Thoracoscopic foreign body removal and right middle lung lobectomy to treat pyothorax in a dog

A three-year-old, 30-kg, spayed female German wirehaired pointer was presented for coughing, pyrexia and lethargy. Thoracic radiographs showed mild right-sided pleural effusion, moderate pneumothorax and a pulmonary lesion in the right middle or caudal lung lobe. A diagnosis of pyothorax was established by fine needle aspiration of the pleural effusion. Thoracoscopic exploration was performed using one-lung ventilation. A vegetal foreign body (grass awn) and an abscess were observed in the distal part of the right middle lung lobe. The foreign body was removed and a right middle lung lobectomy was performed, both thoracoscopically. No complications were noted. The dog was discharged 48 hours after surgery, and no recurrence of the clinical signs was observed during the follow-up time period (three years and three months). Thoracoscopy is a minimally invasive alternative to thoracotomy to explore and successfully treat some non-chronic pyothoraces in dogs, including lesions affecting the right middle lung lobe.     

Right cranial lung lobe torsion after a diaphragmatic rupture repair in a Jack Russell terrier

A seven-year-old male Jack Russell terrier was presented with a history of coughing, generalised weakness and lethargy 10 days after an abdominal coeliotomy to repair a large diaphragmatic rupture. Thoracic radiographs demonstrated a soft tissue mass in the midcaudal right thoracic cavity. Ultrasonographic studies, bronchoscopy and subsequent exploratory thoracotomy confirmed a diagnosis of a right cranial lung lobe torsion (LLT), with an anomalous caudodorsal displacement of the affected lobe. LLT should be considered as a differential diagnosis for respiratory tract disease following diaphragmatic rupture repair.     

Successful treatment of pulmonary aspergillosis in a cat

A 7-year-old, spayed female Domestic Longhair cat was evaluated for a 6-week history of coughing. Thoracic radiography revealed a pleural effusion. Thoracic ultrasound revealed a pleural effusion and a focal lung mass. The cat underwent exploratory thoracotomy and a total left pneumonectomy was performed. Histopathology and cultures revealed fungal pneumonia and pyothorax caused by Aspergillus fumigatus. Abdominal ultrasound, repeat thoracic radiography, urinalysis with culture, and retroviral screening failed to detect evidence of systemic disease. The cat's poorly regulated diabetes mellitus is suspected to be the predisposing factor allowing a fungal pulmonary infection to become established. At 18 months after surgery the cat was still disease-free. To our knowledge this is the first reported case of successful treatment of pulmonary aspergillosis in the cat.     

Lung lobe torsion in association with a chronic diaphragmatic hernia and haemorrhagic pleural effusion in a cat

CLINICAL SUMMARY: This report describes torsion of the right cranial lung lobe in a cat with haemorrhagic pleural effusion and a chronic diaphragmatic hernia. Surgical treatment comprising lung lobectomy without de-rotation, and repair of the diaphragmatic defect, led to an uneventful recovery. PRACTICAL RELEVANCE: Lung lobe torsion is a rare condition in cats. While spontaneous lung lobe torsions may occur, a frequent association with underlying thoracic disease has been recognised in cats. However, neither haemorrhagic pleural effusion nor diaphragmatic hernia have been previously described in cats with lung lobe torsions, although they have been documented in dogs and humans. In a cat with suspected lung lobe torsion, a thorough search for an underlying disease should be undertaken.     

Use of computed tomography and minimum intensity projection in the detection of lobar pneumonia mimicking lung lobe torsion in a dog

A 10‐year‐old female spayed Dachshund was referred with progressive coughing for 1 month. The dog was tentatively diagnosed with right middle lung torsion based on pleural effusion, vesicular emphysema, abruptly ending bronchus in consolidated right middle lung, and no contrast enhancement of the affected lobe on radiography and computed tomography (CT). There was no evidence of torsion upon thoracotomy, and histological examination confirmed lobar pneumonia. The CT images were reevaluated using minimum intensity projection and revealed normal bronchial courses. The minimum intensity projection technique can be to assist in evaluation of the bronchial tree for dogs with suspected lung lobe torsion and other pulmonary diseases.     

Spontaneous midlobar lung lobe torsion in a 2-year-old Newfoundland

A 2-year-old, intact male Newfoundland was presented for evaluation of a 1- to 2-day history of coughing, retching, and progressive lethargy. Thoracic radiographs demonstrated right-sided pleural effusion and lobar vesicular emphysema. An exploratory thoracotomy revealed midlobar torsion of the right caudal lung lobe. A partial lung lobectomy was performed, and following surgery, the dog recovered without complications. Lung lobe torsions in dogs typically occur at the hilus of the affected lung lobe. This report documents that midlobar lung lobe torsions occur in dogs and should be considered as a differential diagnosis in cases of lobar vesicular emphysema and pleural effusion.     

Unusual congenital pulmonary anomaly with presumed left lung hypoplasia in a young dog

A seven‐month‐old, entire, male miniature schnauzer dog was referred with acute vomiting, inappetence and depression primarily as a result of a gastric foreign body (pine cones). During investigations, thoracic radiographs revealed increased volume of the right lung lobes, deviated cardiomediastinal structures and elevation of the heart from the sternum. Thoracic computed tomography revealed left cranial lung lobe hypoplasia and extension of the right cranial lung parenchyma across the midline to the left hemithorax. Branches of the right pulmonary vessels and bronchi also crossed the midline and extended to the left caudal lung lobe. These findings suggested that the right and left lungs were fused. In humans this finding is consistent with horseshoe lung, which is an uncommon congenital malformation. To the authors’ knowledge, this case represents the first report of such a pulmonary anomaly in a dog.     

Right Dorsal Colon Resection and Bypass for Treatment of Right Dorsal Colitis in a Horse

Objective: To describe a novel surgical technique for management of right dorsal colitis in the horse. Study Design: Clinical report. Animals: 14‐year‐old Warmblood gelding. Methods: The horse was referred for treatment of a stromal abscess and signs of right dorsal colitis. Plasma chemistry revealed marked hypoproteinemia. Abdominal ultrasonographic examination showed a thickened right dorsal colon (RDC). Medical treatment was unsuccessful. With the horse in left lateral recumbency under general anesthesia, an approach to the right side of the abdomen through a 16th rib resection was made. The thoracic cavity was entered during the approach. Surgical resection of the RDC and side‐to‐side anastomosis of the diaphragmatic flexure to the small colon (bypass) was performed. The thoracic cavity was closed by attaching the diaphragm to the body wall and air was removed at the completion of surgery. Results: Resection of the RDC and bypass of the resected area was successfully performed. The colic signs and hypoproteinemia resolved. Complications of surgery included a deep surgical site infection with development of a large intrathoracic abscess. The abscess was managed with drainage and long‐term antimicrobial treatment. Conclusion: Right dorsal colitis can be treated successfully with resection and bypass of the RDC. In cases where the thoracic cavity is penetrated during the abdominal approach, the diaphragm should be sutured to the body wall at the beginning of surgery to avoid development of an infection within the thoracic cavity. Clinical Relevance: RDC resection and bypass may be an alternative approach for management of horses with right dorsal colitis.     

Marked pleural effusion causing right atrial collapse simulating cardiac tamponade in a dog

A 16-month-old, female German shepherd dog was presented with severe bicavitary effusions. A diaphragmatic hernia was diagnosed by thoracic radiography. An echocardiogram performed prior to surgical repair of the hernia revealed signs of cardiac tamponade, with right atrial collapse, in the absence of pericardial effusion. Right atrial collapse was presumed to be secondary to severe pleural effusion. At surgery, no pericardial disease was identified. Surgical correction of the diaphragmatic hernia resulted in resolution of the pleural and peritoneal effusions. Follow-up echocardiography demonstrated resolution of the signs of cardiac tamponade.     

IMAGING CHARACTERISTICS OF INTRATHORACIC HISTIOCYTIC SARCOMA IN DOGS

In this retrospective study, two observers independently reviewed thoracic imaging studies of 39 dogs with confirmed histiocytic sarcoma. The most common findings were intrathoracic lymphadenopathy, identified by the first and second observers in 82.1% and 87.2% of dogs, respectively, and pulmonary masses (74.4% and 82.1%). Right middle lung lobe masses were significantly more common than masses in any other lung lobe (P<0.0013), with the majority having a ventral distribution. Sternal and tracheobronchial lymphadenopathy were significantly more common than cranial mediastinal lymphadenopathy (P‐values of 0.0002 and 0.012, respectively). Interobserver agreement regarding distribution of lymphadenopathy and pulmonary masses was good (κ=0.64 and 0.75, respectively). Other findings included pulmonary nodules, pleural effusion, and abnormal pulmonary patterns. In patients with CT examinations, the majority of masses were mildly to moderately enhancing and heterogeneous, poorly marginated, and bronchocentric. Lymphadenopathy and pulmonary masses are the most common intrathoracic findings in dogs with histiocytic sarcoma, and the strong predilection for the ventral aspect of the right middle lung lube may help to differentiate it from other types of neoplasia.     

EVALUATION OF DIAPHRAGMATIC MOTION IN NORMAL AND DIAPHRAGMATIC PARALYZED DOGS USING M‐MODE ULTRASONOGRAPHY

Diagnosis of unilateral diaphragmatic paralysis in dogs is currently based on fluoroscopic detection of unequal movement between the crura. Bilateral paralysis may be more difficult to confirm with fluoroscopy because diaphragmatic movement is sometimes produced by compensatory abdominal muscle contractions. The purpose of this study was to develop a new method to evaluate diaphragmatic movement using M‐mode ultrasonography and to describe findings for normal and diaphragmatic paralyzed dogs. Fifty‐five clinically normal dogs and two dogs with diaphragmatic paralysis were recruited. Thoracic radiographs were acquired for all dogs and fluoroscopy studies were also acquired for clinically affected dogs. Two observers independently measured diaphragmatic direction of motion and amplitude of excursion using M‐mode ultrasonography for dogs meeting study inclusion criteria. Eight of the clinically normal dogs were excluded due to abnormal thoracic radiographic findings. For the remaining normal dogs, the lower limit values of diaphragmatic excursion were 2.85–2.98 mm during normal breathing. One dog with bilateral diaphragmatic paralysis showed paradoxical movement of both crura at the end of inspiration. One dog with unilateral diaphragmatic paralysis had diaphragmatic excursion values of 2.00 ± 0.42 mm on the left side and 4.05 ± 1.48 mm on the right side. The difference between left and right diaphragmatic excursion values was 55%. Findings indicated that M‐mode ultrasonography is a relatively simple and objective method for measuring diaphragmatic movement in dogs. Future studies are needed in a larger number of dogs with diaphragmatic paralysis to determine the diagnostic sensitivity of this promising new technique.     

Surgical correction of a diaphragmatic hernia in a newborn calf

A 2-day-old Holstein calf was admitted to the Veterinary Teaching Hospital (VTH) in St-Hyacinthe for respiratory distress. Thoracic auscultations revealed asymmetric lung sounds. A diaphragmatic hernia was diagnosed on thoracic radiographs. Herniorrhaphy was performed; postoperative recovery was uneventful. This case indicates that diaphragmatic hernia in calves can be surgically treated successfully.     

Equine thoracoscopy: normal anatomy and surgical technique

Six normal, healthy horses age 3-10 years underwent left and right thoracoscopic examination using a rigid telescope. A minimum of 30 days was allowed between procedures. Horses were restrained in stocks and sedated with a continuous detomidine infusion. After surgical preparation of the hemithorax elected for surgery, and administration of local or regional anaesthesia of the surgery sites, thoracoscopy was completed during two 15 min pneumothorax periods. During the procedures, the thoracic structures were viewed using a 57 cm, 10 mm diameter, 30 degrees rigid telescope connected to a digital camcorder to allow computer capture of digital images. The telescope was inserted into the thoracic cavity via 3 different intercostal spaces. The 8th, 10th and 12th intercostal spaces were randomly selected and used among horses. The exploration of each hemithorax started from the dorsal-caudal quadrant continued toward the cranial thorax and was completed by observing the diaphragmatic and caudal pulmonary region. Collapsed lung, aorta, oesophagus and diaphragm were viewed readily in either hemithorax. On exploration of the right hemithorax, the azygos vein, thoracic duct and pulmonary veins were also identified. Horses tolerated thoracoscopy well. Signs of discomfort, such as increased respiratory rate, coughing and decreased level of sedation, were associated with lung collapse in one horse, with pneumothorax on 2 occasions, and when the thorax was approached through the 8th intercostal space. Surgery performed via the 8th intercostal space was hindered by the rigidity of the 8th and 9th ribs, and by the presence of a greater musculature, which did not allow easy cranial and caudal movements of the telescope.     

RADIOGRAPHIC AND HISTOPATHOLOGIC CHARACTERISTICS OF PULMONARY FIBROSIS IN NINE CATS

Pulmonary fibrosis is a progressive fatal interstitial lung disease that is often idiopathic, occurs in multiple species, and may be caused by a number of inciting factors. The purpose of this retrospective, multicenter study was to describe the radiographic and histopathologic characteristics of idiopathic and induced pulmonary fibrosis in a group of cats. Cats with thoracic radiographs and histopathologically confirmed pulmonary fibrosis were recruited using the American College of Veterinary Radiology list serve. A board‐certified veterinary radiologist and diagnostic imaging intern reviewed radiographs and recorded characteristics by consensus. Findings from additional imaging modalities were also recorded when available. All histopathology samples were re‐reviewed by a veterinary pathology resident. A total of nine cats met inclusion criteria. All patients had a broad range of radiographic characteristics that included broncho‐interstitial pattern, alveolar pattern, pulmonary masses, pulmonary bullae, pleural effusion, and cardiomegaly. Cats with available echocardiographic studies had characteristics that included right ventricular dilation and hypertrophy and pulmonary arterial hypertension interpreted to be secondary to primary lung disease. Cats with available CT studies had characteristics that included focally increased soft tissue attenuation, masses, and ventral consolidation that exhibited no improvement with dorsal versus ventral recumbency. Histopathology showed pulmonary fibrosis, type II pneumocyte hyperplasia, and smooth muscle hypertrophy in all patients. Epithelial metaplasia was present only in one patient. Findings from the current study indicated that cats with pulmonary fibrosis have highly variable radiographic characteristics and that these characteristics may mimic other diseases such as asthma, pneumonia, pulmonary edema, or neoplasia.     

Metastatic carcinoma in the ulna of a cat secondary to a suspected pulmonary tumour

A 14-year-old male neutered Burmese cat presented for investigation of right fore limb lameness that was non-responsive to anti-inflammatory drugs and opioids. Thoracic radiography showed multiple pulmonary soft tissue nodules and a larger cavitated mass. Right elbow radiographs revealed marked peri-articular proliferation of new bone and periosteal reaction primarily affecting the ulna. Histopathological examination of an incisional biopsy of the right ulna revealed neoplastic proliferation of epithelial cells; this was confirmed as a poorly differentiated carcinoma with immunohistochemistry. Amputation of the right fore limb was performed at the owner's request. After surgery, radiographs of the limb showed progression of bone proliferation. Repeat pathological analysis confirmed a metastatic carcinoma. The cat deteriorated 3 days after surgery and was euthanased a week later as a result of severe respiratory distress. This case represents an unusual case of metastasis of a suspected primary lung tumour to the ulna in a Burmese cat.     

Intrapericardial neuroendocrine tumour in a dog

An 11-year-old neutered male Border Terrier presented for pericardiectomy after a nine-month history of tricavitary effusion, dyspnoea and lethargy. Transthoracic echocardiography revealed a fluid-filled structure at the heart base, starting at the mid-right ventricle and extending to the middle of the right atrium. Almost complete compression of the right atrium and the cranial vena cava was noted. Thoracic computed tomography revealed a heterogeneously enhancing and poorly marginated mass within the cranial aspect of the pericardium. A median sternotomy and subtotal pericardiectomy were performed. A non-distinct fluid-filled structure within the pericardium adhered to the epicardium was visualised. The structure was removed via marsupialisation along with extirpation of enlarged sternal lymph nodes. Histopathological examination of the sternal lymph nodes revealed expansile, well-demarcated, unencapsulated nodules of neoplastic cells consistent with a neuroendocrine tumour suspected to be thyroid in origin. After surgery, intractable pleural effusion resulted in euthanasia. Intrapericardial ectopic thyroid tumours are rarely reported in animals. The location of the mass and unusual presentation may have made it challenging for echocardiography to identify this neoplasia. Thoracic computed tomography at an earlier stage may have identified the neoplasia and potentially allowed for surgical intervention.     

Congenital pleuroperitoneal hernia presenting as gastrothorax in five cavalier King Charles spaniel dogs

Five cavalier King Charles spaniels were examined for acute onset of respiratory distress. Thoracic radiographs demonstrated diaphragmatic hernia and tension gastrothorax, visible as a distended stomach occupying the left caudal thoracic cavity. Exploratory midline coeliotomy confirmed congenital pleuroperitoneal diaphragmatic hernia with herniation and dilatation of the stomach. The hernia configuration was consistent in all cases, with a defect affecting the left diaphragmatic crus. Congenital pleuroperitoneal diaphragmatic hernia is a rare condition caused by a defect in the dorsolateral diaphragm. Defects of the left crus of the diaphragm could result in the herniation of the stomach into the thoracic cavity with possible subsequent tension gastrothorax. Cavalier King Charles spaniels may have a predisposition to this condition. Tension gastrothorax is an acute life‐threatening consequence of gastric herniation through a diaphragmatic defect that must be promptly recognised and surgically treated.     

Canine bicavitary carcinomatosis with transient needle tract metastasis diagnosed by multiplex immunocytochemistry

A 6‐year‐old, male castrated, mixed‐breed dog was referred to the James L. Voss Veterinary Teaching Hospital at Colorado State University for bicavitary effusion. On examination, the dog was tachycardic and tachypneic with bilaterally decreased lung sounds. Thoracic and abdominal ultrasonic examination revealed pleural and peritoneal effusions, which were aspirated and submitted for fluid analysis and cytology. Both cavity fluids were classified as exudates with a large population of vacuolated mononuclear cells. Multiplex immunocytochemistry (ICC) for cytokeratin and vimentin demonstrated exclusively cytokeratin expression, indicating these cells were of epithelial origin. A full diagnostic evaluation was performed, including CBC, clinical chemistry, a pet‐side test for heartworm disease, ehrlichiosis, Lyme disease, and anaplasmosis, imaging modalities of thorax, abdomen, and heart, urinalysis, and fine‐needle aspirations of spleen, liver, and popliteal lymph nodes. The dog was diagnosed with pleural and peritoneal carcinoma with presumed carcinomatosis. A single dose of intracavitary carboplatin was administered before discharge, and over a period of 2 weeks, 5 thoracocenteses were performed. A subcutaneous mass was noted at a thoracocentesis site one week after initial presentation. Cytology of the mass was consistent with carcinoma, and neoplastic seeding of the tumor cells from the thoracocentesis was suspected. The dog was euthanized 15 days after the first visit, and a necropsy was performed. Findings were consistent with carcinomatosis secondary to anaplastic pulmonary carcinoma with transient subcutaneous seeding of neoplastic cells during routine thoracocentesis. This case demonstrates the utility of multiplex ICC in the clinical setting.     

Recurrence of spontaneous lung lobe torsion in a pug

Lung lobe torsion (LLT) results from a displacement and twisting of a lung lobe around its bronchovascular pedicle. This relatively rare disorder affects dogs, cats, and humans. Etiologies include primary (i.e., spontaneous) and secondary torsion due to thoracic trauma, pleural space disease, thoracic surgery, pulmonary parenchyma disease, and diaphragmatic hernia repair. Although both spontaneous and secondary torsion have been described in small-breed dogs, a spontaneous LLT followed by recurrence of a spontaneous LLT > 2 years later has not been documented. This article describes the presentation, diagnosis, management, and outcome of a pug with recurrent spontaneous LLT.     

IMAGING DIAGNOSIS—HYPOGLYCEMIA ASSOCIATED WITH CHOLANGIOCARCINOMA AND PERITONEAL CARCINOMATOSIS IN A HORSE

An 8‐year‐old Thoroughbred mare presented for decreased appetite, ataxia, and weakness. Abdominal ultrasound revealed a large volume of anechoic fluid along with multiple masses involving the spleen, liver, and diaphragm. Pleural fluid was identified via ultrasonography and thoracic radiography. Thoracic radiographs also identified pulmonary interstitial nodules, an undulant dorsal diaphragmatic margin and enlargement of tracheobronchial lymph nodes. Clinical signs of weakness and mild seizures were concurrent with hypoglycemic episodes. The final diagnosis was cholangiocarcinoma with extensive metastasis. Clinical signs of weakness, ataxia, and seizures were attributed to a paraneoplastic syndrome of tumor‐associated hypoglycemia that has been infrequently reported in horses.