Acute Respiratory Distress Syndrome It’s so shocking, I can’t breathe! Heidi Ditmyer DVM University of Tennessee College of Veterinary Medicine Department of Pathobiology Tifton 2008 Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Signalment Juvenile Female Spayed Yorkshire Terrier Juvenile Female Spayed Yorkshire Terrier Presented to rDVM after chewing electric cord Presented to rDVM after chewing electric cord rDVM treated with Oxygen and diuretics rDVM treated with Oxygen and diuretics Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Case Referred to UT Referred to UT Ventilator Ventilator Febrile Febrile Died 24 hours post arrival Died 24 hours post arrival Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Gross Findings Glossal and gingival ulceration Glossal and gingival ulceration Bilateral interstitial pneumonia Bilateral interstitial pneumonia Congenital portosystemic shunt Congenital portosystemic shunt Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Glossal ulceration Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Histology and etiology Fibrinous interstitial pneumonia Fibrinous interstitial pneumonia Multiple possibilities Multiple possibilities Consistent with Acute Respiratory Distress Syndrome Consistent with Acute Respiratory Distress Syndrome Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Acute Respiratory Distress Syndrome (ARDS) Acute onset Acute onset Bilateral/diffuse pulmonary changes Bilateral/diffuse pulmonary changes Hypoxemia Hypoxemia No evidence of left atrial hypertension No evidence of left atrial hypertension Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

ARDS Secondary inflammatory response Secondary inflammatory response Macrophages  cytokines  enzymes  free radicals  diffuse alveolar and endothelial damage Macrophages  cytokines  enzymes  free radicals  diffuse alveolar and endothelial damage Differential diagnosis for any animal with non-cardiogenic pulmonary edema and appropriate risk factors Differential diagnosis for any animal with non-cardiogenic pulmonary edema and appropriate risk factors Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Conclusion Limited lung response regardless of trigger Limited lung response regardless of trigger Overzealous inflammatory response Overzealous inflammatory response Pathophysiology not entirely understood Pathophysiology not entirely understood Considered as differential diagnosis Considered as differential diagnosis Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Acknowledgements Dr Kim Newkirk Dr Kim Newkirk UT histology staff UT histology staff Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Thank you Questions? Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only