Post-strangulation pulmonary oedema in a puppy
Strangulation is on the list of differentials for pulmonary oedema: post-obstructive pulmonary oedema (POPE). The pathophysiology is thought to involve negative intra-pulmonary presure resulting from strenous efforts to inhale against a closed airway.
This puppy suffered an episode of accidental strangulation. Having survived the acute episode he then presented a few hours later with progressive dyspnoea.
On radiography:
There is a bilateral alveolar-interstitial pattern, with air bronchograms, particularly affecting the caudal lobes.
On ultrasound:
There are a scatter of B-lines in affected areas originating on the pleural interface.
In the worst affected parts these coalesce into ‘blocks’ of hyperechoic lung:
There is little published on the management of this kind of scenario in veterinary species.
In human medicine also there is a lack of controlled studies but it appears that such cases are usually managed with intravenous glucocorticoids, furosemide and, if necessary , intubation and ventilation.
