Page 2443 - Cote clinical veterinary advisor dogs and cats 4th

Cough 1209

Cough
VetBooks.ir Cause Onset Salient Feature

Aspiration pneumonia Acute History suggestive (e.g., anesthesia, regurgitation); harsh/loud sounds ± crackles; right middle or
caudal portion of left cranial lobes often involved but radiographic changes lag up to 24 hours
Cardiogenic pulmonary edema (dogs only) Acute Heart murmur ± arrhythmia; harsh/loud sounds ± crackles; venous distention, perihilar infiltrate
on thoracic radiographs; heart disease confirmed on echocardiography; rare to have cough +
comfortable respirations due to cardiogenic pulmonary edema (especially uncommon in small
breeds), usually dyspnea +/- cough
Noncardiogenic pulmonary edema/acute Acute History of inciting trigger (smoke inhalation, electrocution, sepsis, etc.); respiratory distress and
respiratory distress syndrome hypoxemia; harsh/loud sounds ± crackles; alveolar pattern on thoracic radiographs with normal
heart/blood vessels
Pulmonary hemorrhage Acute History (notably anticoagulant exposure); evidence of systemic bleeding diathesis; harsh/loud sounds
± crackles; thoracic radiographs alveolar pattern
Pulmonary thromboembolism (PTE) Acute Suspected or confirmed hypercoagulable state (cancer, heartworm disease, protein-losing
nephropathy or enteropathy, immune-mediated hemolytic anemia); respiratory distress and
hypoxemia common; normal thoracic radiographs simultaneously = strongly suggestive of PTE; other
radiographic findings possible (e.g., hypoperfused lung lobe, alveolar pattern)
Tracheal/bronchial foreign body Acute Lateral cervical radiograph and/or tracheoscopy
Tracheobronchitis Acute Patient usually feels well; recent history of interaction with new/different dogs (contagion)
Pneumonia (bacterial, fungal, protozoal) Acute or insidious Often systemic illness; harsh/loud sounds ± crackles; thoracic radiographs suggestive; transtracheal
wash or bronchoalveolar lavage to isolate organisms
Eosinophilic bronchopneumopathy Acute or insidious Marked eosinophilic infiltrate on bronchoalveolar lavage; uncommon; radiographic lung infiltrates
can be dramatic Differentials, Lists, and Mnemonics
Heartworm disease Acute or insidious Thoracic radiographs ± arterial distention and right-sided enlargement; heartworm antigen test
(dog); heartworm antibody and antigen test (heat treated) and/or echocardiography (cat)
Interstitial lung disease (e.g., pulmonary Acute or insidious Variable radiographic findings; rule out other conditions; biopsy required for confirmation of most
fibrosis, BOOP) types
Mediastinal mass Acute or insidious Noncompliant cranial thorax (cats); thoracic radiographs or thoracic ultrasound; FeLV antigen test in
cats; evidence of lymphoma elsewhere
Tracheobronchial lymphadenopathy Acute or insidious Often systemic illness; thoracic radiographs confirm lymphadenopathy ± other abnormalities (e.g.,
miliary pattern from fungal pneumonia)
Collapsing trachea (dogs) Insidious Disproportionately loud; often small-breed (+/− obese) dogs; worse with excitement; apparent on
radiographs, fluoroscopy, and/or bronchoscopy
Asthma/allergic airway disease (cats) Insidious Wax/wane cough (often mistaken for hairballs); ± respiratory distress, wheeze; airway eosinophilia is
supportive (rule out lungworms and heartworms)
Bronchiectasis Insidious Radiographic diagnosis, often coexisting with chronic sterile bronchitis or other airway/lung disease
Chronic sterile bronchitis Insidious Disproportionately loud; often small-breed (+/− obese) dogs; no dyspnea at rest; bronchoscopy
identifies mucosal edema, no infection but neutrophilic inflammation
Gastroesophageal reflux disease Insidious Diagnosis based on exclusion of other disorders and response to aggressive gastric acid control
Left atrial enlargement Insidious Mitral heart murmur; confirm enlargement on thoracic radiographs/echocardiogram; contested as
cause of cough since dogs with or without left atrial enlargement show no difference in cough or
degree of airway inflammation cytologically
Lungworms Insidious Systemically well; endemic region; Baermann fecal (but shedding can be intermittent) + fecal
flotation; response to anthelmintic treatment trial
Pulmonary neoplasia (metastatic or primary) Insidious If metastatic, weight loss common ± primary site found on examination; thoracic radiographs and/or
computed tomography (more sensitive); fine-needle aspirate, airway lavage, or biopsy to confirm
Tracheal mass/stenosis Insidious Lateral cervical radiograph and/or tracheoscopy
BOOP, bronchiolitis obliterans with organizing pneumonia, also known as cryptogenic organizing pneumonia; FeLV, feline leukemia virus.

AUTHORS: Etienne Côté, DVM, DACVIM and Leah A. Cohn, DVM, PhD, DACVIM

www.ExpertConsult.com