This week’s case is a 9-year-old female neutered Yorkshire terrier with 6-8 months of a dry, hacking cough. What are your findings?
On a lateral radiograph of the neck, there is increased opacity in the laryngeal region. The soft palate is elongated. The trachea is narrowed in the cervical region and at the thoracic inlet. On both the left and right lateral radiographs, the trachea is narrowed as well as the mainstem bronchi. The cardiac silhouette is moderately enlarged. The apex is raised from the sternum suggesting right sided enlargement. On the dorsoventral projection, the left caudal lobar artery is enlarged and tortuous. The right pulmonary artery is also enlarged but has a straighter course. The cranial mediastinum is widened, likely due to fat. The liver is enlarged and rounded, displacing the gastric axis. There is multifocal mineralization in the subcutaneous tissues dorsal to the spine.
Fluoroscopy was performed to evaluate the airways for collapse. There was dynamic collapse of the cervical and intrathoracic trachea with normal respiration, and with coughing the mainstem bronchi also collapsed (3rd image).
- Dynamic tracheal and bronchial collapse
- Right sided cardiomegaly and tortuous, enlarged arteries – pulmonary hypertension secondary to airway disease or heartworm disease
- Hepatomegaly (inflammatory, metabolic, toxic, neoplastic)
- Probable calcinosis cutis – Cushing’s disease or iatrogenic steroid administration
Severe airway collapse. Echocardiography confirmed severe right sided heart enlargement secondary to pulmonary hypertension (cor pulmonale). Heartworm antigen tests were negative, suggesting the airway disease as the cause for pulmonary hypertension.