Resolution of persistent pneumothorax by use of blood pleurodesis in a dog after surgical correction of a diaphragmatic hernia

Abstract

Case Description—A 15-kg (33-lb) pregnant female mixed-breed dog of unknown age was referred because of a 10-day history of difficulty breathing. Clinical Findings—Physical examination findings were dyspnea, tachypnea, decreased bronchovesicular sounds (bilateral), muffled heart sounds, and abdominal distention with palpable fetuses. Hematologic abnormalities included anemia, leukocytosis, and thrombocytosis. Abnormalities detected during serum biochemical analysis included decreases in concentrations of albumin, sodium, triglycerides, and total calcium and increases in activities of alkaline phosphatase, alanine aminotransferase, γ-glutamyltransferase, aspartate aminotransferase, lactate dehydrogenase, and creatine kinase. Thoracic radiography revealed a diaphragmatic hernia with fetuses and a soft tissue or fluid opacity within the thoracic cavity. Treatment and Outcome—Exploratory celiotomy, ovariohysterectomy, partial sternotomy, placement of a right-sided thoracostomy tube, and herniorrhaphy were performed. After surgery, pneumothorax developed, and the thoracostomy tube was used to remove pleural effusion and free air. The pneumothorax did not resolve after continuous drainage of the thoracic cavity for 4 days. Autologous blood pleurodesis was performed by infusion of 80 mL (6 mL/kg [2.73 mL/lb]) of whole blood. The pneumothorax resolved immediately after injection of the blood. Conclusions and Clinical Relevance—Blood pleurodesis was used for resolution of pneumothorax in a dog after correction of a diaphragmatic hernia. Blood pleurodesis may provide a simple, safe, and inexpensive medical treatment for resolution of persistent (duration > 5 days) pneumothorax when surgery is not an option.

Autologous blood pleurodesis for surgical pneumothorax and outcome with multimodal cancer treatment in a dog with primary pulmonary mast cell tumor

“…A review of pneumothorax by Pawloski et al 15 concluded that ABP should be the gold standard of postoperative care in human patients. In canine patients, blood pleurodesis has been reported effective for correction of pneumothorax following surgical correction of a traumatic diaphragmatic hernia, as well as spontaneous and persistent pneumothorax of multiple etiologies 19–21 . To the author's knowledge, this is the first reported use of ABP in veterinary patients for complications following lung lobectomy.…”

“…The amount of intrapleural instilled autologous blood is between 5 and 10 ml/kg when the technique has been previously described in dogs, and the use of the ABP terminology is consistent with previous reports in the veterinary literature. 19 , 20 , 21 However, intrapleural instillation of autologous blood may be a more physiologically accurate term.…”

“…Two days following the lobectomy procedure, the pneumothorax persisted when air was not actively evacuated and an ABP was performed using between 5 and 10 ml/kg as previously described. 19 , 20 , 21 The dog was sedated with 0.2 mg/kg methadone IV, and a total of 310 ml of blood (8.5 ml/kg) was drawn from the jugular vein using a 60 ml syringe and administered in six 50‐60 ml boluses via the thoracostomy tube into the thoracic cavity and flushed with 5 ml of sterile saline after each bolus. The dog was then placed in right lateral recumbency for 1 h to allow for clot formation under manual restraint.…”

“… 16 , 17 , 18 There are reports of ABP use in dogs and cats for correction of spontaneous pneumothorax as well as persistent pneumothorax of various etiologies including postoperative correction of traumatic diaphragmatic hernia. 19 , 20 , 21 To the authors' knowledge, there is no report of successful ABP following pneumothorax as a complication of lung lobectomy in veterinary medicine. The following report the details and outcome of a case of presumed primary pulmonary MCT that was treated with surgery, chemotherapy, and radiation therapy as well as successful resolution of pneumothorax following lung lobectomy using autologous blood pleurodesis (ABP).…”

Allogenic blood patch pleurodesis for management of pneumothorax in a Cavalier King Charles Spaniel puppy with multiple pulmonary blebs and bullae

“…Treatment options for management of pneumothorax associated with ruptured bullae or blebs include conservative management with placement of a thoracostomy tube and repeated thoracocentesis or continuous suction, blood patch pleurodesis, or surgical thoracotomy for identification and removal of the lung lobe from which air leakage has occurred. 1 , 18 , 31 , 32 Conservative management with repeated or continuous suction was not elected in this case because of the rapid recurrence of pneumothorax after drainage of the thoracotomy tube, the low reported success rate of conservative management 1 and because of concerns that repeated thoracocentesis or continuous suction could cause some of the other bullae or blebs to rupture. Blood patch pleurodesis was elected as an initial treatment option over thoracotomy in this case because of the fact that multiple blebs and bullae were present, which may have complicated identification of the ruptured bleb or bulla intraoperatively.…”