Ch. 103: Lungs

Question 1

McPhetridge JAVMA 2022

Distribution of histopathologic types of primary pulmonary neoplasia in dogs and outcome of affected dogs: 340 cases (2010-2019)

• % distribution/types?
• MST for types?
• what prolonged survival?
• what increased hazard of death?

Answer 1

Pulmonary carcinoma most common 87.1%, sarcoma 7.6%, adenoma 3.2%, Pulmonary neuroendocrine tumor 1.5%,
1 plasmacytoma, and 1 carcinosarcoma

MST: Pulmonary carcinomas 399 days, histiocytic sarcomas 300 days, neuroendocrine tumors 498 days

Dogs with complete surgical margins had significantly (P = 0.027) longer survival times than dogs with incomplete margins

The hazard of death was increased by 1.4 for each increase in stage

Question 2

Perez-Accino JSAP 2021

Endogenous lipoid pneumonia associated with pulmonary neoplasia in three dogs

Answer 2

poorly characterised condition in veterinary medicine

Clinical presentation and imaging lesions can appear non-specific and may be obscured by neoplastic infiltrate and so diagnosis requires cytology or histopathology

Question 3

Bello JSAP 2022

Pulmonary carcinoma associated with cystic airspaces in two dogs

CT progressive changes?
Diagnosis?

Answer 3

CT demonstrated transformation of the cystic airspace lesions - progressive increase of the solid component and reduction of the air component

Cytology and surgical excision confirmed pulmonary carcinoma in both cases

Question 4

Park Vet Sx 2018

Lung lobe torsion in dogs: 52 cases (2005-2017)

• condition less likely to survive?
• breeds / lobe torsion?
  PQ Overall survival? % survival to discharge?
  PQ Associated w mortality?

Answer 4

Dogs with concurrent torsion of the right cranial and middle lung lobes less likely to survive (2/4) than those with torsion of left cranial lung lobe (22/22)

91% pugs torsion of left cranial lung lobe
86% brachycephalic dogs torsion of left cranial lung lobe
50% sighthound groups torsion of right middle

• 46 (92%) dogs survived to discharge *
• Dogs with concurrent R Cr & middle less likely to survive than left. No other risk factors for mortality prior to hospital discharge were identified. *

Overall MST after hospital discharge 1369 d

Question 5

Rossanese Vet Sx 2020

Long-term survival after treatment of idiopathic lung lobe torsion in 80 cases

• common breeds?
• intra/post-op complication rates?
• survival to discharge, 1, 2, 5 yrs?
• what is associated with longer survival?

Answer 5

Most represented breeds were pugs (47.5%) and sighthounds (16.2%)

Intraoperative complications 3% dogs
Postop complications in 14% dogs

95% survived to discharge; 1 yr survival 93%, 2 yr 91%, 5 yr 88%

Primary LLT associated with longer survival (median not reached) vs secondary LLT (921d 7-2073)

Question 6

Belmudes VRU 2021

Lung lobe torsion in 15 dogs: peripheral band sign on ultrasound

US appearance? PQ
CT appearance?
Histology?

Answer 6

Thoracic ultrasonography revealed a peripheral hypoechoic band, overlying areas of scattered, hyperreflecting interfaces in the affected lobe. (14/15)

CT, central emphysema was surrounded by a peripheral, soft tissue attenuation band, affecting the periphery in 14 cases

Histological examination yielded a comparable peripheral band, consisting of a thickened visceral pleura with or without hemorrhagic necrosis of the underlying pulmonary parenchyma

• peripheral hypoechoic band, associated with central emphysema in a noncollapsed lung lobe on ultrasonography *

Question 7

Fowler JVIM 2020

Ecological level analysis of primary lung tumors in dogs and cats and environmental radon activity

what element found?

Answer 7

rate of PPN in counties w/ high radon zone was 2x higher than counties w/ lower radon zones for dogs and cats

Question 8

Tindale JFMS 2022

Clinical characteristics and long-term outcome of lung lobe torsions (LLT) in cats: a review of 10 cases (2000–2021)

clinical signs?
Treatment?
Diagnoses?
survival?

Answer 8

CS: Dyspnoea and tachypnea most common. Pleural effusion in 90%.

Treatment: Lung lobectomy was successfully performed in all cases (10/10, 100%)

Diagnoses:
3 cats idiopathic
7 cats secondary LLT

60% discharged, 30% long term survival

Question 9

Cronin VSURG 2019 PQ

Evaluation of a pre-tied ligature loop for canine total lung lobectomy

which methods leaked?
PLL complications?

Answer 9

NONE of the PLL leaked; 2 stapled and 4 sutured bronchial stumps leaked at supraphysiological pressures > 15 mmHg

Lung lobectomy performed successfully with PLL in 5 cases with no intraoperative or postoperative complications

Conc: Bronchial ligation with the PLL reliably resisted physiological airway pressures and performed comparably to current standard techniques in cadavers. The PLL provided an adequate air and vascular seal in 5 clinical cases undergoing total lung lobectomy.

Question 10

Ishigaki Vet Sx 2021

Resorbable self-locking device for canine lung lobectomy: a clinical and experimental study

complications?
degrade?

Answer 10

No procedural or post-op complications with device

Degradation and resorption of device were progressed at 4 months post-op; after complete resorption of polymer materials, only connective tissue remained

Question 11

Warwick JVIM 2021

Imaging findings in 14 dogs and 3 cats with lobar emphysema

CT findings?
lung lobe(s) most affected?
most common suspected diagnosis?

Answer 11

Lung lobe hyperinflation (CT only), atelectasis of non-affected lung lobes, mediastinal shift, and thoracic wall and diaphragmatic wall deformation were common findings.

Pleural effusion, pneumothorax, and cardiac compression also only CT

71% affected right middle lung lobe, multiple in 41%

Congenital lobar emphysema suspected in 82%

Question 12

Shimbo VRU 2021

CT morphology of anomalous systemic arterial supply to normal lung in dogs

% aberrant vasculature?
findings?
breeds?

Answer 12

aberrant vasculature equivalent to ASANL in humans was detected in 48 dogs. (2.5%)

pulmonary arteries to the caudomedial portions of the right and/or left lung lobes were lacking. The aberrant vessels were running from within the mediastinum toward the bronchi in the region lacking pulmonary arteries; from there, they ran caudally along the bronchi similar to pulmonary arteries

Shelties, Mini dachshunds, and Labs over-represented

Question 13

Guillem JAVMA 2023

Prevalence of bronchial wall thickening and collapse in brachycephalic dogs with and without brachycephalic obstructive airway syndrome and in nonbrachycephalic dogs

brachy + BWT?
brachy + bronchial collapse?

Answer 13

A relationship between brachycephalic conformation and body weight with BWT was established, with heavier dogs having thicker bronchial walls.

Bronchial collapse was also more common in dogs with brachycephalic conformation, which is in agreement with the previously published literature

Question 14

Lisciandro JVECC 2022

The wedge sign: A possible lung ultrasound sign for pulmonary thromboembolism

where is wedge sign seen?
suggest?

Answer 14

“wedge sign” in nongravity-dependent caudodorsal and perihilar lung regions

might suggest PTE

**ONLY 2 cases

Question 15

Dickson JAVMA 2021

Surgical management and outcome of dogs with primary spontaneous pneumothorax: 110 cases (2009-2019)

tx?
PQ recurrence?
MST?

Answer 15

All dogs (110) underwent thoracic explore with 1 or multiple partial or complete lung lobectomies

• Pneumo recurred in 13/100 (13%) dogs followed up for > 30 days. *
  Median time from surgery to recurrence was 9 days (0-421).
• More likely to recur <30 days post-op than >30 days. *

MST without recurrence significantly longer. 1 year survival 91%.

Question 16

Howes JSAP 2020

Long-term clinical outcomes following surgery for spontaneous pneumothorax caused by pulmonary blebs and bullae in dogs - a multicentre (AVSTS Research Cooperative) retrospective study

2-5yr survival rates?
recurrence rate?
MST?

Answer 16

Two- and 5-year survival rates were 88.4% and 83.5%, respectively.

There was recurrence in 14 of 99 dogs (14.1%)

MST 38d for dogs with recurrence and 710d for dogs without recurrence

Question 17

Dickson VRU 2020

Computed tomography in two recumbencies aides in the identification of pulmonary bullae in dogs with spontaneous pneumothorax

% ID in dorsal vs. ventral?
sensitivity? PPV?

Answer 17

85% of the 12 ventrally located lesions were best seen in dorsal

73% of the eight dorsally located lesions were best seen in sternal recumbency

Sensitivity for bulla: 58-69%
PPV for bulla: 62-79%

Question 18

Kim VRU 2023

Thoracic CT incidental pulmonary bullae in dogs: Characterization, interobserver variability, and general anesthesia risks

demographic found in?
most common finding?
adverse ax events?

Answer 18

Bullae were more commonly found in older (median age 11.3 years), large breed dogs (median weight 20.7 kg).

A solitary bulla of < 1 cm was the most common

No adverse ax events were found following CT ax or following repetitive anesthesia procedures

Question 19

Jagodich JVECC 2020

High-flow nasal cannula oxygen therapy in acute hypoxemic respiratory failure in 22 dogs requiring oxygen support escalation

tradition tx vs HF?
% responded?

Answer 19

relative to traditional oxygen therapy HFNC led to decreased RR at 1hr and 7hrs, and a decrease in dyspnea scores at all times and an increase in SpO2 at all times

30% of patients responded to HFNC use by 30min and 45% ultimately responded to HFNC use and survived

Question 20

Nylund VSURG 2019 PQ

Thoracoscopic-assisted lung lobectomy in cat cadavers using a resorbable self-locking ligation device

LigaTie leakage?
TA leakage?
Conclusion?

Answer 20

All LigaTie sites reached max airway pressure without leaking and easily placed at hilus

4/10 TA stapled sites leaked at mean pressure of 22 cmH2O

All leaks occurred when TA staple line > 5 mm from hilus; no leaks occurred when TA staple line < 5 mm from hilus

No difference was found between fresh and frozen cadavers or right vs left lung lobe

Conclusion: lung lobectomies consistently done at hilus only when LIgaTie used

Question 21

Singh VSURG 2019

Optimization of surgical approach for thoracoscopic-assisted pulmonary surgery in dogs
Simulated thoracoscopic-assisted lung

L or R ICS 4 and 5 best for what?
R ICS 5 and 6 best for what?

Answer 21

lobectomy performed at left or right ICS 4 and 5, compared with other ICS evaluated, resulted in a significantly shorter median distance from the stapler anvil to the pulmonary hilus of the left cranial and caudal lung lobes and right cranial and middle lung lobes, respectively

Lobectomy at right ICS 5 or 6 resulted in a significantly shorter median distance from the stapler anvil to the pulmonary hilus of the right caudal and accessory lung lobes, respectively

Conclusion: so there are other positions - These data may inform minithoracotomy positioning to optimize tumor margin excision during thoracoscopic-assisted lung lobectomy for treatment of pulmonary neoplasia in dogs.

Question 22

Diamond VSURG 2021

A randomized, prospective, comparative trial of a variable-angle versus fixed-angle endoscope for exploratory thoracoscopy in canine cadavers

Conclusion?

Answer 22

All anatomical locations were visualized by both endoscopes.

Failure to accurately ID the predetermined locations was more common with the FAE (19 failures) than the VAE (4 failures).

The VAE angulation used ranged from 0-120.

The total time to complete the explore was longer when the lungs were ventilated compared to not ventilated.

When lungs were not ventilated, the total explore time with VAE was not significantly diff than the total explore time using FAE.

When lungs were ventilated, the VAE shorted the total explore time of the FAE.

There was no difference in total explore time between ventilated and non-ventilated lungs when the VAE was used. Not ventilating the lungs improved the total explore time with FAE was used.

Conclusion: Use of a rigid VAE decreased cumulative thoracoscopic exploration time and provided an alternative to one-lung ventilation for circumventing the visual impediments of lung ventilation.

Question 23

Marvel VSURG 2022

Thoracoscopic treatment of persistent right aortic arch in dogs with and without one lung ventilation

Conclusion?

Answer 23

12/15 successful endobronchial blocker placement, 2 dislodged and proceeded as OLV-
10/12 OLV+ and 7/10 OLV- had their left ligamentum arteriosum successfully ligated with thoracoscopy

Median surgical time, surgery complications, anesthesia complications, and rate of conversion were similar

5 conversions
2 grade 4 OLV+ for life threatening hemorrahge
2 grade 1 and 1 grade 4 conversions OLV-
Poor visualization and hemorrahge

Surgical complications 23%
4 major
1 minor

Postoperative complications 59%
Regurg, vomiting, incisional, arrhythmias, esophageal leakage, aspiration, hypothermia, G-tube complications

Conclusion: Thoracoscopic treatment of PRAA can be performed with or without OLV. Surgical time, intraoperative complications, and conversion rates were similar between dogs that underwent thoracoscopic treatment of PRAA with and without OLV. OLV may not have contributed to improved visualization in this group of dogs.

Question 24

Scott VSURG 2023

Complications and outcomes of thoracoscopic-assisted lung lobectomy in dogs

Intraop comps?
Conversion #? Reasons for conversion?
Device for lobectomy?
Most common lesion?

Answer 24

Retrospective, 30 dogs
12 intraoperative complications were recorded in 11 dogs
20% 6 requiring conversion to open thoracotomy.

Reasons for conversion were reported in 5/6 dogs and included adhesions (2), difficultly manipulating the lesion through the mini-thoracotomy (2), and acute oxygen desaturation (1).

One lung ventilation was successful in 4 of the 7 dogs in which this was attempted.

A linear stapling device was used for lung lobe ligation in 14 dogs.

23 dogs underwent surgery for a neoplastic lesion, with 19 of these being carcinoma.
The median lesion size was 4.3 cm (range 1-10 cm); margins were clean, except in 1 dog.
Postop 8 complications were documented in 8 dogs prior to discharge, 5 of these being classified as mild.
29 dogs were discharged at a median of 47 h postoperatively (range 24-120 h).

Death was reported in 9 dogs, with a median survival time of 168 days (range 70-868 days).

Conclusion: Thoracoscopic-assisted lung lobectomy was achieved with few major complications in the population reported here. Dogs were able to be discharged from hospital quickly, with most surviving beyond the follow-up period.