WHAT IF IT IS NOT “JUST” A COUGH?

WHAT IF IT IS NOT “JUST” A COUGH?

WHAT IF IT IS NOT “JUST” A COUGH?

 

It was Friday early in the afternoon and I was already dreaming of my free weekend, when one of the technicians came to get me: “Afrodita came to you for a check-up.”

I got a bit angry, as I told Afrodita’s owners at the last telephone conversation, that they should come to the final check-up with my colleague, who has dealt with her case, but was currently not at work. Afrodita is our very special patient – now 3 years old female pug is the first case of brain neurosurgery, that we performed at our clinic. It has now been about 6 months since the brain abscess surgery, and she was due for the last check-up after cessation of all medicines. A little unwillingly I stepped into the examination room, but a surprise was waiting for me there …

Afrodita didn’t come for her regular check-up. The owners complained: “She is not feeling well. She is coughing since yesterday and today Is breathing more difficult. She is also not as lively as usual.”

When I finished the clinical exam, everything seemed similar to kennel cough. The clinical picture (and of course lung auscultation) was disturbed by Afrodita’s highly pronounced brachiocephalic syndrome, however the owners said, her breathing was more difficult than usually. This bothered me, although breathing in examination room seemed quite normal for a brachiocephalic dog. So, we should move on with the diagnostics, right? I suggested performing chest x-rays and CBC. When I was looking at the pictures I made, my only thoughts were: “?????”. I asked my colleague to help me with the x-ray interpretation, because one of the cranial lung lobes in that small chest seemed “weird” to me. After checking the pictures, my colleague confidently said, that there was a high suspicion of lung lobe torsion and that I should try to order a CT scan for the same day, so that if the diagnosis is confirmed, we could perform surgery before the weekend.

I started watching the pictures on the screen again. Lung lobe torsion? One of those “mysterious diagnoses”, I have only read about so far, but haven’t seen a case of in a few years of my veterinary career. After sending Afrodita to CT scan, I went home. While I was preparing lunch, I received a phone call from my clinic: the diagnosis had been confirmed and Afrodita was on her way back to our clinic, to do the surgery. It left me wondering, how some patients have such bad luck to pick up more than one of those rare conditions …

Lesson learned: sometimes, you have to listen to your inner voice, which tells you something is not right. And give enough attention to the very important anamnesis of the owners. It can tell you a lot and make all the difference. And above all: follow the diagnostic protocol, make a list of differential diagnoses and perform necessary diagnostic procedures. At the same time let’s not forget: some conditions are rare, but that doesn’t mean they don’t exist …

Afrodita recovered quickly after the surgery. A little joke: at the check-up, when the sutures were removed, I promised the owners to investigate which other “rare conditions” came into account in pugs, so that we can be prepared for the next time. One can never know what can happen to a dog that had brain abscess and lung lobe torsion both in less than one year. 😊