Pericardial flap to repair a pulmonary laceration in a cat with pyothorax

Abstract

Case summaryA 2-year-old female neutered domestic shorthair cat was presented for investigation of acute onset tachypnoea and dyspnoea. Pyothorax was diagnosed based on thoracic radiographs and fluid analysis. Medical treatment consisted of bilateral thoracostomy tube placement, antibiotic therapy and thoracic lavage. After 12 days of medical management infection was still present, warranting exploratory thoracotomy. At surgery, encapsulated abscesses were found in the left lung, right cranial and right middle lobes. The right caudal lobe was the only macroscopically non-abscessated lobe, and appeared to have a parenchymal laceration 8 mm long over the dorsolateral surface. Following partial pericardiectomy, mediastinectomy and debridement of abscesses, a pericardial flap was reflected caudolaterally and apposed over the laceration to seal the affected lung lobe. This flap was sutured to a rim of fibrinous adhesion that was partially covering this lobe. After 8 days the cat was discharged with antibiotic therapy for 3 more weeks. Follow-up assessment at 19 and 38 weeks postoperatively confirmed the cat to have good exercise tolerance. Thoracic radiographs at 19 weeks revealed good bilateral aeration of the pulmonary parenchyma without pleural effusion.Relevance and novel informationLung lobe laceration can be treated by lung lobectomy or direct suturing of the lung parenchyma. This is the first report using a pericardial flap to repair a lung laceration. Pericardial flap was successfully used to treat this lung laceration where lobectomy was contraindicated. Encouraging results were present at 8 months postoperatively.

Therapeutic use of autologous blood patch pleurodesis for continuous pneumothorax in a feline pyothorax

“…1,2 More recent reports describing surgery for cases of feline pyothorax, as well as necropsy and histopathology of lung tissue in cats with pyothorax, have demonstrated concurrent pneumonia and pulmonary abscess as common etiologies for pleural infection. 1,3,8,15 It has also been suggested that comorbidities such as upper respiratory tract infections or concurrent periodontal disease may precipitate the disease. 2,15 While no bite wounds were discovered in this case, he was originally adopted from a shelter so may have been at a higher risk of altercations prior to acquisition.…”

“…In patients that fail medical management, surgical exploratory is often recommended to identify the source of the leakage. 5,6,8 Autologous blood patches have been used in humans within the increasing frequency, as persistent air leak is one of the most common complications after pulmonary resection. Pleurodesis with whole blood has shown to be effective, painless and inexpensive in both humans and dogs.…”