is dense, eosinophilic and stippled with some mucinous material and free nuclear material. No microorganisms or parasites are found.

INTERPRETATION

Marked neutrophilic and eosinophilic inflammation.

COMMENT

Cytology from this BAL is consistent with marked neutrophilic and eosinophilic inflammation. Although no bacteria are identified, culture is still indicated (to follow). The eosinophilic component is most commonly associated with allergic/hypersensitivity / disease or parasitism (for which occasionally eosinophilic bronchopneumopathy). Although no parasitic larvae are identified, empirical anthelmintic cover for lungworm may be considered.

(VCUL2) General bacteriology

SAMPLE: Wash

SITE: Bronchoalveolar lavage

Microaerophilic Culture: No growth after 48 hours

Anaerobic Culture: No anaerobes isolated


Additional information:


Here are two excellent abstracts from articles about the condition and the use of CT in diagnosing it. In the study 'Eosinophilic Bronchopneumopathy in Dogs' Siberian Huskies accounted for 26% (6) of the dogs in the study.