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

Abstract

Objective To evaluate the diagnostic and therapeutic utility of bronchoscopy in dogs undergoing computed tomography (CT) and surgery for intrathoracic disease (pyothorax and pneumothorax) secondary to migrating plant awns (MPA) and to report outcomes in dogs that did and did not undergo bronchoscopy in addition to CT and surgery. Study design Retrospective case series. Animals Thirty‐seven client‐owned dogs. Methods Medical records from 2008 to 2017 were reviewed for dogs with documented MPA in the thoracic cavity treated with CT and surgery with or without bronchoscopy. Information regarding diagnostics, treatments, complications, and outcomes relating to hospitalization was evaluated. Results At least one abnormal lung lobe was identified by CT in all dogs. Bronchial abnormalities were identified with bronchoscopy in 21 of 22 dogs (95.4%) with available reports. Agreement between CT and bronchoscopy findings ranged from 50% to 81.8%, depending on lung lobe. Thirty‐six dogs had one or more lung lobes surgically removed. Thirty‐seven MPA were retrieved via bronchoscopy in 10 of 27 (37%) dogs, and 39 MPA were retrieved at surgery in 26 of 37 (70.3%) dogs. Actinomyces spp. were cultured from surgical samples in 7 of 33 (21.2%) dogs. Thirty‐five of 37 (94.6%) dogs survived to discharge. Conclusion Migrating plant awns were successfully retrieved via bronchoscopy. Agreement between CT findings and bronchoscopy was inconsistent, so there may be roles for both modalities. Short‐ and long‐term survival was excellent in this cohort. Clinical significance Bronchoscopy may allow for diagnostic and therapeutic advantages compared with CT in dogs with endobronchial MPA. Actinomyces spp appear to be variably present in surgically acquired bacterial cultures in dogs with MPA.

Treatment and outcome of spontaneous pneumothorax secondary to suspected migrating vegetal foreign body in 37 dogs

“…One study reported a mortality rate of 6% and major delayed complications (lung lobe torsion, pulmonary aspergillosis and pneumonia) in 12% of dogs with intrathoracic grass awn. 28 No such complications were seen in the present study but pyothorax cases were not included, and pneumectomies were not indicated.…”

“…In a recent study, a conversion to sternotomy was observed in only three cases on 37 dogs with thoracic plant migration. Two dogs had a conversion after thoracoscopy and one dog after intercostal thoracotomy 28 . None of our cases necessitated conversion to sternotomy to find the perforated lobe.…”

“…Few reports or clinical studies have been published on that subject. Radiography, bronchoscopy, ultrasonography and computed tomography (CT) have been used to identify and localise the origin of pneumothorax 14,19,24,27,28 . CT has been reported to have a low sensitivity for identification of bullae and blebs 19 .…”

“…This could require a complete extensive thoracic exploratory surgery via median sternotomy. Recently, Gibson et al reported a good outcome of 37 surgically treated dogs when CT combined with bronchoscopy was performed, 28 but both cases of SP and cases of pyothorax secondary to MVFB were represented in that population. Lateralization of pneumothorax, affected lung lobe and location of MVFB are valuable clinical information to choose the correct treatment options and reduce the risk of recurrence of pneumothorax or occurrence of delayed draining tract.…”

“…SP is described in veterinary literature as secondary to bullae or blebs, neoplasia, bacterial or fungal pneumonia, or lung abscesses 1–22 . Some reports also described migrating vegetal foreign bodies (MVFBs) as a cause of SP in dogs, especially plant awns, also named spikelets 23–28 . Ruptured bullae or blebs account for 33‐68% of cases in dogs while lung lobe perforation secondary to plant migration is only reported in 5% of cases 1,14 .…”