Treatment of intrathoracic grass awn migration with video-assisted thoracic surgery in two dogs

Abstract

CASE DESCRIPTION A 17-month-old sexually intact male Vizsla and a 2-year-old spayed female mixed-breed dog were examined because of suspected intrathoracic grass awn migration. CLINICAL FINDINGS Thoracic CT revealed focal areas of pulmonary infiltration in the right caudal lung lobe in one dog and in the left caudal lung lobe in the other. In 1 patient, bronchoscopy revealed 2 grass awns in the bronchi. Results of thoracic radiography and bronchoscopy were unremarkable in the second patient; however, a grass awn was recovered from the tonsillar crypt during oropharyngeal examination. TREATMENT AND OUTCOME In both dogs, grass awns were successfully retrieved from the pleural cavity by means of video-assisted thoracic surgery during 1-lung ventilation. In one patient, a grass awn was recovered bronchoscopically from the left caudal lung lobe bronchus and another was visualized distally in an accessory lung lobe bronchus but could not be retrieved. This dog underwent accessory lung lobectomy. The second dog underwent left caudal lung lobectomy. Both patients recovered uneventfully from surgery, were discharged from the hospital, and had no apparent recurrence of clinical signs at telephone follow-up 31 months and 18 months after surgery. CLINICAL RELEVANCE With careful case selection, successful management of intrathoracic grass awn migration in dogs can be achieved by means of video-assisted thoracic surgery. Comprehensive preoperative evaluation including both computed tomography and bronchoscopy is suggested. Further investigation is necessary to evaluate whether treatment of this condition with video-assisted thoracic surgery is as effective as with traditional open thoracotomy.

Utility of bronchoscopy combined with surgery in the treatment and outcomes of dogs with intrathoracic disease secondary to plant awn migration

“…Therefore, preoperative abdominal imaging, including ultrasound or CT, should be considered for dogs in which MPA are suspected. In addition, the role of thoracoscopy in cases of canine pyothorax secondary to MPA has been investigated, with good outcomes reported . Conversely, in a separate report investigating outcomes of dogs undergoing video‐assisted thoracic surgery for spontaneous pneumothorax in dogs, conversion was required in 7 of 12 dogs because of impairment of visualization .…”

“…In addition, the role of thoracoscopy in cases of canine pyothorax secondary to MPA has been investigated, with good outcomes reported. 38 Conversely, in a separate report investigating outcomes of dogs undergoing video-assisted thoracic surgery for spontaneous pneumothorax in dogs, conversion was required in 7 of 12 dogs because of impairment of visualization. 39 In the present study, 42% of dogs undergoing thoracoscopy were converted to open procedures because of insufficient visibility or identification of extensive disease.…”

Optimization of surgical approach for thoracoscopic‐assisted pulmonary surgery in dogs

“…The finding that there was no significant difference in the distance from the stapler anvil to the accessory lobe hilus during lobectomy from the 5th or 6th ICS combined with subjectively easier pulmonary ligament resection leads us to recommend using the right 6th ICS for thoracoscopic‐assisted lung lobectomy of the accessory lung lobe. An additional consideration for thoracoscopic‐assisted accessory lung lobectomy is to ensure that the lobe is initially passed medial and then dorsal to the caudal vena cava to maximize exposure, as has been previously described for thoracoscopic lung lobectomy of this lobe …”

Nodules and masses are associated with malignant pleural effusion in dogs and cats but many other intrathoracic CT features are poor predictors of the effusion type

“…There are fewer studies in veterinary medicine assessing pleural abnormalities on CT in dogs and cats with pleural effusion with some studies simply describing nonspecific thickening of the parietal and/or visceral pleura . Several studies assess pleural abnormalities in more detail, including the assessment of Hounsfield units in different types of pleural effusion and assessing various types of pleural thickening (eg, smooth, irregular, nodular, mass), such as those seen with mesothelioma, carcinomatosis or other malignancies or with infectious pleuritis/mediastinitis associated with pyothorax such as secondary to foreign body migration or bronchopneumonia .…”