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LUNG LOBE TORSIONS

LUNG LOBE TORSIONS. Acc # 146824. LUNG LOBE TORSION. Definition: Rotation of a lung lobe around its long axis Signalment : Increased incidence in large deep chested, middle aged dogs(Afghan hounds) Also seen in small breed dogs(Pugs) Clinical Signs:

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LUNG LOBE TORSIONS

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  1. LUNG LOBE TORSIONS Acc# 146824

  2. LUNG LOBE TORSION • Definition: Rotation of a lung lobe around its long axis • Signalment: • Increased incidence in large deep chested, middle aged dogs(Afghan hounds) • Also seen in small breed dogs(Pugs) • Clinical Signs: • Resp distress, coughing, hemoptysis, depression, lethargy, fever, anorexia

  3. PATHOPHYSIOLOGY • Lung lobe rotates around its axis twisting the bronchus and vessels at the hilus • Vein collapses first, artery continues to pump blood • Leads to congestion and consolidation • Fluid leaks into the interstitium and airways and eventually into the pleural space • Most commonly affected lobes are the right middle in large breed dogs(Afghans) and left cranial in small breeds(Pugs)

  4. CAUSES • Unknown most of the time • Often associated with thoracic trauma, surgery, pleural effusion, pneumothorax and neoplasia • Spontaneous also occurs

  5. CAUSES • Thought to be due to conditions that result in increased mobility of a lung lobe • Atelectasis or consolidation • Pleural effusion commonly seen with LLT • Cause or sequelae not known • Effusion may be sterile, inflammatory, chylous , or hemorrhagic

  6. RADIOGRAPHIC SIGNS • Pleural effusion and opaque/mass effect of the lung lobe • Initially air bronchograms may be seen extending in an abnormal location • Become less visible as fluid accumulates in the airways • Eventually the air is absorbed from the alveoli and the lobe becomes atelectic • Non-inflated lung that persists post thoracocentesis • Rounded lobe margins as lung becomes engorged • Lobar sign

  7. ACC# 146824 • 11 yr old FS Pug • Presented to NCSU ER • 1 week hx of lethargy and inc RR • rDVM suspicious of lung lobe torsion for pneumonia vsneoplasia • Gave 1 day of Clavamox

  8. THORAX DV

  9. THORAX RIGHT LATERAL

  10. THORAX VD

  11. AFGHAN

  12. DIFFERNTIALS • Radiographic appearance depending on severity and duration of torsion may also look like: • Pneumonia, PTE, contusions, neoplasia, atelectasis, pleural hemorrhage, pyothorax, and diaphgragmatic hernia

  13. ADDITIONAL IMAGING • Computed Tomography • Ultrasound • Bronchoscopy • Exploratory Surgery

  14. ULTRASOUND 2 YR FS PUG http://article.wn.com/view/2000/12/04/Atelectasis_Airlessness_causes_partial_lung_contraction/

  15. TREATMENT • Supportive Oxygen • Thoracocentesis • Lung lobectomy is usually curative depending if there is an underlying cause • Histopathology of resected lobe recommended

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