Presentation
Presents with 6-8 months of a dry, hacking, non-productive cough, most pronounced after drinking water.
Patient Data
Radiographs
On a lateral radiograph of the neck, there is increased opacity in the laryngeal region. The soft palate is elongated. The trachea is narrowed in the cervical region and at the thoracic inlet. On both the left and right lateral radiographs, the trachea is narrowed as well as the mainstem bronchi. The cardiac silhouette is moderately enlarged. The apex is raised from the sternum, suggesting right-sided enlargement. On the dorsoventral projection, the left caudal lobar artery is enlarged and tortuous. The right pulmonary artery is also enlarged but has a straighter course. The cranial mediastinum is widened, likely due to fat. The liver is enlarged and rounded, displacing the gastric axis. There is multifocal mineralization in the subcutaneous tissues dorsal to the spine.
Fluoroscopy was performed to evaluate the airways for collapse. There was dynamic collapse of the cervical and intrathoracic trachea with normal respiration and with coughing the mainstem bronchi also collapsed (3rd image).
Case Discussion
Severe airway collapse. Echocardiography confirmed severe right sided heart enlargement secondary to pulmonary hypertension (cor pulmonale). Heartworm antigen tests were negative, suggesting the airway disease as the cause for pulmonary hypertension, although this is rare. Probable calcinosis cutis - Cushing's disease or iatrogenic steroid administration. Hepatomegaly (inflammatory, metabolic, toxic, neoplastic) was not pursued further.
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