JPC SYSTEMIC PATHOLOGY

RESPIRATORY SYSTEM

September 2017

P-T03

 

Signalment (JPC# 2941213): 6-year-old Rhodesian ridgeback

HISTORY:  Dog presented with vomiting.  Over the course of 6 days, the dog developed lingual ulcers, tachypnea, a cough and excessive salivation.  It fatigued easily and developed cyanosis after exercise.

HISTOPATHOLOGIC DESCRIPTION:

  1. Lung: There are multifocal to coalescing areas of consolidation and atalectasis multifocally throughout the section that often contain abundant hemorrhage. Alveoli coalesce to form multifocal areas of alveolar emphysema. Bronchiole lumina often contain hemorrhage and bronchiolar epithelium is hyperplastic.  Diffusely, the alveolar septa are expanded up to 25um by fibrin, edema, hemorrhage and increased numbers of macrophages and lymphocytes. There is necrosis and loss of type I pneumocytes  which have been replaced by cuboidal type II pneumocytes (hyperplasia), fibrin and varying amounts of fibrous connective tissue (fibrosis).  Alveolar lumina are multifocally collapsed and/or contain abundant hemorrhage, fibrin, edema, increased numbers of alveolar macrophages, fewer neutrophils and small amounts of necrotic debris.  Multifocally, alveolar septa are discontinuous with blunt clubbed ends forming large confluent spaces (emphysema).  Multifocally, perivascular and peribronchiolar connective tissue is expanded by hemorrhage, fibrin, edema and scattered neutrophils.  Diffusely, the pleura is expanded by hemorrhage, fibin, dilated lymphatics (edema), and scattered neutrophils, and lined by plump cubodial mesothelium (reactive mesothelium); there is subpleural fibrosis. 
  2. Kidney: Rental tubules are separated by mild to moderate hemorrhage which expands the interstitium. Multifocally within the cortex and medulla, renal tubular epithelium are swollen with bright eosinophilic, granular cytoplasm (degeneration) or contain one discrete, round cytoplasmic vacuole (lipid degeneration) often with yellow to light green globular pigment (lipofuscin), or have a shrunken, pyknotic nucleus (necrosis). Multifocally, tubular lumina contain eosinophilic cellular and karyorrhectic debris (necrosis).  Multifocally, glomerular uriniferous spaces are expanded by refluxed tubular epithelial cells and an eosinophilic homogenous material (protein).  Multifocally, the interstitium is expanded by aggregates of lymphocytes and plasma cells and there is mild interstitial and periglomerular fibrosis and mineralization 

MORPHOLOGIC DIAGNOSES:

  1. Lung: Pneumonia, interstitial, chronic, diffuse, marked, with loss of type I pneumocytes, type II pneumocyte hyperplasia, alveolar hemorrhage, emphysema and fibrosis, Rhodesian ridgeback, canine.
  2. Kidney: Tubular degeneration and necrosis and interstitial hemorrhage subacute, multifocal, moderate.

ETIOLOGIC DIAGNOSIS:  Bipyridilium pneumonia and nephrosis

CAUSE:  Bipyridilium (paraquat) toxicity

GENERAL DISCUSSION:

PATHOGENESIS:

TYPICAL CLINICAL FINDINGS:

TYPICAL GROSS FINDINGS:  

Acute

Chronic

Heavy, edematous and hemorrhagic lungs

Pale lungs with interstitial emphysema, bullous emphysema +/-pneumomediastinum

Fail to collapse

 

TYPICAL LIGHT MICROSCOPIC FINDINGS:

Acute

Subacute

Chronic

Necrosis of type I pneumocytes

Intestitial and alveolar edema

Intraalveolar hemorrhage

Hyaline membranes

 

Proliferation of type II pneumocytes

Interstitial and intraalveolar fibrosis

Type II pneumocyte hyperplasia

 

Extrapulmonary lesions:

DIFFERENTIAL DIAGNOSIS:  

COMPARATIVE PATHOLOGY:

Other causes of diffuse alveolar damage (DAD):

References:

  1. Caswell JL, Williams KJ. Respiratory system. In: Maxie MG, ed. Jubb, Kennedy, and Palmer"s Pathology of Domestic Animals. Vol. 2 6th ed. Philadelphia, PA: Elsevier; 2017:519.
  2. Costa LG. Bipyridine. In: Klaassen CD, ed. Casarett and Doull"s Toxicology: The Basic Science of Poisons. 8th ed. New York, NY: McGraw-Hill; 2013:961-962.
  3. Gupta RC. Toxicity of herbicides. In: Gupta RC, ed. Veterinary Toxicology: Basic and Clinical Principles. New York, NY: Academic Press; 2007:567-576.
  4. Herfst S, van den Brand JM, Schrauwen EJ, et al. Pandemic 2009 H1N1 Influenza Virus Causes Diffuse Alveolar Damage in Cynomolgus Macaques. Vet Pathol. 2010;47(6):1040-1047.
  5. Husain AL. The Lung. In: Kumar V, Abbas AK, Fausto N, Aster JC, eds. Robbins and Cotran Pathologic Basis of Disease. 8th ed. Philadelphia, PA: Saunder Elsevier; 2010:680-682.
  6. Kehrer JP. Systemic Pulmonary Toxicity. In: Ballantyne B, Marrs TC, Syversen T, eds. General and Applied Toxicology. Vol 2. 2nd ed. London, UK: Macmillan Reference Ltd; 2000:723-724.
  7. Lopez A, Martinson SA. Respiratory System, Mediastinum and Pleurae. In: Zachary JF, McGavin MD, eds. Pathologic Basis of Veterinary Disease. 6th St. Louis, MO: Elsevier; 2016:549.
  8. Nagata T, Kono I, Masaoka T, Akahori F. Subacute Toxicity of Paraquat in Beagle Dogs: Clinicopathology and Pathologic examinations. Vet Hum Toxicol. 1992;34(1):15-20.
  9. Pickrell JA. Respiratory toxicity. In: Gupta RC, ed. Veterinary Toxicology: Basic and Clinical Principles. New York, NY: Academic Press; 2007:185-187.
  10. Syrja P, Saari S, Rajamaki M, Saario E, Jarvinen AK. Pulmonary Histopathology in Dalmatians with Familial Acute Respiratory Distress Syndrome (ARDS). J Comp Pathol. 2009;141(4):254-259.
  11. Uzal FA, Plattner BL, Hostetter JM, Alimentary system. In: Maxie MG, ed. Jubb, Kennedy, and Palmer"s Pathology of Domestic Animals. Vol. 2 6th ed. Philadelphia, PA: Elsevier; 2017:13.Witschi HR, Last JA. Toxic Responses of the Respiratory System. In: Klaassen CD, ed. Casarett and Doull"s Toxicology: The Basic Science of Poisons. 6th ed. New York, NY: McGraw-Hill; 2001:529.
  12. Van Riel D, Rimmelzwann GF, van Amerongen G, Osterhaus AD, Kuiken T. Highly Pathogenic Avian Influenza Virus H7N7 Isolated From a Fatal Human Case Causes Respiratory Disease in Cats but Does Not Spread Systemically. Am J Pathol. 2010;177(5):2185-2190.


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