Persistent Cough/ Skin Lesion?

Hi Vets, I am truly at a loss with my fur baby. I have spent thousands trying to get to the bottom of this persistent cough. I am BEGGING for help. Last June (2020) my 3 y/o chi-poo dog began coughing quite a lot. I noticed it most after she drank water or ran around at the park/ got excited. At the vet, we tested for Valley Fever (neg), did chest x rays which came back clear, did a round of antibiotics and ultimately used regular cough medicine to ease the irritation. This calmed things for a while and I noticed the cough came and went periodically but again it was most prominent after she drank water. It almost sounded like she was aspirating or was drinking too quickly. In January she had another Valley fever test which was negative. I was using cough medicine to help her as needed. A month ago the cough got bad again meaning it would happen about 50% of the time she drank water. We tried prednisone which did not help. We tried another round of antibiotics which did not help. We did chest x rays (attached) and the vet is mildly concerned about collapsing trachea.  I would love some thoughts on this. Secondly, I was doing routine skin checks on my dog and came across this lesion this morning. I know skin is particularly hard to diagnose via images and no biopsy but does this look familiar? Is this a cutaneous manifestation of cocci or did I go down the Google rabbit hole? Maybe a sebaceous cyst or folliculitis? Does anyone have any ideas? Please I am EXHAUSTED of worrying. 

Other X rays for reference :)

Hello!   Let's get under the skin.  You appear to have a flattish, punctate lesion,  with hair-loss around it.  I can't tell the depth,  putting it anywhere on the spectrum between a pustule that is drying up (spot - superficial), or an entry point from a cat bite-wound (deep).  If the latter seems at all likely, your vet may want to give antibiotics right away, so check with them. Assuming that it is superficial however, a cutaneous manifestation of cocci is highly possible.  This would not be a diagnosis, but a consequence of something:  perhaps some kind of insect bite that has caused a mild irritation / infection, for example, or a scratch that introduced some bacteria or yeast.  It could, at a pinch, be ring-worm, so wash your hands after dealing with it just on the off-chance (low likelihood but take no risks).  That may be an epidermal collarette around the outside of an infected follicle. So what to do?  If it is itchy and therefore getting scratched and getting worse, your vet should be made aware of the lesion relatively soon, as such lesions can quickly become much bigger.  If it gets bigger and changes or is not better after the weekend, we would also advise showing this to a vet.

If that is a single punctate wound, has the pet been recently chipped?  As this is one possibility.

We do not interpret radiographs, cat or dog, on this site I'm afraid - these have been taken by a vet and it is up to them to present their findings and recommendations.   Their opinion will generally be more valuable than that of a vet who has not examine the pet, or listened to them.   Questions that can be useful to ask include, 'Why did you take the pictures?  What were you trying to rule in or out?'    'What have you managed to rule in or out' and 'what do you suggest as the next step.'

I hope that this helps.

If an animal becomes depressed or their breathing deteriorates at any point, always see your own vet.

Thank you! This does help. I am not quite asking for interpretations of radiographs, rather a professional opinion on if these should be further send to a radiologist for an extra $150 because my vet sees "something" that "might be" collapsing trachea. Please advise. Also, she saw the lesion and thinks it is an infected scratch.

Hello!  Thankyou for the update.  Hopefully this is now getting the appropriate attention. With the radiographs, I think it is fantastic that your vets had told you that they are not sure about something;  it suggests honesty and an interest in getting things right. It certainly sounds from what you are saying as though further diagnostic effort may be indicated in order to identify the cause of this cough;  whether this is done by referring the whole case, or by referring the radiographs, is something to discuss with them.  A good deciding question may be what views, showing how much of the trachea, does the specialist want to see? - does this match what is provided?   Collapsing trachei are notoriously difficult to diagnose radiographically. so often repeat radiographs or other methods of imaging (e.g. fluoroscopy) may be required.  Other possibilities may also need to be ruled out, so trachea only collapse at certain times.  Best of luck.

Correction last line:  Some trachea may only collapse at certain times.