Management of pneumothorax using thoracostomy and autologous blood patch pleurodesis in a dog and a cat

Abstract

This case series describes the management of two critically ill animals with pneumothorax of different etiologies. The first case involves a five year old male mixed breed dog that sustained multiple thoracic bites. The dog was presented with severe respiratory distress, subcutaneous edema, pale mucous membranes, tachycardia and crackling respiratory sounds. Thoracic radiographs revealed pneumothorax, pneumomediastinum, atelectasis and flail chest due to rib fractures. Initial stabilization included oxygen therapy, thoracocenteses, intravenous fluids, analgesics and antibiotics. Due to persistent air accumulation, autologous blood patch pleurodesis (ABPP) was performed, resulting in initial clinical improvement. However, respiratory deterioration necessitated the placement of a thoracostomy tube with continuous suction. Forty-eight hours later pneumothorax was dissolved, and the dog was discharged. Two years post discharge, the dog remains asymptomatic. The second case involves a 10 month old female cat with chronic respiratory distress due to trauma. Clinical examination revealed abdominal breathing, paradoxical movement and dysmporphy of the thoracic wall. Radiographs were indicative of diaphragmatic hernia. Surgical repair via midline laparotomy was performed, and thoracocentesis was conducted to manage the pneumothorax. However, due to severe postoperative dyspnea and persisted air accumulation in the thorax, repeated thoracocenteses, thoracostomy tube placement and ultimately autologous blood patch were deemed necessary. Suspicion of a ruptured pulmonary bulla led to an exploratory thoracotomy, during which a pulmonary defect was identified and resected. Unfortunately, the cat succumbed due to presumed prolonged hypoxia during surgery. These cases highlight the complexity of managing pneumothorax in small animals. The series underscores the need for a combination of classic pneumothorax management techniques with more recently described options, such as autologous blood pleurodesis. It also emphasizes the importance of advanced diagnostic imaging in managing such patients and the variable prognoses as well.