Pneumothorax secondary to a Pulmonary Bullae in a dog

Background: Pulmonary bullae are thin-walled cavitary lesions within the subpleural parenchyma. They are a result of the destruction, dilatation and coalescence of bordering alveoli and their rupture is the most common cause of pneumothorax in dogs. Radiographic and CT imaging are excellent tools for identifying and quantifying pneumothorax. Surgical treatment is considered standard for treatment of pneumothorax consequential to pulmonary bullae. The aim of this report was to describe a case of pneumothorax secondary to pulmonary bullae in a dog.Case: A 5-year-old male crossbreed dog, weighing 11.5 kg, was presented to the Uberaba’s Veterinary Hospital due to becoming easily tired in the previous 3 weeks, and its worsening in the last 2 days by presenting panting. The dog’s guardian did not witness any traumas, but informed that the animal resided with other 14 dogs and also that it frequently collided the thorax against the door when it came down from the bed. Physical examination showed diaphragmatic breathing, inspiratory dyspnea and stridor lung sound. Thoracocentesis revealed presence of air in the pleural cavity and pneumothorax. Radiographic images confirmed this condition. The dog stayed in the hospital and chest drains were placed. Since the amount of sucked air did not reduce with time and due to the emergence of subcutaneous emphysema, the dog went through exploratory thoracotomy that revealed impairment of the right caudal lung lobe, proceeding to lobectomy. The dog stayed in the hospital with chest drains until the contents of the suctions reduced significantly. With the removal of the drains, the dog was sent home and had a full recovery. Histopathology of the impaired lung revealed pulmonary bullae.Discussion: The dog from this report presented clinical signs consistent with pneumothorax, such as dyspnea, diaphragmatic breathing and exercise intolerance. Radiography of the chest region revealed images consistent with this condition, as it is an excellent tool for identifying it. This dog’s guardian was unable to confirm if there was occurrence of trauma due to the large number of cohabitants. In dogs, spontaneous pneumothorax commonly results from the rupture of pulmonary bullae, and these bullae may result from trauma, infectious diseases, thrombosis, obstructive, neoplastic, congenital or idiopathic conditions. Except from trauma, there were no evidence to support any of the other causes of pulmonary bullae in this case.  Traumatic injuries are very common in veterinary medicine, and blunt thoracic traumas with consequential pneumothorax are especially common. The emerging of subcutaneous emphysema, as happened with this dog, is frequently associated with pneumomediastine, and rarely has pathophysiologic impairments. The patient stayed in the hospital for support therapy and thoracocentesis, corroborating with literature; but since there was no improvement, it went through exploratory lobectomy, which revealed impairment of the right caudal lung lobe, proceeding to its exeresis. Surgical intervention is standard procedure in these cases. Histopathology of the impaired lung suggested the presence of pulmonary bullae. In literature, histopathological definitions for this condition are inconsistent, but usually locate the bullae within the pulmonary parenchyma, having walls less than 1 mm thick. Through radiology, unlike with cysts, identifying pulmonary bullae is challenging. In conclusion, this report showed that pulmonary bullae should be considered as a differential diagnose in patients showing pneumothorax considering it is hard to identify through imaging, and that it is important to adopt early therapy and surgical intervention for better outcomes.Keywords: dyspnea, panting, pulmonary lobectomy, thoracotomy, chest drain.Titulo:  Pneumotórax secundário a bolha pulmonar em cão.Descritores: dispneia, ofegante, lobectomia pulmonar, toracotomia, dreno torácico

Cholecystoduodenostomy for Treatment of Biliary Obstruction Secondary to Feline Platinossomosis

Background: Platynosomum spp. it is a trematode that has a predilection for the liver and biliary tissues whose infection is acquired through the ingestion of metacercarian gecko viscera. Felines are the definitive hosts and clinical signs are variable. The diagnosis is through history, hematological and biochemical exams, ultrasound, bile cytology or histopathology. The treatment of choice is cholecystoduodenostomy. This paper aims to report the case of a cat who was treated at the Uberaba Veterinary Hospital with chronic cholangitis secondary to platinosomosis, but there was a transfusion reaction and she died.Case: A 4-year-old, uncastrated SRD cat was treated at the Uberaba Veterinary Hospital complaining of severe episodes of vomiting three days ago, hyporexia and darkened urine. The general clinical examination showed moderate dehydration, jaundice and hepatomegaly. The animal was hospitalized for better investigation of its condition. Increased values of ALT, alkaline phosphatase and all bilirubins were observed. Ultrasound showed liver suggestive of liver disease and steatosis, and gallbladder without alteration. During hospitalization, she remained jaundiced and hypoxic, and the esophageal tube was placed. The initial clinical suspicion was cholangiohepatitis. Liver biopsy and cholecystoduodenostomy were then suggested, with refusal by the tutor. The ultrasound was repeated and showed the same alterations described, besides cholangitis. Stool examination was negative for Platynosomum spp. and positive for Isospora spp. The patient was treated with anthelmintic for three days and received supportive treatment for another week until the tutor authorized cholecystoduodenostomy. During surgery, cholecystocentesis was performed and the parasite Platynosomum spp. in adult form. After four days, a new blood count was done and the animal was still anemic and the blood transfusion was chosen. The patient died within moments of the transfusion procedure.Discussion: Platynosomum spp. it is a trematode whose ultimate host is the domestic felines and inhabits liver, gallbladder and bile ducts causing biliary obstruction and even fibrosis. In the present report, the tutor reports that the cat had several episodes of vomiting and reduced appetite. Feline jaundice is normal in cases where cholestasis causes a two to three-fold increase in bilirubinemia from normal values. The increase was verified in the analyzed feline. Physical examination revealed jaundice and abdominal palpation suggestive of hepatomegaly. Ultrasound suggested cholangiohepatitis. Without improvement, liver biopsy and cholecystoduodenostomy were suggested, with tutor refusal. After repeated ultrasound, the images suggested cholangitis and the stool examination was negative for Platynosomum spp. The definitive diagnosis for this disease is through liver biopsy, visualization of the operated eggs or the adult form of the parasite in feces or bile as suggested in this case. However, in cases where there is total obstruction of the bile ducts, the eggs are not eliminated in the digestive system and the examination may be false negative as in this case. After the exams, the cat was submitted to cholecystoduodenostomy surgery where gallbladder puncture was performed for microscopic evaluation, and the parasite Platynosomum spp. in adult form. Most cats have blood type A, but even when the donor has the same blood type, cross-reaction may occur, so compatibility testing should be performed prior to any transfusion, thus reducing the risk of transfusion reactions. The patient died within moments of the transfusion procedure.

Pneumothorax secondary to a Pulmonary Bullae in a dog

Background: Pulmonary bullae are thin-walled cavitary lesions within the subpleural parenchyma. They are a result of the destruction, dilatation and coalescence of bordering alveoli and their rupture is the most common cause of pneumothorax in dogs. Radiographic and CT imaging are excellent tools for identifying and quantifying pneumothorax. Surgical treatment is considered standard for treatment of pneumothorax consequential to pulmonary bullae. The aim of this report was to describe a case of pneumothorax secondary to pulmonary bullae in a dog.Case: A 5-year-old male crossbreed dog, weighing 11.5 kg, was presented to the Uberaba’s Veterinary Hospital due to becoming easily tired in the previous 3 weeks, and its worsening in the last 2 days by presenting panting. The dog’s guardian did not witness any traumas, but informed that the animal resided with other 14 dogs and also that it frequently collided the thorax against the door when it came down from the bed. Physical examination showed diaphragmatic breathing, inspiratory dyspnea and stridor lung sound. Thoracocentesis revealed presence of air in the pleural cavity and pneumothorax. Radiographic images confirmed this condition. The dog stayed in the hospital and chest drains were placed. Since the amount of sucked air did not reduce with time and due to the emergence of subcutaneous emphysema, the dog went through exploratory thoracotomy that revealed impairment of the right caudal lung lobe, proceeding to lobectomy. The dog stayed in the hospital with chest drains until the contents of the suctions reduced significantly. With the removal of the drains, the dog was sent home and had a full recovery. Histopathology of the impaired lung revealed pulmonary bullae.Discussion: The dog from this report presented clinical signs consistent with pneumothorax, such as dyspnea, diaphragmatic breathing and exercise intolerance. Radiography of the chest region revealed images consistent with this condition, as it is an excellent tool for identifying it. This dog’s guardian was unable to confirm if there was occurrence of trauma due to the large number of cohabitants. In dogs, spontaneous pneumothorax commonly results from the rupture of pulmonary bullae, and these bullae may result from trauma, infectious diseases, thrombosis, obstructive, neoplastic, congenital or idiopathic conditions. Except from trauma, there were no evidence to support any of the other causes of pulmonary bullae in this case.  Traumatic injuries are very common in veterinary medicine, and blunt thoracic traumas with consequential pneumothorax are especially common. The emerging of subcutaneous emphysema, as happened with this dog, is frequently associated with pneumomediastine, and rarely has pathophysiologic impairments. The patient stayed in the hospital for support therapy and thoracocentesis, corroborating with literature; but since there was no improvement, it went through exploratory lobectomy, which revealed impairment of the right caudal lung lobe, proceeding to its exeresis. Surgical intervention is standard procedure in these cases. Histopathology of the impaired lung suggested the presence of pulmonary bullae. In literature, histopathological definitions for this condition are inconsistent, but usually locate the bullae within the pulmonary parenchyma, having walls less than 1 mm thick. Through radiology, unlike with cysts, identifying pulmonary bullae is challenging. In conclusion, this report showed that pulmonary bullae should be considered as a differential diagnose in patients showing pneumothorax considering it is hard to identify through imaging, and that it is important to adopt early therapy and surgical intervention for better outcomes.Keywords: dyspnea, panting, pulmonary lobectomy, thoracotomy, chest drain.Titulo:  Pneumotórax secundário a bolha pulmonar em cão.Descritores: dispneia, ofegante, lobectomia pulmonar, toracotomia, dreno torácico

Cholecystoduodenostomy for Treatment of Biliary Obstruction Secondary to Feline Platinossomosis

Background: Platynosomum spp. it is a trematode that has a predilection for the liver and biliary tissues whose infection is acquired through the ingestion of metacercarian gecko viscera. Felines are the definitive hosts and clinical signs are variable. The diagnosis is through history, hematological and biochemical exams, ultrasound, bile cytology or histopathology. The treatment of choice is cholecystoduodenostomy. This paper aims to report the case of a cat who was treated at the Uberaba Veterinary Hospital with chronic cholangitis secondary to platinosomosis, but there was a transfusion reaction and she died.Case: A 4-year-old, uncastrated SRD cat was treated at the Uberaba Veterinary Hospital complaining of severe episodes of vomiting three days ago, hyporexia and darkened urine. The general clinical examination showed moderate dehydration, jaundice and hepatomegaly. The animal was hospitalized for better investigation of its condition. Increased values of ALT, alkaline phosphatase and all bilirubins were observed. Ultrasound showed liver suggestive of liver disease and steatosis, and gallbladder without alteration. During hospitalization, she remained jaundiced and hypoxic, and the esophageal tube was placed. The initial clinical suspicion was cholangiohepatitis. Liver biopsy and cholecystoduodenostomy were then suggested, with refusal by the tutor. The ultrasound was repeated and showed the same alterations described, besides cholangitis. Stool examination was negative for Platynosomum spp. and positive for Isospora spp. The patient was treated with anthelmintic for three days and received supportive treatment for another week until the tutor authorized cholecystoduodenostomy. During surgery, cholecystocentesis was performed and the parasite Platynosomum spp. in adult form. After four days, a new blood count was done and the animal was still anemic and the blood transfusion was chosen. The patient died within moments of the transfusion procedure.Discussion: Platynosomum spp. it is a trematode whose ultimate host is the domestic felines and inhabits liver, gallbladder and bile ducts causing biliary obstruction and even fibrosis. In the present report, the tutor reports that the cat had several episodes of vomiting and reduced appetite. Feline jaundice is normal in cases where cholestasis causes a two to three-fold increase in bilirubinemia from normal values. The increase was verified in the analyzed feline. Physical examination revealed jaundice and abdominal palpation suggestive of hepatomegaly. Ultrasound suggested cholangiohepatitis. Without improvement, liver biopsy and cholecystoduodenostomy were suggested, with tutor refusal. After repeated ultrasound, the images suggested cholangitis and the stool examination was negative for Platynosomum spp. The definitive diagnosis for this disease is through liver biopsy, visualization of the operated eggs or the adult form of the parasite in feces or bile as suggested in this case. However, in cases where there is total obstruction of the bile ducts, the eggs are not eliminated in the digestive system and the examination may be false negative as in this case. After the exams, the cat was submitted to cholecystoduodenostomy surgery where gallbladder puncture was performed for microscopic evaluation, and the parasite Platynosomum spp. in adult form. Most cats have blood type A, but even when the donor has the same blood type, cross-reaction may occur, so compatibility testing should be performed prior to any transfusion, thus reducing the risk of transfusion reactions. The patient died within moments of the transfusion procedure.