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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

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And the Curious Case of Shelby Boykin

(Accession 144376)

Trisha J Oura, DVM

December 20, 2010

shelby boykin 144376
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
further diagnostics
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:
slide7
????
  • Could this be congenital bronchial atresia/dysplasia?
  • Is this all secondary to previous infections?
bronchiolitis obliterans
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

slide9

Fibrobascular polyps in a bronchiole with necrosis and inflammatory cell infiltration

  • Atelectasis, discoloration of lung lobes
post infectious bronchiolitis obliterans is recognized in pediatrics
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)
in the literature you may also see boop
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
boop continued
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
so what
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
references
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.