Respiratory Distress in Elephants: Linking Clinical Findings with Thoracic Imaging

Respiratory abnormalities in elephants can be difficult to investigate because conventional thoracic imaging is challenging in such a large animal. 

This makes the quality of the initial clinical assessment and the choice of a practical imaging modality particularly important. 

Start with the respiratory pattern 

Cough, nasal discharge or an altered respiratory pattern should not be interpreted in isolation. 

The assessment should document: 

• Onset and duration of the abnormality; 
• Frequency and character of coughing; 
• Nasal discharge; 
• Respiratory rate; 
• Respiratory effort; 
• Exercise tolerance; 
• Appetite and activity; 
• Body temperature where feasible; 
• Concurrent systemic abnormalities. 

The broader clinical picture matters because respiratory disease is only one of several conditions reported in Asian elephant populations, and veterinary assessments from Asian range countries have identified respiratory disease alongside gastrointestinal, infectious, traumatic and other disorders^[1]. 

A respiratory sign does not identify the cause 

A cough or altered respiratory pattern should prompt investigation rather than immediate attribution to a particular disease. 

For example, tuberculosis has been confirmed in free-ranging Asian elephants in southern India, with pulmonary lesions identified at post-mortem examination and Mycobacterium tuberculosis confirmed by PCR and sequencing^[2]. 

This establishes that tuberculosis is an important differential diagnosis in the appropriate epidemiological setting. 

It does not mean that every elephant with respiratory signs should be presumed to have tuberculosis. 

Similarly, respiratory abnormalities may occur as part of other systemic or infectious conditions. 

Lung ultrasound offers a practical imaging option 

A major development for elephant respiratory assessment is the recent evaluation of transthoracic lung ultrasonography in Asiatic elephants. 

The 2026 study performed 68 non-cardiac transthoracic ultrasound examinations in 28 elephants and mapped specific thoracic regions that could be used as acoustic windows for more consistent examination^[3]. 

The investigators were able to identify recognised ultrasound features including A-lines, B-lines, lung sliding and bronchograms and developed a semi-quantitative lung-ultrasound score across 24 thoracic regions^[3]. 

This provides a practical framework for performing and documenting lung ultrasound rather than relying on an isolated descriptive scan. 

Interpret ultrasound findings with the clinical picture 

The study identified sonographic patterns associated with different degrees of loss of lung aeration, including patterns compatible with interstitial changes, pulmonary oedema, consolidation and pneumothorax^[3]. 

However, these findings should not be interpreted as disease-specific diagnoses. 

The ultrasound pattern indicates an abnormality that requires clinical correlation. 

For example, B-lines may occur with more than one pulmonary process, while consolidation can have several possible causes. 

The useful question is therefore not simply: 

“Is the ultrasound abnormal?” 

But: 

“Does the ultrasound finding explain the clinical presentation, and what additional investigation is needed?” 

Baseline imaging may improve interpretation 

One particularly useful implication of the 2026 study is the possibility of documenting pulmonary findings longitudinally. 

Because the investigators developed defined thoracic regions and a semi-quantitative scoring system, repeated examinations can potentially be compared more systematically over time^[3]. 

This may be particularly useful for elephants with recurrent respiratory abnormalities or those requiring monitoring of a known pulmonary condition. 

However, the study establishes the feasibility and structure of the approach; it does not establish that serial ultrasound alone can determine treatment response or prognosis. 

Keep infectious disease testing targeted 

Where clinical findings and epidemiological history raise suspicion of an infectious cause, ultrasound should complement—not replace—appropriate laboratory investigation. 

In southern India, post-mortem investigation of wild Asian elephants with tuberculosis combined gross pathology, histopathology, acid-fast staining and molecular confirmation^[2]. 

This illustrates the broader diagnostic principle: imaging can identify and localise an abnormality, while laboratory testing may be required to determine its cause. 

Document findings consistently 

For elephants undergoing repeated respiratory assessment, the record should ideally include: 

• Clinical respiratory findings; 
• Respiratory rate and effort; 
• Ultrasound examination date; 
• Thoracic regions examined; 
• Significant sonographic findings; 
• Lung-ultrasound score where the validated approach is used; 
• Laboratory investigations; 
• Treatment and subsequent clinical changes. 

Consistent documentation makes subsequent examinations more useful than isolated descriptions such as “lungs appear abnormal”. 

Clinical takeaway 

Respiratory assessment in Asian elephants should integrate the clinical pattern with appropriate diagnostic testing rather than relying on a single sign or imaging finding. 

The recent development of a structured lung-ultrasound approach provides a practical, non-invasive method for examining and monitoring pulmonary abnormalities in Asiatic elephants. 

Its greatest clinical value is likely to come from systematic examination, consistent documentation and interpretation alongside the rest of the clinical evidence.

References:

Miller D, Jackson B, Riddle HS, Stremme C, Schmitt D, Miller T. Elephant (Elephas maximus) Health and Management in Asia: Variations in Veterinary Perspectives. Vet Med Int. 2015;2015:614690. https://doi.org/10.1155/2015/614690

Chandranaik BM, Shivashankar BP, Umashankar KS, et al. Mycobacterium tuberculosis Infection in Free-Roaming Wild Asian Elephant. Emerg Infect Dis. 2017;23(3):555-557. https://doi.org/10.3201/eid2303.161439

Sarma N, Lachenpa TL, Khadpekar Y, et al. Ultrasonographic Assessment of the Lungs in Asiatic Elephants (Elephas maximus). Vet Radiol Ultrasound. 2026;67(4):e70194. https://doi.org/10.1111/vru.7019