8.23.21
Publication Date: 2021-08-20
History
8 year old male castrated husky. Respiratory distress
6 images
Findings
Orthogonal radiographs of the thorax are available for interpretation.
There is a large amount of gas in the pleural space bilaterally resulting in severe dorsal deviation of the cardiac silhouette and trachea. The lungs are moderately to markedly collapsed with severe retraction of the caudodorsal and ventral lung margins from the thoracic wall and rounded caudal margins. There is a mild mediastinal shift to the left. There is a diffuse, moderate to severe unstructured interstitial pattern in the caudal lung lobes as well as an alveolar pattern with associated air bronchograms in the right middle and caudal subsegment of the left cranial lung lobes. There is marked flattened of the diaphragm and doming of the thorax with the gas distending the pleural space caudally to the level of the 13th ribs.
There are two radiopaque tubes within the subcutaneous tissues of the caudal right and left thoracic cavity, extending into the left and right thoracic cavity with their tips in the right and left caudodorsal pleural spaces at the level of the 5th and 8th intercostal spaces. The cardiac silhouette and cranial vena cava are mildly small. There is a small volume of gas in the esophagus.
Diagnosis
Severe, bilateral, tension pneumothorax, likely spontaneous given the absence of historic trauma, which may be secondary to a ruptured bulla or bleb, although a pulmonary bulla is not radiographically identified. Pulmonary changes are most consistent with atelectasis, which may also be obscuring a potential underlying cause of pneumothorax. A CT can be considered for further evaluation of the pulmonary parenchyma following removal of pleural gas to better evaluate the pulmonary parenchyma.
- Small size of the cardiac silhouette and pulmonary vasculature may represent dehydration/hypovolemia, although may also be exacerbated by the marked pneumothorax.
- Chest tube placement.
Discussion
The patient underwent a CT. No pulmonary bullae could be identified. The patient underwent medical management and has recovered fully.
A recent review article is available here for free:
https://www.sciencedirect.com/science/article/pii/S1938973621000568?via%3Dihub#fig0002
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