Tutorial Module 2

THE CONDUCTIVE SYSTEM

y, Guttural Pouches,, Larynx,
The Nasal Cavity, y ,
Trachea and Bronchi

Alfonso López
Atlantic Veterinary
y College
g
University of Prince Edward Island
Canada

©2009 Febrero 3
 Type of Rhinitis According to Exudate

Exudate Type of reaction Implications

Serous Serous secretions by reactive sub mucosal glands Mild irritation

Catarrhal Mucus secretions due to goblet cell hyperplasia Chronic, irritation, moderate injury

Fibrino s
Fibrinous Fibrinogen leakage from nasal blood vessels
essels Se ere injury
Severe inj r to mucosa
m cosa

Purulent Accumulation and exudation of neutrophils (pus) Pyogenic organisms

Granulomatous Accumulation of macrophages, lymphocytes, plasma Chronic inflammation, pathogens

cells and connective tissue resistant to phagocytosis

Two types of exudates can be seen at the same time with names like mucopurulent (mucus and pus);
fibrinopurulent (fibrin and pus); fibrinonecrotic (fibrin and necrosis); fibrinohemorrhagic (fibrin and blood), etc
 Example of Purulent Rhinitis

Strangles (Streptococcus equi) is an important

equine disease that may occur as an outbreak
with high morbidity (90%) but low mortality (5%
> foals).

Strangles cases purulent (suppurative) rhinitis

and lymphadenitis with formation of abscesses.
abscesses

Purulent discharge in the left nostril Some horses develop purpura hemorrhagica
(vasculitis). Bacterial metastasis to the internal
organs is referred to as "bastard strangles.”

Involvement of retro pharyngeal lymph nodes can

compress laryngeal nerves and cause secondary
laryngeal hemiplegia.

Strangles is only seen sporadically in North

America.

Courtesy of Dr. Jeanne Lofstedt

 Example of mucopurulent rhinitis in a dog

Viral infections can predispose dogs to

secondary bacterial rhinitis. Most common
organisms are Bordetella bronchiseptica,
bronchiseptica E.
E
coli, Streptococci, Staphylococci.

Viruses causing canine upper respiratory

infection include Canine Distemper
(
(Morbillivirus),
b ll ) Canine Adenovirus
d ((CAV-2),
)
Canine Parainfluenza virus (CPI-1). CAV-2 and
CPI-1. Viral rhinitis are generally acute and
transient and can cause a highly contagious
condition referred to as Kennel Cough.

In pure viral infections lesions are minimal

except for hyperemia; when viral rhinitis gets
complicated with bacterial infections, mild
hyperemic lesions turn into mucopurulent
rhinitis and/or chronic sinusitis. In Canine
Distemper, non-suppurative encephalitis and
enteritis have more clinical significance.

Note mucopurulent discharge from nostrils

(Courtesy of Dr. Darcy Shaw)

• This dog was euthanized because
recurrent and poorly responsive rhinitis
and sinusitis.

• The palate was removed to visualize the

exudate in the nasal cavity.

In chronic rhinitis
rhinitis-sinusitis
sinusitis there is severe
goblet cell hyperplasia and increased mucus
production as shown in these two diagrams.
 Rhinitis and Conjunctivitis in cats

Rhinitis and conjunctivitis are frequently

seen in cats. The most common differential
g
diagnoses are:

Viral:
• Feline Calicivirus
• Feline Infectious Rhinotracheitis

Chlamydial:
• Chlamydiophila psittaci
Rhinitis often co-exists with
conjunctivitis. Note exudate crusts in
nostrils and conjunctiva Bacterial:
• Bordetella bronchiseptica
• Escherichia coli
• Streptococcus
• Staphylococcus

Mycotic:
• Cryptococcus neoformans
(Courtesy of Dr. Cheryl Cullen)
 Mucopurulent Rhinitis post mortem

Exudates and turbinate necrosis (arrows)

Mucopurulent discharge from nostrils

Feline Rhinotracheitis (FHV-1), Feline Calicivirus and Chlamydophila spp cause feline rhinitis-
sinusitis-conjunctivitis. Also, Cryptococcus neoformans (fungus) is frequently associated with rhinitis
in cats.

As in other species, feline nasal viral infections are generally acute and transient, but can also
predispose secondary bacterial rhinitis (Bordetella bronchiseptica, Pasteurella multocida and
Pseudomonas aeruginosa).
 Example of purulent rhinitis in a calf

Note a purulent exudate on dorsal and ventral conchae and in meatuses.

Mucosal surfaces are not hyperemic and this could raise the possibility that the exudate was
produced elsewhere and coughed into the nasal cavity. Histology would be required here to
confirm that exudation of polymorphonuclear leukocytes is taking place in nasal mucosa.
 Example of fibrinous rhinitis in a calf / IBR

Note the thick plaques of fibrin on the nasal mucosa. Fibrinous exudation
implies severe damage to the vasculature and escape of fibrinogen from blood
that subsequently is polymerized into fibrin

This is an example of viral lesion (IBR) with superimposed bacterial rhinitis. Remember that some
bacteria causing this type of infection are inhabitants of the normal flora. Tissues tested positive for
IBR virus by FAT in this calf.
 Example of granulomatous rhinitis in a calf

Granulomas consist of necrotic center

surrounded by macrophages, plasma
cells and lymphocytes. The nodule may
b encapsulated
be l t d with
ith fib
fibroblasts
bl t

Granulomatous rhinitis is typically associated to organisms that survive phagocytosis such as Mycobacterium spp,
some fungal organisms such as Cryptococcus and Blastomyces among others. Allergic rhinitis has also been
reported in cattle (common in Australia) with nasal granulomas.
 Multiple small nodules on nasal
Examples of granulomatous rhinitis mucosa. Granulomatous
inflammation always indicates
chronic inflammation. Lesions
like these may be caused by
hypersensitivity reactions or
mycotic infections.

Granulomatous rhinitis is rare

Cow and most likely of little clinical
significance. If found during a
physical
p y examination,, a biopsyp y is
recommended.

Note polypoid nodule in the

Mule
nasal cavity of this mule.
Although it looked tumoral,
histopathology revealed a
multilobulated granuloma
containing round bodies with a
* thick capsule (asterisks in the
insert). Organisms were
identified as Rhinosporidium
seeberi, a human and animal
pathogen classified as a protist
and not as a true fungus.
* Courtesy of Dr. Alexis Berrocal, Costa Rica
 Histological section H&E. Note the enormously large cells
Inclusion Body Rhinitis with large viral intranuclear inclusion bodies (arrows
(arrows),
),

IInclusion
l i B Body
d Rhi
Rhinitis
iti iis a viral
i l di
disease caused
dbby a H
Herpes virus
i (C
(Cytomegalovirus)
t l i ) iin piglets
i l t lless
than 2 weeks old. The infection generally goes unnoticed, causing only transient rhinitis and
epiphora (overflow of tears). Epiphora (excessive tears) results from the obstruction of lachrymal
ducts by inflammation of the nasal mucosa. Overflow of tears mixes with dust and dirt producing
l
localized
li d skin
ki iirritation
it ti around d th
the eyes.

There is no mortality except in immune-suppressed piglets that develop a disseminated fatal

infection.
.
Grossly there is only hyperemia but microscopic examination of the nasal mucosa shows typical
cytomegaly (large cells) containing large basophilic intranuclear inclusion bodies, hence the term
"Cytomegalovirus.”
 Atrophic Rhinitis Normal Atrophic Rhinitis

Note facial deformity

Note complete absence (atrophy) of left conchae, deviation of

septum, and moderate atrophy of right conchae.

Atrophic Rhinitis is a widely distributed disease of pigs and it’s etiology is still controversial.
Bacterial? (Pasteurella multocida, Bordetella bronchiseptica, Mycoplasma spp.), Viral?. nutritional
(Vitamin D, Ca, P), Genetic? , Environmental? (Humidity, temperature, etc.).

Current literature suggests a combined (co-infection) with toxigenic Pasteurella multocida and
Bordetella bronchiseptica.

In spite of the name

name, inflammation in atrophic rhinitis is minimal.
minimal However,
However as you may expect there
is notable resorption of bone.

Different degrees of atrophy are shown in the next slide.

 Various degrees of Atrophic Rhinitis

Note also deviation of the nasal septum

Four sections
F ti showing
h i moderated t tto severe (complete)
( l t ) atrophy
t h off conchae.
h Coiled
C il d conchaeh
normally produce air turbulence which, in turn produce impaction of inspired particles into the wall.
Pigs with atrophic rhinitis may have a higher incidence of pneumonia. The effect on weight gain
has been a subject of controversy.
 Sinusitis

Meningitis

Sequels to
Guttural
pouch Rhi iti
Rhinitis
empyema

Lymphadentiits

There are several nasty sequels to nasal infection and rhinitis. Infection can spread:
• To sinuses causing sinusitis (S).
• To brain through the “lamina cribosa” (small
small arrow)
arrow causing meningitis and encephalitis.
• To middle ear through the Eustachian tube causing otitis.
• To guttural pouches (gp) through the Eustachian tube causing guttural pouch empyema.
• To retropharyngeal lymph nodes via lymphatic vessels (ln ln) causing lymphadenitis.
 Sinusitis and Sinus Empyema

* *

Normal Sinuses

• Note accumulation of inspissated pus in

paranasal sinuses (asterisk).
(asterisk)

• Remember that drainage in sinuses (and

guttural pouches in horses) is poor, therefore
mucus and pus can easily accumulate
accumulate.

• Accumulation of pus is referred to as

empyema, while accumulation of mucus is
known as mucocele.
mucocele

• Sinusitis in cattle can be caused by improper

dehorning.
 • Guttural pouches are ventral dilations of auditory tubes
(Eustachian tubes) in horses.
Guttural Pouches
• Eustachian tubes conect the middle ear with the p
pharynx
y in
all species.

• The function of the guttural pouches is uncertain but it is

believed that they cool down the blood going to the brain.

Empyema
Mucocele
Tympani
Mycosis
H
Hemorrhage
h

Guttural Pouches
 Guttural Pouches

Note the forceps illustrating the communication

between pharynx and guttural pouch (GP)
GP

Mucus is produced in guttural pouches and then removed into the pharynx where it is swallowed. Flow
obstruction results in abnormal mucus accumulation which is known as "guttural pouch mucocele.”

Like other parts of the upper respiratory tract, alterations in the defense mechanisms may result in secondary
bacterial or fungal infection.

Infections with pyogenic organisms often results in accumulation of pus which is referred to as "guttural
guttural pouch
empyema.”

Other common abnormalities of guttural pouches include tympany characterized by an abnormal accumulation of
air and fungal infections known as guttural pouch mycosis.
 Guttural Pouch Empyema

Note severe swelling and distention

in the parotid region (red arrow),
and muco-purulent
p discharge
g from
the nostrils (blue arrow).

Empyema of guttural pouches can

be uni- or bilateral and it is often a
sequel of upper respiratory infection
with S. equi (Strangles ) or other
pyogenic bacteria.

Clinical signs included intermittent

nasal discharge, enlargement of
retro pharyngeal lymph nodes, and
parotid swelling.
p g In severe cases
guttural pouch empyema can
interfere with swallowing
(dysphagia).

(Courtesy of Dr. Jeanne Löfstedt)

 Unilateral Guttural Pouches Empyema

• Note thick purulent exudate in the right guttural pouch

(asterisk).

• Bacteriologic examination is always required for

identification of an etiologic agent and Streptococcus equi
is one of the most common isolate.
isolate

• Endoscopy is often used for the clinical diagnosis guttural

pouch empyema.

Guttural Pouch (Necropsy)

Exudate in guttural pouch (courtesy IVIS)

Opened guttural pouch and occipital condyles
(C). Note round, multifocal, raised plaques of
Guttural Pouch Mycosis
fibrinonecrotic exudate on pouch mucosa
Opened guttural pouch. C are the occipital condyles. Note a
(arrows).
large
g mass of fibrinonecrotic exudate firmlyy attached to the
pouch mucosa (asterisk).

Inset: Microscopic view of fungal hyphae in mycotic plaque

(circle).

HE Histology

*
c
C = occipital condyles.
Cornell Cornell
Guttural Pouch Hemorrhage

Acute hemorrhage
Fresh flood filling the guttural pouch

Cornell
• Guttural pouches are immediately adjacent
to the internal carotid artery and several
cranial nerves.

• Erosion of the carotid artery is an important

sequel to guttural pouch mycosis.
mycosis It causes
epistaxis that is in some cases fatal.

• Thrombosis of a carotid artery leading to brain

thromboembolism with ataxia and blindness Chronic hemorrhage
i another
is th iimportant
t t sequell tto guttural
tt l pouch h Organized blood clot in guttural pouch
mycosis.

• Injury to cranial nerves is another sequel.

Rhinitis and Sinusitis Etiological diagnosis typically requires
laboratory tests
Clinical signs:
• Sneezing, wheezing, stertor
• Nasal discharge
• Unilateral or bilateral

Virology
Bacterial
culture

Biopsy
Bi

Cytology
 NASAL TUMORS
Epidemiology
The overall incidence off nasal tumors in animals is low and they are most commonly seen in dogs
and cats and to a lesser extent, horses. The concept that long-nose breeds are most frequently
affected has been recently challenged. Retrovirus-induced nasal carcinoma in ruminants is
common in some geographical areas.

Pathology
Over 80% of nasal tumors are malignant and could arise from epithelial or mesenchymal cells.
Epithelial tumors of the nasal passages include adenomas (benign and rare) and carcinomas
( li
(malignant t and
d common).) T
Tumors off stromal
t l origin
i i iinclude
l d fib
fibrosarcoma, osteosarcoma
t and
d
chondrosarcoma. Malignant tumors often metastasize to the brain and other organs.

Clinical Signs
I severe cases nasall ttumors can resultlt in
In i craniofacial
i f i l deformation,
d f ti exophthalmia,
hth l i andd metastasis.
t t i
Nasal tumors often bleed or become infected causing a nasal discharge that may be mistaken
for a bacterial or mycotic rhinitis. Some locally invasive tumors cause damage to nerves and
brain and a variety of neurological signs.
 Canine Nasal Carcinoma

*
*

• N
Note iinvasion
i off the
h nasall cavity
i b by a llarge tumorall mass ((asterisks).
i k )

• The most common nasal stromal tumors are fibrosarcoma, osteosarcoma, and chondrosarcoma
and the most common epithelial tumors are carcinoma, adenocarcinoma and undifferentiated
carcinoma.
i

• Biopsies or cytological examinations of the tumor are always required to identify the cell origin
and arrive at a final diagnosis in the live animal.
 F li Nasal
Feline N l Carcinoma
C i

• This cat suffered from progressive

swelling and deformation of facial
bones. The cat also had loose
teeth.

• Cytological examination of nasal

lavage fluid demonstrated
malignant epithelial cells and the
diagnosis of a nasal carcinoma was
made.

• Because of the poor prognosis, the

cat was euthanized and sent to
postmortem examination.
 Feline Nasal Carcinoma

Cut surface of the nasal cavity.

Note large
g mass arising g from the nasal
epithelium. This tumor was locally
invasive, but there was no evidence of
metastasis in this cat.

Histological section H&E.

Note sheaths of neoplastic

epithelial cells with eosinophilic
cytoplasm large nuclei
cytoplasm,
containing prominent nucleoli.
 Equine Nasal Fibrosarcoma

Note large tumoral mass occupying the entire left

nasal cavity and pressing on the nasal septum.

Remember that nasal tumors can become rather serious because

of their close association to the brain, eyes and nerves.
 Nasal tumor eroding the cribiform plate (arrows
(arrows))

Nasal Carcinoma

Metastasis to the Brain

Tomography: Brain metastasis (arrow)

Brain; coronal section Metastatatic

nasal carcinoma (arrow)
 Enzootic Nasal Carcinoma / Enzootic Ethmoid Tumor

Enzootic Nasal Carcinoma or “Endemic

Endemic Ethmoidal Tumor
Tumor” is a retroviral-induced
retroviral induced neoplasia of sheep,
sheep goats and
cattle. In some endemic regions the incidence may be considerable. Clinical signs are nonspecific (hemorrhage) and
the tumor often becomes infected causing mucopurulent nasal discharge.

Note the large mass occupying the nasal cavity.

 SIGNS AND DIAGNOSIS NASAL TUMORS

CLINICAL SIGNS
• Persistent nasal discharge
• Epistaxis
• Airflow obstruction
• Facial deformity (+ / -)
• Exophthalmia (+ / -)
• Neurological signs (mets)

Clinical Diagnosis:
• Radiographs / CT / MRI
• Rhinoscopy

Biopsy
Inflammation Neoplasia
vs
Necrotic Laryngitis (Calf Diphtheria)

Note the plaques of fibrinonecrotic

diphtheritic exudate (asterisk) in
the larynx of these two calves. This
lesion is the result of a secondary
infection caused by Fusobacterium
necrophorum in animals in which the
integrity of the normal laryngeal
mucosa has been compromised such
as in viral infections (i.e. IBR),
trauma, etc.

Pieces of exudate may be aspirated

into the lung and cause
bronchopneumonia.

In pigs the lesions associated to

secondary infection (Fusobacterium
necrophorum) are generally
restricted to the oral mucosa and
the condition is referred to as oral
necrobacillosis (diphtheria).
 Tracheitis

Viral Tracheitis

Note hyperemic mucosa in the trachea

affected by pure viral infection alone. Injury,
inflammation and repair for trachea and
bronchi are identical to those previously
described for nasal cavity. Pure viral
tracheitis are rarely seen at necropsy since
they are not fatal unless complicated with
secondary
d b
bacterial
t i l iinfection.
f ti

Viral + Bacterial Tracheitis

Note the accumulation of fibrinonecrotic

exudate in the trachea (bottom) with
secondary bacterial infection.

Tracheitis is generally found in combination

with rhinotracheitis, laryngotracheitis,
tracheobronchitis or bronchopneumonia.
 Suppurative Tracheitis

Note plaques of purulent exudate on

the surface of the tracheal mucosa.

The mucosa is also notably hyperemic

due to an underlying viral infection.
Affected mucosa was subsequently
complicated with a secondary
bacterial infection.

In cattle, this lesion is often seen in

IBR,
IBR BRSV and d PI
PI--3 virus
i iinfections.
f ti

In horses suppurative tracheitis may be

a sequel to EVR infection.
 Fibrino necrotic (Diphtheritic) Tracheitis

Viral
Chemical

Note the necrotic mucosa detaching from Note the fibrino

fibrino-necrotic
necrotic exudate on tracheal
the trachea (diphtheritic membranes). mucosa (diphtheritic membranes).
This cow was accidentally given a This steer died of IBR
disinfectant (ammonium chloride) and
subsequently aspirated. Courtesy of Cornell
 Parasitic Tracheobronchitis
(Oslerus osleri)

Canine lungs with a parasitic bronchitis

caused by Oslerus (Filaroides) osleri.

Close-up of multiple parasitic nodules in the

tracheobronchial bifurcation.

Insert: Histological view of the nodules in the

bronchial lumen (BL) lined by ciliated epithelium
(arrows) and containing coiled parasites
(asterisks).

Oslerus osleri is a metastrongyle nematode

found worldwide that generally affects young
dogs.

The parasitic nodules are typically seen at the

t h b
tracheobronchial
hi l bif
bifurcation
ti b butt occasionally
i ll
these nodules extend deeper into the distal
intrapulmonary bronchi.

Clinical signs
g in dogs
g with Filaroides osleri are
only observed in severe parasitic infections and
include cough, inspiratory wheezing, exercise
intolerance, etc.
 Parasitic Bronchitis
(Verminous Pneumonia)

Some nematodes (lungworms)

parasitize the bronchi and
Note the extension of the neck. The airways are
bronchioles causing chronic
plugged with mucus and parasites. bronchitis and bronchiolitis.

These parasitic diseases are often

referred to as verminous pneumonia
or verminous bronchitis.
Calf with verminous pneumonia. Note the large
number of Dictyocaulus viviparus in bronchi The most common forms are:

• Dictyocaulus viviparus (Bovines)

• Dictyocaulus filariae (Ovine)

• Metastrongylus apri (Porcine)

• Cronosoma vulpis (Foxes, dogs)

 Dictyocaulus viviparus in bronchi

Dictyocaulus viviparus in trachea

Animals with severe parasitic bronchitis develop

obstructive pulmonary disease caused by bronchial
plugs of mucus mixed with parasites.

Obstruction could also lead to atelectasis (See next

module).

Lungworms n
Diagnosis in the life animal is done in finding parasitic
larvae in feces by the Baernann technique
Bronchus containing cross sections nematodes (arrows)
9 Rhinitis is classified according to the types of exudates as serous, catarrhal, purulent, muco-
purulent, fibrinous and granulomatous. Fibrinous rhinitis typically implies severe mucosal
injury with leakage of fibrinogen from blood vessels.

9 Feline calicivirus, Feline Infectious Rhinotracheitis, Chlamydophila spp and Cryptococcus

neoformans are primary causes of rhinitis in cats. Bordetella bronchiseptica, E. coli and
Streptococcus spp are common secondary pathogens in feline rhinitis.

9 IBR, EVR, PI-3 virus, Adenovirus, Canine Distemper, Canine Adenovirus (CAV-2) and Canine
PI-1 virus are also important pathogens of the nasal cavity. Strangles (Streptococcus equi)
causes rhinitis, lymphadenitis and guttural pouch empyema.

9 Rhinitis cause nasty sequels such as sinusitis, meningitis, lymphadenitis in all species, and
guttural pouch empyema in horses.

9 Inclusion Body Rhinitis is a transient infection of young piglets caused by herpes-

Cytomegalovirus. This infection typically induces cytomegaly (cell enlargement) and large
intranuclear inclusions in nasal epithelium. In rare cases disseminated fatal infection can
occur.

9 Atrophic rhinitis is a world wide disease characterized by inflammation and atrophy of the
nasal turbinates. The current proposed etiology is a dual infection with toxigenic strains of
Pasteurella multocida and Bordetella bronchiseptica.
9 Streptococcus equi is the causative agent of Strangles in horses which is characterized by
rhinitis, sinusitis, lymphadenitis and in some cases guttural pouch empyema.

9 Accumulation of mucus in sinuses is known as sinus mucocele and purulent exudate is

known as sinus empyema.
empyema

9 Guttural pouches are ventral dilations of the auditory (Eustachian) tubes in horses.

9 The most common guttural pouch problems are empyema, mucocele, tympany, mycosis, and
hemorrhage.

9 Because of the close association of guttural pouches with blood vessels and nerves, epistaxis
and neurological signs are common sequels to inflammation.

9 Nasal tumors often produce nasal discharge mimicking rhinitis or may induce exophthalmia or
craniofacial deformation. The final diagnosis requires lab work particularly a nasal biopsy. In
ruminants nasal carcinomas are often caused by a retrovirus.

9 Nasal tumors are generally invasive and can metastasize to the brain.

9 Necrotic laryngitis also known as Calf Diphtheria is caused by Fusobacterium necrophorum

following mucosal damage. Lesions are typically a fibrinonecrotic inflammation of the larynx
that in some cases results in airway obstruction, aspiration of exudate into the lungs and only
rarely in septicemia known as fusobacteremia.
9 Tracheitis is the inflammation of the tracheal mucosa and can be caused by a virus, bacteria,
virus bacteria
fungus or even tracheal aspiration and irritant gases.

9 Viral tracheitis can be complicated with a secondary bacterial infection such as it commonly
happens in cattle with IBR.
IBR

9 Oslerus osleri is a parasitic disease of dogs and other carnivores characterized by the
presence of large nodules in the tracheobronchial bifurcation. Only in very severe cases it
has clinical significance.

9 Some nematodes known as lungworms parasitize the bronchi and bronchioles causing
chronic bronchitis and bronchiolitis. The best known lungworms are Dictyocaulus viviparus in
cattle, Dictyocaulus filariae in sheep, Metastrongylus apri in pigs, and Cronosoma vulpis in
foxes, dogs and other wild mammals.
ƒ Some images were acquired from veterinary colleges of
Canada, United States and Mexico and the names of
pathologists who contributed with some slides are known.
Their valuable contribution is sincerely acknowledged.

ƒ I would like to thank Adriana Lopez, University of Western

Ontario, and Eileen Kinch for editorial assistance; Dr.
María Forzán, Atlantic Veterinary College, for critically
reviewing these modules.
 Module 2

If you have any comments, criticisms or suggestions about these

tutorial modules please let me know.

Also, if you find any errors or typos please let me know too
lopez@upeica