Signalment: 8 Years, M, Doberman
Presenting Complaint: An 8 year old male Doberman presented for coughing (“huffing”) daily for the past two weeks.

Presenting History

Lateral view

DV view

Lateral View:
	Evidence of Chamber Enlargement learn more
		Left Ventricle: No
		Right Ventricle: Yes    It is slightly more than 2.5 intercostal spaces for a deep chested dog.
		Left Atrium: Yes    Mild loss of the caudal waist.
		Right Atrium: Indeterminate    It usually cannot be assessed in this projection.
		Left Auricle: Indeterminate    It usually cannot be assessed in this projection.
		Right Auricle: No    No loss of the cranial waist.
	Abnormalities of Great Vessels learn more
		Aortic Dilation: No    No loss of the cranial waist.
		Main Pulmonary Artery Dilation: No    No loss of the cranial waist.
		Caudal Vena Caval Enlargement: No
	Pulmonary Venous Distention learn more: Yes    The lower pulmonary vein to the cranial lung appears slightly enlarged.
	Airway Changes learn more
		Peribronchial Pattern: Yes    Mild to moderate evidence present.
	Alveolar Changes learn more
		Air Bronchograms: No
		Cotton-like Densities: No
		Lobar Sign: No
	Pleural Effusion learn more
		Fissure Lines: No
		Leafing of Lung Lobes: No
	Pulmonary Edema learn more: Indeterminate    Perhaps. There are airway changes and the cranial lower pulmonary vein appears enlarged. But with the other lung disease present these changes may not be related to the heart. The left atrium is not very enlarged for pulmonary edema.
	Evidence of Heartworm Disease learn more: No
	Other Findings
		There is a large bullous present over carina.
	Radiographic Diagnosis
		Large pulmonary bullous.
	Description
		These radiographs are noteworthy for the incidental finding of a large pulmonary bullous. At this time we have no etiology for this finding.

DV View:
	Evidence of Chamber Enlargement learn more
		Heart too Wide: No
		Left Ventricle: No
		Right Ventricle: No
		Left Atrium: No    This projection is much inferior to the lateral projection to evaluate the left atrium.
		Right Atrium: No
		Left Auricle: No
		Right Auricle: No
	Abnormalities of Great Vessels learn more
		Aortic Dilation: No
		Main Pulmonary Artery Dilation: No
		Caudal Vena Caval Enlargement: Indeterminate    The caudal cava is obscured in this projection.
	Pulmonary Venous Distention learn more: No
	Airway Changes learn more
		Peribronchial Pattern: Yes    Mild evidence present.
	Alveolar Changes learn more
		Air Bronchograms: No
		Cotton-like Densities: No
		Lobar Sign: No
	Pleural Effusion learn more
		Fissure Lines: No
		Leafing of Lung Lobes: No
	Pulmonary Edema learn more: No
	Evidence of Heartworm Disease learn more: No
	Other Findings
		The bullous is noted in the right caudal lung.
	Radiographic Diagnosis
		A large pulmonary bullous
	Description
		This radiograph is noteworthy for the presence of the large pulmonary bullous.

Clinical Diagnosis   Idiopathic pulmonary bullous

Comment   This case gives us a chance to reconsider the case of a coughing Doberman. Based on signalment one is inclined to rush to a diagnosis of DCM and congestive heart failure. In fact the echocardiogram indicates that this patient does also have occult DCM.

We await further data to determine the cause for the bullous.