SUCCESSFUL MANAGEMENT OF SPONTANEOUS PNEUMOTHORAX IN A DOBERMAN PINSCHER

SUCCESSFUL MANAGEMENT OF SPONTANEOUS PNEUMOTHORAX IN A DOBERMAN PINSCHER

Sunaina Dash^1*, Biswadeep Jena², Sidhartha Sankar Behera²,

Dhatrika Vamshi krishna¹, Kiran Pattnaik³

¹PG Scholar, Department of Veterinary Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Odisha University of Agriculture & Technology, Bhubaneswar – 751 003, Odisha

²Assistant Professor, Department of Veterinary Surgery & Radiology,

College of Veterinary Science & Animal Husbandry,

Odisha University of Agriculture & Technology, Bhubaneswar – 751 003, Odisha

³Assistant Professor, Department of Veterinary Surgery & Radiology,

Institute of Veterinary Science and Animal Husbandry, SOA University, Odisha

*Corresponding author:

Sunaina Dash, ¹PG Scholar, Department of Veterinary Surgery & Radiology,

College of Veterinary Science & Animal Husbandry,

Odisha University of Agriculture & Technology, Bhubaneswar – 751 003, Odisha

Email: drsunainadash28@gmail.com

Mobile: (+91) –9861083073‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬

ABSTRACT:

A 6yearold male, intact Dobermann Pinscher, weighing 28.5Kg, presented with the history of acute onset respiratory distress and progressive exercise intolerance. The owner reported sudden lethargy, restlessness, and reluctance to lie down comfortably. On physical examination, the patient exhibited marked dyspnoea, tachypnoea, and cyanosis of the tongue and mucous membranes. Auscultation revealed diminished lung sounds on the right side of thorax. The heart sounds were muffled, and the patient demonstrated anxiety consistent with hypoxemia. Importantly, there was no history of trauma, indicating a spontaneous pneumothorax. Thoracic radiographs confirmed the presence of free air within the pleural cavity, consistent with pneumothorax. T-FAST (Thoracic Focused Assessment with Sonography for Trauma) revealed absent lung sliding with A-lines and no B-lines strongly supports the diagnosis of pneumothorax. Initial stabilization was attempted with oxygen supplementation and through repeated aspiration of air, using a Seldinger Method of 7 FG central venous catheter placement using a J-wire placed in the right 7th intercostal space (ICS), which provided temporary relief. However, subsequent recurrence of clinical signs after three days necessitated aggressive action. Under general anaesthesia, a 32FG thoracic drainage catheter was introduced via a subcutaneous tunnelling from 10^th ICS into 8^th ICS and connected to a suction apparatus. Immediate evacuation of air resulted in marked clinical improvement, evidenced by normalization of oxygen saturation, improved breathing pattern, and restoration of healthy tongue colour. Postevacuation radiographs demonstrated reexpansion of lung fields. The patient remained stable under this regimen with progressive clinical recovery. This case highlights the importance of early recognition, radiographic confirmation, and secure chest tube placement with suction drainage in the management of spontaneous pneumothorax. It underscores the limitations of repeated thoracocentesis and emphasizes the role of multimodal supportive therapy in achieving successful outcomes in canine respiratory emergencies.

INTRODUCTION

Pneumothorax is defined as the abnormal accumulation of air within the pleural cavity. It occurs when the integrity of the visceral or parietal pleural membranes is disrupted, permitting air from the respiratory tract or external environment to enter the pleural space^1,2,4,18,20. This condition is often a medical emergency, as the loss of negative intrathoracic pressure can rapidly compromise ventilation and oxygenation. Pneumothorax can be classified by cause and by mechanism^4,9,10,18. Etiologically, it is divided into spontaneous and acquired forms, with acquired cases further categorized as traumatic or iatrogenic. Pathophysiologically, pneumothorax may be described as open or closed, and as simple or tension, depending on how air enters and accumulates. Spontaneous pneumothorax refers to air within the pleural space without a traumatic or iatrogenic origin. Primary spontaneous pneumothorax (PSP) develops in the absence of clinically evident lung disease, most commonly due to rupture of subpleural blebs or bullae. Secondary spontaneous pneumothorax (SSP), on the other hand, arises as a consequence of underlying pulmonary pathology such as diffuse parenchymal disease or focal lesions. Understanding these distinctions is essential for accurate diagnosis and effective management.

KEYWORDS: Pneumothorax, Dog, Dobermann, Cyanosis, Anaesthesia, T-FAST.

HISTORY AND CLINCAL FINDINGS

A 6yr old Dobermann male dog weighing 28.5kg was presented to the Veterinary Clinical Complex, OUAT, Bhubaneswar with a sudden onset of respiratory distress. The owner reported that the dog had been previously healthy, with no history of trauma, surgery, or known pulmonary disease. The clinical episode began abruptly, characterized by restlessness, reluctance to exercise, and difficulty lying down comfortably. The owner also observed discoloration of the tongue, described as blackened, which raised concern for severe hypoxemia. There was no evidence of external injury, bite wounds, or thoracic trauma, supporting the suspicion of a spontaneous pneumothorax. On physical examination, the patient was anxious and demonstrated marked dyspnoea with openmouth breathing. Respiratory rate was elevated (tachypnoea), and inspiratory effort was laboured. Mucous membranes were cyanotic, with the tongue appearing darkened, consistent with oxygen deprivation. Heart rate was increased (tachycardia), and peripheral pulses were weak. Auscultation of the thorax revealed diminished lung sounds bilaterally, more pronounced dorsally, while heart sounds were muffled. Percussion of the thoracic wall produced a hyperresonant note, suggestive of intrapleural air. The dog’s posture was abnormal, with extended neck and abducted elbows, reflecting attempts to maximize airflow.

Thoracic radiographs were obtained, which confirmed the presence of free air within the pleural cavity and partial collapse of the lung fields. Ultrasonography (USG) was also performed, revealing reverberation artifacts and absence of normal lung sliding, consistent with pneumothorax. Together, these findings established the diagnosis of spontaneous pneumothorax. Prior to referral, thoracocentesis had been attempted two to three times to evacuate the intrapleural air, but these procedures provided only temporary relief and failed to prevent recurrence. The persistence of air accumulation despite repeated thoracocentesis underscored the need for definitive management with chest tube placement.

TREATMENT:

The dog presented with sudden onset of respiratory distress, laboured breathing, cyanosis with blackened tongue, and diminished lung sounds on auscultation, all in the absence of trauma or prior surgery. Thoracic radiographs revealed free intrapleural air with partial lung collapse, while ultrasonography confirmed absence of normal lung sliding and reverberation artifacts. Collectively, these findings confirm the diagnosis of spontaneous pneumothorax, most likely secondary to rupture of pulmonary blebs or bullae.

The animal was premedicated with meloxicam @ 0.2 mg/kbw subcutaneously and atropine sulphate (0.04 mg/kg), butorphanol(0.4mg/kbw), xylazine(1mg/kbw) intramuscular. Anaesthesia was subsequently induced using a combination of ketamine(5mg/kbw) and diazepam(2mg/kbw) in the ratio 2:1. Following induction the dog was intubated and maintained on oxygen supplementation throughout the procedure. Under Seldinger method a guidewire-assisted technique first described by Sven-Ivar Seldinger in 1953, catheters can be placed into body cavities in a controlled and minimally traumatic manner^12-17. In this case, after thorough aseptic preparation of the 7th intercostal space, local anaesthetic(Lignocaine 2%) was infiltrated into the skin, subcutaneous tissue, and intercostal muscles to ensure patient comfort, following which a small skin incision was made and a needle was advanced carefully into the pleural cavity; once intrapleural air was aspirated confirming correct placement, a Jtipped guidewire was introduced through the needle and advanced smoothly into the cavity, the needle was then withdrawn leaving the guidewire in situ, and a dilator was passed over the wire to enlarge the tract before the 7FG central venous catheter(CVC) was threaded over the guidewire and positioned appropriately, after which the guidewire was removed, the catheter secured with sutures, and the site dressed sterilely, thereby establishing a safe channel for evacuation of intrapleural air. Air was aspirated through this catheter twice daily, which initially provided relief and partial stabilization of the patient’s respiratory function. However, after three days, the dog was again presented with similar symptoms including laboured breathing, cyanosis, and a blackened tongue. Clinical and radiological examination confirmed recurrence of pneumothorax, with diminished lung sounds and hyperresonant percussion notes. The animal was premedicated and anaesthesia was induced again using a combination of ketamine (5 mg/kg body weight) and diazepam (2.5 mg/kg body weight) in a 2:1 ratio, followed by intubation and oxygen supplementation.

Given the persistence and recurrence despite repeated air evacuation via the catheter, a more definitive intervention was undertaken. A 32FG Thoracic drainage catheter was then introduced using subcutaneous tunnelling technique from the 10^th intercostal space into the 8^th intercostal space. Once secured, the tube was connected to a suction apparatus, and air was evacuated immediately. The patient showed rapid improvement in respiratory effort and oxygenation following drainage. A thoracic radiograph was taken after evacuation, which demonstrated reexpansion of the lung fields and significant improvement compared to pretreatment imaging. The chest tube was maintained for continuous drainage, with supportive care including analgesia, restricted activity, and serial monitoring of respiratory parameters. Postoperatively, antibiotic Ceftriaxone+tazobactam(20mg/kbw), pantoprazole(1mg/kbw) and meloxicam(0.2mg/kbw) was administered. The patient remained stable under this regimen, with progressive clinical improvement noted during the postoperative period.

DISCUSSION:

Pneumothorax is defined as the presence of free air or gas within the pleural space. Air may enter this space through three possible routes: from the lung itself via a pleuropulmonary leak, from the external environment through pleurocutaneous, pleuroesophageal, or pleurobronchial communications, or as a result of gasproducing organisms within the pleural cavity. Pneumothorax can be classified according to its cause (etiology), underlying pathophysiology, or the degree of lung collapse^{4,5,9,10,18,20}. Pneumothorax may arise either from trauma or spontaneously. Traumatic pneumothorax accounts for approximately 47% of chest trauma cases in small animals, most often following automobile accidents. In contrast, spontaneous pneumothorax is a closed form in which air leakage originates from the lung parenchyma, occurring without any preceding trauma. Although uncommon, its exact incidence in small animal patients remains unknown. Spontaneous pneumothorax is further divided into primary and secondary types. Primary spontaneous pneumothorax refers to cases without clinical evidence of preexisting pulmonary disease, whereas secondary spontaneous pneumothorax occurs in association with identifiable structural or functional abnormalities of the lung. All secondary cases are linked to an underlying pulmonary disorder. Spontaneous pneumothorax in dogs is an uncommon but potentially lifethreatening condition characterized by the accumulation of free air within the pleural space in the absence of antecedent trauma. In the present case, the diagnosis was supported by clinical signs of dyspnea, cyanosis, diminished lung sounds, and hyperresonant percussion notes, together with radiographic evidence of intrapleural air and therapeutic confirmation through repeated aspiration^6,7,8. The recurrence of clinical signs after initial catheterbased evacuation highlights the limitations of intermittent thoracocentesis in cases of persistent air leakage. Placement of a thoracic drainage catheter using a subcutaneous tunneling technique provided a secure and effective means of continuous drainage^1,2,12-17. This approach is widely recommended in veterinary practice, as tunneling reduces the risk of leakage, accidental dislodgement, and infection compared to direct tube insertion^1,2. Immediate improvement in oxygen saturation, breathing pattern, and tongue color following suction drainage confirmed the efficacy of this intervention. Radiographic monitoring further demonstrated lung reexpansion, underscoring the importance of imaging in both diagnosis and postoperative assessment.  Postoperative administration of Montaz (antibiotic), pantoprazole (gastroprotectant), and meloxicam (NSAID) for five days ensured infection control, gastrointestinal protection, and analgesia, reflecting a multimodal therapeutic strategy. Such supportive care is critical in optimizing recovery and minimizing complications associated with prolonged chest tube placement. This case emphasizes the need for early recognition of spontaneous pneumothorax, the limitations of repeated thoracocentesis, and the superiority of chest tube drainage with suction in achieving sustained resolution. Incorporating the Seldinger method into thoracic drainage procedures further enhances safety and precision, reinforcing its value as a cornerstone technique in both human and veterinary medicine. Continuous monitoring, radiographic confirmation, and appropriate postoperative care remain essential components of successful management.

CONCLUSION:

In managing spontaneous pneumothorax in dogs, the choice of pleural air evacuation technique is critical. For cases involving low-volume air, the Seldinger method provides a minimally invasive and effective option^12-17. When the pneumothorax volume is high and arises from idiopathic causes, however, chest drainage methods are preferred to ensure adequate and continuous evacuation. As highlighted by the author, although a 16 FG Seldinger catheter is typically recommended for pleural air evacuation, it was insufficient in the present case owing to the large volume of pneumothorax. A 20 FG chest tube would have represented the optimal balance between adequate drainage capacity and minimal invasiveness; however, this size was not commercially available. As a result, a 32 FG chest tube was employed and proved effective in achieving successful and sustained resolution of the pneumothorax. Spontaneous pneumothorax in dogs most frequently arises from the rupture of pulmonary bullae, and it represents a lifethreatening emergency requiring rapid recognition and decisive management^1-5,18,20. Unlike cats, where diffuse airway disease predominates, canine cases tend to involve focal lesions, making surgical intervention the cornerstone of therapy. The clinical presentation is often acute, with severe respiratory distress, cyanosis, and exercise intolerance, underscoring the need for prompt diagnostic imaging and stabilization. Thoracic radiography and ultrasonography remain valuable tools for confirming pleural air accumulation, but computed tomography, while useful, may fail to identify all lesions^6,7,8. For this reason, median sternotomy is widely recommended, as it permits complete thoracic exploration and maximizes the likelihood of detecting and excising ruptured bullae. Despite surgical intervention, recurrence of pneumothorax can occur, most commonly due to missed lesions. In such cases, repeat thoracic exploration is justified and often necessary to achieve definitive resolution. When surgery is declined, delayed, or contraindicated due to patient instability or financial limitations, thoracostomy tube placement provides an effective interim measure, allowing continuous evacuation of pleural air and stabilization of the patient^12-17. However, repeated thoracocentesis alone is generally insufficient, as it fails to address the underlying pathology and carries a high risk of recurrence. In situations where pneumothorax persists despite surgery, or when surgical management is not feasible, alternative strategies such as autologous blood patch (ABP) therapy and pleural port placement may be considered. These approaches, although less definitive than surgical excision, can provide meaningful palliation and improve quality of life in select patients. The choice of therapy must therefore balance clinical urgency, patient factors, and owner preferences, with the overarching goal of restoring pulmonary function and preventing recurrence. Prognosis in canine spontaneous pneumothorax is variable, reflecting the complexity of lesion detection and management. Nevertheless, when ruptured bullae or other causative lesions are successfully identified and removed, outcomes are typically excellent, with longterm survival and return to normal activity reported in many cases. This emphasizes the importance of thorough thoracic exploration, vigilant postoperative monitoring, and individualized treatment planning. Ultimately, early recognition, decisive surgical intervention, and consideration of adjunctive therapies form the foundation of successful management in dogs with spontaneous pneumothorax.

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