The Veterinary Centre

Henley and Twyford

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Case Notes: Branson: Labrador with Thymoma
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When a normally ebullient labrador walks sedately into the surgery, and when simply trotting into the consulting room to greet the vet makes him huff and puff like an old man, alarm bells start to ring. When you put a stethascope to his chest and all the normal sounds of heart and lungs are strangely muffled an x-ray is a must. When your x-rays show that two thirds of the chest has been taken over by something much denser than the air-filled lungs that should fill that space, then your heart really sinks. This was the situation we faced with Branson just two short months ago and this is the story of how he survived to become our patient of the month!

We first established, by ultrasound, that the density within the chest was solid tissue and not free fluid that could be drained (the two look the same on x-ray). This left us with several possible diagnoses, none of them exactly good news. There was a faint hope that Branson had sustained some previous trauma (unseen by the owners) which had resulted in a tear or rupture in his diaphragm. Organs such as liver lobes or spleen or bowel can then, sometimes months or even years after the original injury, slide through the defect into the chest causing sudden respiratory distress. Surgical repair of a diaphragm is not without its hazards but is entirely within our capabilities. A granulomatous abscess within the chest (usually the result of some penetrating foreign body) would also be eminently treatable. After this we come down to tumours of various sorts. Of course, not all tumours are malignant and even some that are malignant may be responsive to drug treatment. To find out exactly what we were dealing with in this case we opted to go for exploratory surgery.

Branson was anaesthetised,prepped for both abdominal and thoracic surgery and wheeled through to theatre. We first opened his abdomen in order to get a clear view of the whole diaphragm. This was undamaged and all abdominal organs appeared entirely normal so the incision was closed routinely. Next we made an 8'' incision between the sixth and seventh ribs on the left side of the chest. This allowed us to visualise the mass, to ascertain the true extent of it and to take biopsies safely, avoiding major blood vessels and ligating the smaller ones. A chest drain was then installed and the thoracotomy wound closed. The biopsy samples were dispatched to the laboratory marked URGENT PLEASE.

Branson coped well with his anaesthetic despite his lungs being compressed to a quarter of their normal capacity and the heart being markedly displaced by the mass (affecting his circulation). Of course he required continuous manual ventilation throughout the period that his chest was open. For the next 48 hours he needed round the clock supervision to manage his grossly impaired respiratory function and his post-operative pain control. The lab. pulled out all the stops for us, the pathologist phoning me half way through Saturday afternoon surgery to report that the mass was a thymoma. This was great news! A thymoma is a benign tumour (arising from the vestigial remains of the infant's thymus gland) and if it is physically possible to remove it, then it should never recur.

At this point we knew that it was worth while referring Branson to the experts at the Royal Veterinary College. They have the equipment and experience necessary to split open a big dog's chest, right through the breast bone, and to perform the delicate surgery necessary to remove a large tumour from around vital structures such as the aorta, the pulmonary artery and the windpipe. In Branson's case it took two surgeons five and a half hours of painstaking disection to remove the mass. He survived the ordeal, like the trooper he is, and recovered slowly but steadily, in their intensive care unit. A week later he came home. A month after that he came bounding into the surgery, wagging not just his tail but his whole hind-quarters, just like the Branson we have always known and loved!

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Henley Vets and Twyford Vets
The Veterinary Centre: 271 Reading Road, Henley-on-Thames, RG9 1EL - Phone 01491 574490
Also at Twycombe Lodge, Loddon Hall Road, Twyford, RG10 9JA - Phone 0118 934 0259