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Dr. John
Dr. John, Texas Veterinarian
Category: Dog Veterinary
Satisfied Customers: 4855
Experience:  Over 14 years of clinical veterinary experience
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Lucy, my dog recently went in care and dental cleaning. A

Customer Question

Lucy, my dog recently went in for preventive care and dental cleaning. A chest xray was done prior to the dental cleaning and her lungs look black. The radiologist report said it was either fungal or cancer. I took my dog to a specialist who did an abdominal ultrasound and an echo. The ultrasound showed all organs were normal except her spleen. It had a mottled appearance and a fine needle aspiration was done. The results were ok on the spleen. The vet was unable to aspirate anything from her lungs. The echo showed she has cardiomyopathy. She was treated with Fenbendazole and Doxycycline in case she had lung worms and in case the cardiomyopathy was caused by a tick borne illness. She's also on benazepril, vetmedin, lasix, and spironolactone. She went back for a repeat CXR and echo yesterday (6 weeks after the ultrasound and echo) and the radiologists report on the repeat CXR is the same as before. Either fungal or cancer. The vet is recommending another ultrasound to try to aspirate something from her lungs again. My question is if she was unable to aspirate anything 6 weeks ago and the CXR looks the same as it did before, does this make sense? I ask her if we could treat her for the possible fungal infection (she said the test for this is unreliable) and do a repeat CSX after finishing the meds and she said the med to treat this is dangerous and she wouldn't treat a dog without a diagnosis. How do you determine if it's a fungal infection if the test is unreliable? I want to have my dog treated and healed, but in the most cost effective way. She already had TPLO surgery and then had to have the plate and screws removed about a year later, so she's quite expensive. I don't mind the cost, but don't want to do something that is unnecessary and not the best approach.
Submitted: 3 months ago.
Category: Dog Veterinary
Expert:  Ronald Reupert replied 3 months ago.

Hello this is dr. Reupert . I'm sorry to hear about the trouble you're having getting to the bottom of the mass in the chest . Fungal infection in the lung can usually be diagnosed with a urine test from a company called Mira Vista . I have had good luck diagnosing blastomycosis early with this test . It is very non-invasive obviously and just requires a tablespoon of urine . another approach that I've used to diagnose fungal lung infections is a transtracheal wash . this involves moderate to heavy sedation . Saline is flushed into the lung through the trachea and aspirated and examined under a microscope . you don't mention any symptoms like coughing, lethargy or loss of appetite . Most fungal infections cause a fever and symptoms of illness.
Please write back if you have more questions.

Customer: replied 3 months ago.
Do you think doing another ultrasound is appropriate 6 weeks after the first one? She was unable to aspirate anything from the lungs to biopsy 6 weeks ago. Lucy has not had any coughing. She does start panting occasionally, but it's hot in GA. She acts fine, still running, chasing squirrels, has not had any fever when she's been at the vet. She has lost over 10 pounds in 7 months. That concerned me since her eating habits have not really changed.
Expert:  Ronald Reupert replied 3 months ago.

I would like to know if this mass is enlarging, static, or shrinking. An xray would be the best way to compare it to the first one. An ultrasound is most helpful to guide the needle to the mass to re biodsy/aspirate. The wight loss does concern me, and a panel w thyroid levels would be nice to have.

Fine needle aspirates are difficult on smaller masses, and non-diagnostic results are common. Another needle aspirate would be approriate if the mass is enlarging.

Customer: replied 3 months ago.
There was no change in the CXR from 6 weeks ago. That is why I was concerned about doing another ultrasound and trying to do a biopsy again. Since there was no change on the xray, I felt like it was not the best route to take. Lucy had routine lab work 6 weeks ago and everything was normal. I'm not sure if the thyroid levels were incuded in the routine lab work. I'll have to check on that.
Expert:  Ronald Reupert replied 3 months ago.

I guess I missed that a 6wk follow up cxr was unchanged. In that case, I do not feel a biopsy is strongly indicated at this point. I would probably do another cxr in 6-12 weeks if no other symptoms arise. Certain fungal infections can cause a mass that leaves scar/granulation tissue that is quiet and not an active infection. Characteristicly these masses do not enlarge, and have well defined smooth borders. It would be nice to know exactly what it is, but it may be more trouble than it is worth.

I think that watching carefully and rechecking an xray is a reasonable approach.