Ch. 104-105: Thoracic Wall & Cavity Flashcards
Lux JAVMA 2018
Factors associated with survival to hospital discharge for cats treated surgically for thoracic trauma
Types of trauma?
Sx needed for %?
Overall periop mortality?
Variables sig associated with outcome?
Types of trauma that cats had: dog bite/attack 35% (8/23), HBC 26% (6/23), other animal attack 9% (2/23), impalement or fall 9% (2/23), projectile penetrating trauma 4% (1), unknown 17% (4)
Intrathoracic surgery needed for 65% (15/23)
Overall perioperative mortality rate 13% (3/23)
Variables sig associated with outcome:
Mean ATT scores for surviving cats 6.4 +/- 2.2 and nonsurviving 10 +/- 1.7
19/20 cats with no CPA survived to discharge vs 1/3 with CPA
animal trauma triage ATT
McCarthy VCOT 2018
Use of ATT score, ribscore, and modified ribscore and other clinical factors for prognostication in canine rib fractures
Types of trauma?
Sig correlations with RF only with what?
All pts that died had what ATT score?
ATT score correlations?
animal trauma triage = ATT
HBC 56% of rib fx etiology, 41% dog bites, 1 case unknown
Significant correlations with risk factors only with ATT score -
- All patients that died had ATT score ≥ 5
- ATT score correlated positively with mortality (p < 0.05) with an ATT score ≥ 7 was 88% Sn and 81% Sp for predicting mortality
- A 1-point increase in ATT score corresponded to 2.1 times decreased likelihood of survival
Von Hekkel VSURG 2020
Thoracic dog bite wounds in dogs: A retrospective study of 123 cases (2003-2016)
% that had ex thoracotomy?
RF & OR for undergoing ex thoracotomy?
RF & OR for increased mortality?
Correlated factor with length of hosp?
25 dogs (19.5%) had exploratory thoracotomy - lung lobectomy in 12 dogs
Pneumothorax (OR 25.4), pseudo-flail chest (OR 15.8), or rib fracture (OR 11.2) SA increased odds of undergoing exploratory thoracotomy
Presence of pleural effusion (OR 12.1) and obtaining positive culture (OR 23.4) SA with increased odds mortality
Level of wound mgmt. correlated with length of hospitalization but not associated with mortality
Dicker JVECC 2020
Diagnosis of pulmonary contusions with point-of-care lung ultrasonography (LUS) and thoracic radiography compared to thoracic computed tomography (TCT) in dogs with motor vehicle trauma: 29 cases (2017-2018)
TCT found how many dogs (+) for pulm contusions?
LUS results/Sn/Sp compared to TCT?
TXR “ compared to TCT?
TCT
21 of 29 (72.4%) dogs were positive
8 of 29 (27.6%) dogs were negative
LUS - point-of-care lung US
19 of 21 dogs were positive (90.5% Sn)
7 of 8 dogs were negative (87.5% Sp)
LUS PC score correlated strongly with TCT PC score
TXR
14 of 21 dogs were positive (66.7% Sn)
7 of 8 dogs were negative (87.5% Sp)
TXR PC score correlated strongly with TCT PC score
more ID with LUS > TXR
Gonzalez Montaño VSURG 2023
Traumatic pulmonary pseudocysts (TPP) in nine dogs and two cats
Rate of TXR detection of TPP vs CT?
Tx undergone?
Survival %?
Ratio of TPP detected by radiographs when compared to CT was 7:11 (64%)
7 cases were managed conservatively, and 3 underwent lung lobectomy.
10 patients survived to discharge (10/11 = 91%)
No patients died as a result of the TPP (100% survival)
Ruby VRU 2020
Radiographic differentiation of mediastinal versus pulmonary masses in dogs and cats can be challenging
Overall agreement between TXR and CT for mediastinal masses? Pulm masses?
Interobs agreement?
Intraobserver agreement?
Mediastinal masses did what to other structures?
Lateral and caudal thorax masses correlated with what?
Overall agreement between radiographs and CT was moderate for both mediastinal (68.6%) and pulmonary masses (63%)
Overall, interobserver agreement was moderate (κ = 0.50-0.74), with moderate to strong intraobserver agreement (κ = 0.58-0.93)
Masses within the mediastinum were significantly more likely to displace other mediastinal structures
Masses lateral to midline and in the caudal thorax were found to be significantly positively correlated with a pulmonary origin
Kim VSURG 2019/2020
CT lymphangiography of TD by SQ iohexol injection into metatarsal region
Amount of iohexol to see TD?
The thoracic duct was visualized when at least 0.75 mL/kg of iohexol was injected subcutaneously into the metatarsal region of dogs
Shriwise VSURG 2020
Lymphaticovenous anastomosis of the caudal thoracic duct to an intercostal vein: a canine cadaver study
Main findings?
Anastomosis was successful in all eight dogs, and flow into the azygos vein without leakage or persistent flow through the cranial TD was confirmed via lymphography
Rengert VSURG 2020 PQ
Morphology of the cisterna chyli in nine dogs with idiopathic chylothorax and in six healthy dogs assessed by computed tomographic lymphangiography
CC differences in IC dogs vs normal dogs?
PQ What findings on CT was different between dogs with this condition vs normal?
cisterna chyli included more branches in dogs with chylothorax (4.30) than in unaffected dogs (1.67), occupying a relative perimeter ~ double that in unaffected dogs
relative cross-sectional area of the cisterna chyli was approximately twofold smaller in affected vs unaffected dogs
- cisterna chyli of dogs with idiopathic chylothorax contained smaller and more numerous branches compared with that of unaffected dogs. *
Lee-Shuan Lin VRU 2020
Computed tomographic lymphangiography via intra-metatarsal pad injection is feasible in dogs with chylothorax
Successful enhancement of TD in what % after what time?
Enhancement of popliteal LN?
Best dose?
Any SE?
Enhancement of thoracic ducts (TDs) was successful in 18/20 (90%) dogs within 5-14 min after initiating the injection
Successful enhancement of the lymphatic vessels cranial to the popliteal LN was seen in all dogs within 5 min after injection
Dose with good success to achieve TD enhancement was 1 mL/kg
2 dogs had mild discomfort
Carvajal VSURG 2022
** prospective
Prospective evaluation of lymphatic embolization as part of the treatment in dogs with presumptive idiopathic chylothorax
What did they inject?
Technical success?
Clinical success?
What did 12 weeks post-op CTLa show?
Long term results?
mixture of 3:1 lipiodol: n-butyl cyanoacrylate embolic solution was injected through a catheterized mesenteric lymphatic vessel via limited abdominal approach using intraoperative fluoroscopy;
Also had thoracic duct ligation and pericardiectomy
LE technically successful in 6/8 dogs,
LE clinically successful in 5/6 dogs
Unsuccessful dog had a diagnosis of lymphoangiosarcoma
5 successful dogs had CTLa at 12 weeks
- Complete resolution of pleural effusion occurred in 3 dogs and scant pleural effusion in 2 dogs.
A robust lymphatic embolus preventing antegrade continuation of radiocontrast was documented in all 5 dogs.
5/6 dogs that underwent LE, were alive and clinically normal at 358-960 days postoperatively.
Kanai VRU 2021
Canine idiopathic chylothorax: anatomic characterization of the pre- and postoperative thoracic duct using computed tomography lymphography (CTLG)
TD locations?
Sx Txs performed?
Post-op CTLG findings? Unsuccessful %?
Thoracic ducts present on the right side in 10 dogs, left side in one dog, and bilaterally in one dog.
All the 14 dogs received a combination therapy of pericardiectomy and thoracic duct ligation (TDL) by video-assisted thoracoscopic surgery.
One week after surgery, a postop CTLG was performed, and the thoracic ducts were apparent in 7/14 dogs (50% unsuccessful?)
- 3 dogs had an unchanged course of the thoracic duct, which could have resulted from a missed duct.
- 4 dogs were identified as having a bypass formation: the oblique duct originated at the ligation site and connected to the duct on the other side.
Mayhew JAVMA 2023
(note year)
** Prospective
Resolution, recurrence, and chyle redistribution after thoracic duct ligation with or without pericardiectomy in dogs with naturally occurring idiopathic chylothorax
Tx groups?
Periop survival %?
Resolution rates for both?
3 month post-op CTLA findings?
Where did chyle flow post-TDL?
Thoracoscopic TDL with pericardiectomy was performed if CPP was present (TDL/P group).
Dogs without evidence of CPP underwent thoracoscopic TDL alone (TDL group)
17 dogs underwent TDL, and 9 underwent TDL/P
25/26 (96%) survived the perioperative period.
One dog died from ventricular fibrillation during pericardiectomy.
Resolution rates for TDL: 94% (16/17)
- 1 late recurrence a median follow-up of 25 months
Resolution rates for TDL/P: 88%
Late recurrence rates: 3-month postoperative CT lymphangiography studies, ongoing chyle flow past the ligation site was demonstrated in 5/17 dogs, of which 1 dog developed recurrence at 13 months postoperatively.
In 15 of 17 dogs, chylous redistribution after TDL was principally by retrograde flow to the lumbar lymphatic plexus.
Sevy JAVMA 2023
Porcupine quilling–associated pneumothorax in dogs: 25 cases (2001–2022)
How many cases needed sx? Was imaging helpful pre-op?
Quills found where?
% survival to dc?
Recurrence of quill migration?
21/25 dogs (84%) underwent median sternotomy for quill removal, w/ quills found in lung tissue of 19 dogs.
2 had none intrathoracic, but had quills in intercostal mm
Imaging was not helpful in IDing the quills
4 dogs had resolution of pneumothorax without sx (16%)
100% survived to discharge
5 dogs required additional subsequent quill removal (25%)
Walker VSURG 2022
Treatment and outcomes of five dogs with intrathoracic migration of porcupine quills
Methods of pulmonary quill removal?
Indication for each?
Surprise finding in 3 dogs?
Pulmonary quills were treated with gentle traction or lung lobectomy.
Traction allowed removal of quills that were superficially attached to the pulmonary parenchyma without the need for subsequent lobectomy. Lobectomy performed for deep penetrating quills or lung leakage
Intraop palpation or appearance of the pericardium prompted pericardiotomy in 3 dogs, exposing epicardial and intravascular quills.
No evidence of these quills on preop advanced imaging or on gross appearance of the pericardium.
Quills were removed with a combination of gentle traction, purse-string sutures, and mattress sutures
Hennessey VRU 2022
CT can identify characteristic features of hypaxial muscle abscesses in dogs due to presumed migrating vegetal foreign material as well as additional changes along the migratory tract in other anatomic regions
MC breed type?
Rad/US finding description?
CT findings?
How many with plant material found at sx?
11/12 dogs hunting breeds
Rad or US findings: osteomyelitis in the cranial lumbar vertebrae and heterogenous, hypoechoic areas in the hypaxial musculature consistent w/ abscesses.
CT findings: enlargement of hypaxial muscles with well-defined fluid attenuating noncontrast enhancing areas with a contrast-enhancing rim consistent with abscesses, periosteal reaction and lysis of vertebrae, & retroperitoneal effusion.
4/12 cases had plant material identified & removed at surgery.
8/12 were presumed to be the same disease process
Ruiz JAVMA 2018
Characterization of and factors associated with causes of pleural effusion in cats
% died or euth before dc?
Two MC causes and %?
Other causes of PE?
Trauma & FIP sig for what?
Cats with lymphoma sig diff how?
Cats with CHF sig diff how?
23% (87) cats died or euthanized before discharge
CHF most common cause 41% (155) of pleural effusion, followed by neoplasia 26% (98)
Other causes : pyothorax, idiopathic chylothorax, trauma, FIP, and nontraumatic diaphragmatic hernia
Cats with trauma or FIP Sig younger than those with CHF or neoplasia
Cats with lymphoma Sig younger than those with carcinoma
Cats with CHF had Sig lower rectal temp at hospital admission than cats with pleural effusion from other causes
Kramer JSAP 2021
Short- and long-term outcome in cats diagnosed with pyothorax: 47 cases (2009-2018)
% underwent MM?
% that failed MM and needed sx?
Short term 14 d survival rate %?
Long term survival rate?
Recurrence rate?
85% (47/55) underwent medical management with thoracostomy tubes, pleural lavage and broad-spectrum antibiotics.
15% (5) cases failed medical treatment and underwent thoracotomy.
28% (13) did not survive to hospital discharge
(72% survived; they considered this excellent).
(4 died at chest tube placement, 8 during MM, 1 periop)
Short-term survival (14 days) in 72%
Long-term follow-up was available for 31 of 34 with a long-term survival rate of 68% (n=30).
The recurrence rate was 6% (n=2).
Eiras-Diaz JSAP 2021
CT findings, management and short-term outcome of dogs with pyothorax: 101 cases (2010-2019)
Common CT findings?
% managed surgically? Survival %?
% with MM? Survival %?
Overall mortality %?
What % died within 48 h of admission?
CT abnormalities included pleural thickening (84%), pannus (67%), pneumothorax (61%), mediastinal effusion (29%), pulmonary (14%) and mediastinal (8%) abscessation, foreign body presence (8%), foreign body tracts (7%) and pneumonia (7%).
71% of dogs managed surgically, of which 90.2% survived
29% were managed medically, of which 72% survived.
Overall mortality was 15%
87% of these dogs died within 48 hours of admission.
Tran VRU 2023
CT features of rounded atelectasis in chronic inflammatory pleural effusions in cats and dogs
What is “rounded atelectasis” in human med & CT features of it?
What % of nodules on dog CTs had these findings?
Conclusion?
Human med - Rounded atelectasis is focal lung deformation & collapse secondary to inflammatory pleural effusions and pleuritis.
Specific CT features (round to ovoid soft tissue pulmonary attenuations, creation of an acute angle with the adjoining visceral pleura, and the presence of perinodular comet tail signs) support the diagnosis
Of 36 pulmonary ST attenuating nodules:
Comet tail signs, consisting of bundles of bronchi & vessels coalescing into the pulmonary nodules, were associated with:
92% of the nodules (33/36), and 92% of the nodules abutted & created an acute angle with the pleura (33/36)
Pulmonary malignant neoplasms were not found cytologically (in 6/11 patients) or histologically (in 5/11 patients)
Consider Rounded atelectasis as a ddx for nodular lesions
Barker VSURG 2018
Fluoroscopically guided wide-bore thoracostomy tube placement: Description of the technique and comparison to blind placement
Which group had major placement (blind vs fluoro)?
Complication difference?
Major errors in placement requiring removal and replacement in 2 dogs Bind PTT and 0 Fluoro GTT
Complications did not differ between groups – no postop complication w/I 1st 12 hr of placement
Rossanese VSURG 2020
Crimped monofilament nylon leader for median sternotomy closure in 10 dogs (retrospective)
Application feasible?
Intraop comps?
Short term comps - # and what were they?
Long term comps?
Application of the MNL around the sternebrae was uncomplicated in all cases, facilitating a subjectively adequate closure of the sternum
No intraoperative complications
Complications:
1 perioperative minor (10%) - Delayed healing of superficial surgical incision - conservatively managed
1 short-term major complication (10%) - Wound dehiscence at the caudal limit of the surgical incision approximately 3 weeks postop – Required removal of the crimp clamp and MNL
0% long term complications
Nutt VSURG 2021
** Prospective
Influence of muscle-sparing lateral thoracotomy on postoperative pain and lameness: a randomized clinical trial
Two groups?
How did they assess outcome?
Difference / change in SI pre-op vs post-op?
Difference in pain scores?
PQ How did modified surgical approach affect lameness and pain?
latissimus dorsi muscle was retracted in the MSLT group and was transected in the SLT group
Peak vertical force symmetry index (SI) & pain scores
SI 3 days postop was sig lower compared with the preop SI value in all dogs, consistent with lameness of the ipsilateral thoracic limb
- Change in preop and 3-day-postop SI was 3.1-fold greater after SLT compared with after MSLT *
- Pain scores 1 day after surgery were lower after MSLT (1) compared with after SLT (2.5) *
- Lateral thoracotomies caused postoperative pain and ipsilateral forelimb lameness, and both were reduced by sparing the latissimus dorsi. *
Cole JSAP 2021
Diagnostic accuracy of a lung ultrasound protocol (Vet BLUE) for detection of pleural fluid, pneumothorax, and lung pathology in dogs & cats
VetBLUE Sn and Sp for detection of alveolar-interstitial syndrome?
Overall accuracy with their 2 criteria?
VetBLUE correct what % for other pathologies?
When using CT as the reference standard, detection of ≥3 B lines with Vet BLUE had a Sn of 18% and Sp of 98% for detection of site specific alveolar-interstitial syndrome.
The Sn of Vet BLUE to detect alveolar-interstitial syndrome increased to 57% when including the presence of any B line as abnormal.
Overall accuracy for detection of alveolar-interstitial syndrome based on ≥3 B lines = 79%; any B lines = 73%.
Vet BLUE correctly identified consolidation in 58% (14/24) sites, pleural effusion in 67% (2/3) cases, pneumothorax in 33% (1/3) cases and intrathoracic mass in 25% (1/4) cases.
