WHAT IS YOUR DIAGNOSIS?UNUSUAL BRONCHIAL FOREIGN BODY (TOOTH) IN A DOG.

An 11-year-old 10-kg (22-lb) sexually intact male Pekingese-type dog was evaluated for dyspnea, coughing, and fever of 3 days’ duration. According to the owner, there was no recent history of trauma. The dog was treated by the referring veterinarian with amoxicillin and clavulanic acid without any improvement in respiratory tract signs. On physical examination, the dog was afebrile but its respiratory rate was high. During auscultation of the thorax, bronchial sounds were detected in both lung fields during inspiration; these sounds were louder on the right than on the left side of the thorax. The dog had severe dental calculus and gingivitis, and several teeth were missing. Mild leukocytosis with neutrophilia were detected on CBC. Radiographs of the thorax were obtained. A spiked radiopacity, which appears to be a tooth, is superimposed over the inlet of the right caudal bronchus. A mixed bronchial and interstitial pattern can be seen in the right cranial lung lobe and the ventral aspect of the right caudal lung lobe, and an alveolar pattern can be seen in the caudal aspect of the left cranial lung lobe. A bronchial foreign body was suspected, with generalized aspiration bronchopneumonia. A ventrodorsal oblique radiographic view was obtained to better visualize the foreign body by shifting its position from the cardiac silhouette. No lesions of the esophageal wall or leakage of contrast medium was detected. A radiographic diagnosis of foreign body in the right caudal bronchus and aspiration bronchopneumonia in the left cranial lung lobe was made. Bronchoscopy was performed during anesthesia. A flexible endoscope, 8 mm in diameter, was used to as- sess the position of the foreign body that was seen at the inlet of the right caudal bronchus. The foreign body was successfully removed by use of a 4-wired basket retriever, and it was identified as the fourth left upper premolar tooth. The dog recovered well and was treated with a third-generation cephalosporin for 10 days, with rapid resolution of the clinical signs and abnormal radiographic findings. No postoperative complications were detected for 3 months after surgery. Aspiration of the fourth left upper premolar tooth was likely due to loos- ening of the tooth caused by severe periodontitis. Aspi- ration of a tooth should be considered in animals with severe respiratory tract disease and pathologic condi- tions in which tooth loss is possible.