Wednesday, August 31, 2011

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

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