This week’s case is a 9 year old male neutered German Shepherd cross with chronic cough. What’s your interpretation? Post it in the comments section. Questions? Post them too!
9 year old German Shepherd with cough
Teaching and learning about veterinary diagnostic imaging.
This is a tuffie!
There is a diffuse broncho-interstitial pattern.
On the lateral views the heart looks too wide for a German Shepperd, which can indicate enlargement of the right side.
The pulmonary arteries are quite prominent.
Looks like a chronic airway disease (allergic most likely) with possible pulmonary hypertension.
Broncho-alveolar lavage woul be helpful, and echocardiography with Doppler to asses the pressure of the pulmonary a.
There is severe bronchointerstitial pulmonary pattern that obscures the visualization of the pulmonary vasculature. The cartilage of the bronchi are mineralized wich are also mildly enlarged (bronchiectasia?). It seems to me a case of pulmonary fibrosis maybe secondary to a chronic bronchitis (idiopatic? allergic?).
The cardiac silhouette shows the right side with the dimensions increased (mainly the right ventriculus – cor pulmonale?).
Can we exclude dextrocardia in this case ? Why is the cardiac silhouette not in direct contact with the sternum ?
Presented with 4views. A right lateral of the neck, a DV and two laterals of the chest. Positioning and exposure is good.
There is some mild ankyloses of C4-5 articular process
There is moderate to marked increase in peribronchial opacity and thickening supportive of pulmonary bronchial pattern, with some bronchioles not tapering completely, a sign bronchoiectasia. There is also an increase in overall lung opacity which may be due to concurrent diffuse interstitial pattern, however the dog is obese, and is likely fat deposition.
The cardiac silhouette appears normal, however is directed to the right thoracic cavity on the DV, there may be potentially dextrocardia but would suggest repeating the X-ray as it may have fallen into this position.
Sorry
DDx
Mineralised Bronchial Pattern – chronic Bronchitis = inflammatory/infectious > allergic > eosionophilic > idiopathic pulmonary fibrosis>> neoplasia.
Plan
BAL and bronchoscopy with cytology and c/sensitivity and would consider pulmonary biopsy.
On Dv projection, I think no abnormality with cardiac sillhouette or heart inducing radiographic chages except the right shifted apex. Can I say that this is an individual difference?