30 Clinical Signs and Diagnostic Tests for Nasal Disease

Maxillo: respiratory epithelium

Ethmo: olfactory epithelium

What is the difference between the lining of the maxilloturbinates and the ethmoturbinates

Cribriform plate

What separates the ethmoturbinates from the brain?

1. nasal discharge

2. sneezing

3. stertor (snoring, snorting)

Name the most common clinical signs of nasal disorders:

Serous (clear, watery): may be associated with viral disease

Describe this nasal discharge. It can be normal, but what MIGHT is be associated with?

Mucopurulent (white, yellow or green + thick): associated with inflammation (viral, bacteria, fungal, foreign bodies, oral dz, lower airway dz)

Describe this nasal discharge. What is it associated with?

Hemorrhagic epistaxis: associated with trauma, locally aggressive disease, hypertension, coagulopathies

Describe this nasal discharge. What is it associated with?

Facial deformity + mucopurulent discharge

Describe what is happening in this cat

Depigmentation and ulceration of nasal planum = blastomycoses

Describe what is happening in this dog

Depigmentation and ulceration of nasal planum = aspergillosis

Describe what is happening in this dog

Phases I thru IV

How many phases are there for diagnostic approach of chronic nasal discharge

Phase I noninvasive

This phase of chronic nasal discharge diagnosis includes history, PE, fundic exam, fecal float, nasal swabs and viral testing

Phase II requiring general anesthesia

This phase of chronic nasal discharge diagnosis includes *nasal radiography, rhinoscopy,* dental rads, nasal biopsy with histopath, and CT

Phase III

This phase of chronic nasal discharge diagnosis includes CT, MRI, and frontal sinus exploration which you usually refer for

Phase IV

This phase of chronic nasal discharge diagnosis includes repeat phase II in several months using CT, MRI, exploratory rhinotomy with turbinectomy, usually a referral

4 views: lateral, open mouth VD, intraoral DV, skyline frontal sinuses

How many views should you get when doing nasal radiographs in phase II of chronic nasal discharge?

Palatine fissure

What is 1 in this normal radiograph?

Nasal septum, vomer

What is 2 in this normal radiograph?

Maxilloturbinates aka nasal conchae

What is 3 in this normal radiograph?

Ethmoid turbinates

What is 4 in this normal radiograph?

Cribriform plate

What is 5 in this normal radiograph?

Abnormal: loss of trabecular detail

Is this normal or abnormal?

Abnormal: loss of trabecular detail and soft tissue swelling

Is this normal or abnormal?

Abnormal: metallic object

Is this normal or abnormal?

Abnormal: loss of detail

Is this normal or abnormal?

Normal

Is this normal or abnormal?

Abnormal

Is this normal or abnormal?

Abnormal: lysis of vomer bone (neoplasia)

Is this normal or abnormal?

Neoplasia: commonly causes lysis of vomer bone

Aspergillus: commonly causes roughening of vomer bone

What is the difference between neoplasia and aspergillus and what they will do to the vomer bone (NORMALLY but not ALWAYS)?

Abnormal: extension of abnormality into frontal sinus

Is this normal or abnormal?

Eye

What is 1?

Ethmoid turbinates = normal

What is 2?

Normal nasopharyngeal meatus

What is 3?

Et tube

What is 4?

Tongue

What is 5?

Normal

Is this normal or abnormal?

Abnormal

Is this normal or abnormal?

lysis of vomer bone

What is 1?

Lysis of nasal cavity into orbit = may present with exopthalamos or hard to retropulse

What is 2?

Tumor extended into nasopharyngeal meatus = common sign of malignancy

What is 3?

Bony lysis

What is a HALLMARK of neoplasia in the nasal cavity?

Abnormal = Lysis thru vomer bone and hard palate

Is this normal or abnormal?

Rhinoscopy. Look at normal side first under general anesthesia

What is this, and how do you decide where to look first?

Rigid rhinoscopy = never blindly pass anything into the nose. measure medial canthus and do not go beyond that because the cribriform plate and brain are beyond this

What is this and what do you have to keep in mind if you do this?

Rigid

Would you get biopsies and cultures with *rigid or flexible* rhinoscopy

Flexible rhinoscopy (pass into oral cavity and retroflex to see caudal aspect of nasopharynx)

What is this?

Nasopharyngeal disease

Sterterous breathing is a hallmark of disease where?

Cryptococcus neoformans

What is this?

Cryptococcus in feline (though FNA may also be used)

Nasal swabs are least invasive but typically considered to be nondiagnostic due to nonspecific results. Which problem is the exception to this?

True

TRUE OR FALSE: animals must be under anesthesia for a nasal flush

Nasal flush

This diagnostic nasal test is minimally invasive and involves saline flush from internal nares rostrally towards external nares to produce a cytologic sample

Pinch biopsy (alligator biopsy)

This diagnostic nasal test is *invasive* and coagulation panels and buccal bleeding time (BMBT) *need to be collected beforehand*, where a minimum of *6 samples* should be collected from small forceps to collect tissue samples

Measuring to medial canthus and taking a pinch (alligator) biopsy

What is this?

Pinch biopsy

What is the *preferred nonsurgical method of specimen collection* for nasal disease?

Turbinectomy

This is the MOST AGGRESSIVE AND INVASIVE diagnostic nasal test which is performed thru a rhinotomy incision

On right side of image: missing cribriform plate due to left nasal tumor

Describe what is happening here