LADIS Case of the Month

Transcription

1 November 2018 LADIS Case of the Month Drs Valentin Janvier and Brieuc Cossic Hospital for Animals and Animal Health Diagnostic Center

2 Signalment and presenting complaint 13 year old Thoroughbred gelding Progressive lethargy and weight loss for 2 months Intermittent fever for 2 months Treated for presumptive colics without improvement Recent increase respiratory rate and effort

3 Physical examination BCS 2/9 Diffuse muscle wasting and weakness Fever (103.3 F; 39.6 C) Tachycardia (80 bpm) Tachypnea (56 rpm) Harsh lung sounds diffusely with crackles Complimentary exams Blood work: Fibrinogen: 15,000 mg/dl WBC: 12,700cells/uL Serum Amyloid A > 2500 ug/ml Bronchoalveolar lavage: Marked mixed inflammation No infectious agents or inclusions noted Photos, illustrations, graphics here. Thoracic ultrasonography Thoracic radiography

4 Thoracic ultrasonography

5 Thoracic ultrasonography

6 Thoracic radiography

7 Thoracic radiography

8 Thoracic radiography

9 Thoracic radiography

10 Thoracic radiography

11 Thoracic radiography

12 What are your imaging findings and differential diagnoses? What would you recommend to do next?

13 November 2018 LADIS Case of the Month Answers Drs Valentin Janvier and Brieuc Cossic Hospital for Animals and Animal Health Diagnostic Center

14 ULTRASONOGRAPHIC FINDINGS Severe, bilateral, multifocal B-lines Severe, bilateral, multifocal pulmonary nodules Moderate, bilateral, locally extensive cranioventral consolidation Mild, bilateral pleural effusion

15 RADIOGRAPHIC FINDINGS

16 RESULTS Both lungs are well expanded and have severe, multifocal, structured pulmonary opacification that forms innumerable, indistinctly margined, coalescing, small-tolarge soft-tissue nodules with a generalized random distribution. No other abnormality is detected. SUMMARY Severe, generalized random, multifocal, nodular lung pattern CONCLUSION Primary differential diagnosis for the pulmonary pattern is Equine Multinodular Pulmonary Fibrosis (EMPF). Other possible causes include pulmonary abscessation, granulomatous and neoplastic lung diseases.

17 RECOMMENDATION Lung Biopsies for final diagnosis OUTCOME v Humane euthanasia was elected considering the severity of the clinical signs and the guarded prognosis v Necropsy was performed

18 MACROSCOPIC FINDINGS Approximately 70% of the normal pulmonary parenchyma is replaced by multifocal, discrete, pale-tan to white, firm, coalescing nodules. Bilateral severe, chronic, multinodular fibrosis with severe, acute, fibrinous pleuritis

19 MICROSCOPIC FINDINGS Discrete nodules consisted of moderate to severe interstitial expansion by mature collagen, well demarcated from the adjacent parenchyma, admixed with increased numbers of macrophages (HE stain). The presence of EHV-5 viral particles is confirmed by in-situ hybridization (inset, upper corner) and PCR (not shown). The unusual excess of collagen is highlighted in blue by histochemical staining (Masson trichrome). Hematoxylin and Eosin stain Masson trichrome stain

20 FINAL DIAGNOSIS Equine multinodular pulmonary fibrosis with pleuritis PERTINENT LITERATURE