Presentation
Presented with a 10-day history of dry, non-productive cough with exercise and overnight. Moderate lethargy.
Patient Data
There is a large soft tissue opacity mass in the right caudal lung lobe with ill-defined borders and an air bronchogram. There is a mild bronchointerstitial pattern in the remainder of the pulmonary parenchyma. There is increased opacity in the perihilar region with widening of the mainstem bronchi.
Impression:
Pulmonary mass with hilar lymphadenopathy (granuloma, neoplasia, abscess).
There is a large, soft tissue attenuating, contrast enhancing mass in the dorsal aspect of the right caudal lung lobe measuring ~7.6 x 6.4 x 6 cm in dimension. Following contrast medium administration there are several, small, tubular, branching structures identified within the mass but minimal contrast enhancement. Surrounding the mass, throughout the remainder of the right caudal lung lobe there is patchy ground glass to alveolar patterns. Multiple bronchi, including the right caudal lobar bronchus are displaced laterally and compressed by the mass. Several dorsally located bronchi are enlarged at the periphery of the lung consistent with bronchiectasis. There is moderate to marked thickening of the bronchi within all lobes of the right lung. This thickening is most pronounced in the right caudal lobe. There is mild thickening of the bronchi in the left lung lobes. The tracheobronchial lymph nodes are markedly enlarged at ~4.2cm diameter. Multiple cranial mediastinal lymph nodes are enlarged up to 2.5cm in thickness. The sternal lymph nodes are enlarged at 0.8cm. Within the abdomen the hepatic and splenic lymph nodes are mildly to moderately enlarged at 1cm.
Impression:
Differential diagnoses for the pulmonary mass, diffuse bronchial pattern and thoracic lymphadenopathy include eosinophilic bronchopneumopathy or primary lung tumor (carcinoma) with metastatic disease to the lungs and lymph nodes.
On recheck images, the pulmonary mass, hilar lymphadenopathy, and peribronchial thickening have resolved.
Case Discussion
A CBC revealed peripheral eosinophilia, and a bronchial lavage was also eosinophilic. No organisms were cultured.
The imaging findings most consistent with eosinophilic bronchopneumopathy are the mass plus alveolar infiltrates, bronchiectasis, and bronchial pattern. The reduced contrast enhancement of the mass is more consistent with a granuloma than a primary lung tumor.
The dog was treated with prednisolone and the pulmonary mass and hilar lymphadenopathy gradually resolved over 6 months.
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