Case: Thoracotomy for mass removal
3rd October 2012
A dog presented with coughing and the referring vet had identified a large solitary soft tissue mass in one of his lungs. We arranged for a skilled ultrasonographer at a neighbouring practice to perform an ultrasound guided biopsy.
We then performed a thoracotomy, separating the ribs over the mass so that it could be gently isolated and removed along with the lung lobe in which it was located. Two of our highly experienced nurses managed the general anaesthetic. The affected lung lobe was adherent to the pericardium , the sac that surrounds the heart. These anaesthetics require skill as the patient is unable to breath for itself while the chest is open. Our nurses, all RVNs, do the anaesthetics. They inflate the lungs enough to ventilate them with oxygen and anaesthetic gas, while allowing the surgeons to get on and remove the affected lung lobe. As well as monitoring basic clinical parameters like heart rate and membrane colour, they use monitoring equipment like pulse oximetry to ensure that circulating oxygen levels stay nice and high. The mass was removed, a chest drain was placed and the dog made a remarkably fast recovery from what was a pretty major surgery. The chest drain allowed immediate post-operative drainage of the chest, but it proved un-necessary after that and it was removed 12 hours later.
The tissue that was removed was sent to an external lab. We had the results within 48 hours, confirming the presence of a malignant lung tumour, and confirming complete removal of the primary mass. However the pathologist was able to see evidence of tumour spread into the local lymphatic drainage system and so we feared that spread of the tumour may have occurred. So we sought the advice of a specialist oncologist at Cambridge University. Based on their advice, chemotherapy was instituted back at the referring practice.
The patient did well and was still going strong when the referring practice kindly sent us some follow up chest radiographs taken about 6 months post-operatively. The difference to the preoperative pictures was striking! The heart sat against the chest wall on the right hand side now, because the lung lobe that would normally sit in this position had been removed.
Unfortunately the initial fears of spread via lymphatics proved well founded, and the patient succumbed to wide-spread metastatic disease about 9 months post-operatively.