Autologous blood-patch pleurodesis treatment for persistent pneumothorax: A case series of 5 dogs (2016 -2020)

Autologous blood patch pleurodesis for management of persistent pneumothorax in a dog with metastatic osteosarcoma

“…9,11,16 Although the precise mechanism is not fully understood, ABPP has fairly high reported success rate, ranging from 84% to 96.8% in humans. 7,9,18 A second ABPP procedure was required in this patient, which is consistent with a retrospective study in dogs that reported a 62.5% success rate for resolution of pneumothorax after one ABPP procedure and 87.5% after a second procedure. 10 Success rates as high as 80% following a single ABPP procedure have been reported in dogs, although most studies of ABPP procedures in dogs have very small patient populations, which make these success rates difficult to fully interpret.…”

“…4,7,8,10 In these refractory cases, an exploratory thoracotomy would be performed for either repair or resection of the affected lung lobe, requiring either a partial or total lobectomy if the source of the leak is able to be identified. 7,13 Exploratory thoracotomies may not be recommended in patients with diffuse pulmonary pathology, dogs with poor general status, or may not be elected by the owner due to financial constraints. In the dog reported herein, the pneumothorax was suspected to be secondary to its underlying metastatic disease, which as noted in Figures 2-4 was characterised by multifocal lesions and affecting multiple lung lobes.…”

“…7,[9][10][11]14,16,17 Pleurodesis is the act of injecting a substance into the pleural space that causes inflammation, ultimately leading to adhesion formation, with the goal of sealing the site of air leak in the lung. 7,14 This technique was extrapolated from human medicine, and many agents such as talc, silver nitrate, tetracycline and bleomycin have historically been used to induce adhesion formation. 7,14,16 The most common reported side effects are secondary to the inflammatory response that it invokes, including pain, fever, dyspnoea and acute respiratory distress syndrome.…”

“…7,[9][10][11]14,16,18 The most common complication reported in humans after blood pleurodesis is empyema, with approximately 9%-10% of human cases developing this sequela. 7,9,11,18 In one canine study, 25% of the patients developed an infection following ABPP; however, there were only eight dogs in this study, and one of the dogs that developed an infection had suffered a penetrating  of  F I G U R E  (a-d) On the left lateral projection (a), all lung lobes are scalloped and moderate to severely retracted from the body wall by gas opacity and minimal fluid. These findings are more severe on the left, as noted on the ventrodorsal projection (b).…”

“…6 In patients with a continuous air leak despite conservative management, surgical intervention to find the source of the leak is the treatment of choice. 4,[6][7][8] However, surgical intervention may not be indicated in many canine patients with metastatic neoplasia due to the diffuse nature of the disease and quality-of-life concerns. Recent studies in both human and veterinary literature have evaluated the use of autologous blood patch pleurodesis (ABPP) in the management of pneumothoraces refractory to conservative management, and it appears to be an effective, minimally invasive treatment for continuous pneumothoraces.…”