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Is an uncommon cause of
Respiratory distress and Pleural Effusion in Dogs. The condition has been
reported more frequently in the deep chested breeds.
It is unclear as to
whether the twisting of a lung lobe around the axis of the bronchus results
in the pleural effusion or whether the presence of pleural fluid facilitates
the lung lobe to twist. The condition has been reported in ALL deep chested
breeds, including some toy breeds, and it is often found in association with
CHYLOTHORAX , this is the leakage of Chyl, a milky white fluid containing
lymph and fat, from the Lymphatic System into the Chest Cavity. Damage to
the chest cavity from Trauma; Neoplastic Tumours and Inflammation are known
possible causes for this condition....BUT....an idiopathic form probably
CONGENITAL, resulting from abnormal connections between the venous and
lymphatic systems is seen particularly in the Afghan Hound and Afghan Hounds
are believed to be at a higher risk of LUNG TORSION than most other breeds.
A particular survey was undertaken at the
University of Pennsylvania
Veterinary School1981...1999.
A brief summary of the
findings from this study is as follows
1. Deep chested
dogs developed LT more frequently as expected
2. Afghan Hounds
were predisposed both to LT and to coincident Chylothorax
3. Interestingly
this study supported a previous report detailing the occurrence of LT in
several Toy Breeds, indicating that the diagnosis should always be
considered in ANY breed
4. A potential
cause for torsion was identified in only I dog who had suffered trauma some
3 weeks before being diagnosed with LT
5. Whether a
malignancy (tumour) in the lung or chest cavity could predispose to LT
remains unclear, however few patients demonstrated concurrent thoracic
disease at time of diagnosis
6. From the
records, it appeared that the pleural effusions developed as a result of the
torsion rather than preceding it, indicating that torsion of the lung lobe
is a primary event. However because the cause of chyl leakage within the
chest cavity is often designated as idiopathic (no known cause) it remains
unclear whether such is the cause of the Lung lobe twist.
7. Surgical
outcome from this study was considered to be generally favourable but some
chest complications post-surgery were not uncommon.
Now read JO BOULTER's
experience below.
Keep this article for
future reference & show to Your Vet if necessary in such a situation.
SYLVIA EVANS.December
2003
We adopted Dodger as a
rescue at the end of April 2003. We were to be his fourth home, although he
was loved and cared for in his last home they were unable to keep him. In
the first year of his life we have no medical records but we know he had not
had any of his inoculations or health checks until he was 11 months old at
his third home.
From about July onward
we noticed that Dodge would get very tired on walks (after about 40 minutes
to an hour). He would often sit and refuse to move for a few minutes.
Although his breathing was heavy it was never worrying and we put it down to
the heat affecting him. We did get him checked out by the vet and were told
he was fine. I then began to notice he would wheeze like an asthmatic
especially in the evenings. I mentioned this when we took him in for his
kennel cough and again no problem could be detected. To this day I still
don't know whether these were warning signs or nothing to do with the later
traumas he went through.
In mid Sept we came
home from an evening out around 10pm to find the neighbour who had been dog
sitting for us quite distressed. Dodge had been fine when we left but
shortly after he ate his dinner he started to cough up blood. Although there
was what seemed like a vast qty of blood up the walls, across the floor,
over the patio and even on our other Affie Monty, Dodger seemed fine in
himself. By about 2am he there was no more blood and we took him to the vet
first thing in the morning.
To the vet it was not
clear what the problem was but although the symptoms were concerning they
were now gone and Dodger was just a young dog with a bit of a cough. We were
given antibiotics and steroids which it was hoped would clear up any hidden
issues. The following Sunday there was more blood and back to the vets we
went. The next day Dodger had an Xray and blood tests. Because of Dodgers
size the x-ray machine at my local vets struggled to take a clear film so no
conclusions could be drawn. From what could be seen there appeared to be a
lot of fluid in the lungs and also a swab of his throat revealed a lot of
blood in his throat. By the time these results were available a few days
later Dodger was back to his normal self. Stronger antibiotics and we were
prescribed to clear up a couple of infections detected from the throat swap.
These however were not an explanation for the problem with his lungs. We
were told to think about referring him to
Cambridge Vetinary
School if the symptoms came back. Two weeks later on the Weds Dodger started
coughing again (no blood) so I asked my vet to refer us. By the Friday
Dodger was in a lot of distress and I took him straight to our local vet.
Our vet was excellent
and said she was concerned but he was not yet an emergency, to take him
home, keep him rested and take him to
Cambridge on Monday when our
appointment was. If at any point over the weekend he deteriorated she said
she could get him admitted to Cambridge.
That weekend was
horrendous and several times we thought we were going to lose him. He
respiratory rate was 50 breaths per minute versus a normal resting rate of
20. He wouldn't eat, hardly moved and his heart felt like it was about to
jump out of his chest. By Sunday as I was about to panic and call the vet he
seemed to rally and improved enough that we could wait until Monday.
Monday morning we went
to Cambridge and after a thorough history was taken we were asked to leave
him there for various X-Rays and tests over the next few days. At 6pm that
evening the vet called to tell me he had a diagnosis and it was good news.
They had diagnosed a lung lobe torsion of the middle right lobe and they
could operate and remove it on Wednesday if I agreed.
Talking with the vet we
found out that lung lobe torsion is 133 times more common in an Afghan than
the majority of other breeds. It is seen in deep chested dogs. They see
around 1 to 2 cases per year at Cambridge but believe there are many more
dogs, particularly Afghans that die of this condition because it is not
diagnosed. We now believe Dodge twisted his lung back in Sept and how he
managed to keep going so long is anybodies guess. The care the Cambridge
centre gave to Dodge is second to none and we were so lucky to get him there
in time. We were told 33% of cases have complication in surgery, whilst half
of the remaining cases are likely to lead a full and healthy life.
6 weeks on and Dodger
looks like the famous character from the 'What a Mess' books since he lost
all of his coat down one side. He's back to his devilish self - trying to
escape at every opportunity and turning his energies to beg, steal or borrow
food and slippers to chew. We need to keep a close eye on him to make sure
there is no build up of fluid in his lungs as this could cause one of the
remaining lobes to twist.
In
terms of things to look out for:
Laboured breathing
Coughing up blood (but
not necessarily)
Problem with hearing
clear breathe sounds in the right lung (middle right lobe is the most common
to twist)
This whole thing has
cost approx £2700 so I would urge anyone out there to check their pet
insurance is adequate to cover surgery as this is an expensive treatment.
However even if I had had to pay out of my own pocket I wouldn't begrudge a
penny - its worth it when you see Dodge running through the park at full
tilt!
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The following article
was kindly sent in to us by Jayne Edwards and had been supplied to her by
hew own vet. Thank you Jayne
Lung lobe torsion in
dogs: 22 cases (1981-1999).
Neath PJ, Brockman DJ,
King LG.
Section of Surgery,
School of Veterinary Medicine, University
of Pennsylvania, Philadelphia
19104-6010, USA.
OBJECTIVE: To identify
breed disposition, postoperative complications, and outcome in dogs with
lung lobe torsion. DESIGN: Retrospective study. ANIMALS: 22 client-owned
dogs. PROCEDURE: Information on signalment; history; clinical findings;
results of clinicopathologic testing, diagnostic imaging, and pleural fluid
analysis; surgical treatment; intra- and postoperative complications;
histologic findings; and outcome were obtained from medical records.
RESULTS: All 22 dogs had pleural effusion; dyspnea was the most common
reason for examination. Fifteen dogs were large deep-chested breeds; 5 were
toy breeds. Afghan Hounds were over represented, compared with the hospital
population. One dog was euthanatized without treatment; the remaining dogs
underwent exploratory thoracotomy and lung lobectomy. Eleven dogs recovered
from surgery without complications, but 3 of these later died of thoracic
disease. Four dogs survived to discharge but had clinically important
complications within 2 months, including chylothorax, mediastinal
mesothelioma, gastric dilatation, and a second lung lobe torsion. Six dogs
died or were euthanatized within 2 weeks after surgery because of acute
respiratory distress syndrome, pneumonia, septic shock, pneumothorax, or
chylothorax. Chylothorax was diagnosed in 8 of the 22 dogs, including 4
Afghan Hounds. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that lung
lobe torsion is rare in dogs and develops most frequently in large deep-chested
dogs, particularly Afghan Hounds. Other predisposing causes were not
identified, but an association with chylothorax was evident, especially in
Afghan Hounds. Prognosis for dogs with lung lobe torsion was fair to
guarded.
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