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:– Resp distress, coughing, hemoptysis, depression,
lethargy, fever, anorexia
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)
CAUSES
• Unknown most of the time• Often associated with thoracic trauma,
surgery, pleural effusion, pneumothorax and neoplasia
• Spontaneous also occurs
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
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
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 vs neoplasia– Gave 1 day of Clavamox
THORAX DV
THORAX RIGHT LATERAL
THORAX VD
AFGHAN
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
ADDITIONAL IMAGING
• Computed Tomography
• Ultrasound
• Bronchoscopy
• Exploratory Surgery
ULTRASOUND 2 YR FS PUG
http://article.wn.com/view/2000/12/04/Atelectasis_Airlessness_causes_partial_lung_contraction/
TREATMENT
• Supportive Oxygen• Thoracocentesis• Lung lobectomy is usually curative depending
if there is an underlying cause• Histopathology of resected lobe recommended