Air leak syndrome in animals: definition and pathogenesis.

Air leak syndrome (ALS) is described in human medicine as a constellation of clinical disorders including pneumomediastinum, pneumopericardium, pulmonary interstitial emphysema, pneumothorax, pneumoperitoneum, pneumoretroperitoneum and subcutaneous emphysema. The pathogenesis of ALS depends on the anatomy of the mediastinum and its associations with thoracic, abdominal and cervical connective tissues, as well as a physical phenomenon referred to as the Macklin effect. Various animal species develop diverse combinations of these lesions, although ALS has not been recognized in animals. However, this term aids pathologists in addressing this disease compilation. The aim of this retrospective study is to illustrate examples of ALS in animals by arbitrarily selecting 13 cases in dogs, cats, pinnipeds, sea otters and harbour porpoises. ALS can be classified into three groups based on aetiology: iatrogenic, secondary or spontaneous. Iatrogenic ALS was diagnosed in two cats with tracheal laceration following endotracheal intubation. Secondary ALS was identified in two dogs, one with acute respiratory distress syndrome and the other due to grass awn migration. Secondary ALS in pinnipeds was diagnosed following severe pulmonary parasitism, uraemic pneumonia and oesophageal perforation. The other marine mammals developed ALS following trauma. Spontaneous ALS was also diagnosed in one cat and one dog without any apparent predisposing causes.

Physical examination and CT to assess thoracic injury in 137 cats presented to UK referral hospitals after trauma.

OBJECTIVES: The aim of the study was to describe clinical examination and thoracic CT (TCT) findings in cats after trauma, and to identify physical examination findings associated with both abnormalities on TCT and the need for therapeutic interventions. METHODS: A multicentre, retrospective, observational study was conducted. Cats admitted to the participating hospitals with a history of blunt trauma and that underwent TCT were eligible. Data were collected on signalment, history, physical examination, TCT findings and subsequent interventions. RESULTS: In total, 137 cats were included. Road traffic accidents (RTAs) were the most frequently reported cause of trauma (69%). Tachypnoea (32%), pale mucous membranes (22%) and dyspnoea (20%) were the most common abnormal findings on thoracic examination. The most frequently identified thoracic pathologies on TCT were atelectasis (34%), pulmonary contusions (33%), pneumothorax (29%) and pleural effusion (20%). Thoracocentesis was the most commonly performed intervention (12%), followed by chest drain placement (7%). A total of 45 (33%) cats had no physical examination abnormalities but did have abnormalities detected on TCT; six of these cats required interventions. Increasing numbers of thoracic abnormalities on clinical examination were associated with increasing likelihood of having abnormal findings on TCT (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.21-3.44, P = 0.008) and of requiring an intervention (OR 1.82, 95% CI 1.32-2.51, P <0.001). CONCLUSIONS AND RELEVANCE: RTAs were the most common reported cause of blunt trauma. Atelectasis, pulmonary contusions and pneumothorax were the most common abnormalities identified on TCT, and thoracic drainage was the most utilised intervention. TCT may be useful in identifying cats with normal thoracic physical examination findings that have significant thoracic pathology, and a high number of abnormal findings on thoracic examination should raise suspicion for both minor and major thoracic pathology. The results of this study can be used to assist in selecting appropriate cases for TCT after blunt trauma.

Laparoscopic surgical treatment for sliding hiatal hernia is associated with an owner-perceived improvement in clinical outcome in dogs.

OBJECTIVE: To report perioperative complications and client-perceived outcome following laparoscopic surgical treatment for sliding hiatal hernia (SHH) in dogs. ANIMALS: Client-owned dogs (n = 9). METHODS: Medical records were reviewed and perioperative data collected including preoperative diagnostic imaging, operative details, complications, and need for conversion to open celiotomy. A single-incision, multicannulated port was inserted in the subumbilical region followed by placement of an additional 2 or 3 instrument portals. Hiatal plication, esophagopexy, and left-sided gastropexy were performed laparoscopically. Follow-up information was collected with telephone interview with the owners and/or referring veterinarian. A standardized questionnaire was completed by dog owners postoperatively. RESULTS: Intraoperative pneumothorax occurred in 5 of 9 (55.6%) dogs and resulted in conversion to open celiotomy in 2 (22.2%) dogs. In 4 dogs, pneumothorax was suspected to be the result of progressive leakage of capnoperitoneum through the suture bite holes of the esophageal hiatal plication sutures. Hiatal plication was performed using intracorporeal simple interrupted sutures (n = 4) or a simple continuous pattern with barbed suture (4). Esophagopexy was performed using barbed suture in all dogs. Gastropexy was performed using a total laparoscopic technique (n = 4) or laparoscopic-assisted technique (3). Using a standardized questionnaire, dog owners perceived a postoperative improvement in regurgitation after eating and regurgitation after excitement/increased activity. CLINICAL RELEVANCE: Laparoscopic treatment of SHH resulted in owner-perceived improvement in clinical signs. Intraoperative pneumothorax occurred in a high proportion of dogs but did not result in long-term sequelae.

Spontaneous pneumothorax in a dog with a history of successfully treated heartworm disease: A case report.

OBJECTIVE: To describe a dog presented with spontaneous pneumothorax secondary to chronic pulmonary changes associated with a history of resolved canine heartworm disease. CASE OR SERIES SUMMARY: A 7-year-old 25.2kg female spayed German Shepherd mix was presented for management of spontaneous pneumothorax. The dog had a history of heartworm disease that underwent therapy prior to adoption, and the dog was heartworm antigen negative (SNAP 4Dx) during hospitalization for the pneumothorax. An exploratory thoracotomy was performed due to an unresolving pneumothorax requiring multiple thoracocenteses. Perioperatively, the lungs did not expand with positive pressure ventilation and diffuse, multifocal to coalescing areas of darkened tissue that were grossly consistent with necrosis and/or hemorrhage were noted. The dog was euthanized intraoperatively due to an assumed poor prognosis. Histopathologic examination findings were consistent with chronic reactive changes related to previous heartworm infection. No neoplastic or infectious etiologies were identified. NEW OR UNIQUE INFORMATION PROVIDED: Spontaneous pneumothorax is a known complication of active heartworm infection. However, this case represents the first report of spontaneous pneumothorax secondary to chronic pulmonary changes caused by resolved heartworm infection.

Successful Medical Management of Bilateral Pneumothorax Due to Nasogastric Tube Misplacement in a Cat.

A 7 yr old female spayed domestic shorthair was evaluated for suspected lily ingestion and acute vomiting. The cat had vomited suspected lily plant material before presentation, and a nasogastric tube (NGT) was placed to continue to administer activated charcoal. The NGT was passed with sedation and limited restraint. To confirm placement, a single lateral radiograph was taken, which showed that the tube was in the trachea, bronchus, through the pulmonary parenchyma, and extending into the region of the craniodorsal retroperitoneal space. The tube was subsequently removed, resulting in a tension pneumothorax. Bilateral thoracostomy tubes were placed and attached to continuous suction. The pneumothorax resolved after 2 days, the thoracostomy tubes were removed, and the cat was discharged on day 3 after admission. To the authors' knowledge, this is the first described pneumothorax complication with successful medical management secondary to routine nasogastric tube placement in a cat. This case report underscores the importance of preparedness for thoracostomy tube placement before removal of any NGT that has been confirmed to be placed through the pulmonary parenchyma.

Complications and outcome of traumatic diaphragmatic hernia repair without post-operative chest drain: Retrospective study in 90 cats.

Background: Diaphragmatic herniorraphy is the treatment of choice for traumatic diaphragmatic hernia (TDH). Several methods have been described for the removal of residual air and fluid during and after surgery, such as the insertion of chest drains, intercostal thoracentesis, and transdiaphragmatic thoracentesis. However, there are no indications regarding the most useful technique and the impact that choice of technique could have in the immediate postoperative period. Aim: To evaluate the development of complications and outcomes associated with the use of intraoperative transdiaphragmatic thoracentesis in cats undergoing diaphragmatic herniorrhaphy for TDH. Methods: Medical records of cats treated for acute and chronic TDH between 2010 and 2019 were reviewed. Cats were included if intraoperative pneumothorax was treated with transdiaphragmatic thoracentesis, without the use of intercostal chest drain. Outcome, intra- and post-operative complications were recorded. Results: Intraoperative and postoperative complication rates were 3.3% and 12.4%, respectively. Development of postoperative pneumothorax was associated with the presence of comorbidities (p = 0.046). The overall survival rate was 93.3%. Long-term survival had a significant association with the presence of comorbidities (p = 0.045), if the procedure was performed as an emergency (p = 0.041) or in older cats (p = 0.011). Conclusion: Intraoperative transdiaphragmatic thoracentesis could be considered an effective method for the removal of residual air after surgery for TDH, because it ensures a good outcome for the patient, with low development of complications, especially for uncomplicated cases. The presence of comorbidities, the need to perform a surgical procedure in emergency, and the age of the patient can be considered factors influencing the development of complications. Critical patient selection, based on assessment of potential risk factors for complications is warranted to understand which patient will benefit from thoracostomy tube placement.

Tension pneumothorax in small odontocetes.

Pneumothorax, the accumulation of air in the pleural cavity, occurs when air enters the pleural space by the pleuro-cutaneous, pleuro-pulmonary, or pleuro-oesophageal-mediastinal route. Tension pneumothorax is an infrequent and severe form of pneumothorax where a positive pressure in the pleural space is built up during at least part of the respiratory cycle, with compression of both lungs and mediastinal vessels, and, if unilateral, with midline deviation towards the unaffected hemithorax. We describe 9 cases of tension pneumothorax in 3 species of small cetaceans (striped dolphin Stenella coeruleoalba, common dolphin Delphinus delphis, and common bottlenose dolphin Tursiops truncatus) from the western Mediterranean coast of Spain, and one case from a dolphinarium. Computed tomography (CT) imaging performed in 2 carcasses before necropsy showed lung compression, midline deviation, and pressure on the diaphragm, which was caudally displaced. Tension pneumothorax was recognized at necropsy by the presence of pressurized air in one of the hemithoraces. Seven of the pneumothorax cases were spontaneous (2 primary and 5 secondary to previous lung pathology). In the other 2 dolphins, the pneumothorax was traumatic, due to oesophageal-pleural perforation or rib fractures. We hypothesize that pneumothorax in dolphins is predominantly tensional because of their specific anatomical and physiological adaptations to marine life and the obligate exposure to extreme pressure changes as diving mammals.

Local outbreak of spontaneous pneumothorax secondary to paragonimosis in southwestern Ontario dogs.

Three dogs were diagnosed with spontaneous pneumothorax and referred to the Ontario Veterinary College Health Sciences Centre for management. The 3 dogs were diagnosed with secondary spontaneous pneumothorax due to paragonimosis. The diagnosis was made by visualization of adult trematodes during surgical exploration with histopathological confirmation in 1 dog, and detection of trematode eggs via fecal sedimentation in the other 2 dogs. Two of the dogs developed unusual additional lesions, including hemoabdomen, muscle abscess, and abdominal adhesions. These were suspected to be secondary to aberrant fluke larval migration. All 3 dogs lived within a relatively small geographical area of Ontario and were hospitalized between December 2021 and March 2022. Each dog survived to discharge with surgical or medical management of the pneumothorax and treatment with a prolonged course of fenbendazole. Key clinical message: Paragonimosis should be considered as a differential diagnosis for canine spontaneous pneumothorax in areas where Paragonimus kellicotti is, or may be, endemic, or in dogs that have travelled to endemic areas - particularly if the patient has a history of cough or potential exposure to freshwater crayfish. Routine anthelmintic treatment does not prevent infection and standard fecal floatation methods may not detect the eggs. Therefore, diagnostic testing should include a fecal sedimentation test and thoracic radiographs to screen for P. kellicotti.

Éclosion locale de pneumothorax spontané secondaire à la paragonimose chez des chiens du sud-ouest de l'Ontario. Trois chiens ont reçu un diagnostic de pneumothorax spontané et ont été référés au Ontario Veterinary College Health Sciences Centre pour prise en charge. Les 3 chiens ont été diagnostiqués avec un pneumothorax spontané secondaire dû à la paragonimose. Le diagnostic a été posé par la visualisation des trématodes adultes lors de l'exploration chirurgicale avec confirmation histopathologique chez 1 chien, et la détection des oeufs de trématodes par sédimentation fécale chez les 2 autres chiens. Deux des chiens ont développé des lésions supplémentaires inhabituelles, notamment un hémoabdomen, un abcès musculaire et des adhérences abdominales. Ces lésions étaient soupçonnées d'être secondaires à une migration larvaire aberrante de la douve. Les 3 chiens vivaient dans une zone géographique relativement restreinte de l'Ontario et ont été hospitalisés entre décembre 2021 et mars 2022. Chaque chien a survécu jusqu'à sa sortie avec une prise en charge chirurgicale ou médicale du pneumothorax et un traitement avec un traitement prolongé au fenbendazole.Message clinique clé :La paragonimose doit être considérée comme un diagnostic différentiel du pneumothorax spontané canin dans les zones où Paragonimus kellicotti est, ou peut être, endémique, ou chez les chiens qui ont voyagé dans des zones endémiques ­ en particulier si le patient a des antécédents de toux ou une exposition potentielle aux écrevisses d'eau douce. Le traitement vermifuge de routine n'empêche pas l'infection et les méthodes de flottaison fécale standard peuvent ne pas détecter les oeufs. Par conséquent, les tests de diagnostic doivent inclure un test de sédimentation fécale et des radiographies thoraciques pour dépister P. kellicotti.(Traduit par Dr Serge Messier).

Use of an equine compression suit to manage a deep axillary wound in a horse.

PURPOSE: To describe the use of an equine compression suit to manage a deep axillary wound in a Thoroughbred filly with bilateral pneumothorax. CASE SUMMARY: A 2-year-old Thoroughbred filly was referred for management of a deep wound to the left axilla. Packing and bandaging of the area were initially attempted, but this became repeatedly dislodged, and bandaging was discontinued. The filly subsequently developed widespread subcutaneous emphysema, and the wound was slow to granulate. Acute onset respiratory distress occurred 11 days after admission, secondary to bilateral worsening pneumothorax, and required placement of a chest drain. A commercially available equine compression suit was then successfully used to hold a primary dressing in place. This resulted in a marked improvement in the subcutaneous emphysema and pneumothorax. Wound granulation subsequently progressed well, and the filly was discharged from the clinic on day 36. UNIQUE INFORMATION PROVIDED: This case report highlights the potential applicability of a compression suit as an alternative to a stent to effectively prevent entry of air and successfully manage axillary wounds in the horse. It was also noted how delayed the progression of a pneumothorax can be after inadequate bandaging of a deep wound in the axillary region. The compression suit provided an alternative means of securing a dressing onto an awkwardly placed wound and may be useful in locations other than the axilla.

Outcomes, including death, in dogs with pneumothorax following nasogastric feeding tube misplacement in the tracheobronchial tree: 13 cases (2017-2022).

OBJECTIVE: Complications of feeding tube placement are uncommon, but life-threatening pneumothorax has been reported in human and veterinary patients during feeding tube placement. This article describes the development of pneumothorax and the outcome associated with misplacement of nasogastric (NG) tubes in the tracheobronchial tree in 13 dogs. ANIMALS: 13 dogs being treated for various medical conditions that had NG tubes placed in 4 hospitals. PROCEDURES: A review was carried out of the medical records of 13 dogs that developed pneumothorax after misplacement of NG tubes between 2017 and 2022. RESULTS: 14 dogs out of 4,777 (0.3%) developed pneumothorax as an adverse effect of NG tube misplacement in the tracheobronchial tree. One dog was excluded due to incomplete medical records. The feeding tube size ranged from 5F to 10F, and the most common tubes utilized were polyurethane tubes with flushing stylets. Nine out of 13 dogs developed evidence of respiratory compromise after the NG tube was placed. Eleven dogs required thoracocentesis, and 5 dogs had thoracostomy tubes placed. Five dogs suffered cardiopulmonary arrest after developing pneumothorax, with 3 of 5 undergoing cardiopulmonary resuscitation. Two out of 3 dogs that underwent cardiopulmonary resuscitation were discharged from the hospital. Five of 13 dogs were successfully discharged from the hospital, while 5 dogs died or were euthanized because of the pneumothorax. CLINICAL RELEVANCE: Pneumothorax is a rare but potentially life-threatening complication of NG tube placement in dogs and may lead to death if not immediately addressed. Practitioners should be aware of this complication and be ready to perform thoracocentesis quickly if appropriate.

Is pneumothorax secondary to pneumoperitoneum a real risk in dogs undergoing total laparoscopic gastropexy?

Background: There were described in veterinary literature, the possibility of pneumothorax as a complication of laparoscopic surgery in dogs undergoing laparoscopic ovariectomy associated with total laparoscopic gastropexy. Aim: To assess if spontaneous pneumothorax secondary to pneumoperitoneum is a real risk in dogs undergoing total laparoscopic gastropexy. Methods: Dogs undergoing totally laparoscopic gastropexy received chest X-rays (CXR) in lateral (left and right) and ventro-dorsal projection before and after the surgery. Two veterinary radiologists reported the x-rays and indicated the presence or not of pneumothorax. Results: Postoperative pneumothorax was not detected on postoperative CXR in the total of 76 dogs of the study. Conclusion: The odds risk of pneumothorax after total laparoscopic gastropexy surgical procedure is low.

Traumatic pulmonary pseudocysts in nine dogs and two cats.

OBJECTIVE: To describe the clinical presentation, imaging findings, treatment, and outcome in dogs and cats with traumatic pulmonary pseudocysts (TPP). STUDY DESIGN: Retrospective observational study. ANIMALS: Nine client-owned dogs and two cats. METHODS: The hospital database of Anderson Moores Veterinary Specialists was reviewed for cases with a diagnosis of TPP based on computed tomography (CT). Clinical presentation, additional injuries, treatment, and outcome were recorded. RESULTS: Eleven patients with TPP were identified. The ratio of TPP detected by radiographs when compared to CT was 7:11 (64%). Seven cases were managed conservatively, and three underwent lung lobectomy. One cat was euthanized due to the severity of concomitant injuries. The decision to perform thoracic surgery was due to refractory pneumothorax (2) or very large TPP (1). Ten patients survived to discharge. No patients died as a result of the TPP. CONCLUSION: Radiographic lesions were identified in about two-thirds of cases diagnosed by CT. TPPs were not fatal in our population but were commonly associated with severe concomitant injuries. Conservative treatment led to the resolution of smaller TPPs. CLINICAL SIGNIFICANCE: Conservative management of TPP is appropriate in most cases, although selected cases may benefit from surgical treatment.

Porcupine quilling-associated pneumothorax in dogs: 25 cases (2001-2022).

OBJECTIVE: To describe the clinical outcome of dogs that developed pneumothorax after an encounter with a porcupine. ANIMALS: 25 client-owned dogs from 2 practices in New England. PROCEDURES: The medical records were searched for those of dogs that underwent care for porcupine quilling-associated pneumothorax (PQAP) between August 1, 2001, and October 15, 2023. Dogs were all large-breed dogs or large mixed-breed dogs and most frequently had clinical signs associated with pneumothorax, including labored breathing and tachypnea. RESULTS: No cases occurred in winter months. Diagnostic imaging was useful for identifying pneumothorax, but not for localizing quills. Twenty-one of the 25 dogs underwent median sternotomy for quill removal, with quills found in lung tissue of 19 dogs. Two dogs had no intrathoracic quills identified at thoracotomy, but residual quills were identified in the intercostal muscles. Four dogs were discharged without surgery after apparent resolution of the pneumothorax. All dogs survived to hospital discharge; however, 5 dogs required subsequent quill removal from ongoing quill migration. CLINICAL RELEVANCE: Porcupine quillings may result in traumatic pneumothorax associated with quill migration. Following quill removal, monitoring for the development of a pneumothorax is advised. Surgical removal of quills from the lungs has a good prognosis.

A proposed improvised pleural drainage system for veterinary use.

BACKGROUND: Active pleural suction devices may be required for continuous drainage of pleural fluid or air. Such devices may not always be available or economical to stock at all veterinary hospitals. Three designs of pleural drainage systems adapted from standard suction canisters are proposed. KEY FINDINGS: The designs were constructed from readily available materials from the veterinary hospital and consist of (1) a 1-bottle system intended for use with pneumothoraces, (2) a 2-bottle system, which can be used for draining air and fluid, and (3) an abbreviated 2-bottle system. The suction pressure was tested using a water manometer for each design. The suction pressure was consistently accurate with designs 1 and 2, with mild fluctuations, intermittently increasing suction pressure in design 1 due to bubbling through the air vent. Design 3 demonstrated a greater degree of pressure fluctuations, which was attributed to having the least water volume, reaching suction pressures up to 1 cm H2 O above what was set. SIGNIFICANCE: The improvised devices appear effective, allow accurate delivery of a set suction pressure, and can be rapidly constructed from inexpensive and readily available equipment.

Treatment and outcomes of five dogs with intrathoracic migration of porcupine quills.

OBJECTIVE: To describe the perioperative findings and outcomes in dogs that underwent exploratory thoracotomy following porcupine quill migration and report (1) the use of traction alone for the removal of superficial quills in the pulmonary parenchyma, and (2) the use of exploratory pericardiotomy for the incidental identification of cardiac quills. ANIMALS: Five client-owned dogs. STUDY DESIGN: Short case series. METHODS: Medical records of dogs with pneumothorax or pericardial effusion secondary to porcupine quill migration from January 2019 to January 2022 were reviewed. Advanced imaging and a median sternotomy were performed in each dog. Demographics, preoperative findings, surgical treatment, and outcome were recorded. RESULTS: Pulmonary quills were treated with gentle traction or lung lobectomy. The intraoperative palpation or appearance of the pericardium prompted pericardiotomy in three dogs, exposing epicardial and intravascular quills. No evidence of these quills was detected on preoperative advanced imaging or on gross appearance of the pericardium. Quills were removed with a combination of gentle traction, purse-string sutures, and mattress sutures. Pneumothorax and pericardial effusion resolved postoperatively in all dogs. All dogs survived to discharge. CONCLUSION: Traction allowed removal of quills that were superficially attached to the pulmonary parenchyma without the need for subsequent lobectomy. Epicardial and myocardial quills were detected following pericardiotomy in three dogs despite the absence of quills grossly penetrating the pericardium. Preoperative imaging did not allow consistent detection of quills.

A novel video-assisted thoracoscopic approach for pectus excavatum surgical treatment in a dog.

OBJECTIVE: To describe a novel, video-assisted thoracoscopic surgery (VATS) approach used to treat pectus excavatum (PE) in a dog. ANIMALS: A 5 month-old, 5.1 kg, intact, female, Cockapoo. STUDY DESIGN: Case report. METHODS: Clinical, imaging and surgical records of a dog with severe PE who underwent VATS-assisted sternal cast placement were reviewed and reported. Treatment involved introduction of a mild pneumothorax and use of VATS, allowing direct visualization and therefore safe passage of circumsternal sutures as they were placed to reduce the risk of vascular/cardiac or pulmonary penetration and intraoperative complication in this patient. RESULTS: Treatment involved introduction of a mild pneumothorax and use of VATS, allowing direct visualization and therefore safe passage of circumsternal sutures as they were placed to reduce the risk of vascular/cardiac or pulmonary penetration and intraoperative complications in this patient. The patient recovered well and had an excellent long-term outcome with significantly improved vertebral index and frontosagittal index. CONCLUSION: This modified technique resulted in an excellent outcome and minimized the risk of intraoperative complications during the surgical procedure in a dog. CLINICAL SIGNIFICANCE: This novel VATS approach for PE correction may provide a useful technique to help reduce intraoperative risk during PE correction in dogs.

Allogenic blood patch pleurodesis for management of pneumothorax in a Cavalier King Charles Spaniel puppy with multiple pulmonary blebs and bullae.

A 9-week-old male intact Cavalier King Charles Spaniel was presented for evaluation of acute onset dyspnea caused by left-sided pneumothorax. Thoracic computed tomography (CT) identified multiple pulmonary bullae and blebs in multiple lung lobes. Rupture of ≥1 pulmonary blebs or bullae, precipitated by low impact trauma, was the suspected cause of pneumothorax. A volume of 7.5 mL/kg of fresh whole blood was collected from a type-matched donor dog and administered into the left pleural space using a thoracostomy tube. The pneumothorax was successfully resolved and no adverse effects of blood patch pleurodesis were noted. The dog was clinically normal 12 months later.

Pneumoperitoneum as an uncommon complication after an axillary laceration in a horse.

Lacerations of the axillary region occur frequently in horses. Typical complications caused by entrapment of air in the wound during locomotion are subcutaneous emphysema, with consecutive pneumomediastinum and pneumothorax. In this case report, the clinical, radiographic and laboratory diagnosis and management of these complications after an axillary laceration that finally resulted in pneumoperitoneum are described. A 1-year-old Hannoveranian was presented with a pre-existing axillary laceration of unknown duration and subcutaneous emphysema in the surrounding tissue. Due to extensive tissue loss, attempts to adequately close the wound surgically and by packing with sterile dressing material were unsuccessful. Despite stall confinement and tying of the horse, subcutaneous emphysema was progressive and pneumomediastinum as well as pneumothorax was developed. These complications were monitored radiographically. On day 5 after admission, signs of air accumulation were detected on radiographs craniodorsally in the peritoneum and a pneumoperitoneum was diagnosed. Repeated thoracentesis with a teat cannula to gradually evacuate the thoracic cavity was used in combination with nasal oxygen insufflation to treat global respiratory insufficiency. Subcutaneous emphysema and all other complications resolved progressively and the horse was discharged from the hospital 21 days after admission when the axillary wound was adequately filled with granulation tissue. The wound healed fully 1 month later and the horse did not develop long-term complications within the following year. To the authors´ knowledge, the development of pneumoperitoneum including its radiographic monitoring following an axillary laceration has not been described in horses previously.

Partial lung lobectomy with the Caiman® Seal & Cut device in a dog with spontaneous pneumothorax: Case report.

Background: Spontaneous pneumothorax in dogs is characterized by an accumulation of air in the interpleural space without underlying trauma and consecutive acute onset of respiratory distress. Underlying causes for spontaneous pneumothorax vary with ruptured bullae being one of the main causes. Treatment after initial stabilization often requires partial or complete surgical resection of affected lung lobes. Partial lung lobectomy can be performed with stapling devices or sealing devices for example, by different surgical approaches including video-assisted thoracoscopic surgery. However, inter-thoracic surgery in small-sized dogs using either of the techniques is challenging. Case Description: A 12-year-old Shih Tzu was presented with spontaneous pneumothorax. Further diagnostics with computed tomography and intercostal thoracoscopy revealed a bulla in the right middle lung lobe. Partial lung lobectomy (2.5 × 2.5 × 2 cm) of the respective lung lobe was performed by an intercostal approach using the Caiman® 5 Seal & Cut sealing device. The Caiman® 5 Seal & Cut device allowed quick and safe partial lung lobectomy in the treatment of spontaneous pneumothorax without intra- or post-operative complications. The dog was discharged 2 days after surgery in good clinical condition. This report demonstrates the in-vivo efficacy and safety of the Caiman® 5 Seal & Cut sealing device for partial lung lobectomy in a small breed dog. Conclusion: Using the Caiman® 5 Seal & Cut device lung tissue could be resected without intra- or post-operative complications in a small breed dog. This case may emphasize the use of the device in fully video-assisted thoracoscopic surgery also in small-sized patients.