Thoracotomy / Chest surgery in dogs / the Vet Vault Podcast / Drs. Hubert Hiemstra + Shadi Ireifej скачать в хорошем качестве

Thoracotomy / Chest surgery in dogs / the Vet Vault Podcast / Drs. Hubert Hiemstra + Shadi Ireifej

All DVMs and veterinary professionals should have access to this amazingly informative podcast! Link // https://thevetvault.com All DVMs and veterinary professionals should have access to this amazingly informative podcast! Link // https://thevetvault.com Lung lobe torsion A longitudinal axis rotation at the pulmonary hilus obstructs the bronchus and its associated structures, causing congestion, consolidation, and pleural effusion. Atelectasis, hypoxemia, edema, hemorrhage, and necrosis occur. Systemic inflammatory response syndrome leads to cardiovascular dysfunction, disseminated intravascular coagulopathy, and acute respiratory distress syndrome. Causes include chylothorax, any bronchial or lung lobe pathology, thoracic trauma, neoplasia, and chylothorax. Signs Male dogs 4.5 years of age or younger are most often reported. The Afghan Hound breed is at a 133-times greater risk. Small breed dogs are less commonly affected with the Pug breed being predisposed. Clinical signs reflect respiratory disease. The duration of clinical signs averages 4.5 days in large breed dogs and 3.5 days in the small breed dogs. Diagnostics Thoracocentesis is performed prior to collecting thoracic radiographs for patient stability and improved radiographic diagnostic ability. Pleural fluid type and characteristics may vary. Most common findings on plain orthogonal thoracic radiographs include pleural effusion (100% incidence) and vesicular emphysema (97%). Surgical therapy Lung lobe resection may be performed via an exploratory thoracotomy. Derotation is avoided as it risks cytokine release and reperfusion injury. In those cases in which chylothorax is present, additional procedures may be performed. The diseased tissue is submitted for both culture and histopathologic evaluation. Chest tube production is monitored post-operatively. Example surgery report for DVMs -- Emergency lateral 5th intercostal space (ICS) thoracotomy, lung lobectomy, LigaSure usage, and chest tube placement: The patient was clipped and prepped in routine and placed in left lateral recumbency. A 5th routine lateral ICS thoracotomy revealed a minimal to mild amount of hemorrhagic pleural fluid. Right cranial and accessory lobes appeared unremarkable. The entire right middle lung lobe appeared diffusely and grossly emphysematous and torsed. After dissecting the lobe from the supporting facial attachments and isolating the lobe with lap pads, the pedicle was secured with and excised using a large LigaSure device. After flush and glove and instrument change, leak testing was negative. The remainder of the thoracic exploratory was unremarkable. No overt evidence of obvious disease could be identified. 500 ml of flush followed by glove and instrument change and an additional liter. After placing 16ga thoracostomy tube in the right 7th ICS and secured with 2-0 Ethilon Chinese fingertrap pattern, routine closure: 1 Prolene in simple interrupted pattern for rib apposition, 3-0 PDS in simple continuous pattern for muscular apposition and fascial attachments, 3-0 PDS in subcuticular for SQ and intradermal. Skin sutures cruciate pattern 2-0 Ethilon. The removed right middle lung lobe was submitted for histopathological evaluation. Outcome The prognosis in cases of idiopathic disease or those occurring secondary to trauma is fair to guarded. Lung lobe excision survival rate ranges from of 50 to 91%. Without treatment, disease recurrence is seen within 5 to 180 days after the initial onset. Shadi Ireifej DVM DACVS