This week’s case is a 4-year-old male-neutered French bulldog presented with frequent vomiting, anorexia, aspiration pneumonia, septic shock and is currently on ventilator support. Comments?
Findings
Diffuse patchy alveolar infiltrates are seen throughout both hemithoraces. The pattern is present in all lung lobes with many indistinct air bronchograms. The pulmonary vasculature is poorly visualized; however, the cardiovascular structures appear to be within normal limits. An endotracheal tube is present within the trachea to the level of the carina. An esophageal feeding tube is also seen extending to the level 3rd ribs before folding back on itself on the initial lateral projections. A final left lateral projection reveals the esophageal tube passing through the length of the esophagus and into the gastric fundus where it again curves backwards but remains within the gastric lumen. A few anomalous vertebrae are present within the thoracic spine and are likely within normal limits given the breed of the patient.
Differential Diagnosis
Alveolar infiltrates, consistent with aspiration pneumonia. Concurrent non cardiogenic edema secondary to increased vascular permeability or partial atelectasis due to general anesthesia are also possibilities. Anomalous thoracic vertebrae. E-tube placement check.
Diagnosis
Sepsis and ARDS secondary to aspiration pneumonia.
Discussion
Necropsy: The most striking finding in this dog was the severe pulmonary disease. Alveolar septa were diffusely moderately thickened by edema, multifocal hyaline membranes, fibrosis, and type II-pneumocyte hyperplasia, consistent with an interstitial pneumonia and the clinical suspicion of acute respiratory distress syndrome (ARDS). Amongst a diffuse background of interstitial pneumonia was a more chronic airway centric fibrosing reparative process, characterized by bronchiolar and alveolar interstitial fibrosis which could be consistent with aspiration of gastric irritants leading to bronchiolar epithelial damage and repair by fibrosis with narrowing of airways (bronchiolitis obliterans).
regarding the Frenchie with Sepsis and ARDS secondary to aspiration pneumonia, was there any indication this might be a Valley Fever infection?