Severe bilateral fibrosing pleuritis associated with chronic chylothorax in five cats and two dogs.

Severe bilateral fibrosing pleuritis was diagnosed in 5 cats and 2 dogs with chronic chylothorax. All animals were dyspneic on initial examination and remained moderately to severely dyspneic after thoracentesis. Radiographic evidence of fibrosing pleuritis included rounded lung lobes and failure of the lungs to reexpand following effective pleural drainage. Fibrosing pleuritis was also suggested in several animals with radiographic evidence of pleural fluid, in which pleural fluid could not be retrieved. Macroscopically, the lung lobes of all animals were compressed and atelectatic to various degrees, and the pleura appeared to be diffusely thickened and roughened. In several animals, fibrous adhesions were found between the parietal and visceral pleura of some lobes. Lung lobes were markedly constricted and appeared as small, smooth, rounded hilar masses in 4 animals. Mild to moderate pulmonary edema was evident in 3 animals at necropsy. Six of the 7 animals died (2) or were euthanatized (4) within 72 hours after the diagnosis of fibrosing pleuritis. The fibrosing pleuritis developed in 1 animal with lymphoblastic lymphosarcoma and chylothorax after treatment via passive pleuroperitoneal drainage; this animal was euthanatized because of underlying neoplasia. One cat, in which decortication was performed and resulted in marked reexpansion of the lung lobes, died 4 hours after surgery with signs compatible with pulmonary edema. On the basis of our findings, we suggest that animals with chronic chylothorax are at risk to develop fibrosing pleuritis. Furthermore, animals with severe bilateral fibrosing pleuritis should be given extremely guarded prognoses.     

Cisterna chyli ablation with thoracic duct ligation for chylothorax: results in eight dogs

OBJECTIVE: To report use of combined cisterna chyli ablation (CCA) and thoracic duct ligation (TDL) for treatment of spontaneously occurring chylothorax in dogs. STUDY DESIGN: Retrospective study. ANIMALS: Eight dogs with chylothorax. METHODS: TDL was performed through a right caudal intercostal thoracotomy and CCA through a left flank paracostal approach or ventral median celiotomy. Long-term outcome (range, 2-48 months; median, 11.5 months) was evaluated by telephone communication with owners. RESULTS: Seven dogs were free of clinical signs related to chylothorax at last follow-up (range, 4-48 months; median, 15.5 months). One dog was euthanatized 2 months after surgery because of lack of improvement. No major complications occurred from CCA. CONCLUSION: CCA and TDL resolved chylothorax in most dogs (88%). CLINICAL RELEVANCE: CCA combined with TDL may improve the outcome of chylothorax in dogs.     

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.     

Treatment of chronic pleural effusion with pleuroperitoneal shunts in dogs: 14 cases (1985-1999).

OBJECTIVE: To describe complications and outcome associated with chronic nonseptic pleural effusion treated with pleuroperitoneal shunts in dogs. DESIGN: Retrospective study. ANIMALS: 14 dogs. PROCEDURE: Medical records at 4 veterinary schools were examined to identify dogs with chronic nonseptic pleural effusion that were treated by use of a pleuroperitoneal shunt between 1985 and 1999. Signalment, history, physical examination and laboratory findings, cause and type of pleural effusion, medical and surgical treatments, complications, and outcome were reviewed. RESULTS: 10 of 14 dogs had idiopathic chylothorax, and 4 had an identified disease. All but 1 dog with idiopathic chylothorax and 1 dog with chylothorax from a heart base tumor had unsuccessful thoracic duct ligation prior to pump placement. No intraoperative complications developed during shunt placement. Short-term complications developed in 7 of 13 dogs, necessitating shunt removal in 2 dogs and euthanasia in 1. Eight of 11 dogs with long-term follow-up developed complications; the overall mean survival time and the interval in which dogs remained free of clinical signs of pleural effusion were 27 months (range, 1 to 108 months) and 20 months (range, 0.5 to 108 months), respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Pleuroperitoneal shunts can effectively palliate clinical signs associated with intractable pleural effusion in dogs. Numerous short- and long-term complications related to the shunt should be expected. Most complications can be successfully managed, but even when shunts are functional some treatments fail because of severe abdominal distension or massive pleural fluid production that overwhelms the functional capacity of the shunt.     

Complications and management of a long-term pleural access port in a dog with chronic chylothorax associated with lung lobe torsion

A 2-year-old neutered male 35-kg golden retriever mixed breed dog was presented because of a 3-day history of increased respiratory effort. The patient was subsequently diagnosed with a lung lobe torsion and underwent lung lobectomy. Chylothorax developed after surgery and persisted for 3.5 y. Pleural access port (PAP) placement was used for long-term medical management. Several complications were encountered, including 2 episodes of PAP occlusion that were successfully treated with unfractionated heparin. The dog had a surgical site seroma and 2 episodes of pleuritis; euthanasia was elected after the second episode.Key clinical message:This case demonstrates successful long-term management of chylothorax with a pleural access port and management of 3 complications. Instead of the less accessible and more expensive tissue plasminogen activator, unfractionated heparin was used as an effective treatment for PAP occlusions.     

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.     

HIP DYSPLASIA IN THE AFGHAN HOUND*

In evaluation of pelvic radiographs and necropsy specimens of 3 litters of Afghan Hound puppies resulting from matings of dysplastic parents a spectrum of radiographic phenotypes similar to that reported in other breeds was found. The percentage of dysplastic offspring (75% and 71%) and age at which the diagnosis of canine hip dysplasia could be made (28.5% at 6; 67% at 12; 90.5%at 18; 95% at 35; and 100% at 36 months of age) was also similar to that reported for other breeds. Hip dysplasia in the Afghan Hound is similar in radiographic appearance to hip dysplasia in other breeds despite the low. incidence of this condition among Afghan Hounds. The inheritance of hip dysplasia appeared to be the same in Afghan Hounds as that reported in other breeds     

Isolation and identification of Mycobacterium kansasii from pleural fluid of a dog with persistent pleural effusion

A 3-year-old spayed female Whippet was examined for cough and respiratory distress. Lung lobe torsion with pleural effusion was diagnosed, and lung lobectomy was performed. Pleural effusion recurred during the following 27 months; conventional bacteriologic cultures of pleural effusion did not result in bacterial growth. A second lung lobectomy, pleuroperitoneal shunt placement. and pericardectomy were subsequently performed. Mycobacterium kansasii was eventually isolated from pleural fluid and identified by polymerase chain reaction amplification and DNA sequencing. The dog was euthanatized before therapeutic response could be evaluated. To our knowledge, this is the first report of M. kansasii infection in a dog. Additionally, this is the first report of mycobacterial isolation from pleural fluid, and one of few reports of antemortem mycobacterial isolation from a body fluid, as opposed to identification in specimens during histologic examination. Routine bacteriologic culture methods are insufficient to isolate mycobacterial agents, and special methods are indicated in dogs with persistent pleural effusion.     

Carotid Body Tumors in the Dog Eleven Cases (1978–1988)

Case records of 11 dogs with histologically confirmed carotid body tumors were reviewed. Surgical excision had been attempted in ten dogs with carotid body tumors, and one dog had been euthanatized at diagnosis. There were no intraoperative deaths but perioperative mortality was 40%. Horner's syndrome and laryngeal paralysis were the most common postoperative morbidities. The median survival time after surgery alone in the four dogs that survived the perioperative period was 25.5 months (range, 12-45 months). Two dogs treated with postoperative radiation therapy had survival times of 6 and 27 months. Of the six dogs surviving the perioperative period, two dogs are still alive at 19 and 32 months postoperatively. Of the four dogs that died, one was euthanatized 12 months postoperatively for nontumor-related causes. The remaining three dogs died of distant metastases. The carotid body tumors studied were characterized by local tissue invasion, neurovascular complications after therapy, and a propensity to metastasize to multiple sites in the body.     

Chylothorax in 34 dogs

Thirty-four dogs with chylothorax were studied retrospectively. In 24 dogs, chylothorax appeared to be idiopathic, with only 10 dogs having evidence of neoplasia or trauma. Rupture of the thoracic duct secondary to trauma appeared to be a much less common cause for the development of a chylous pleural effusion than that reported previously. The Afghan Hound was the breed most commonly affected, comprising 37.5% of the dogs in the idiopathic category and 26.5% of all dogs with chylothorax. A clear correlation between the cause of chylothorax and age was not apparent, and gender and neutering appeared to have no relationship to the development of chylothorax in the dog.     

COMPUTED TOMOGRAPHIC FEATURES OF LUNG LOBE TORSION

The imaging features of lung lobe torsion in 10 dogs (nine complete, one partial torsion) acquired with a helical single‐slice computed tomography (CT) unit are described. Attenuation values of normal, rotated, and adjacent collapsed lung lobes before and after intravenous contrast medium administration were compared. Affected lung lobes were: left cranial (5), right middle (3), right cranial (1), and left caudal (1). CT findings in nine dogs with complete lung lobe torsion included pleural effusion and an abruptly ending bronchus. In eight of these dogs, enlargement, consolidation, emphysema of the affected lung lobe, and mediastinal shift to the contralateral side were present. Rotated lung lobes did not enhance, whereas adjacent collapsed and aerated lung lobes did (P<0.05). Apnea induced with hyperventilation or breath‐hold is essential to reduce motion artefacts and obtain a diagnostic study.     

Partial Gastrectomy with an Automatic Stapling Instrument for Treatment of Gastric Necrosis Secondary to Gastric Dilatation-Volvulus

A gastrointestinal anastomosis stapling instrument was used to perform partial gastrectomy in nine dogs undergoing emergency surgery for gastric dilatation-volvulus. The amount of necrotic stomach resected was 20% to 50%. Permanent gastropexy was performed, and six dogs also required partial or total splenectomy. Six dogs (67%) were normal after surgery, with follow-up periods of 6 to 16 months for five dogs. One dog died and two dogs were euthanatized because of postoperative complications unrelated to the surgical technique. There were no complications involving the partial gastrectomy staple line.     

RADIOGRAPHIC DIAGNOSIS OF LUNG LOBE TORSION

Clinical data, thoracic radiographs, ultrasonographic exams, and histopathologic reports in 13 dogs and two cats with confirmed lung lobe torsion were reviewed. Age of dogs ranged from 4 months to 11.5 years, (mean of 6.4 years) and several breeds of large and small dogs were represented. Right middle lobe torsion was predominant in large dogs (five of eight large breed dogs) and left cranial lobe torsion was more commonly seen in small dogs (three of five small-breed dogs). Two domestic short-hair cats, 10 and 14 years of age, had right cranial and right middle lobe torsion, respectively. Underlying thoracic disease was found in only five of 15 patients. On thoracic radiographs, increased lobar opacity and pleural effusion were found in all patients (100%). Small dispersed air bubbles were found within the affected lobe of 13 patients (87%). This pattern, which was the result of vesicular emphysema, was variably extensive, and became more evident on follow-up radiographs in five of six dogs. The lobar bronchi could be seen in only eight of 15 patients (54%), and appeared irregular, focally narrowed or blunted in six of the eight patients, and displaced in five of the eight. Other common radiographic findings included mediastinal shift (nine), curved and dorsally displaced trachea (seven), and axial rotation of the carina (seven). Ultrasonography was used in seven patients and considered generally useful, although variable signs were observed.     

Evaluation of lung lobe torsion in Pugs: 7 cases (1991-2004)

OBJECTIVE: To determine whether there is a predis-position for lung lobe torsion (LLT) in Pugs and describe clinical findings associated with LLT in that breed, compared with findings in other breeds. DESIGN: Retrospective case series. ANIMALS: 7 Pugs and 16 dogs of other breeds. PROCEDURE: Information collected from records included signalment, history, lung lobe affected, results of clinicopathologic testing, histologic findings, diagnostic imaging results, surgical treatment, and outcome. RESULTS: 23 dogs were diagnosed with LLT, 10 of which were large-breed dogs and 13 of which were small-breed dogs. Seven of the small-breed dogs were Pugs. Pugs with LLT were significantly overrepresented, compared with the general hospital population. Affected Pugs ranged in age from 4.5 months to 4 years (median, 1.5 years). Six of the 7 Pugs had no predisposing conditions, and 6 were male. Six Pugs survived to discharge. Of the other small- and large-breed dogs, 3 of 6 and 5 of 10 survived to discharge, respectively. None of the Pugs were readmitted for complications or recurrence. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that young male Pugs may be predisposed to developing spontaneous LLT. The prognosis for survival and resolution of clinical signs in Pugs with LLT appeared to be excellent. Factors contributing to the development of LLT in Pugs are not known.     

Results of thoracic duct ligation in dogs with chylothorax

Thoracic duct lymphangiography and ligation were done on 15 dogs with idiopathic chylothorax. Lymphangiography revealed thoracic lymphangiectasia in all dogs; none had a thoracic duct rupture. Lymphangiography immediately after ligation demonstrated missed branches of the thoracic duct in 4 of the 15 dogs. Eleven of the 15 dogs are alive and doing well. Eight of the 11 had no radiographic or clinical signs of pleural effusion (mean follow-up, 31.5 months; range, 4 to 75 months). The other 3 living dogs had persistent effusion; 2 were successfully managed with a pleuroperitoneal shunt (follow-up, 15 months) or pleurodesis (follow-up, 5 months), respectively, and 1 was not treated because the effusion was mild and the dog did not have clinical signs of disease (follow-up, 14 months). Four of the 15 dogs died or were euthanatized because of persistent effusion (mean follow-up, 11.5 months; range, 3 to 24 months). Considering the lack of treatment alternatives for dogs with idiopathic chylothorax, these results support thoracic duct ligation as a treatment method for dogs.     

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.     

Pneumonectomy: four case studies and a comparative review

Pneumonectomy is the resection of all lung lobes in either the left or right lung field. The surgical technique and postoperative results of pneumonectomy for clinical disease have not been reported in companion animals. Pneumonectomy was performed in three dogs and one cat to treat pulmonary or pleural disease, and the postoperative outcome compared with the complications and results reported in the human literature. One dog died immediately postoperatively due to suspected respiratory insufficiency and the remaining three animals survived the perioperative period. Postoperative complications were reported in two animals. Cardiac complications occurred in the cat, with perioperative arrhythmias and progressive congestive heart failure. Gastrointestinal complications were diagnosed in one dog, with mediastinal shift and oesophageal dysfunction. Left- and right-sided pneumonectomy is feasible in companion animals, and the postoperative outcome and complications encountered in this series were similar to those reported in humans.     

Mesenteric torsion in dogs with exocrine pancreatic insufficiency: 21 cases (1978-1987)

Mesenteric torsion was diagnosed in 21 of 199 German Shepherd Dogs suffering from exocrine pancreatic insufficiency. Eight dogs were euthanatized at the request of the owners; 4 dogs died at home before any treatment for mesenteric torsion was initiated. Surgery was performed on 9 dogs, all of which died during recovery from anesthesia.     

A modified ventral fixation for surgical management of atlantoaxial subluxation in 19 dogs

OBJECTIVE: To describe a modified ventral stabilization technique for surgical management of atlantoaxial subluxation in dogs and to evaluate the outcome. STUDY DESIGN: Retrospective clinical study. SAMPLE POPULATION: Nineteen client-owned dogs. METHODS: Medical records of 19 dogs with a radiographic diagnosis of atlantoaxial subluxation surgically managed by a modified ventral fixation technique (cortical screws, Kirschner wires, polymethylmethacrylate) were reviewed. Data on pre- and post-operative neurologic status, surgical technique, and complications were retrieved. Follow-up evaluation was performed at approximately 1 month. Telephone interview of the owner was used for long-term assessment (median follow-up for 17 surviving dogs was 10.5 months). RESULTS: Adequate reduction and stabilization was achieved in all dogs based on radiographic assessment immediately after surgery. Improved neurologic outcome occurred in 16 dogs at 1 month and in 15 dogs at follow-up; 2 dogs died of post-operative complications within 24 hours of surgery. One dog was euthanatized at the owners' request because of recurrent neck pain associated with implant failure after 1 month. Two dogs required surgery to remove broken and migrated implants, but further stabilization was not necessary. CONCLUSIONS: Adequate stabilization and improved neurologic outcome was achieved in most dogs. However, on account of the small size of the study and the variable neurologic signs of the dogs on admission, the surgical technique described could not be compared to those previously reported. CLINICAL RELEVANCE: The surgical technique described is an effective means of surgical treatment for atlantoaxial subluxation.