XNUMX. 2023

theCareer girlVeterinary continuing education onlinenews, Ph.D.Amy kaplan, CVMA, DACVECC, blunt trauma MRCVS emphasized in dogs and cats can cause a rare condition: pericardial pneumatosis.Listen to for more information!

Author: Amy, Dr. Kaplan CVMA, DACVECC, MRCVS
VETgirl contributors/webinar host

The dog pericardium pneumatosis after trauma

In today's VETgirl continuing education online blog, we emphasize a rare condition, it may caused by blunt injury of dogs and cats...The pericardium pneumatosis and ubiquitous pneumatosis!!!

As an "experienced man" maybe?ECC doctor (the white-haired and pain really started...)Emergency pet careIn the emergency room, I think I've seen almost everything.We see a lot of traffic trauma patients, I personally treated crash...- cars, bicycles, motorcycles, buses, -, - the train snowmobiles, yes, even the Midwest tractor crash. Traffic trauma treatment and shunt is now more like a reflection: to triage of patients with the initial shock, rapid wound bleeding wound for later processing, first and foremost is to assess the patient's respiratory status and treat any life-threatening condition. Although the check may be a bit blunt force trauma, routine, but I see from time to time "well, this is the first time!"The joy of.Let me stay alert.

Before the case with many other car accident patients: a seven-year-old sterilization male labrador retriever from a rural veterinarian transferred to our emergency department (Ed), let's deal with suspected (but no one saw) accident consequences - auto-driving event.The owner of the dog at 6 o 'clock in the morning she found it on the outside, conscious, breathing a lot faster than usual, they saw it had blood on his front PAWS.At 8 o 'clock in the morning, the dog at their local veterinary office accepted the right beauty holds the mi sedation for X-ray and parcel claws (figure 1).Medical records report bilateral pneumothorax and radiographic evidence of subcutaneous emphysema, but cannot view the images in clinic.

Amanda, Dr Meyer photos left dog damage

Figure 1. The injured leg.Photographs provided by Dr Amanda Meyer

For reference only, because when he hindsight, everything will be easier to remember, not life-threatening laceration in a lower priority at triage, surgery should be quickly after the stable patients with bandage and processing.Critics of the general rule?Unless there is a life threatening objects (for example, intestines, etc.) hanging outside the wound, or it can wait (and even eye).As a critic, I often use in the emergency room right beautiful mi set, because it is a kind of very good sedative;However, please note that the blood vessel activity.In general, I limit the right use of mi in patients with unstable and shock, until their recovery and stability.

Go to the emergency room visits.When the dog to the emergency room, it is in a state of decompensated shock.His blood pressure, can't be measured on the doppler breathing rate is 90 BPM, bilateral lung sound back disappeared, the heart rate is 180 BPM, CRT to extend more than 3 seconds.Placing the IV catheter and left pleural puncture, remove the 3 liters of air.Intravenous within 1 minute 10 litres Normosol -r push note to improve the perfusion, and intravenous methadone to ease the pain.After completion, thoracentesis and push on through the review of the doppler blood pressure showed that systolic blood pressure of 130 mm hg.

Baseline blood test (for example, CBC, chemical) showed excitability leukemia: 12.35 * 10 ^ 3 increased neutrophils in mild/uL (refer to 3.62-12.3 * 10 ^ 3 / uL), mild lymphopenia 0.66 * 10 ^ 3 / uL (reference. 0.83-4.91 * 10 ^ 3 / uL) and mild acidophil reduce disease 0.03 (ref. 0.04-1.62 * 10 ^ 3 / uL).Chemical showed that phosphorus mild rise by 5.4 mg/dL (refer to 1.9 to 5.0 mg/dL), elevated ALT > 1000 (0-120 - U/l), total protein moderately reduced 5.3 (refer to 5.5 to 7.7 g/dL) and the normal reference range of all other values.Biochemical changes were evaluated for secondary to shock and organ perfusion.ECG monitoring shows that polymorphism of ventricular premature beat (VPC), the frequency fluctuation between 100-160 BPM.Due to the VPC polymorphism (and its development is the potential risk of lethal arrhythmia is small), patients received 2 mg/kg lidocaine intravenous injection;VPCs soon settled, and immediately shows new arrhythmia...

Consulting the case at home, I received a text message, "do you think that looks like electric alternator?"(see figure 2).

Electrocardiogram (ecg) alternating electric dog

Figure 2. It seems to me like alternating electric...Photographs provided by Dr Amanda Meyer

I see may be a slight electric alternating, the occasional isolated VPC, I asked if the doctor see any pericardial effusion.The body come back?Below three!

Figure 3. Pneumatic everything.Photographs provided by Dr Amanda Meyer

Later, when boarding the radiologist confirms our suspicions: bilateral pneumothorax or pneumomediastinum, peritoneal pneumatosis, subcutaneous emphysema and pericardial pneumatosis (AKA - pneumopericardium)!

The AIR is how to enter the pericardium?After all, even critics, I rarely see pericardium pneumatosis in dog!

Sorry everyone, but, unfortunately, we still don't fully understand why dogs and cats in the formation of pericardium pneumatosis theory!The cause of the pericardium pneumatosis only from blunt trauma, a theory that formed a small tear in the pericardium, make the air can be torn from the trachea, bronchi or circulation of air (pneumothorax) in pleural cavity.1另一种理论来自人类文献描述了一种称为“麦克林效应”的现象,即破裂的肺泡中的空气沿着肺间质内的血管外部流动,向上移动到血管周围鞘,血管在心包内与心脏汇合。 2

So, the problem is?We must get rid of the dog pericardium air/pericardium product?Well, like the pericardial effusion, air velocity and volume will determine whether we need to discharge it.Beware of air or liquid package cavity fast or when a large number of accumulation, the heart will be compressed, patients may appear circulatory failure (this is cardiac tamponade!).If the accumulation slowly and small volume, is unlikely to intervention in patients with cardiovascular effects (for example, don't hurt!.In these cases, the air will disappear as time goes on, the air from the pericardial laceration on leakage or air is absorbed is still unknown, and indicates that it may take 24 hours to a week's time to disappear.2, 3

So, how did the dog do?Initially, round-the-clock monitoring the patients with nasal oxygen injection.In the evening, his breathing rate increased;To check the X-ray, his pulmonary contusion (this is) can be expected with the deterioration of pneumothorax.Placed the chest tube on both sides, but for cost reasons, not for continuous time, but when the air in the pleural cavity in a short period of time accumulated to this level, the Suggestions to fit.Aseptic suction tube, an hour, on the other hand, if the output of each pump to reduce, will reduce frequency.The left breast duct discharge air, and every 30 to 40 hours about 2-3 ml serum hemorrhagic secretions.With methadone and chest colostomy tube of cloth than paid block to control the pain.As the dog perfusion parameters improved, intravenous infusion speed dropped to 60-75 - ml/kg/day, to prevent fluid overload (this may enhance pulmonary contusion).Because with jaw injury, the patient also started taking ampicillin/shu ba temple (mg/kg, and IV q 8).

The next day, the left breast is still in the blood;Review of X-ray shows that the chest tube has pushed backwards and caudal mobile, therefore to remove it.(why don't you just stay put the chest tube.Although the right chest tube also to move the tail, but remain open.

Stop oxygen cure after 24 hours, because patients oxygenation good (pulse oxygen saturation in indoor air, for example, reading is 96-97%).Third day, around the left front PAWS wound using local blockers to promote wound closure under minimum calm.The fourth day, pulling up right chest tube, observation through the night.

Figure 4.The fourth day review X-ray photos.Photographs provided by Dr Amanda Meyer

Figure 4.The fourth day review X-ray photos.Photographs provided by Dr Amanda Meyer

Finally in the fifth day, the dog dog discharged smoothly.In the three days of review, the dog is eating at home and did very well, even though it doesn't like his limited activity to allow for continued recovery (and solve his lung disease).

Figure 5.The most adorable labrador patients.Of course, at dinner as soon as he got home.Photographs provided by Dr Amanda Meyer

Despite reported is not much, but the dog pericardium pneumatosis cases seem to fade without any drainage of the pericardial cavity.In this particular case, although pneumothorax or pneumomediastinum persist, but realized the imaging resolution within 48 hours.Other veterinary literature reported any time between 2 to 10 days of resolution.

Traumatic pericardium pneumatosis in human blunt trauma are clearly not as rare as in our veterinary literature.For dogs and cats, quick Google search shows only a few case reports, so I want to expose this kind of situation can help others in the face of such "well, this is the first time!"Vision.This is the reason why I like emergency medicine, because even if you have some regular in more common emergency cases you will never truly know whether curve balls and when coming to you!

PS: thank you very much Amanda and Dr MeyerEmergency pet careMake it a successful result!

References:
1. Leclerc, Brisson BA, Dobson h. a. related to dog lungs - pericardium connected pericardium pneumatosis.J Am Vet Med AssocIn January 224, 2004;5 (710) : 2-698, 10.2460.Doi: 2004.224.710 / javma. 15002809.PMID: XNUMX.
2. Anand R Y and Richmond, Brooks both Facs SE Md, Puckett, RE Ronaghan CA.The pericardium pneumatosis caused by blunt chest trauma.Cureus22 month 12, 2020;11(11625):e10.7759。 内政部:11625/cureus.33376639。 PMID:7755601; PMCID:PMCXNUMX。
3. A and Costa Agut - Teixeira MA, Cardoso, Zarelli M L, Soler M.What is your diagnosis?The pericardium pneumatosis.J Am Vet Med AssocOn 15, 237, in 2010;4 (363) : 4-10.2460.The ministry of the interior: 237.4.363 / javma. 20707744.PMID: XNUMX.

  1. For a lucky dog, it is such a great case!I'm glad to know that, if the air and liquid for heart pressure is not big, so the pericardium pneumatosis in most cases do regress!Good reading!

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