Chronic Bronchocutaneous Fistula Caused by Toothpick Foreign Body in a Maltese Dog

Abstract

AbSTRAcT. A 7-year-old, 1.76 kg Maltese dog presented with a 4-year history of a chronic pustular lesion and a wet cough. Erosive lesions were seen at the left thoracic wall. Radiology and computed tomography (CT) revealed a bronchocutaneous fistula connecting from the left cranial bronchus to the skin. On definitive surgery, a long wooden toothpick was observed within this tract, and clinical signs resolved after retrieval of the foreign body. Three-dimensional cT was useful to identify the characteristics of the bronchocutaneous fistula. However, the wooden foreign body was not apparent on CT. Here, we report the clinical, clinicopathological and diagnostic imaging findings of a chronic bronchocutaneous fistula caused by a foreign body in a dog. A fistula is a draining tract and a pathological connection between body organs and cavities [2,6]. Most fistulas are associated with a foreign body, most commonly a wooden object [8]. Fistulas associated with foreign bodies in dogs involve the esophagoaortic, esophagotracheal, esophagobronchial, gastrocutaneous and cutaneopulmonary tracts [2,5,9,12]. Numerous cases of bronchocutaneous fistulas have been reported in humans, which develop as a complication of infection [3,4], chest tube placement [6], lung lobectomy [7], mechanical ventilation [1], or epicardial pacing [10]. In veterinary medicine, an uncommon case of bronchocutaneous fistula with unknown etiology in a large breed of dog has been reported [11]. The clinical manifestations were very similar to those of a dog with a cutaneopulmonary fistula associated with a foreign body [5]. However, no cases of a bronchocutaneous fistula caused by a foreign body diagnosed by cT have been reported in a small breed dog.This case report demonstrated the clinical, clinicopathological, and diagnostic imaging findings of a bronchocutaneous fistula within a long wooden toothpick in a dog.A 7-year-old, 1.76 kg, intact female Maltese dog presented due to a chronic and recurrent pustular lesion over the left thoracic wall and a productive cough during the past 4 years. The lesion had not improved despite the use of various medications and surgical excisions. In the past, the dog was a stray and had been adopted by the present owner from an animal shelter. Upon physical examination, two erosive lesions with purulent discharge at the left thoracic wall were observed (Fig. 1A). Other vital signs including body temperature, heart rate and respiration rate were normal. A thoracic auscultation revealed normal heart sounds and pulmonary fields. A complete blood count was normal. Serum biochemical examination revealed mild hyperglobulinemia with normal albumin level (globulin 4.5 g/dl, reference range 2.5-4.0 g/dl). Routine thoracic radiographs demonstrated a soft tissue-density of tubular structure in the left lung lobe, with the caudal part consisting of the skin lesions ( Fig. 2A and 2b). No evidence of pleural effusion or pneumothorax was noted. A purulent discharge from the erosive lesions was revealed as a neutrophilic inflammation...

Results of Computed Tomography in Dogs With Suspected Wooden Foreign Bodies

“…In such cases, surgical exploration and lavage of the wound and removal of foreign material usually resolves the problem . When the initial trauma is not recognized or treated and stick injuries become chronic, an abscess and/or discharging sinus may develop . Stick foreign bodies can also reach sites distant from the point of penetration by migration through tissues, which complicates diagnosis and management .…”

“…Stick foreign bodies can also reach sites distant from the point of penetration by migration through tissues, which complicates diagnosis and management . Sticks, wooden fragments, and other wooden foreign bodies have been reported in many anatomic sites in dogs, including the orbit, larynx, cervical region, axilla, thorax, abdomen, and limbs …”

Pyothorax induced by an intrathoracic foreign body in a miniature dachshund: Migration of a popsicle stick from the stomach

“…The presence of intrathoracic foreign bodies, resulting from a penetrating thoracic injury [ 5 , 8 , 11 , 15 , 19 , 20 ], migration of an implant such as a Kirschner wire [ 6 , 10 ], or migration of a foreign body from the respiratory [ 2 ] or gastrointestinal tract [ 4 , 12 , 13 , 23 , 26 ], is not often reported in small animals. Wooden foreign bodies such as kebab or popsicle sticks are often ingested by dogs because of their palatability, and given their length and sharply pointed ends, can easily migrate from the gastrointestinal tract.…”

Unusual intravascular migration of a wooden skewer resulting in vena caval thrombosis identified postmortem in a dog

“…Vena caval thrombosis is rare in dogs and is usually associated with trauma to the endothelium caused by catheters, pacemaker leads (Bliss and others 2002, Murray and others 2010), infiltrative tumours (Schoeman and Stidworthy 2001), or due to loss of antithrombin III in renal failure. In the present case, vena‐caval thrombosis was induced by a linear wooden foreign body.…”

“…These have resulted in an array of clinical signs including: lethargy, pyrexia, coughing, dyspnoea and vomiting (Zanotti and others 1989, Hunt and others 2004, Holmberg and others 2006); ataxia and paraparesis (Beischer and Robins 1993); and urinary incontinence (Wyatt and others 1999). Vena caval thrombosis in dogs is uncommon and has been associated with: the trauma induced by catheters and endocardial pacemaker ‘leads’ (Murray and others 2010); invasive adrenal gland tumours (Schoeman and Stidworthy 2001); and where antithrombin III is lost from the circulation in renal failure.…”