And the Curious Case of Shelby Boykin(Accession 144376)

Trisha J Oura, DVMDecember 20, 2010

Shelby Boykin (144376)Shelby Boykin (144376)

5 mo F Chihuahua5 mo F Chihuahua

Chronic cough x 4 months, increasing in severity Chronic cough x 4 months, increasing in severity and frequency recentlyand frequency recently

History of green nasal discharge, especially when History of green nasal discharge, especially when cough is worsecough is worse

Multiple courses of antibiotics = Multiple courses of antibiotics = improvement/resolution of clinical signsimprovement/resolution of clinical signs

No known history of traumaNo known history of trauma

~25 other dogs at home~25 other dogs at home

rDVM radiographs-August (1 mo rDVM radiographs-August (1 mo old)old)

Radiographs 12/17/2010Radiographs 12/17/2010

Further DiagnosticsFurther Diagnostics

Bronchoscopy:Bronchoscopy:Sacculated appearance to left sided bronchiSacculated appearance to left sided bronchi

Possible blind-ended bronchiPossible blind-ended bronchi

MucusMucus

Right sided airways are abnormal tooRight sided airways are abnormal too

BAL:BAL:Septic, suppurative inflammationSeptic, suppurative inflammation

CT:CT:

????????

Could this be congenital Could this be congenital bronchial atresia/dysplasia?bronchial atresia/dysplasia?

Is this all secondary to Is this all secondary to previous infections?previous infections?

Bronchiolitis ObliteransBronchiolitis ObliteransNonspecific response to lung damageNonspecific response to lung damage

Epithelial necrosis leads to bronchiole Epithelial necrosis leads to bronchiole occlusion with fibro-cartilaginous tissueocclusion with fibro-cartilaginous tissue

Can be due to inhaled Can be due to inhaled irritants/toxins, parasites, viral, irritants/toxins, parasites, viral, fungal, bacterial infectionsfungal, bacterial infections

Damage to bronchiolar epithelium Damage to bronchiolar epithelium formation of polyps of collagen, formation of polyps of collagen, fibroblasts, inflammatory cells fibroblasts, inflammatory cells polyps polyps can cause complete obstruction of can cause complete obstruction of airwayairway

Causes irreversible airflow Causes irreversible airflow obstructionobstruction

Reported in dogs, pigs, cattle, Reported in dogs, pigs, cattle, rodents, humans (especially after rodents, humans (especially after lung and stem cell transplants)—lung and stem cell transplants)—often fataloften fatal

Almost∧

Fibrobascular polyps in a Fibrobascular polyps in a bronchiole with necrosis bronchiole with necrosis and inflammatory cell and inflammatory cell infiltrationinfiltration

Atelectasis, Atelectasis, discoloration of lung discoloration of lung lobeslobes

Post-Infectious Bronchiolitis Post-Infectious Bronchiolitis Obliterans is Recognized in Obliterans is Recognized in

PediatricsPediatricsAssociated with adenovirus, Associated with adenovirus, MycoplasmaMycoplasma, , flu, syncytial virus, etcflu, syncytial virus, etc

Histopath: granulation tissue plugs within Histopath: granulation tissue plugs within the lumens of small airways and/or complete the lumens of small airways and/or complete destruction of airways leaving a scardestruction of airways leaving a scar

Imaging:Imaging:Bronchogram: “pruned tree”Bronchogram: “pruned tree”HRCT: bronchial dilation, wall thickening, HRCT: bronchial dilation, wall thickening, parenchymal and vascular attenuation, parenchymal and vascular attenuation, areas of collapse, air trapping during areas of collapse, air trapping during expirationexpirationNucMed: patchy decreases in ventilation NucMed: patchy decreases in ventilation and perfusionand perfusionCXR: variable but can includeCXR: variable but can include

unilateral hyperlucency of all/part of a lung unilateral hyperlucency of all/part of a lung which is enlargedwhich is enlargedpersistent collapse of affected lobe (up to 8 persistent collapse of affected lobe (up to 8 years post in one study)years post in one study)

In the Literature You May Also In the Literature You May Also See BOOPSee BOOP

Bronchiolitis Obliterans with Organizing PneumoniaBronchiolitis Obliterans with Organizing PneumoniaOften reserved for idiopathic version in humans (newer Often reserved for idiopathic version in humans (newer literature uses Cryptogenic Organizing Pneumonia), literature uses Cryptogenic Organizing Pneumonia), used somewhat interchangeably in vet medused somewhat interchangeably in vet med

Case report of 8 yo FS mixed breed with exercise Case report of 8 yo FS mixed breed with exercise intolerance and dyspnea x 1 mointolerance and dyspnea x 1 mo

CXR: diffuse interstitial, BAL: mucus without CXR: diffuse interstitial, BAL: mucus without inflammation, CT: bronchiectasis, patchy consolidationinflammation, CT: bronchiectasis, patchy consolidationDiagnosis via histopathDiagnosis via histopathInterestingly, dog had pulmonary hypertension so this Interestingly, dog had pulmonary hypertension so this could be a rule out for cor pulmonalecould be a rule out for cor pulmonaleTreated with steroidsTreated with steroids

BOOP Continued…BOOP Continued…

Animal model of BOOP with oleic acid injuryAnimal model of BOOP with oleic acid injury

DIFFERENT from ARDS:DIFFERENT from ARDS:ARDS involves diffuse injury to capillary/alveolar ARDS involves diffuse injury to capillary/alveolar endothelium leading to leakage endothelium leading to leakage edema edema

BOOP primarily affects distal airways and adjacent BOOP primarily affects distal airways and adjacent alvoeli and has airway pluggingalvoeli and has airway plugging

BUT both could look similar on radiographsBUT both could look similar on radiographs

So What?So What?

Shelby remains a mysteryShelby remains a mystery

Bronchial atresia/dyplasia seems unlikely given the Bronchial atresia/dyplasia seems unlikely given the normal radiographs, unilateral appearancenormal radiographs, unilateral appearance

BOOP (idiopathic entitiy) seems unlikely because BOOP (idiopathic entitiy) seems unlikely because Shelby’s disease is not limited to Shelby’s disease is not limited to PERIPHERALPERIPHERAL airways airways & her imaging does not fit the few case reports& her imaging does not fit the few case reports

Post-infectious bronchiolitis obliterans ….. Still an Post-infectious bronchiolitis obliterans ….. Still an option?option?

Ultimately needs histopathologyUltimately needs histopathology

As of 12/19 @ 12pm, Shelby is stable, but in oxygenAs of 12/19 @ 12pm, Shelby is stable, but in oxygen

ReferencesReferences

Bronchiolitis oliterans—dog lung. http://www.vspo.us/vspo/show-page.php?Bronchiolitis oliterans—dog lung. http://www.vspo.us/vspo/show-page.php?id=565. Accessed 19 Dec 2010.id=565. Accessed 19 Dec 2010.

Castleman, WL. Bronchiolitis obliterans and pneumoia induced in young Castleman, WL. Bronchiolitis obliterans and pneumoia induced in young dogs by experimental adenovirus infection. dogs by experimental adenovirus infection. Am J PatholAm J Pathol. 1985;119:496-. 1985;119:496-504.504.

Chang AB, JP Masel, B Masters. Post-infectious bronchiolitis obliterans: Chang AB, JP Masel, B Masters. Post-infectious bronchiolitis obliterans: clinical, radiological and pulmonary function sequelae. clinical, radiological and pulmonary function sequelae. Pediatr RadiolPediatr Radiol. . 1998;28:23-29.1998;28:23-29.

Li X, et al. Oliec acid-associated bronchiolitis obliterans organizing Li X, et al. Oliec acid-associated bronchiolitis obliterans organizing pneumonia in beagle dogs. pneumonia in beagle dogs. Vet PatholVet Pathol. 2006;43:183-185.. 2006;43:183-185.

Martin LD, et al. High-resolution CT findings of bronchiolitis obliterans Martin LD, et al. High-resolution CT findings of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. syndrome after hematopoietic stem cell transplantation. J Thorac ImagingJ Thorac Imaging. . 2008;23:244-250. 2008;23:244-250.

Phillips S, et al. Bronchiolitis obliterans with organizing pneumonia in a Phillips S, et al. Bronchiolitis obliterans with organizing pneumonia in a dog. dog. J Vet Intern MedJ Vet Intern Med. 2000;14:204-207.. 2000;14:204-207.