Case Study

RADS – Bilateral Pneumothorax and Pulmonary Collapse in a 5 year old MN Terrier Mix dog

This 5 year old MN Terrier Mix was presented in respiratory distress. Radiographs and chest taps were performed.

Image Interpretation

Rads of thorax, right lateral and VD: The osseous structures showed the intervertebral disc C3/4 presented mild mineralization. Extrathoracic soft tissue structures showed the liver extended far caudally beyond the costal arch, the stomach and liver were displaced caudally and to the left, both due to the caudal expansion of the right hemidiaphragm. The stomach and small intestine contained a moderate amount of gas. The soft issues of the neck were within normal limits. Intrathoracic structures showed the chest was expanded. There was a bilateral pneumothorax with nearly complete collapse of the lung lobes. Residual aeration was noted within the left caudal lobe only. The right hemidiaphragm revealed severe caudal expansion. The cardiac silhouette was retracted from the sternum. There was a severe mediastinal shift towards the left including the cardiac silhouette, esophagus and caudal vena cava. The lungs were retracted from the thoracic wall, collapsed and centralized. There were multiple large bullae and/or blebs associated with the right lung lobes. The cardiac silhouette and caudal vena cava were small. There was no pneumomediastinum or pneumoretroperitoneum. No radiographic sign of trauma was noted.

DX

The radiographic findings are compatible with a right sided tension pneumothorax and a secondary left sided pneumothorax with severe bilateral pulmonary collapse, right greater than left

Outcome

A spontaneous pneumothorax due to rupture of pulmonary bullae/blebs is very likely. No sign of primary pulmonary or pleural disease was evident. However, the assessment was limited to the degree of lung expansion. Moreover, the patient presents a hypovolemic state. The site of leakage cannot be determined based on a radiographic study. In case of lack of response or stabilization after drainage, or repeated recurrence, a thoracic CT and/or explorative thoracoscopy/thoracotomy is recommended for further evaluation.