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Background Comparison of clinical findings, chest radiographs (CXR), lung ultrasound (LUS) findings, and C‐reactive protein (CRP) concentrations at admission and serial follow‐up in dogs with aspiration pneumonia (AP) is lacking. Hypothesis Lung ultrasound lesions in dogs with AP are similar to those described in humans with community‐acquired pneumonia (comAP); the severity of CXR and LUS lesions are similar; normalization of CRP concentration precedes resolution of imaging abnormalities and more closely reflects the clinical improvement of dogs. Animals Seventeen dogs with AP. Methods Prospective observational study. Clinical examination, CXR, LUS, and CRP measurements performed at admission (n = 17), 2 weeks (n = 13), and 1 month after diagnosis (n = 6). All dogs received antimicrobial therapy. Lung ultrasound and CXR canine aspiration scoring systems used to compare abnormalities. Results B‐lines and shred signs with or without bronchograms were identified on LUS in 14 of 17 and 16 of 17, at admission. Chest radiographs and LUS scores differed significantly using both canine AP scoring systems at each time point (18 regions per dog, P < .001). Clinical and CRP normalization occurred in all dogs during follow up. Shred signs disappeared on LUS in all but 1 of 6 dogs at 1 month follow‐up, while B‐lines and CXR abnormalities persisted in 4 of 6 and all dogs, respectively. Conclusion and Clinical Importance Lung ultrasound findings resemble those of humans with comAP and differ from CXR findings. Shred signs and high CRP concentrations better reflect clinical findings during serial evaluation of dogs.

Background Evidence regarding optimal treatment duration in dogs with aspiration pneumonia (AP) and the role of thoracic radiographs (TXR) and lung ultrasonography (LUS) in the long‐term follow‐up of affected dogs is lacking. C‐reactive protein (CRP) is a reliable acute phase protein to monitor bacterial pneumonia in dogs. Hypothesis Investigate the safety of antimicrobial discontinuation based on clinical improvement and serum CRP normalization, as well as the usefulness of TXR and LUS for follow‐up. Animals Dogs diagnosed with AP and treated with antimicrobials. Methods Prospective observational study. Antimicrobials were discontinued based on clinical improvement and serum CRP normalization after 1, 3, or 5 weeks. At each consultation, a quality‐of‐life questionnaire, physical examination, serum CRP, TXR, and LUS were assessed. Short‐ (2 weeks) and long‐term (>1 month) follow‐ups after treatment discontinuation were performed to monitor for possible relapses. Results Seventeen dogs were included. Antimicrobials were discontinued after 1 week in 12 dogs (70.6%) and 3 weeks in the remaining 5 dogs (29.4%). Short‐term relapse was not observed in any dog and long‐term relapse was diagnosed in 3 dogs. Thoracic radiographs and LUS were useful for diagnosis, but did not add additional information during follow‐up, because image normalization lagged behind clinical improvement and serum CRP normalization. Conclusion and Clinical Importance Dogs with AP can be safely and effectively treated using a short‐term antimicrobial regimen discontinued after clinical improvement and serum CRP normalization. Imaging might still be useful for complicated cases with a less favorable response to treatment.

Dear Editor, I read with interest the recent publication entitled “Comparison of lung ultrasound, chest radiographs, C-reactive protein, and clinical findings in dogs treated for aspiration pneumonia.” 1 This study was presented in 2019 at the European Veterinary Emergency and Critical Care Symposium (EVECCS) titled “Comparison of thoracic point of care ultrasound and radiographic findings as well as clinical evolution and C Reactive Protein concentrations in dogs treated for aspiration pneumonia” and published as an abstract. 2,3 Both the abstract and this publication appear to present the same data based on an identical study cohort at identical time points (T0-admission, n = 17; T1-2 weeks, n = 13, and T2, 30-days, n = 6); 16 of 17 dogs having shred signs at T0; and median C-reactive protein (CRP) values of 129 mg/L (24-267) at T0, 7.7 (3-32) at T1, and 5.2 (3-8) at T2 when comparing Table 1 of the EVECCS published abstract and this article in the Journal of Veterinary Internal Medicine. 1,3 It appears that the authors changed their lung ultrasound protocol from an imprecisely defined 9-view sliding methodology called “point of care thorax” as described in their abstract 2,3 to a 9-view lung ultrasound protocol. 1 In other words, the authors changed from a nondiscrete sliding protocol over the upper, middle and lower thirds of the thorax as approximately—view 1-8th intercostal space (ICS), view 2-5th ICS, view 3-3rd ICS, view 4-3rd ICS, view 5-5th ICS, view 6-6th ICS, view 7-6th ICS, view 8-5th ICS, and view 9-4th ICS to a discrete intercostal lung examination of the 4th ICS, 6th ICS and 8th ICSs in the upper third, middle third, and lower third of the thorax. CONFLICT OF INTEREST DECLARATION Dr Lisciandro is the co-owner of FASTVet.com, a private corporation that provides veterinary ultrasound training to practicing veterinarians.

3 In the authors' experience, this border tends to vary with species, breed, respiratory effort and underlying lung lesions. 3 It is also the authors' experience that it can be difficult to determine the caudal extent of the lung margin on a lateral radiograph, particularly given this border changes during the respiratory cycle. [...]it is interesting to note that as VetBLUE increases the sites assessed from a single intercostal space to multiple intercostal spaces, it more closely aligns with earlier studies published by Dr Armenise 6 and the protocol used in the current study. An abstract in dogs suggests LUS protocols that examine larger lung surface area can detect pathology otherwise missed with protocols that scan less lung surface area, although this is a small study and prospective veterinary studies are needed to know how many sites need to be scanned to maximize sensitivity and specificity at finding underlying pleural and lung pathology. 8 The duration of time to perform lung ultrasound will likely need to be balanced against the speed with which a diagnosis needs to be made.

Background In dogs, antimicrobial drugs are widely prescribed for aspiration pneumonia (AP) despite poor documentation of bacterial infection in AP (b‐AP) using bronchoalveolar lavage fluid (BALF) analysis. Interpretating discordant cytology and culture results is challenging, contributing to lack of a criterion standard, and highlighting differences between veterinary and human medical criteria for b‐AP. Objectives Determine how many dogs with AP had BALF collection and differences in diagnosis of b‐AP using veterinary vs human medical criteria. Report findings of noninvasive markers (e.g. fever, band neutrophilia, radiographic severity score) in dogs with and without b‐AP. Animals Retrospective cohort study of client‐owned dogs (n = 429) with AP at 2 university veterinary hospitals. Twenty‐four dogs met enrollment criteria. Methods Inclusion criteria were radiographic diagnosis of AP, ≥1 risk factor, CBC findings, and BALF cytology and culture results. Veterinary medical b‐AP criteria were cytology findings compatible with sepsis with or without positive culture, or cytology findings not consistent with sepsis and positive culture (≥1.7 × 103 cfu/mL). Human medical b‐AP criteria required culture with ≥104 cfu/mL or > 7% cells with intracellular bacteria on cytology. Results Only 24/429 dogs met all enrollment criteria; 379/429 dogs lacked BALF collection. Diagnosis of b‐AP differed using veterinary (79%) vs human (29%) medical criteria. Fever, band neutrophils and high radiographic scores were noted in dogs with and without b‐AP. Conclusions and Clinical Importance Lack of routine BALF collection hampers definitive recognition of bacterial infection in AP. Differences in dogs meeting veterinary vs human medical definitions for b‐AP and usefulness of noninvasive markers warrant further study to improve understanding of the role of bacteria in AP.

Background New drugs for veterinary patients with acute respiratory distress syndrome (ARDS) are urgently needed. Early or late postinfection treatment of influenza‐infected mice with the liponucleotide cytidine diphosphocholine (CDP‐choline) resulted in decreased hypoxemia, pulmonary edema, lung dysfunction, and inflammation without altering viral replication. These findings suggested CDP‐choline could have benefit as adjunctive treatment for ARDS in veterinary patients (VetARDS). Objectives Determine if parenterally administered CDP‐choline can attenuate mild VetARDS in dogs with aspiration pneumonia. Animals Dogs admitted to a veterinary intensive care unit (ICU) for aspiration pneumonia. Methods Subjects were enrolled in a randomized, double‐blinded, placebo‐controlled trial of treatment with vehicle (0.1 mL/kg sterile 0.9% saline, IV; n = 8) or CDP‐choline (5 mg/kg in 0.1 mL/kg 0.9% saline, IV; n = 9) q12h over the first 48 hours after ICU admission. Results No significant differences in signalment or clinical findings were found between placebo‐ and CDP‐choline‐treated dogs on admission. All dogs exhibited tachycardia, tachypnea, hypertension, hypoxemia, hypocapnia, lymphopenia, and neutrophilia. CDP‐choline administration resulted in rapid, progressive, and clinically relevant increases in oxygenation as determined by pulse oximetry and ratios of arterial oxygen partial pressure (PaO2 mmHg) to fractional inspired oxygen (% FiO2) and decreases in alveolar‐arterial (A‐a) gradients that did not occur in placebo (saline)‐treated animals. Treatment with CDP‐choline was also associated with less platelet consumption over the first 48 hours, but had no detectable detrimental effects. Conclusions and Clinical Importance Ctyidine diphosphcholine acts rapidly to promote gas exchange in dogs with naturally occurring aspiration pneumonia and is a potential adjunctive treatment in VetARDS patients.

Background In humans, respiratory complications in patients with acute pancreatitis (AP) are a common life-threatening comorbidity. Since possible lung impairment has not been individually evaluated in canine AP, the aims of the present study were to: (1) describe the prevalence, types and severity of pulmonary complications in dogs with acute presentation of AP, and (2) evaluate their association with mortality. AP diagnosis was based on compatible clinical and laboratory parameters, abnormal canine pancreatic-lipase test, and positive abdominal ultrasound within 48 h from admission. The canine acute pancreatitis severity score (CAPS) was calculated for each dog at admission. Arterial blood gas analysis and thoracic radiography were performed at admission. Thoracic radiography was classified on the basis of pulmonary pattern (normal, interstitial or alveolar) and a modified lung injury score (mLIS) was applied to the ventrodorsal projections for each dog. VetALI/VetARDS were diagnosed using current veterinary consensus. Dogs were divided into non-survivors or survivors (hospital discharge). Clinical, radiological and blood gas parameters collected at presentation were compared between survivors and non-survivors and associated with mortality. Results This prospective cohort study included twenty-six client-owned dogs with AP. Twelve out of twenty-six dogs (46%) died or were euthanized. At admission, thirteen dogs showed respiratory distress at physical examination, which was associated with death ( P  < 0.001). Radiographic abnormalities were found in twenty-one dogs: alveolar ( n  = 11) and interstitial pattern ( n  = 10). Radiographic alterations and mLIS score were both associated with death ( P  = 0.02 and P  = 0.0023). The results of the arterial blood-gas evaluation showed that non-survivors had lower PaCO 2 and HCO 3 − levels, and higher A-a gradient than survivors ( P  = 0.0014, P  = 0.019 and P  = 0.004, respectively). Specifically, three dogs had aspiration pneumonia, and VetALI was diagnosed in nine dogs (34.6%), and no dogs met the criteria for VetARDS. The presence of VetALI was associated with mortality ( P  < 0.001). Conclusions As with humans, possible lung impairments, such as VetALI, should be investigated in dogs with acute presentation of pancreatitis.

Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice, 4th ed. Granulomatous amebic meningoencephalitis causing the syndrome of inappropriate secretion of antidiuretic hormone in a dog. Syndrome of inappropriate antidiuretic hormone secretion concurrent with liver disease in a dog. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations.

A 12-year-old spayed Newfoundland bitch was presented with chronic non-productive vomiting, regurgitation and coughing of six weeks’ duration. On clinical examination, the dog was depressed with no other significant findings. Haematology and biochemistry investigations detected no abnormalities. Thoracic and abdominal radiographs revealed a megaoesophagus and an abnormally positioned pylorus. A thoracic and abdominal computed tomography scan confirmed the abnormal position of the stomach, together with moderate aspiration pneumonia. Laparoscopic examination of the peritoneal cavity revealed the greater omentum wrapped over the stomach, with a fold visualised between the abnormally positioned pyloric antrum and the gastric corpus. A 180-degree clockwise gastric rotation was laparoscopically diagnosed and corrected. The normal position of the stomach was confirmed before a laparoscopic-assisted incisional gastropexy was performed. Post-operatively the vomiting and regurgitation resolved and the patient was discharged. Twenty-four hours after discharge, the dog was presented with deteriorating clinical signs of aspiration pneumonia. The owner declined treatment, additional diagnostics as well as a necropsy and requested euthanasia. Chronic gastric volvulus should be considered as a rare differential diagnosis in dogs with non-specific, chronic gastrointestinal signs. Radiography, computed tomography and laparoscopy are valuable diagnostic aids in making this diagnosis. Chronic gastric volvulus can be successfully reduced laparoscopically as reported here for the first time.