Coughing Coyote Pup and Radiology 101

Unfortunately shortly after posting the last blog entry, our little coyote with adenovirus started wheezing and coughing.  He has continued to eat, which was encouraging, but after watching him for a few days and only seeing signs progress, we took radiographs (ie x-rays) of his chest.

 

August 19, 2011 - right lateral radiograph




August 19, 2011 - dorsoventral radiograph

 
Look at these carefully (click on them to enlarge the image) and try and figure out what you can find before continuing on reading the rest of the post....

First, we'll go over radiograph basics.  The little "R" and "L" that you see on the films represents the right and left side of the animal.  The right lateral radiograph means that he is laying down with his right side down on the radiograph table (where the x-ray film is).  The x-ray beam then goes through the his left side to his right side then to the film to create this picture.  That is the first image above.  The dorsoventral radiograph, means that the x-ray beam went from his dorsum to his ventrum (or more easily put, the x-ray beam went through the top of his back to the bottom of his chest while he was laying with his stomach on the x-ray table).  The second image above  To visualize this, take a look at the next few images of my own dog, Hagan, who graciously demonstrated his expertise of proper x-ray positioning...



Radiograph Table at Southern
Arizona Veterinary Specialty
and Emergency Center

  

Hagan in right lateral position - the x-ray beam
would go through his left side, through his chest,
then through his right side and onto the x-ray film



Dorsoventral position -  the x-ray beam would
go through the top of his back, through his chest,
then through the bottom of his chest onto the x-ray film

 

Hagan in ventrodorsal position -
the x-ray beam would go through the
bottom of his chest, through his chest, then
out through his back onto the x-ray film

Now you can call yourself an expert and amaze your friends with x-ray knowledge; saying ventrodorsal or dorsoventral at dinner really impresses people.  But back to the little coughing coyote...

The coyote pup didn't exactly cooperate as well as Hagan so we had to give him some light sedation to get accurate films.  In case you haven't guessed it already, and it's okay if you haven't, the radiographs show that the pup has a bad case of pneumonia.  A veterinary radiologist would most likely say, "a moderate patchy interstitial to alveolar lung pattern suggestive of bronchopneumonia or fungal pneumonia with possible tracheobronchial lymph node enlargement."  This description can be basically broken down to mean;

"a moderate patchy interstitial to alveolar lung pattern" - lungs appear to have a wispy cotton-like appearance
"possible tracheobronchial lymph node enlargement" - above the heart lay some lymph nodes which may be enlarged

Take a look at a normal radiograph of Hagan's chest...try to guess what way he was laying (right lateral, dorsoventral, or ventrodorsal)


Normal thoracic film



Normal thoracic film - labeled

 
Notice that Hagan's lungs are nice and black (on radiographs, black = air) and with our coyote above his lungs looked as though they had wispy pieces of cotton in them (ie interstitial to alveolar pattern).  If you now go back to the radiographs of the coyote puppy and take a look, you hopefully can now appreciate this change.  For some of you, you may even be able to see that the trachea (wind pipe) is pushed up or deviated a little bit upwards and that is where the area of possible tracheobronchial lymph node enlargement.  Those lymph nodes may actually be so large that they are pushing the trachea up (or it could just be really bad infiltration of disease)!

The pup was immediately placed on a strict antibiotic regiment.  He wasn't very keen to our plan and has proven very difficult to medicate but thanks to the help of our volunteers we devised a way to trick him into taking his medications; mixing it in a sugary treat!  Over the past week, he has continued to eat and drink normally.  His behavior is a little more lethargic than usual but still acts like a coyote puppy and very inquisitive of his surroundings.  A few days ago one of the volunteers who works with him very closely, Sherry, noticed that he was more lethargic than usual so we decided to retake radiographs to see if we were making any progress...

August 26, 2011 - right lateral radiograph

August 26, 2011 - dorsoventral radiograph

Although it would have been nice to be able to get a little bit more of the front part (also known as cranial) of his chest in the film we can see that there is some improvement since the last films; still not perfect, but improved.  Clinically, to date, the pup continues to do well and loves his sugary treats to go along with his meals.  We have also started nebulizing him three times daily to help add moisture to his airways to facilitate productive coughing and break up of the disease.  We will be checking radiographs periodically to continue to monitor his progress and I will post them as soon as we do so you can stay updated!

As always, please do not hesitate to ask questions or comments in the comment section below and keep the donations coming in (button on the left of this page)!  It is very expensive to maintain our x-ray machine and associated equipment to keep it in tip-top shape, and every little bit helps!

Special thanks to the following people who have been available for consultation:
Dr. Diane Dereszynski, DVM, Diplomate ACVIM of Southern Arizona Veterinary Specialty and Emergency Center
Dr. Graham Burns, DVM, Diplomate ACVR

The great coyote puppy mystery!

* As always, if you find that you do not understand something and need more of an explanation remember to click the links or just post a question and I'll be more than happy to answer them.  Thanks for reading!

We recently responded to a call about a litter of abandoned coyote puppies in Tucson.  When Lou Rae got to the scene, she found two puppies outside the den; one lifeless puppy near the road and another was bleeding from his mouth.  Three other puppies remained inside the security of their den but they appeared dehydrated and were very lethargic.  The caller had not seen any adults in the area in the recent future so we were worried that the adults were injured, sick, or killed.  We also noticed that there were a number of dead rodents outside of the coyote den.  We quickly gathered the litter together and headed back to the Wildlife Center.

Once at the Tucson Wildlife Center (TWC), the puppies received their intake physical examinations.  The puppy that was bleeding from his mouth, unfortunately passed away shortly after arriving to the center.  The remaining three puppies were given fluids (to help rehydrate them), given some food, and allowed to rest in a dark, quiet place.  Physical examinations confirmed moderate dehydration and some evidence of bruising on two of the puppies.  We were immediately concerned that this may be related to the dead rodents around the den; which could mean the puppies were exposed to rodenticide!  Rodenticide toxicities can also cause depression, anorexia, anemia, bloody feces, ataxia (lack of coordination), weakness and subcutaneous hemorrhages.

There are many different types of rodenticide but all have the same end result; they affect the body’s natural ability to stop bleeding.  Most of these toxins target Vitamin K, which is essential for certain proteins responsible to help prevent bleeding, and decrease the Vitamin K storages in the body (essentially).  Since we noticed some of the puppies were bleeding and saw a number of dead rodents near the den, we started treating immediately with Vitamin K.

Despite our best efforts, two of the remaining three puppies died within a few days.  The only survivor started vomiting and had diarrhea.  We became very aggressive with his treatment for fear that we would lose him too!  He continued to receive Vitamin K (to help restore any vitamin K that may have been affected by the suspected rodenticide poisoning), subcutaneous fluids, and assist feedings.  In the meantime, we sent a body of one of the other puppies to Arizona Veterinary Diagnostic Laboratory to be analyzed so we would have a better idea of what we were treating. This was made possible with funding from donations from our generous supporters, just like you!

Within a few days, we received the necropsy report which revealed extensive granulomatous pneumonia with Coccidioides immitis.  Coccidioides immitis is the fungal organism that causes valley fever in both our pets and ourselves.  This was a very peculiar finding in such a young pup but after we received this news we started the surviving puppy on fluconazole (an antifungal medication) right away. 

Puppy on arrival with his best friend

He started eating and drinking on his own and the diarrhea and vomiting resolved as quickly as it began.  We were very happy with his progress up until the day we arrived to the facility to find that his eyes were a cloudy-blue color.

Blue eyes from corneal edema

The puppy was brought to Southern Arizona Veterinary Specialists for an emergency ophthalmology appointment.  Dr. Marcella Ashton, BVSc, Diplomate ACVO was concerned that the puppy had corneal edema (fluid swelling) which could be caused by a number of different diseases such as toxoplasma, canine adenovirus, and leptospirosis (among others).

Eye anatomy

Dr. Ashton started the coyote puppy on daily eye medications and started an antibiotic.  A small amount of blood was taken from the puppy to be sent for analysis to screen for toxoplasma, canine adenovirus, leptospirosis, and valley fever.  After waiting for about a week and a half, results came back from the laboratory stating that the puppy was positive for canine adenovirus type 1 (CAV-1) and negative for all other diseases tested!

Adenoviruses infects a wide variety of mammals and birds but only two have been identified to infect canines/dogs.  Canine adenovirus type 1 (CAV-1) infects most of the major organs causing, amongst other diseases, hepatitis.  Canine adenovirus type 2 (CAV-2) causes primarily respiratory diseases. 

Adenovirus

In CAV-1, the virus invades the liver, quickly causing swelling, cell damage, and sometimes causes bleeding.  This often results in acute death (much like seen in the other puppies from the litter).  An infected dog will shed the virus in the feces and urine for up to 6-months.  Other dogs can become contaminated via the mouth or nose and the virus then lodges itself in the tonsils.  The virus is not airborne.  Incubation period is 4-7 days.  Symptoms include, but not limited to; fever, lethargy, tonsillitis, abdominal distension and pain, loss of appetite, pale color gums, and vomiting.  The classic “hepatitis” blue eyes are also seen in many cases like we saw in our little coyote puppy.  The “blue eyes” are caused by edema (fluid swelling) of the cornea of the eye.  Without treatment, death can occur in 1 to 2 days, but if they are treated and survive the initial few days, puppies usually recover and have lifelong immunity. 

Since the coyote puppy received appropriate treatment at our center and was seen by Dr. Ashton who helped save his eye-sight; he is happily playing in our large coyote pen today!  TWC will keep him for about 6-months and try to train him how to hunt by himself.  At that time, we will bring him to an isolated spot, away from the urban environment, and be able to release him with another young coyote.  This, of course, is all possible because of the donations received from the public allowing us to continue to …. Rescue, Rehab, and Release!

After treatment, clear eyes!
*Disclaimer - Sure he's cute, but never handle wild
animals unless you are a trained professional

Note to Readers/Case Discussion:
In this particular case, it would have been beneficial to have the diagnostic equipment needed to test coagulation times (clotting times) in the patients.  If the clotting times were prolonged, we would have had a stronger diagnosis of exposure to rodenticide and could have treated accordingly or if the clotting times were normal we may have tried to treat for other illnesses other than toxicity.  Your support could help us pay for a $3,500 Coagulation Analyzer needed to check clotting times in patients that we take in on emergency within minutes!  It would also help us continue to provide the intensive care and medical treatment all poisoned patients face.  With your help, the Tucson Wildlife Center could also start compiling data to help provide scientific diagnoses of poisoning for other wildlife centers and obtain standards in “normal clotting times” in our wild friends!

Golden Eagle Released!

Our Golden Eagle treated for signs of dehydration and generalized wasting has been released back to the wild!  After being displaced by the Horsehoe Two Fire, the eagle continued to recuperate at the center.  After a few days he began to eat great and gained a significant amount of weight and muscle mass.  We were able to exercise him in our new flight cage and after a few weeks of regaining his strength he was allowed to go back and roam the skies once again.  Thank you for all of your support!