Bella is a 5-month old female English Bull Terrier, who was referred to Vets Now Referrals (Swindon) Critical Care service with acute onset severe respiratory distress after choking on kibble earlier in the day. Poor Bella was cyanotic and orthopnoeic at presentation.

A chest X-ray taken by the referring vet showed a diffuse, severe, alveolar pattern bilaterally. A diagnosis of noncardiogenic pulmonary oedema was made, and Bella was treated with oxygen supplementation. Once she was more stable, a CT scan of the thorax was performed and showed no other underlying disease or airway obstruction.

Noncardiogenic pulmonary oedema is an uncommon condition that can arise after choking, electrical shock, or seizures/traumatic brain injury. Respiratory distress is usually acute in onset and severe. The pathophysiology is controversial, but one proposed mechanism is that a rush of catecholamines causes a transient surge in hydrostatic pressure leading to leakage of fluid in the lungs. With intensive care, animals can make a full recovery. Our ICU has an oxygen cage and incubator with the capability to provide up to 90% inspired oxygen in severe respiratory cases where application of nasal prongs might destabilize the patient.

Bella improved dramatically over the following 48 hours with us, and oxygen therapy was gradually weaned. Bella was discharged several days later and is doing well at home, although she still tends to bolt her food!