Presentation
Presented for coughing two days earlier. Today, she presents with pneumothorax.
Patient Data
There is a large volume pneumothorax with visbility of the mediastinal structures and fluid in the caudal esophagus. The patient was not stable for additional views.
There is bilateral pneumothorax with a chest tube present in the left hemithorax. The left caudal lung lobe has thickened pleura. There is a focal wedge-shaped area of increased opacity extending to the pleural space, and containing areas of gas cavitation. Additional ground glass opacity is present peripheral to the focal lesion.
There are additional areas of consolidation in the right caudal and accessory lung lobes, without pleural involvement.
Referral radiographs taken 2 days previously were initially deemed normal. In retrospect, there is a focal, ill-defined alveolar pattern in the left caudal lung lobe. The alveolar pattern is superimposed over the 8th rib on the lateral projection, and just to the left of the spine on the v/d projection.
Case Discussion
A left lung lobectomy was peformed. A thorn was found to be the cause of the pneumonia and pneumothorax. On histopathology, there was suppurative pneumonia and necrosis.
The pleural thickening and lung cavitation is typical of a foreign body that enters from a bronchus and exits through the pleura, causing pneumothorax.
A non-traumatic pneumothorax can be caused by rupture of a bulla or an inhaled foreign body. In certain geographic areas, plant species such as grasses can cause this as a recognized etiology. This dog had a fever prior to the pneumothorax, which was likely caused by the foreign body pneumonia. The fever was responsive to antibiotics however the pneumothorax occurred within a week of initial presentation.
The referral radiographs show an extremely subtle alveolar pattern in the early course of the case, six days before the pneumothorax. While we can identify it in retrospect, it was below the threshold of detection and limited by the physics of radiographs and location of the lesion.
Unable to process the form. Check for errors and try again.