Autologous Blood Pleurodesis in a Great Dane with a Persistent Spontaneous Pneumothorax
Winter, Margaret F.
A 7 year old, spayed female, Great Dane was referred to Cornell University’s Hospital for Animals’ emergency service for further work-up and treatment of a spontaneous pneumothorax. Three days prior to presentation, the patient started to become dyspneic and tachypneic while at a boarding facility. She was sent to a referral hospital, where radiographs revealed a bilateral pneumothorax and diffuse interstitial pattern. The patient had bilateral Mila chest tubes placed, was put on continuous suction, had bilateral intranasal cannulas placed for oxygen supplementation, was maintained on IV antibiotics and analgesia over night, and was referred to Cornell the following day. On presentation, the patient was tachycardic and tachypneic with decreased bronchovesicular lung sounds dorsally. She was under-conditioned with a BCS of 3/9, moderate, diffuse muscle atrophy, severe medial buttress bilaterally, was short strided in all four limbs, had all of her claws scuffed down to distal P3, and severe pododermatitis in all four paws. Point of care blood work was unremarkable, her SpO2 was 97% on room air, and her tachycardia improved with methadone and removal of a total of 2.7 liters of air and 20 mL of pleural effusion. Thoracic CT revealed a small amount of air in each hemithorax and 5-6 small gas filled bullae in the right caudal lung lobe. An exploratory thoracotomy with several partial lung lobectomies was performed. Histopathology was consistent with pulmonary emphysema and multifocal bullae. The patient continued to produce large amounts of air and some suppurative pleural effusion, but her owner elected to have a pleural port placed for palliative home care. Prior to discharge, blood pleurodesis was performed as an additional attempt to resolve the persistent pneumothorax. This presentation will focus on alternative and experimental treatments of persistent spontaneous pneumothorax in both companion animals and humans.
Canine; Spontaneous pneumothorax; Persistent pneumothorax; Pleurodesis; Pleural port; Blood pleurodesis; Sclerosing agents