A challenging case: Lethargy and inappetence in a Pekingese


A challenging case: Lethargy and inappetence in a Pekingese

If it were not for the suspicious thoracic radiography results, this dog would likely have been discharged before its primary problem was discovered.

A 7-month-old 11.9-lb (5.4-kg) intact male Pekingese was presented to the Veterinary Medical Centre (VMC) at the Western College of Veterinary Medicine for evaluation of lethargy and inappetence of one week's duration and a cough of one day's duration. The owners described the cough as mild, intermittent, dry, hacking, and nonproductive.


The dog had vomited once seven days earlier at the onset of its signs. There was no history of trauma or previous illness.

The dog had been vaccinated in accordance with its primary veterinarian's recommendations, including receiving an intranasal Bordetella species parainfluenza vaccination. The dog had never been boarded and had not been in direct contact with other dogs aside from one housemate, a Shih Tzu.


Vital Stats
The physical examination revealed a quiet but alert dog in good body condition. Its mucous membranes were pink, and the capillary refill time was two seconds. The dog's heart rate, respiratory rate, and temperature were normal. Thoracic auscultation was normal, and the dog's femoral pulses were strong and regular. No spontaneous coughing was noted during the physical examination; however, a hacking, nonproductive cough was easily elicited on tracheal and laryngeal palpation. The remainder of the physical examination was unremarkable.

An emergency panel revealed no abnormalities in packed cell volume or total protein, blood urea nitrogen, or blood glucose concentrations. Oxygen saturation, assessed by using a portable pulse oximeter, was normal (98%).

1. A ventrodorsal thoracic radiograph of the 7-month-old intact male Pekingese in this report revealed a predominantly soft tissue homogeneous opacity with central gas lucencies in the region of the left cranial lung lobe. No air bronchograms are visible. The trachea deviates mildly to the right. The cardiac silhouette appears normal in size and shape.
Thoracic radiography revealed a soft tissue heterogeneous opacity with central gas lucencies filling the left cranial thorax (Figure 1). No air bronchograms were visible. The trachea was deviated dorsally and mildly to the right. Cardiovascular structures were within normal limits for size and shape. The initial interpretation was that these radiographic changes could suggest a fluid-and-gas-filled cranial esophagus, abscessation and necrosis within the left cranial lung lobe, focal aspiration pneumonia, or lung lobe torsion.