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Inflammatory Lung Disease

Inflammatory Parenchymal
Pulmonary

Infiltrates with Eosinophils (PIE) Lymphomatoid Granulomatosis

Pulmonary Infiltrates with Eosinophils (PIE)

Synonyms: eosinophilic pneumonia allergic pneumonitis hypersensitivity pneumonitis

PIE
Allergic

(Primary PIE) - most cases are result of hypersensitivity to inhaled allergens (type 1 and 3) - allergen not identified - dust, mold, chemical, pollen

PIE
Parasitic

(Secondary PIE) - heartworm - lungworm, flukes - migrating helminths

PIE Clinical signs

Usually medium to large breed dog Variety of signs Usually no fever Ascultation: - increased breath sounds, crackles, - wheezes

PIE - Radiographs
Variety of radiographic signs exist +/- hilar lymphadenopathy Increased interstitial pattern Peribronchial pattern Alveolar pattern

Diagnostics
CBC
Rule

out other parasites - heartworm - fecals TTW

Diagnostics
If

nodular, interstitial - fine-needle aspirate - biopsy

Treatment of PIE
Allergen avoidance Treat allergic disease Corticosteroids - lifetime therapy

Prognosis

Good for control Cure if identify and remove inciting cause If eosinophilic pulmonary granulomatosis : more guarded prognosis and may need cytotoxic drugs

Lymphomatoid Granulomatosis
Underlying etiology unknown Vasculitis immune-mediated

Only seen in the dog Slowly progressive

Clinical Signs
Cough Respiratory distress Variety of signs - fever, weight loss - ascult crackles, wheezes.

Diagnosis
History and clinical signs Radiology - multiple, ill defined nodules - hilar lymphadenopathy

Diagnostics
TTW
Histopathology

- definitive diagnosis

Treatment
Immunosuppression

Prognosis:

poor

Parenchymal - Neoplasia

Signalment - Canine
Mean

age is 10 years No sex or breed predilection

History - Canine
Cough Dyspnea, exercise intolerance Duration Peracute presentation

Physical Examination
25%

have no clinical signs Unremarkable Variable clinical signs with paraneoplastic syndromes

Differential Diagnoses
Parenchymal Infection Allergic Embolic Edema Contusion - hemorrhage

Diagnostics

Blood Work - rule out other disease - may have a chronic anemia - may have increase WBC if inflammation

Radiographs
3 views - still only reliabel in 77% of cases Cant pick up masses < 1 cm in diameter Metastases are much, much more common than primary

Radiographs
Solitary nodule Multiple nodules Diffuse miliary, interstial Pleural effusions Hilar lymphadenopathy Lung consolidation Abdominal radiographs

Cytology
TTW
BAL

Fine

needle aspirate

Biopsy - Histopathology
Transthoracic
Surgery

Tumor types:
Epithelial
Mesenchymal

Lymphoma
Lymphomatoid

granulomatosis

Treatment
Dependent

on location, type,

patient Chemotherapy Surgery

Feline - Lung Neoplasia


Less common than dog average age is 11 - 12 years History - vague clinical signs - respiratory signs - metastases to digits

Physical Examination - Cat

Usually unremarkable

Differential Diagnoses

Same old same old...

Diagnostic Evaluation
Blood work Thoracic radiographs

Cytology
Similar to dogs Pleural effusion - may be helpful with lymphoma

Tumor type
Most

are carcinoma

Treatment
Advanced

stage Prognosis: poor

Trauma
Contusions - hemorrhage, edema Presentation Radiographs: 2 - 12 hours post trauma Treatment: - do not forget about heart bruising

Pulmonary Thromboembolism
Obstruction

of vessel by clot from another area in the body

PTE - Virchows Triad


Changes

in vessel endotheliumn Impairment of blood flow (stasis) Development of pro-thrombotic tendencies in the blood

Risk Factors for PTE

Cushings, Hypothyroidism Protein losing disease Immune-mediated hemolytic anemia Heartworm disease Neoplasia Sepsis, vasculitis Cardiac disease

History
Acute

onset of severe respiratory distress restlessness Cough+/-

Clinical Signs of PTE


Signs are usually non-specific Normal ascultation Cyanosis May develop split S-2 heart sound (rarely detected)

Severity depends on:


Extent

of embolism Reflex humoral factors Patients prior condition

Diagnostics:
ECG Thoracic radiology Blood gases Nuclear medicine scan Angiography CT

Radiology

Rule out other pulmonary disease Non-specific May appear normal Pulmonary infiltrate Pleural effusion Hypoperfusion/hyperperfusion Pulmonary vessels affected

Nuclear Medicine

Therapy of PTE

Supportive care: O2, fluids Prevention of further PTE - heparin - warfarin Thrombolytic therapy - streptokinase - tissue plasminogen activator

His story? Well, I dunno.I always


assumed he was just a bad dog