Retrospective evaluation of the use of autologous blood-patch treatment for persistent pneumothorax in 8 dogs (2009-2012)

AUTOLOGOUS OR ALLOGENIC BLOOD PLEURODESIS AS TREATMENT FOR PNEUMOCOELOM IN FOUR SEA TURTLES (LEPIDOCHELYS KEMPII, CARETTA CARETTA)

Pneumocoelom secondary to primary pulmonary disease was diagnosed via CT (three cases) or radiographs and coelioscopy (one case) in one Kemp's ridley (Lepidochelys kempii) and three loggerhead (Caretta caretta) sea turtles. All cases were suspected to be caused by trauma to the lung, and all exhibited positive buoyancy disorders. Coelomocentesis alone was ineffective at resolving each pneumocoelom, suggesting a large and persistent tear in the pulmonary parenchyma. An autologous (in three cases) or allogenic (in one case) blood patch pleurodesis was performed. The pneumocoelom was resolved in all four cases with no noted postoperative complications. Follow-up diagnostic imaging confirmed resolution of the pneumocoelom in three cases, and all four patients were successfully rehabilitated and had normal buoyancy at the time of release. One rehabilitated loggerhead was satellite tagged, and the tracking data demonstrated that the animal was still alive and moving normally 126 d postrelease, when the tag stopped transmitting. In sea turtles, an autologous or allogenic blood patch pleurodesis can be safely performed in cases of persistent pneumocoelom secondary to traumatic primary pulmonary disease.

Successful resolution of a continuous pneumothorax using canine xeno-blood patch pleurodesis in a cat

Case summary

An 11-year-old male neutered cat was referred to The Ohio State University's Veterinary Teaching Hospital after being diagnosed with pleural effusion by a referral veterinarian. After thoracocentesis, analysis of the effusion was consistent with chyle. Echocardiography, radiographs and bloodwork were used to diagnose hypertrophic cardiomyopathy phenotype and left-sided congestive heart failure, suspected to be secondary to uncontrolled hyperthyroidism. While initiating medical therapy, repeated thoracocenteses were required. A severe pneumothorax developed, necessitating placement of bilateral thoracostomy tubes. A thoracic CT scan did not reveal a cause for the pneumothorax; therefore, it was suspected to have occurred secondarily to an iatrogenic laceration of the parenchyma during thoracocentesis. An autologous blood patch pleurodesis was considered contraindicated so instead the cat was administered a blood patch using blood from a canine blood donor. The cat's respiratory status remained stable without additional intervention. At 30 h after blood patch pleurodesis, the thoracostomy tubes were removed and thoracic radiographs revealed near resolution of the pleural effusion and pneumothorax. The cat remained subclinical and was discharged from the hospital 48 h after the blood patch pleurodesis. Upon follow-up at 4 and 8 weeks after discharge, the cat was alive and had no complications or adverse reactions from the blood patch pleurodesis.

Relevance and novel information

This case documents the first report of a xeno-blood patch pleurodesis performed in a cat using blood from a canine donor. The cat had a successful discharge from the hospital with no adverse reactions from the xeno-blood patch pleurodesis.

Spontaneous pneumothorax in a dog with a history of successfully treated heartworm disease: A case report

OBJECTIVE

To describe a dog presented with spontaneous pneumothorax secondary to chronic pulmonary changes associated with a history of resolved canine heartworm disease.

CASE OR SERIES SUMMARY

A 7-year-old 25.2kg female spayed German Shepherd mix was presented for management of spontaneous pneumothorax. The dog had a history of heartworm disease that underwent therapy prior to adoption, and the dog was heartworm antigen negative (SNAP 4Dx) during hospitalization for the pneumothorax. An exploratory thoracotomy was performed due to an unresolving pneumothorax requiring multiple thoracocenteses. Perioperatively, the lungs did not expand with positive pressure ventilation and diffuse, multifocal to coalescing areas of darkened tissue that were grossly consistent with necrosis and/or hemorrhage were noted. The dog was euthanized intraoperatively due to an assumed poor prognosis. Histopathologic examination findings were consistent with chronic reactive changes related to previous heartworm infection. No neoplastic or infectious etiologies were identified.

NEW OR UNIQUE INFORMATION PROVIDED

Spontaneous pneumothorax is a known complication of active heartworm infection. However, this case represents the first report of spontaneous pneumothorax secondary to chronic pulmonary changes caused by resolved heartworm infection.

Autologous blood pleurodesis for surgical pneumothorax and outcome with multimodal cancer treatment in a dog with primary pulmonary mast cell tumor

A dog underwent lung lobectomy for removal of a mass. Histopathology was consistent with narrow resection of a mast cell tumor. Postoperative pneumothorax was successfully treated using autologous blood pleurodesis. Progression of disease despite adjunctive treatment with several chemotherapetutic agents and radiation therapy resulted in euthanasia approximately 4 months postoperatively.

Allogenic blood patch pleurodesis for management of pneumothorax in a Cavalier King Charles Spaniel puppy with multiple pulmonary blebs and bullae

A 9‐week‐old male intact Cavalier King Charles Spaniel was presented for evaluation of acute onset dyspnea caused by left‐sided pneumothorax. Thoracic computed tomography (CT) identified multiple pulmonary bullae and blebs in multiple lung lobes. Rupture of ≥1 pulmonary blebs or bullae, precipitated by low impact trauma, was the suspected cause of pneumothorax. A volume of 7.5 mL/kg of fresh whole blood was collected from a type‐matched donor dog and administered into the left pleural space using a thoracostomy tube. The pneumothorax was successfully resolved and no adverse effects of blood patch pleurodesis were noted. The dog was clinically normal 12 months later.

Spontaneous Pneumothorax: Management and Prognosis

This review article will review treatment and prognosis of spontaneous pneumothorax in dogs and cats. The advantages of surgical and medical management in dogs and cats, as well as current treatment practices, including autologous blood pleurodesis and small-bore chest tubes, will be discussed.

Autologous blood patch pleurodesis treatment for persistent pneumothorax: A case series of five dogs (2016-2020)

Background

Autologous blood patch pleurodesis (ABP) has been described as a treatment for persistent pneumothorax in the dogs and among humans. Although the treatment of persistent or recurring spontaneous pneumothorax is classically surgical, it cannot always be performed due to medical or financial constraints. This case series describes the clinical course, etiology, and outcome of five dogs with persistent pneumothorax treated with ABP.

Case Description

Five client-owned dogs with persistent pneumothorax are presented. Two dogs had pneumothorax due to congenital pulmonary bullae, one due to thoracic trauma, another due to lungworm infection, and a fifth with unknown cause in the context of a relapsing subcutaneous haemangiosarcoma. Around 5 ml/kg of non-coagulated blood was aseptically collected from the jugular vein and injected via a thoracotomy tube immediately into the pleural cavity of dogs with persistent pneumothorax. The procedure was successful in four out of five dogs after one procedure, therefore a success rate of 80%. A repeat of the pleurodesis was attempted in the fifth dog, 12 hours after the first injection due to the recollection of the pneumothorax. Still, the dog died during anesthesia in preparation for the procedure. No complications that could be directly linked to ABP occurred.

Conclusion

ABP is a simple, rapid, inexpensive, effective, and safe procedure that can be useful for treating persistent pneumothorax that does not respond to conservative treatment and where surgical exploration cannot be carried out. Pneumothorax secondary due to trauma and congenital pulmonary bullae seem to respond well to ABP.

Allogenic blood patch pleurodesis for continuous pneumothorax in three cats

Case series summary

Following diaphragmatic herniorrhaphy, three cats developed a continuous pneumothorax. All three cats required continuous suction to evacuate air from the thoracic cavity. Despite continuous suction, the pneumothorax persisted for all cats and blood patch pleurodesis (BPP) was performed using blood donor cats. All three cats had resolution of their pneumothorax within 24 h of BPP.

Relevance and novel information

This is the first report of BPP used in feline patients. More recently autologous BPP has been reported for use in dogs and humans, with a reportedly high success rate. BPP may allow timely resolution of continuous pneumothorax in cats and provide an alternative treatment option to prolonged medical management or surgical intervention. Allogenic blood from a donor cat may be necessitated in feline BPP when cardiovascular instability is appreciated in these small patients.

Evaluation of intracavitary carboplatin chemotherapy for treatment of pleural carcinomatosis in cats: a retrospective study of eight cases

OBJECTIVES

The aim of this study was to evaluate the benefit of intracavitary carboplatin chemotherapy in cats with malignant pleural effusion of epithelial origin.

METHODS

The medical records of cats with a cytological diagnosis of neoplastic pleural effusion of epithelial origin were reviewed at three referral institutions between January 2013 and June 2018. Only cats treated with intracavitary carboplatin chemotherapy were enrolled. Data collection included signalment, medical history, clinical signs, pleural effusion analysis, diagnostic imaging findings, intracavitary carboplatin chemotherapy protocol, adverse events, response to chemotherapy, outcome and underlying primary tumour, if possible.

RESULTS

Eight cats met the inclusion criteria. Three cats had previous surgical removal of a tumour, including a poorly differentiated primary lung carcinoma, a uterine adenocarcinoma and a benign mammary tumour. The main clinical signs were tachypnoea and/or dyspnoea, inappetence and weight loss. Thoracic radiographs revealed marked bilateral pleural effusion in all cats. Pleural fluid analysis was consistent with a modified transudate, with malignant epithelial cells on cytology, leading to a diagnosis of pleural carcinomatosis. All cats received only one cycle of intracavitary carboplatin chemotherapy at a dose of 200-240 mg/m2. Recurrence of pleural effusion was reported in 7/8 cats within 4-15 days of chemotherapy, and death was recorded in all cats within 5-16 days, owing to recurrent pleural effusion or poor general condition. The primary cancer was suspected to be of pulmonary, mammary and pancreatic origin in four cats, two cats and one cat, respectively, and of unknown origin in the remaining cat.

CONCLUSIONS AND RELEVANCE

In this study, intracavitary carboplatin chemotherapy seems ineffective in managing neoplastic pleural effusion of epithelial origin in cats with pleural carcinomatosis. Other cytotoxic drugs and/or techniques should be investigated in the future to improve the quality of life and survival of cats with pleural carcinomatosis.