Today we have a 10 year old male neutered Yorkshire Terrier with 3 day history of worsening cough and lethargy. This one is interesting, see what you think and post your comments.
10 year old Yorkshire Terrier
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{ 7 comments… read them below or add one }
On the lateral projections, there is generalized increased opacity of the thoracic region and the cardiac silhouette cannot be visualized. Several lobar and fissure signs are evident. Cranial lung lobes seem to be pushed away caudally.
Right side of the cardiac border is delineated on the dorsoventral view, indicating the presence of moderate amount of plural effusion. However, left caudal lung lobe is partially and markedly opacified and silhouettes the heart leaving its left border oblitrated. There is a prominent lobar sign between the left caudal lobe and the caudal subsegment of the cranial lobe.
Cranial mediastinum is noticeably enlarged and there is severely increased interstitial pattern throughout the lung.
Ultrasonography is recommended to further evaluate the cardiac structure and the left caudal lung lobe and detect any possible cardiac masses.
There is a small amount of pleural effusuin. The left caudal lung lobe seems consolidated with no bronchial marking. I suspect an obstruction of the left lobar bronchus due to inflamation/neoplasia/foreign body/thrombus
I forgot to mention that from the level of the carina on there are no bronchial markings on the left side
The findings so far are an alveolar pattern in the left caudal lung lobe, pleural effusion, and a wide mediastinum. One suggestion was a lobar bronchus obstruction, but is there any evidence of volume loss in that lung lobe? I’d expect to see a mediastinal shift to the left in that case. What other differentials can you think of?
Could the widening of the cranial mediastinum be secondary to fat deposition? There’s no mass signal on trachea wich is not displaced or compressed. The alveolar density of caudal left lung lobe is not accompanied of decreasing in its volume, therefore, I exclude an atelectasia of the lung lobe. I would include consolidation of lung lobe secondary to fluid deposition related to a lobar bronchopnaumonia and lung lobar torsion in my list of differential diagnosis.
There is, in my opinion, an interstitial and peribronchial pattern in all right lung lobes. The mediastinum is widened (enlarged lymph nodes?) and between lobes pleural effusion is visible. There is alveolar pattern in caudal left lung lobe with partial aerobronchogram. Left main bronchi is very narrowed. My first suggestion would be infiltration due to lobar neoplasm, infection, fungus? I see no evidence of mediastinal shift or volume loss in left lung. I know that is probably not important, but the axis of a stomach is abnormal and a shadow of a liver is very small. Maybe the breathing problems are the result of a general disease?
With all this changes I consider lynphoma like one of the differentials. The enlarged of mediastinum may be due increase of mediastinal linphonode placed in ventral midle of trachea (thorax) – the image in one lateral view sugest a mild dorsal desplacement in the midle of trachea.
Changes viewed in lungs may be consequence or a concomitant pneumonia.
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