Page 196 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 14 · Surgery of the lung

pulmonary disease. Radiography is good for detecting of larger breeds (>10 kg). About one-quarter of all cats and
pneumothorax but has low sensitivity for detecting pulmo- dogs with primary lung neoplasia are free of clinical signs,
VetBooks.ir detection of bullae, but the positive predictive value is low of several weeks’ to months’ duration, anorexia, weight
with the remainder presenting with a non-productive cough
nary bullae. CT is more sensitive than radiography for
loss, lethargy, haemoptysis or spontaneous pneumothorax.
and its clinical usefulness is poor as lesions may be
missed or incorrectly diagnosed (Reetz et al., 2013).
Median sternotomy is the surgical approach of choice
because it allows evaluation of all lung lobes, including the Diagnosis
accessory lobe (see Chapter 11). Alternatively, a transdia- The diagnosis is usually made on plain thoracic radio-
phragmatic thoracoscopic approach allows inspection of graphs (Figure 14.10). Metastatic lung disease from other
both hemithoraces. Immersion of the lung lobes in saline neoplasia tends to be small, circumscribed and located in
can help in localization of the affected lobe; once identi- the peripheral or middle portions of the lung. Primary lung
fied, a partial (Figure 14.9) or complete lobectomy is per- tumours are usually solitary large masses. If there are
formed. Thoracoscopy with partial lung lobectomy has metastases, there are usually additional smaller masses.
been reported for the surgical treatment of spontaneous Evaluation of BAL fluid may also be useful in the early
pneumothorax (Brissot et al., 2003). diagnosis of malignant primary or metastatic neoplasia
Surgical treatment resulted in resolution of spontan- (Danielski et al., 2007). CT should also be considered for
eous pneumothorax with only a 3% recurrence rate in one staging of patients with pulmonary neoplasia because it
study (Puerto et al., 2002). Non-surgical treatment can be has a high sensitivity for detecting tracheobronchial lymph -
offered if surgical treatment is not feasible, but owners adenopathy (Paoloni et al., 2006).
should be advised of higher recurrence and mortality Hypertrophic osteopathy, involving soft tissue swelling
rates. Blood-patch pleurodesis has also been reported and palisading periosteal proliferation of the bones of the
for treating spontaneous pneumothorax and can be extremities (Figure 14.11), is uncommon but can result in
attempted following failure of conservative or surgical limb pain and lameness. Pulmonary metastatectomy pro-
management (Oppenheimer et al., 2014). Omentalization of duces early and sustained alleviation of the clinical signs
all lung lobes is also a treatment option for dogs that have of hypertrophic osteopathy (Liptak et al., 2004). Metastasis
bullae in multiple lung lobes or where previous surgical of primary lung tumours to one or more digits is quite
management has failed. common in cats.

Lateral thoracic radiograph of a 14-year-old Domestic
14.10
Longhaired cat with a primary lung tumour.
Ruptured bulla excised by using a thoracoabdominal stapler
14.9 to perform partial lung lobectomy.

PRACTICAL TIP

Do not rely on radiographs for diagnosis of pulmonary
bullae. Radiography is inconsistent and surgical
findings often differ from what would be expected
based on radiographs

Lung neoplasia

Primary pulmonary neoplasia is far less common than met-
astatic pulmonary neoplasia. Most primary lung tumours
are malignant adenocarcinomas and metastasize early in
the course of the disease. Affected cats and dogs are often ypertrophic osteopathy of the radius and ulna in a 1 -year-
relatively old (>10 years); affected dogs are more commonly 14.11 old mixed-breed dog with a primary lung tumour.

187

Ch14 HNT.indd 187 31/08/2018 13:20