Ivan Doran BVSc CertSAS DSAS(Soft Tissue) FHEA MRCVS

RCVS Specialist in Small Animal Soft Tissue Surgery

This young male lurcher, Blake Fryer, was presented as a classic case of spontaneous pneumothorax secondary to rupture of a pulmonary bulla. Acute onset respiratory distress with no history of trauma and no notable prior respiratory disease.

Radiographs will show pneumothorax and typically no other anomalies. Bullae are often not visible radiographically, certainly for the ruptured bulla which has caused the pneumothorax but also for remaining intact bullae which may be present.

Conservative treatment is an option, through the placement of chest drain(s) to relieve pneumothorax. Periodic or continuous air drainage is employed and it may soon become apparent, if no reduction in the need for air drainage is evident, that conservative measures will not suffice. Equally, the air leak may indeed resolve through such management.

However, it should be noted that the recurrence rate after conservative management is high with figures as high as 70 to 90% reported.

Surgical treatment is most commonly via a sternotomy approach, to allow optimal inspection of all lung lobes. Bullae are very often located near/at the visceral pleural surface and so lend themselves to identification by direct visualisation. It is important to examine all surfaces of all the lung lobes and this may be challenging for the caudal and accessory lobes, particularly in deep chested dogs. A ruptured bulla is seen here during thoracotomy (Pic 2) being held up by Duval tissue forceps, prior to lobectomy. The same lesion is also pictured following excision using a surgical stapler (Pic 3). This is the commonest method of addressing these lesions.

Happily, this lovely dog made a swift recovery. Dogs typically enjoy an uncomplicated and comfortable recovery from sternotomy and, after a few weeks rest, are able to resume their normal activities. Fewer than 10% of surgical cases show a second episode of spontaneous pneumothorax and such was the case here.

Pic 2

Pic 3