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218 Cranial Cruciate Ligament Injury

• Cough is a marker of disease control in the • Respiratory fluoroscopy: dynamic airway PEARLS & CONSIDERATIONS
case of chronic inflammatory disease (e.g., collapse/obstruction (e.g., tracheal collapse, Comments
VetBooks.ir • Cough may result in progressive disease • Thoracic CT: more detail than thoracic • Treatments for some disorders causing cough
mainstem bronchial collapse, epiglottic
asthma).
retroversion)
may be contraindicated in others (e.g., cough
through the perpetuation of inflammation
(e.g., collapsing trachea).
radiographs, quick assessment of all thoracic
rial pneumonia).
structures suppressants should not be used with bacte-
DIAGNOSIS • Bronchoscopy with bronchoalveolar lavage • Gastroesophageal reflux can cause cough. For
for culture and cytology (p. 1073) dogs with chronic cough but otherwise in
Diagnostic Overview • Bronchoalveolar lavage, blind or transtracheal good health for whom more serious causes of
Signalment, history, and physical examination wash (p. 1073) cough have been ruled out, a trial course of
are often adequate to formulate a likely dif- • Fine-needle aspiration (p. 1113): mass lesion, omeprazole 1 mg/kg PO q 12h 30 minutes
ferential diagnosis list and guide further tests, heavy infiltrates before meals may be warranted.
but thoracic radiographs are almost always • Lung biopsy: diagnosis of interstitial lung • Ironically, angiotensin-converting enzyme
indicated. disease (p. 553) (ACE) inhibitors that are often used to treat
• Infectious disease testing, as appropriate heart disease cause cough in humans. This
Differential Diagnosis has not been reported in dogs or cats.
See Cough, Section 3 (p. 1209). TREATMENT
Prevention
Initial Database Treatment Overview Dogs and cats should be kept on heartworm
• Thoracic radiographs: a minimum of Treatment depends on underlying cause of prophylaxis.
three-view thoracic radiographs obtained cough
on inspiration is standard (p. 1155) Technician Tips
○ If collapsing trachea suspected, include Acute General Treatment Ask about the regular use of heartworm preven-
cervical trachea, and obtain inspiratory If cough accompanied by respiratory distress, tion in all coughing pets.
and expiratory imaging. oxygen supplementation (p. 1146) and
○ Assess size of cardiac silhouette, pulmonary possibly other intervention may be required Client Education
vasculature (p. 879) • Cough suppression is not beneficial, and may
○ Assess airway diameter, deviation, or be harmful for many causes of cough.
compression Chronic Treatment • Resting respiratory rates may be performed
○ Assess pulmonary parenchymal pattern Varies with the underlying disease process. at home to monitor for disease progression.
(e.g., alveolar, unstructured or nodular Cough suppressants should be avoided
interstitial) in cases of cardiogenic cough, infectious/ SUGGESTED READING
○ Assess pleural space (e.g., effusion, inflammatory cough, and when the patient Lappin MR, et al: Antimicrobial use guidelines for
pneumothorax, diaphragmatic hernia) has evidence of systemic illness. Animals treatment of respiratory tract disease in dogs and
• Heartworm testing (pp. 415 and 418) with degenerative disorders (e.g., collapsing cats: antimicrobial guidelines working group of
• Retroviral testing (cats) trachea) may benefit from cough suppres- the International Society for Companion Animal
• Fecal sedimentation (Baermann) or flotation sion (e.g., butorphanol 0.25-1 mg/kg PO Infectious Diseases. J Vet Intern Med 31:2. 2017.
for respiratory parasites q 8-24h; hydrocodone 0.25 mg/kg PO
• CBC/serum biochemical profile/urinalysis: q 6-24h) RELATED CLIENT EDUCATION
normal or reflects cause of cough SHEETS
Recommended Monitoring
Advanced or Confirmatory Testing Often, acute, uncomplicated cough without How to Count Respirations and Monitor
Choice of tests guided by prior findings. Com- evidence of systemic illness resolves in 7-10 Respiratory Effort
monly used tests: days. Failure to resolve or systemic illness How to Deal With Incessant Coughing
• Laryngeal function examination (p. 574) warrants investigation. How to Provide Home Respiratory Therapy
• Plasma N-terminal pro-B-type natriuretic (Humidification, Nebulization, Coupage)
peptide (NT-pro-BNP) (p. 1369): cardiac PROGNOSIS & OUTCOME
disease AUTHOR: Megan Grobman, DVM, MS, DACVIM
• Echocardiography (p. 1094): CHF, pulmo- Depends on underlying disease process EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
nary hypertension

Video
Cranial Cruciate Ligament Injury Available Bonus Material Client Education
Sheet
Online
Epidemiology
BASIC INFORMATION rare. Multiple ligamentous disruptions of the
stifle are uncommon traumatic injuries of dogs SPECIES, AGE, SEX
Definition and cats. Seen in dogs and less frequently in cats of all
Partial or complete tearing of the cranial ages
cruciate ligament (CrCL), causing stifle Synonyms
instability; a very common condition in • Anterior cruciate ligament (ACL) rupture GENETICS, BREED PREDISPOSITION
dogs and an uncommon condition in cats. • For multiple ligamentous disruption: stifle • Dogs: especially common in rottweilers,
Isolated caudal cruciate ligament tears are derangement, stifle luxation Labrador retrievers, Newfoundlands,

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