Vol.18, No.
1 January 1996
Continuing Education Article
FOCAL POINT
★ In dogs with undefined
spontaneous pneumothorax,
early surgical exploration is
recommended; diagnostic and
therapeutic benefits result from
such exploration.
KEY FACTS
■ Although the most common
cause of spontaneous
pneumothorax in dogs is
bullous emphysema, underlying
(nonemphysematous) lung
disease can be documented in
50% of affected patients.
■ Identification of underlying lung
disease can have prognostic
value.
■ A presumptive diagnosis of
bullous emphysema should be
made if no other lung disease
can be identified; surgical
management should be
considered early.
■ After surgical management, the
long-term recurrence rate for
spontaneous pneumothorax
resulting from bullous
emphysema is 12.5%.
Spontaneous
Pneumothorax in Dogs
The Ohio State University
Amy Valentine, DVM, MS John Mauterer, DVM
Daniel Smeak, DVM Anne Minihan, DVM
David Allen, DVM, PhD
S pontaneous pneumothorax is accumulation of air in the pleural space
from lung or airway leakage that is not associated with trauma. In con-
trast to trauma-induced pneumothorax, spontaneous pneumothorax oc-
curs rarely in dogs.1,2 The numerous causes for spontaneous pneumothorax
that have been reported in dogs include parasitism,3–5 bacterial pneumonia,6
neoplasia,7 and pulmonary abscess formation.8 Ruptured subpleural blebs have
been cited as the most common cause of spontaneous pneumothorax in hu-
mans9,10 and dogs.11–13
In human patients, spontaneous pneumothorax most often occurs after the
adolescent growth period in tall, ectomorphic males. The cause of pulmonary
bleb formation is not known. It has been suggested that apical bleb formation
results from disproportionate volume strain on the apical parenchyma as lung
height increases; the strain leads to focal emphysematous changes.10 Conversely,
in dogs with spontaneous pneumothorax resulting from ruptured pulmonary
blebs, bullous emphysema is often diagnosed histologically in surrounding
lung tissue.11–13 Despite the histologic changes in these dogs, there is no clinical
or radiographic evidence of generalized emphysematous lung disease. The diag-
nosis and treatment of bullous emphysema in dogs thus remains a perplexing
issue for veterinarians.
The therapeutic protocol for spontaneous pneumothorax in humans is stan-
dardized and based on historical, clinical, and radiographic evaluation; most
patients are successfully managed with rest, thoracentesis, or tube thoracosto-
my. The recurrence rate in humans is 10% to 60% during the first two years
after the initial episode; higher rates are associated with successive episodes.9
The clinical, epidemiologic, and radiographic features of canine sponta-
neous pneumothorax have been described in the literature.2,14 Despite the dif-
ferences between humans and dogs, recommendations concerning treatment
and prognosis for spontaneous pneumothorax in dogs have been based on
findings in humans.2 The short-term (six-month)14 recurrence rate in dogs has
been examined, but long-term prognosis has not been established, probably be-
cause of the paucity of follow-up information and the lack of standardized
medical or surgical treatment. Prognosis for survival based on cause has not yet
Small Animal The Compendium January 1996

TABLE I
Management of Spontaneous Pneumothorax in Patients with Nonbullous Emphysema
Case
Number Signalment Cause Treatment Outcome Recurrence
1 5Y FS mixed breed Bacterial pneumonia None Died Not applicable
2 4-month-old F German Bacterial pneumonia TC Died Not applicable
shepherd
3 3Y FS English setter Bacterial pneumonia TC, TT, LL Died Not applicable
4 5Y M Great Dane Bacterial pneumonia TC, TT, LL Discharged None (5.2Y)
5 6Y FS doberman pinscher Adenocarcinoma None Died Not applicable
6 10Y FS schnauzer Adenocarcinoma LL Euthanatized Not applicable
7 10Y FS German shepherd Dirofilariasis TC, dirofilaricide Discharged None (5.8Y)
8 5Y M mixed breed Paragonimiasis TC, fenbendazole Discharged None (2.5Y)
9 1Y M rottweiler Uremic pneumonitis TC, TT, LL Euthanatized Not applicable
10 3Y M mixed breed Blastomycosis None Euthanatized Not applicable
11 11Y M mixed breed Thromboembolism TC Euthanatized Not applicable
Y = years or year-old, F = Female, FS = Female spayed, M = Male, TC = Thoracentesis, TT = Tube thoracostomy, LL = Lung lobecto-
my (complete or partial), ( ) = Time of follow-up.

been examined, and the recurrence rate based on cause
and therapeutic protocol remains undefined.
The purpose of this article is to document the rela-
tionship between outcome and causative factors that re-
sult in spontaneous pneumothorax. Long-term follow-
up information regarding the efficacy of medical and
surgical management of spontaneous pneumothorax is
provided.
MATERIALS AND METHODS
Criteria for Selecting Cases
Medical records from 1983 to 1989 at the Ohio State
University Veterinary Teaching Hospital were reviewed.
Of the 26 cases of spontaneous pneumothorax identi-
fied, 22 were accepted based on a minimum of two
years posttreatment follow-up or postmortem examina-
tion of dogs that died before the end of the minimum
follow-up period. All follow-up information was col-
lected from owners by telephone. Data collected in-
cluded signalment, cause, outcome (discharged, died,
or euthanatized), treatment protocol (medical and/or
surgical), and follow-up (recurrence rate) information.
General diagnostic work-up for underlying causes of
spontaneous pneumothorax included complete blood
count, serum profile, dirofilarial examination, fecal
flotation and sediment examination, and thoracic ra-
diography evaluation. Necropsy and histopathology
findings were included when applicable.
Management of spontaneous pneumothorax involved
thoracentesis, tube thoracostomy, exploratory thoraco-
tomy, and treatment of underlying pulmonary disease.
Lateral thoracotomy was performed when lung disease
could be radiographically localized to a single lung
lobe. Sternal thoracotomy was performed when the
cause of the spontaneous pneumothorax could not be
documented radiographically. Partial or complete lung
lobectomy was performed based on the location (pe-
ripheral or hilar) and distribution (focal or multifocal)
of the bullous lesions. Mechanical pleurodesis was per-
formed when diffuse bullous emphysema was grossly
evident during surgery.15 Treatment of spontaneous
pneumothorax varied according to referral history, pre-
vious treatment, and diagnostic assessment by the pri-
mary clinician during hospitalization.
Statistical Analysis
Standard descriptive statistics were applied to the
data and reported as frequency ratios, in fraction and
percentage form. Statistical significance testing was not
performed because of the variability in treatment proto-
cols and limited number (22) of patients.
RESULTS
Signalment
The mean age of the 22 dogs was 6.2 years; the range
was 4 months to 11 years of age (Tables I and II). There
were 11 spayed females, 1 intact female, 2 castrated
males, and 8 intact males; the female-to-male ratio was
1.1:1. There were 13 large- or giant-breed dogs repre-
sented, 8 mixed-breed dogs, and 1 small-breed dog.

OUTCOME AND CAUSATIVE FACTORS ■ FOLLOW-UP INFORMATION ■ FREQUENCY RATIOS

The Compendium January 1996 Small Animal

TABLE II
Management of Spontaneous Pneumothorax in Patients with Bullous Emphysema
Case
Number Signalment Cause Treatment Outcome Recurrence
12 8Y FS German shepherd Bullous emphysema TT, LL Discharged None (4.3Y)
13 7Y FS doberman pinscher Bullous emphysema TT, TC, LL Discharged None (3.5Y)
14 8Y FS afghan Bullous emphysema TC, TT, LL Discharged None (2.4Y)
15 8Y M mixed breed Bullous emphysema TC, TT, LL Discharged None (3.4Y)
16 11Y M husky Bullous emphysema TC, TT, LL Discharged None (2Y)
17 5Y FS mixed breed Bullous emphysema TC, TT, LL Discharged Yes (6.4Y)
TCa Dischargeda None (1.3Y)a
18 11Y FS mixed breed Bullous emphysema TC Discharged Yes (2Y)
LLa Dischargeda None (3.5Y)a
19 5Y FS Great Dane Bullous emphysema TC, TT Discharged Yes (1.7Y)
LLa Dieda Not applicablea
20 2Y M bluetick hound Unknown TT Discharged None (6Y)
21 4Y MC Irish wolfhound Unknown TC, TT Discharged None (2.5Y)
22 2Y MC mixed breed Unknown TT Discharged None (3Y)
aSecond hospitalization for recurrent episode.
Y = years or year-old, FS = Female spayed, M = Male, MC = Male castrated, TC = Thoracentesis, TT = Tube thoracostomy, LL =
Lung lobectomy (complete or partial), ( ) = Time of follow-up.

Cause, Treatment, and Outcome
After the general diagnostic protocol was performed,
the cause of spontaneous pneumothorax was deter-
mined in 11 of the 22 dogs (Table I). Bacterial pneumo-
nia was diagnosed in four dogs. One dog died peracute-
ly and was not treated for spontaneous pneumothorax.
Three dogs were initially treated medically; one dog
died and two eventually required exploratory thoraco-
tomy and lung lobectomy. One of the surgically man-
aged dogs died within 24 hours after surgery as a result
of generalized pulmonary microlithiasis, and one was
successfully discharged from the hospital. The surviving
dog has not had a recurrent episode of spontaneous
pneumothorax in 5.2 years.
Pulmonary adenocarcinoma was diagnosed in two
dogs. One died peracutely and was not treated for
spontaneous pneumothorax. The other patient under-
went exploratory thoracotomy for excisional biopsy and
was euthanatized after histopathologic confirmation of
disseminated pulmonary adenocarcinoma.
Parasitic disease was diagnosed in two dogs. One had
a heartworm-positive filter test and was successfully
managed with thoracentesis and adulticide–microfilari-
cide therapy. There has been no recurrence of sponta-
neous pneumothorax in 5.8 years, and subsequent
heartworm evaluations were negative. In the second pa-
tient, thoracic radiographs and tracheal-wash cytology
indicated paragonimiasis. The dog was successfully
treated with thoracentesis and fenbendazole and has
not had a recurrent episode of spontaneous pneumoth-
orax in 2.5 years.
Uremic pneumonitis was histologically confirmed in
one dog diagnosed with congenital renal failure. Thora-
centesis, tube thoracostomy, and exploratory thoracoto-
my were performed. The patient was euthanatized 7
days after surgery because of the diffuse involvement of
the uremic lung disease and refractory renal disease.
Blastomycosis was diagnosed in one dog by means of
radiographic and serologic findings; the patient was eu-
thanatized. Thromboembolic disease was histologically
confirmed in one dog with immune-mediated vasculi-
tis. The dog was initially treated with thoracentesis but
was euthanatized because of persistent pneumothorax
related to chronic, multisystemic involvement of the
vasculitis.
In 11 of the 22 dogs, the cause of spontaneous pneu-
mothorax could not be determined after the general
diagnostic protocol (Table II). After exploratory thora-
cotomy for persistent or recurrent spontaneous pneu-
mothorax, bullous emphysema was histologically diag-
nosed in eight of the dogs. Hematologic and serologic
parameters were within normal limits, and radiographic
findings were equivocal for pulmonary blebs or bullae.
During initial hospitalization because of persistent

PULMONARY ADENOCARCINOMA ■ PARASITIC DISEASE ■ UREMIC PNEUMONITIS ■ BLASTOMYCOSIS

Small Animal
TABLE III
Treatment During Initial Hospitalization of Patients with Spontaneous Pneumothorax
Lung Disease Treatment
Nonbullous emphysemaa Thoracentesis
Tube thoracostomy
Lung lobectomy
Bullous emphysema Thoracentesis
(confirmed and presumptive) Tube thoracostomy
Lung lobectomy
aPatients also received medical treatment for the underlying pulmonary disease.
pneumothorax, six of the eight dogs with bullous em-
physema underwent exploratory thoracotomy despite
treatment with thoracentesis and/or tube thoracostomy.
Five of the six patients have not had recurrent episodes
of spontaneous pneumothorax for at least two years
after surgery (mean of 3.1 years). One dog had a re-
current episode 6.4 years after surgery; the episode
resolved after thoracentesis, and the patient was dis-
charged from the hospital. The dog did not have a sub-
sequent recurrent episode of spontaneous pneumotho-
rax during the 1.3 years before euthanasia (for nasal
adenocarcinoma).
The other two dogs required exploratory thoracoto-
my because of recurrent spontaneous pneumothorax.
One dog clinically recovered after thoracentesis but had
a recurrent episode of spontaneous pneumothorax
within two weeks and was readmitted for exploratory
thoracotomy and lung lobectomy. The patient has not
had a recurrence in the 3.5 years since surgery. One dog
was successfully discharged after tube thoracostomy but
had a recurrent episode of spontaneous pneumothorax
1.6 years later. The patient was readmitted for ex-
ploratory thoracotomy and lung lobectomy but died of
cardiopulmonary arrest in the intensive care unit 7 days
after surgery. The dog had persistent pneumothorax af-
ter surgery, but necropsy findings did not indicate the
source of air leakage.
In three dogs, the cause of spontaneous pneumotho-
rax was not determined. The findings of hematologic
and serologic examinations were within normal limits,
and radiographs were equivocal for pulmonary blebs or
bullae. There was no radiographic evidence of underly-
ing lung disease. All three patients responded well to
tube thoracostomy and were successfully discharged
from the hospital without exploratory thoracotomy.
None of the dogs had a recurrent episode of sponta-
EXPLORATORY THORACOTOMY ■ LUNG LOBECTOMY ■ TUBE THORACOSTOMY ■ PARENCHYMAL DISEASE
The Compendium January 1996
Resolution of Pneumothorax /
Number of Dogs
Number of Dogs Receiving Treatment
7 2/7 (28.5%)
3 0/3 (0%)
4 1/4 (25%)
8 1/8 (12.5%)
10 4/10 (40%)
6 6/6 (100%)
neous pneumothorax during the long-term follow-up
period (2.5 to 6 years).
Treatment Summary
Thoracentesis was performed on 7 of the 11 dogs
with identifiable lung disease (Table III). One dog died,
and one was euthanatized without additional treat-
ment. Two dogs responded well (with appropriate
treatment for paragonimiasis and dirofilariasis), and 3
dogs had persistent pneumothorax. The pneumothorax
did not resolve in any dog in which thoracentesis was
the sole means of treatment. Thoracentesis was per-
formed on 8 of 11 dogs with unidentified lung disease
(Table III). Seven of these patients (88%) had persis-
tent pneumothorax and required additional methods of
treatment. The 1 dog that responded well to thoracen-
tesis during the initial hospitalization had recurrent
spontaneous pneumothorax two weeks later.
Because of persistent pneumothorax, tube thoracos-
tomy was performed on 3 of 11 dogs with identified
lung disease (Table III). In none of the three did the
pneumothorax resolve after tube thoracostomy, and all
three required exploratory thoracotomy. Ten of 11 dogs
with no identifiable lung disease received tube thora-
costomy during the initial hospitalization. Four of these
patients (40%) exhibited resolution of spontaneous
pneumothorax after tube thoracostomy and required
no additional treatment. Six of the 10 dogs (60%) had
persistent pneumothorax after tube thoracostomy and
required exploratory thoracotomy during the initial
hospitalization. The average duration of tube thoracos-
tomy drainage was 4.5 days (range of 1 to 8 days).
Continuous suction was used in 9 of the 11 tube thora-
costomy protocols.
During the initial hospitalization, exploratory thora-
cotomy was the definitive diagnostic procedure in 10 of
Small Animal
TABLE IV
Long-Term Outcome of Patients with Spontaneous Pneumothorax
Lung Disease Outcome
Nonbullous emphysema Died
Euthanatized
Discharged
Bullous emphysema Died
(confirmed and presumptive) Euthanatized
Discharged
Recurrent episode (three dogs) Died
Euthanatized
Discharged
22 dogs (Table III). Four dogs had radiographically evi-
dent lung disease and received complete or partial lung
lobectomy; however, only one dog (25%) was success-
fully discharged from the hospital. The remaining 6
dogs had unidentified lung disease before surgical ex-
ploration. All 6 (100%) were histologically confirmed
to have bullous emphysema after partial or complete
lung lobectomy and were successfully discharged from
the initial hospitalization following resolution of the
pneumothorax after surgery.
Outcome Summary
The 11 dogs with underlying, radiographically iden-
tifiable parenchymal disease had no recurrences and an
overall mortality of 73% (Table IV). Five dogs were di-
agnosed with terminal or refractory illness (adenocarci-
noma, blastomycosis, congenital renal failure, or im-
mune-mediated vasculitis) and had 100% mortality; 4
of the 5 were euthanatized. Four dogs with bacterial
pneumonia had a mortality of 75%; none of the dogs
were euthanatized, and one recovered after lung lobec-
tomy for a pulmonary abscess. Two dogs with parasitic
disease had no mortality or recurrence of pneumotho-
rax after medical treatment of the underlying parenchy-
mal disease.
The 11 dogs with no radiographically identifiable
parenchymal disease (Table IV) had a recurrence rate of
27% (3/11). One of the dogs with recurrence received
thoracentesis, one received tube thoracostomy, and one
underwent exploratory thoracotomy. The recurrence
interval after initial treatment was 2 weeks, 1.6 years,
and 6.4 years, respectively. The mortality for this group
was 33%; the only death occurred 1 week after surgery,
during the second hospitalization for spontaneous
pneumothorax. None of the 3 patients with undeter-
mined cause had a recurrent episode of spontaneous
TERMINAL OR REFRACTORY ILLNESS ■ RECURRENCE INTERVAL ■ CRITERIA FOR DIAGNOSIS
The Compendium January 1996
Number and Percentage
of Dogs Recurrence
4 (36%) Not applicable
4 (36%) Not applicable
3 (28%) 0/3 (0%)
0 (0%) Not applicable
0 (0%) Not applicable
11 (100%) 3/11 (27%)
1 (33%) Not applicable
0 (0%) Not applicable
2 (67%) 0/2 (0%)
pneumothorax for at least 2 years posttreatment; the
mean was at 3.8 years (range of 2.5 to 6 years).
DISCUSSION
Spontaneous pneumothorax, by definition, is air in
the pleural space without preceding trauma. In the hu-
man literature, spontaneous pneumothorax is subclas-
sified as primary or secondary based on the absence or
presence of underlying lung disease, respectively. The
most common cause of secondary spontaneous pneu-
mothorax in humans is chronic obstructive pulmonary
disease (COPD). Other diseases that are associated
with secondary spontaneous pneumothorax include tu-
berculosis, cystic fibrosis, sarcoidosis, pulmonary fibro-
sis, lung abscess, primary bronchogenic carcinoma, and
metastatic pleural disease.16
Primary spontaneous pneumothorax occurs in histor-
ically healthy individuals and results from rupture of a
subpleural emphysematous bleb, which is usually locat-
ed in the apex of the lung. The pathogenesis of the
blebs is unknown, but a connection with small airway
disease related to tobacco smoking has been suggest-
ed.16 Human patients with primary spontaneous pneu-
mothorax tend to be tall, young, ectomorphic males.
Chest height and differences in pleural pressure gradi-
ents may contribute to subpleural bleb formation in
these individuals. Diagnosis of primary spontaneous
pneumothorax is suggested by clinical history (an oth-
erwise healthy individual), physical examination, and
radiographic evaluation.
Classification of spontaneous pneumothorax in dogs
is not as well defined. The criteria for diagnosis of pri-
mary spontaneous pneumothorax in dogs have been
described clinically,2 histologically,1 and as subpleural
bleb formation.17 Adapting human terminology to clas-
sify spontaneous pneumothorax in dogs may be inap-
Small Animal
propriate because of diffuse histologic changes in the
lung tissue surrounding the blebs.1 Despite this discrep-
ancy at the histologic level, humans and dogs with
spontaneous pneumothorax due to ruptured pul-
monary bullae have similar clinical presentations. Spon-
taneous pneumothorax is not usually associated with
exercise, and no underlying disease is identified by
hematologic, serologic, or radiographic examination.
Plain thoracic radiographs can provide equivocal evi-
dence of the presence or location of pulmonary blebs or
bullae. Bullous disease thus is often confirmed by in-
trathoracic procedures or as a diagnosis by exclusion.
Although the lung lesions of dogs with bullous emphy-
sema may not histologically resemble primary sponta-
neous pneumothorax in humans, we believe it is clini-
cally important to distinguish this group of dogs from
those with noninvasively identifiable, underlying pul-
monary disease. This distinction between bullous em-
physema and noninvasively identified pulmonary dis-
ease is necessary because the treatment protocol and
outcome may be affected by confirmation of nonbul-
lous lung disease.
In humans, the incidence of secondary spontaneous
pneumothorax is similar to that of primary sponta-
neous pneumothorax.16 Unlike primary spontaneous
pneumothorax (which is usually only a nuisance to the
human patient), secondary spontaneous pneumothorax
is frequently life-threatening because of underlying
lung disease.16 Similarly, in this study, underlying lung
disease was identified by noninvasive methods with the
same frequency as was a lack of radiographically appar-
ent lung disease. The higher mortality in the first group
can be explained by the increased prevalence of termi-
nal or refractory illness and by a high occurrence of eu-
thanasia. Only three dogs in this group had underlying
pulmonary disease (dirofilariasis, paragonimiasis, and
bacterial pneumonia) that was amenable to therapy and
responded well to appropriate management. These
dogs have a favorable prognosis; there are no docu-
mented recurrences of spontaneous pneumothorax with
resolution of the underlying lung disease.
Chronic obstructive pulmonary disease, the most
common cause of secondary spontaneous pneumo-
thorax in humans, is rarely encountered clinically in
dogs. Spontaneous pneumothorax secondary to pul-
monary parasitism,3–5 neoplasia,7 bacterial pneumonia,6
and abscess formation8 has been reported in the veteri-
nary literature. Our findings support these reports,
which suggest that appropriate medical or surgical
treatment of the underlying lung disease results in long-
term resolution of the spontaneous pneumothorax.
The outcome for long-term survival and recurrence
in dogs with no radiographically identifiable pul-
OCCURRENCE OF EUTHANASIA ■ UNDERLYING PULMONARY DISEASE ■ SURGICAL MANAGEMENT
The Compendium January 1996
monary infiltrate was more favorable. Recurrence rates
in dogs with pulmonary bullae or blebs are difficult to
assess because of variability of diagnosis and treatment,
too few cases, and lack of long-term follow-up data.
Previous reports suggest a high incidence of recurrent
or persistent spontaneous pneumothorax associated
with medical management (rest, thoracentesis, and tho-
racostomy) in patients with bullous emphysema.2,13,14 In
most cases, long-term follow-up was limited to less
than two years after surgery and the prognosis for re-
currence was unknown or guarded. The minimum fol-
low-up time for this study was established as two years
posttreatment because of the high recurrence rate re-
ported in humans within two years of the initial episode.
The rate in humans with primary spontaneous pneu-
mothorax has been documented as 10% to 60%9; tho-
racotomy reduces the rate to less than 1%.16
In this study, the dogs in the second group were suc-
cessfully treated; long-term follow-up data were ob-
tained on 10 dogs that were alive at two years (Table II).
Because 73% of the patients required exploratory thora-
cotomy due to persistent or recurrent pneumothorax,
medical management was the definitive treatment in
only 27% of the dogs in this group. Thoracotomy re-
duced the recurrence rate to 12.5%; one patient had a
recurrent episode of spontaneous pneumothorax 6.5
years after surgery. This late recurrence may support the
assertion that dogs have diffuse emphysematous changes
that are clinically difficult to detect. The mortality asso-
ciated with exploratory thoracotomy for this group was
12.5%. This finding is reflected in the literature.14
Previous guidelines for the treatment of spontaneous
pneumothorax in dogs have been adapted from the hu-
man literature based on the clinical similarities between
primary spontaneous pneumothorax in humans and
pulmonary bullous disease in dogs.2 This may be inap-
propriate in light of the histologic differences between
species and the poor response to medical management
in dogs with bullous emphysema.14 Earlier surgical
management for spontaneous pneumothorax in dogs
has been recommended based on lower recurrence rates
and shortened average hospitalization time compared
with those of traditional nonsurgical therapy.
Our results indicate that long-term survival, efficacy
of treatment, and recurrence rate may be affected by
the underlying cause of the spontaneous pneumo-
thorax. Although bullous emphysema has been the
most commonly reported cause of spontaneous pneu-
mothorax in dogs,2,11–14 our study confirmed nonem-
physematous lung disease in 50% of the dogs. Because
the dogs with noninvasively identifiable lung disease
had a poorer outcome, we believe it is important to es-
tablish different recommendations for therapy based on
Small Animal
cause. Diagnosis of terminal or refractory illness ad-
versely affects long-term outcome regardless of medical
or surgical therapy. Parasitic or infectious disease may
be amenable to appropriate therapy with slight chance
of recurrent spontaneous pneumothorax when the un-
derlying disease is controlled.
In our study, dogs with bullous emphysema had a
better long-term survival rate and a lower recurrence
rate than has been previously documented.13,14 Our data
support recommendations that dogs with spontaneous
pneumothorax resulting from bullous emphysema
should be managed surgically based on the lower recur-
rence rate and possible economic advantages of treat-
ment.14 We believe that bullous emphysema is difficult
to confirm without exploratory thoracotomy and histo-
logic examination.
Radiographic confirmation of pulmonary bullae in
dogs and humans is not reliable.1,2,13 The presence of
pulmonary blebs or bullae was not confirmed radio-
graphically before surgery in any of our patients. This
finding supports previous reports that plain radiography
is generally nondiagnostic and potentially misleading in
patients with pneumothorax associated with ruptured
pulmonary blebs or bullae.11,13 Median sternotomy has
been recommended as the preferred surgical approach.2,13
If underlying lung disease cannot be diagnosed by rou-
tine examinations, we therefore believe that a presump-
tive diagnosis of bullous emphysema should be estab-
lished and that exploratory thoracotomy should be
considered early in the course of treatment.
CONCLUSION
Spontaneous pneumothorax in dogs is an uncommon
but life-threatening disease that occurs secondary to pre-
existing lung disease. Because the long-term outcome
and treatment protocol might be affected by the nature
of the primary lung disease, it is important to identify
the cause of spontaneous pneumothorax. Routine, non-
invasive examination identified underlying lung disease
in 50% of the dogs in this study; the treatment protocol
was based on the diagnosis. Mortality in this group of
dogs was high because of the incidence of terminal or
refractory disease. The other 50% of the dogs were not
diagnosed by routine examination and initially received
palliative treatment for spontaneous pneumothorax.
Most of the patients responded poorly to conserva-
tive management and required exploratory thoracoto-
my because of persistent or recurrent pneumothorax.
The most common histologic diagnosis was bullous
emphysema. The postoperative recurrence rate and
long-term outcome were better than those previously
reported for dogs with bullous emphysema. Based on
the results of this study, we recommend early surgical
HISTOLOGIC EXAMINATION ■ MEDIAN STERNOTOMY ■ CONSERVATIVE MANAGEMENT
The Compendium January 1996
exploration in dogs with undefined spontaneous pneu-
mothorax; such exploration provides diagnostic and
therapeutic benefits.
About the Authors
When this article was written, Drs. Valentine, Smeak,
Allen, Mauterer, and Minihan were affiliated with the De-
partment of Veterinary Clinical Sciences, College of Vet-
erinary Medicine, The Ohio State University, Columbus,
Ohio. Dr. Valentine is currently in private practice in Cor-
vallis, Oregon. Dr. Allen is in private practice in Mission,
Kansas.
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