Lung Lobe Torsion

 

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 Inflamation 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's experience

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 X-ray 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 Veterinary 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.