Endoscopy of the Respiratory TractPatrick Lecoindre, DVM, Dip ECVIM(CA)
St Priest, France |
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RHINOSCOPYDiagnosis of nasal disease is complicated by the similarity of signs and the non specificity of the symptoms of most nasal diseases and by inaccessibility of the nasal cavity. It's often necessary to use complementary exams. Rhinoscopy gives access to the nasal cavity for the examination of the mucosal surface, for the biopsy of mucosa and suspects lesions, for therapeutic procedures in some cases. Previous reports have shown that effective rhinoscopy is essential for differential diagnosis of nasal diseases . But this exam alone cannot be relied on to provide a diagnosis for every case and must be included in a protocol that associates history, physical examination and other exams: radiographs, culture, histopathology, fungal serology, allergy screening. The aim of this conference si to present after define indications of rhinoscopy, different abnormal aspects of the nasal cavity, in the nasal diseases that we have observed in an important study of about 324 cases in dogs and cats. Indications The most common indication for rhinoscopy is the chronic unresolved diseases that have not responded to a symptomatic treatment and in which a diagnosis has not been established. Table 1.
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TRACHEO-BRONCHOSCOPYToday, respiratory endoscopy has become an important diagnostic technique in the practice of high-quality veterinary medicine. Bronchoscopy has allowed to understand the physiopathology of respiratory diseases in dogs and cats and has made easier the diagnosis and treatment of many respiratory disorders. Supplementing the X-ray examination, the respiratory endoscopy gives a totally reliable diagnosis. Indications They are many indications for a tracheobronchoscopy. The two main indications are the acute cough for which an inhalated foreign body is the suspected cause, or the chronic cough that has an unknown cause or does not respond to standard therapy. Unexplained lung infiltrate, unexplained abnormal breathing pattern, staging of chronic bronchitis, diagnosis and staging of pulmonary neoplasia, are other important indications for using this technique. This technique can confirm functional disorders (tracheal collapse) difficult to bring to light with usual techniques of exploration. Bronchoscopy is a technique that can reveal the nature, vascularity, extent and distribution of inflammatory infectious or infiltrative lesions of the pulmonary tract. When there are indirect signs such as an abnormal production of mucus, presence of pus or blood, the endoscopic examination enables to make complementary investigations, sometimes determining as cytologic evaluation, bronchoalveolar lavage, biopsy. An endoscopy may have been decided after the observation of abnormal x-ray pictures, for which the etiology was not precise enough. In this case a bronchoalveolar lavage (BAL) is an examine which, for a first step determines the cellular profile of a pulmonary area so as to give a better description of an alveolitis (inflammation of the alveolar area). Doing a BAL is based upon the principle that the cells in the alveolar lumen reflect the cells of the pulmonary interstitium. The histocytology of this lavage will make it possible to describe a luminal alveolitis, to confirm a tumoral process, an allergic etiology, a chronic inflammation, a bacterial infection. Patrick Lecoindre, DVM, Dip ECVIM(CA)
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