1 / 14

And the Curious Case of Shelby Boykin (Accession 144376)

And the Curious Case of Shelby Boykin (Accession 144376). Trisha J Oura, DVM December 20, 2010. Shelby Boykin (144376). 5 mo F Chihuahua Chronic cough x 4 months, increasing in severity and frequency recently History of green nasal discharge, especially when cough is worse

miriam
Download Presentation

And the Curious Case of Shelby Boykin (Accession 144376)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. And the Curious Case of Shelby Boykin (Accession 144376) Trisha J Oura, DVM December 20, 2010

  2. Shelby Boykin (144376) • 5 mo F Chihuahua • Chronic cough x 4 months, increasing in severity and frequency recently • History of green nasal discharge, especially when cough is worse • Multiple courses of antibiotics = improvement/resolution of clinical signs • No known history of trauma • ~25 other dogs at home

  3. rDVM radiographs-August (1 mo old)

  4. Radiographs 12/17/2010

  5. Further Diagnostics • Bronchoscopy: • Sacculated appearance to left sided bronchi • Possible blind-ended bronchi • Mucus • Right sided airways are abnormal too • BAL: • Septic, suppurative inflammation • CT:

  6. ???? • Could this be congenital bronchial atresia/dysplasia? • Is this all secondary to previous infections?

  7. Bronchiolitis Obliterans • Nonspecific response to lung damage • Epithelial necrosis leads to bronchiole occlusion with fibro-cartilaginous tissue • Can be due to inhaled irritants/toxins, parasites, viral, fungal, bacterial infections • Damage to bronchiolar epithelium  formation of polyps of collagen, fibroblasts, inflammatory cells  polyps can cause complete obstruction of airway • Causes irreversible airflow obstruction • Reported in dogs, pigs, cattle, rodents, humans (especially after lung and stem cell transplants)—often fatal Almost ∧

  8. Fibrobascular polyps in a bronchiole with necrosis and inflammatory cell infiltration • Atelectasis, discoloration of lung lobes

  9. Post-Infectious BronchiolitisObliterans is Recognized in Pediatrics • Associated with adenovirus, Mycoplasma, flu, syncytial virus, etc • Histopath: granulation tissue plugs within the lumens of small airways and/or complete destruction of airways leaving a scar • Imaging: • Bronchogram: “pruned tree” • HRCT: bronchial dilation, wall thickening, parenchymal and vascular attenuation, areas of collapse, air trapping during expiration • NucMed: patchy decreases in ventilation and perfusion • CXR: variable but can include • unilateral hyperlucency of all/part of a lung which is enlarged • persistent collapse of affected lobe (up to 8 years post in one study)

  10. In the Literature You May Also See BOOP • BronchiolitisObliterans with Organizing Pneumonia • Often reserved for idiopathic version in humans (newer literature uses Cryptogenic Organizing Pneumonia), used somewhat interchangeably in vet med • Case report of 8 yo FS mixed breed with exercise intolerance and dyspneax 1 mo • CXR: diffuse interstitial, BAL: mucus without inflammation, CT: bronchiectasis, patchy consolidation • Diagnosis via histopath • Interestingly, dog had pulmonary hypertension so this could be a rule out for corpulmonale • Treated with steroids

  11. BOOP Continued… • Animal model of BOOP with oleic acid injury • DIFFERENT from ARDS: • ARDS involves diffuse injury to capillary/alveolar endothelium leading to leakage  edema • BOOP primarily affects distal airways and adjacent alvoeli and has airway plugging • BUT both could look similar on radiographs

  12. So What? • Shelby remains a mystery • Bronchial atresia/dyplasia seems unlikely given the normal radiographs, unilateral appearance • BOOP (idiopathic entitiy) seems unlikely because Shelby’s disease is not limited to PERIPHERAL airways & her imaging does not fit the few case reports • Post-infectious bronchiolitisobliterans ….. Still an option? • Ultimately needs histopathology • As of 12/19 @ 12pm, Shelby is stable, but in oxygen

  13. References • Bronchiolitisoliterans—dog lung. http://www.vspo.us/vspo/show-page.php?id=565. Accessed 19 Dec 2010. • Castleman, WL. Bronchiolitisobliterans and pneumoia induced in young dogs by experimental adenovirus infection. Am J Pathol. 1985;119:496-504. • Chang AB, JP Masel, B Masters. Post-infectious bronchiolitisobliterans: clinical, radiological and pulmonary function sequelae. PediatrRadiol. 1998;28:23-29. • Li X, et al. Oliec acid-associated bronchiolitisobliterans organizing pneumonia in beagle dogs. Vet Pathol. 2006;43:183-185. • Martin LD, et al. High-resolution CT findings of bronchiolitisobliterans syndrome after hematopoietic stem cell transplantation. J Thorac Imaging. 2008;23:244-250. • Phillips S, et al. Bronchiolitisobliterans with organizing pneumonia in a dog. J Vet Intern Med. 2000;14:204-207.

More Related