Today’s case is a 12-year-old female neutered Golden Retriever with coughing and lethargy. Feel free to post your interpretations in the comments section.
A severe diffuse alveolar pattern is present in the right cranial, left cranial, and right middle lung lobes. On the left lateral projection, multiple rounded gas opacities are present within the right cranial lung lobe and the caudal margin of the alveolar pattern in this lobe is rounded. A dense interstitial to alveolar pattern is present in the left caudal lung lobe and a moderate interstitial pattern is present in the right caudal lung lobe. A chest tube is present extending through the right thoracic wall to the right cranioventral thorax. A small amount of gas is present in the pleural space ventral to the heart. There is mild pleural effusion. The cardiovascular structures are obscured by the pulmonary pattern. Periarticular osteophytes are present at the caudal aspect of one of the shoulder joints.
CTâ€”7-mm transverse slices were obtained of the entire thorax. Additional 3 mm slices were obtained of the cranial and caudal lungs. There are severe alveolar consolidation of the ventral lungs bilaterally. The ventral aspect of the right cranial lung lobe appears enlarged and has cavitary gas accumulation. There are severe diffuse interstitial infiltrates involving all lung lobes. Bilateral chest tubes are present. There is minimal pleural effusion. There is a small amount of pleural gas bilaterally, left worse than right. There is a large amount of subcutaneous emphysema along the right lateral thorax.
Severe alveolar pattern worse in the cranioventral lung lobes most likely represents bronchopneumonia. A gas pattern and rounding of the caudal margin of the right cranial lung lobe is suggestive of a pulmonary abscess or a neoplasia. The interstitial pattern in the caudal lung lobes may represent infectious or non-infectious inflammatory processes such as ARDS or DIC or partial atelectasis of these lung lobes.
Necropsy – The pathological findings show a severe necrotizing pleuropneumonia. Possible etiologies include hematogenous infections, aspiration pneumonia or foreign body. In this dog, however, no evidence of foreign body, neoplasm or extra-pulmonary active infection was grossly observed. The pneumothorax and pyothorax are likely secondary to the multiple rupture of the lung parenchyma.