Page 194 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 14 · Surgery of the lung

sterile saline, inflating the lungs and watching for air PRACTICAL TIP
bubbles. Increasing airway pressure at the time of leak
VetBooks.ir lacerations can be sealed using a simple continuous • With any patient that has sustained thoracic bites, be
testing will improve detection rates. Superficial lung
prepared to ventilate during exploration of the wound
inverting mattress (Lembert) pattern (1.5 metric (4/0 USP)
• Perioperative antibiotics should be delayed if
or 1 metric (5/0 USP) absorbable suture material). Deeper
lacerations may require deep interrupted mattress sutures pleural fluid has not been obtained for culture and
sensitivity testing
(2 metric (3/0 USP) or 1.5 metric (4/0 USP) absorbable • Patients being treated for severe traumatic lung
suture material) to achieve haemostasis and pneumo- injuries may require mechanical ventilation to allow
stasis, followed by a simple continuous pattern (1.5 metric time for pulmonary contusions to resolve. If
(4/0 USP) or 1 metric (5/0 USP) absorbable suture mate- oxygenation and ventilation are not adequate
rial). Contused or oedematous lung tissue may be so postoperatively, referral for such advanced care
friable that attempts to close the laceration can be diffi- should be considered
cult. In these cases partial or complete lung lobectomy
should be considered if the injuries are confined to a
single lung lobe (see below).
As much gross foreign material, such as grit or hair,
should be removed from the wound and thoracic cavity as Pulmonary abscess
possible. A sample of pleural fluid should be retained for
cytology and culture. Patients with pulmonary abscesses may present with a
Fractured rib ends that protrude into the thorax can be variety of clinical signs, including coughing, tachypnoea,
cut short using a rongeur. They may also be reapposed haemoptysis, lethargy and fever. Radiography may be
using a K-wire inserted into the medullary cavity on the helpful identification of a mass lesion with a gas fluid
distal rib segment, and ‘shuttled’ into the proximal seg- interface in the lung is diagnostic of a pulmonary abscess.
ment (Figure 14.6), or reapposed using cerclage wire or Such a radiographic appearance, however, is uncommon
large-gauge (4 metric (1 USP) or 3.5 metric (0 USP)) when radiographs are made in lateral recumbency and
absorbable suture material. The thorax must be thoroughly further diagnostic tests may be necessary. Medical testing
lavaged with several litres of sterile saline flush before should include a complete blood count, chemistry profile,
testing for leaks. urinalysis and thoracic radiography. One of the most useful
aids to diagnosing pulmonary abscessation is trans-
thoracic ultrasonography and aspiration of the lesion. CT
imaging may also aid in the identification of a foreign body
and accurate localization of the lesion.
If the lesion is solitary, the treatment of choice is thora-
cotomy with lung lobectomy. Once the affected lobe has
been removed, it should be submitted for histopathology
and culture and sensitivity testing, and appropriate anti-
biotic therapy should be instituted. One of the more com-
mon causes of pulmonary abscess formation is inhaled
plant material (e.g. a grass awn). If there are multiple pul-
monary abscesses, aggressive medical management may
be indicated.

Pneumonia and bronchiectasis
(a) Chronic lower respiratory tract infections can result in the
accumulation of mucopurulent and purulent exudates or
plugs that obstruct bronchi and bronchioles. Local inflam-
matory mediators cause loss of collagen and elastin in the
bronchial walls, which dilate, causing further retention of
infected secretions and creating a chronic disease. Clinical
signs include recurrent fever, anorexia, debilitation and
exercise intolerance. Brachycephalic dogs (Darcy et al.,
2016), spaniels and older dogs are over-represented
(Hawkins et al., 2003).
Pneumonia and bronchiectasis affect cranial and
middle lung lobes most profoundly and are usually sus-
pected on the basis of plain radiography. Most cases of
chronic pneumonia should be managed medically, based
on cytology and culture and sensitivity testing results
following BAL. Affected dogs can survive for years.
Complete or partial lobectomy has been described as a
definitive diagnostic and therapeutic option where one or
two isolated lobes are involved and the pneumonia has not
(b) responded to appropriate aggressive medical treatment.
Pulmonary lobectomy in such circumstances resulted in a
14.6 (a) Rib fractures (b) repaired using Kirschner wires.
resolution of the pneumonia in 54% of animals treated

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