Inhalation pneumonia may result from inhalation of rumen contents following hypocalcaemia, especially if the cow becomes cast, and after the faulty administration of drenches. Affected cows show fever, marked thoracic pain, congested mucous membranes, and halitosis. Auscultation of the chest typically reveals widespread crackles over the affected area; pyothorax may result. The prognosis is guarded. Sonograms reveal pleurisy and columnar changes to the visceral pleura suggestive of chronic pneumonia but their distribution is in the dorsal areas mainly of the diaphragmatic lobe and not the ventral portions of the apical and cardiac lobes characteristic of chronic suppurative pulmonary disease (CSPD).