UNASSIGNED: An 11-year-old male neutered cat was referred to The Ohio State University\'s Veterinary Teaching Hospital after being diagnosed with pleural effusion by a referral veterinarian. After thoracocentesis, analysis of the effusion was consistent with chyle. Echocardiography, radiographs and bloodwork were used to diagnose hypertrophic cardiomyopathy phenotype and left-sided congestive heart failure, suspected to be secondary to uncontrolled hyperthyroidism. While initiating medical therapy, repeated thoracocenteses were required. A severe pneumothorax developed, necessitating placement of bilateral thoracostomy tubes. A thoracic CT scan did not reveal a cause for the pneumothorax; therefore, it was suspected to have occurred secondarily to an iatrogenic laceration of the parenchyma during thoracocentesis. An autologous blood patch pleurodesis was considered contraindicated so instead the cat was administered a blood patch using blood from a canine blood donor. The cat\'s respiratory status remained stable without additional intervention. At 30 h after blood patch pleurodesis, the thoracostomy tubes were removed and thoracic radiographs revealed near resolution of the pleural effusion and pneumothorax. The cat remained subclinical and was discharged from the hospital 48 h after the blood patch pleurodesis. Upon follow-up at 4 and 8 weeks after discharge, the cat was alive and had no complications or adverse reactions from the blood patch pleurodesis.
UNASSIGNED: This case documents the first report of a xeno-blood patch pleurodesis performed in a cat using blood from a canine donor. The cat had a successful discharge from the hospital with no adverse reactions from the xeno-blood patch pleurodesis.

OBJECTIVE: The mini-open lateral retropleural (MO-LRP) approach is an effective option for surgically treating thoracic disc herniations, but the approach raises concerns for pneumothorax (PTX). However, chest tube placement causes insertion site tenderness, necessitates consultation services, increases radiation exposure (requires multiple radiographs), delays the progression of care, and increases narcotic requirements. This study examined the incidence of radiographic and clinically significant PTX and hemothorax (HTX) after the MO-LRP approach, without the placement of a prophylactic chest tube, for thoracic disc herniation.
METHODS: This study was a single-institution retrospective evaluation of consecutive cases from 2017 to 2022. Electronic medical records were reviewed, including postoperative chest radiographs, radiology and operative reports, and postoperative notes. The presence of PTX or HTX was determined on chest radiographs obtained in all patients immediately after surgery, with interval radiographs if either was present. The size was categorized as large (≥ 3 cm) or small (< 3 cm) based on guidelines of the American College of Chest Physicians. PTX or HTX was considered clinically significant if it required intervention.
RESULTS: Thirty patients underwent thoracic discectomy via the MO-LRP approach. All patients were included. Twenty patients were men (67%), and 10 (33%) were women. The patients ranged in age from 25 to 74 years. The most commonly treated level was T11-12 (n = 11, 37%). Intraoperative violation of parietal pleura occurred in 5 patients (17%). No patient had prophylactic chest tube placement. Fifteen patients (50%) had PTX on postoperative chest radiographs; 2 patients had large PTXs, and 13 had small PTXs. Both patients with large PTXs had expansion on repeat radiographs and were treated with chest tube insertion. Of the 13 patients with a small PTX, 1 required 100% oxygen using a nonrebreather mask; the remainder were asymptomatic. One patient, who had no abnormal findings on the immediate postoperative chest radiograph, developed an incidental HTX on postoperative day 6 and was treated with chest tube insertion. Thus, 3 patients (10%) required a chest tube: 2 for expanding PTX and 1 for delayed HTX.
CONCLUSIONS: Most patients who undergo thoracic discectomy via the MO-LRP approach do not develop clinically significant PTX or HTX. PTX and HTX in this patient population should be treated with a chest tube only when there are postoperative clinical and radiographic indications.

OBJECTIVE: To assess factors associated with increased pleural fluid and air evacuation, longer duration of thoracostomy tube usage, and longer hospitalization in dogs and cats following surgery for thoracic neoplasms.
METHODS: 62 dogs and 10 cats.
METHODS: Medical records were reviewed for dogs and cats undergoing thoracic surgeries between August 1, 2019, and June 30, 2023, for resection of suspected neoplasia in which a thoracostomy tube was placed. Data collected included patient signalment, type of procedure performed, histologic diagnosis of the primary mass removed, volume of fluid and air evacuated from the thoracostomy tube, and time in hospital.
RESULTS: Median sternotomy was associated with increased total fluid evacuation (median, 12.1 mL/kg; IQR, 15.4 mL/kg; P = .012), whereas rib resection was associated with increased total air evacuation (median, 2.1 mL/kg; IQR, 13.6 mL/kg; P = .06). The presence of preoperative pleural effusion was associated with higher total fluid evacuation (20.6 mL/kg; IQR, 32.1 mL/kg; P = .009), longer duration with a thoracostomy tube in place (42.5 hours; IQR, 41.9 hours; P = .027), and longer hospitalization period (61 hours; IQR, 52.8 hours; P = .025). Cats had a thoracostomy tube in place for a longer time compared to dogs (median, 42.6 hours; IQR, 23.5 hours; P = .043).
CONCLUSIONS: Animals undergoing median sternotomy and rib resection may be expected to have higher fluid and air volumes, respectively, evacuated postoperatively. This often leads to an increased duration of thoracostomy tube usage and a longer period of hospitalization.

Retained hemothorax (RH) is a commonly encountered and potentially severe complication of intrapleural bleeding that can organize with lung restriction. Early surgical intervention and intrapleural fibrinolytic therapy have been advocated. However, the lack of a reliable, cost-effective model amenable to interventional testing has hampered our understanding of the role of pharmacological interventions in RH management. Here, we report the development of a new RH model in rabbits. RH was induced by sequential administration of up to three doses of recalcified citrated homologous rabbit donor blood plus thrombin via a chest tube. RH at 4, 7, and 10 days post-induction (RH4, RH7, and RH10, respectively) was characterized by clot retention, intrapleural organization, and increased pleural rind, similar to that of clinical RH. Clinical imaging techniques such as ultrasonography and computed tomography (CT) revealed the dynamic formation and resorption of intrapleural clots over time and the resulting lung restriction. RH7 and RH10 were evaluated in young (3 mo) animals of both sexes. The RH7 recapitulated the most clinically relevant RH attributes; therefore, we used this model further to evaluate the effect of age on RH development. Sanguineous pleural fluids (PFs) in the model were generally small and variably detected among different models. The rabbit model PFs exhibited a proinflammatory response reminiscent of human hemothorax PFs. Overall, RH7 results in the consistent formation of durable intrapleural clots, pleural adhesions, pleural thickening, and lung restriction. Protracted chest tube placement over 7 d was achieved, enabling direct intrapleural access for sampling and treatment. The model, particularly RH7, is amenable to testing new intrapleural pharmacologic interventions, including iterations of currently used empirically dosed agents or new candidates designed to safely and more effectively clear RH.

BACKGROUND: This study aims to review the primary spontaneous pneumothorax (PSP) patients we have treated and to discuss the results in terms of PSP treatment management and video-assisted thoracoscopic surgery (VATS) use in the light of the literature.
METHODS: The study was designed retrospectively and conducted at a tertiary referral university hospital between January 1, 2015 and May 1, 2021. Patients under the age of 18 years with a diagnosis of pneumothorax (PTX) were included in the study. Medical records were analyzed in terms of clinical characteristics, demographic data, findings from imaging data, procedures performed, and course of the disease at hospital. Patients with no evidence of PTX on radiologic imaging (direct postero-anterior chest X-ray (PACXR) or thoracic computed tomography (TCT)), incomplete medical records for follow-up, history of trauma, and neonatal PTX were excluded from the study.
RESULTS: The study was conducted on a total of 98 PTX cases in 69 patients, 61 (88.4%) males and eight (11.6%) females. The ages of the patients ranged between 13 and 17 years with a mean of 16.59 ± 0.95 years. While 48 (49%) PTX cases were treated with tube thoracostomy, 19 (19.4%) were treated with medical follow-up (nonsurgical treatment) and 31 (31.6%) were treated with VATS. A total of 31 VATS procedures were performed on 28 patients. The follow-up period after VATS ranged from tthree to 78 months, with a mean of 31.5 ± 20.3 months and a median of 28 months.
CONCLUSIONS:  Our retrospective study showed that TCT scanning did not provide additional benefit when PSP was detected on PACXR in patients presenting with chest pain and respiratory distress. According to the findings of our study, it was thought that the probability of undergoing an invasive procedure and surgical intervention increased as the percentage of PTX detected in PACXR increased. Tube thoracostomy may be required in a patient with PSP if PTX does not start to decrease and lung expansion does not increase after an average of 60 hours after the decision for medical follow-up, and if PTX is progressive in the follow-up. VATS can be performed on a patient with PSP when lung expansion does not increase after an average of 18 hours after tube thoracostomy, when PTX progresses, when air leakage continues for more than 10 days despite increased lung expansion, and when recurrent PTX occurs.

OBJECTIVE: In patients with thoracic injuries, tube thoracostomy is routinely employed. There is disagreement over which manner of tube withdrawal is best, the latter phases of expiration or inspiration. Considering several earlier investigations\' inconsistent findings, their comparative effectiveness is still up for debate. In light of this, we carried out a systematic analysis of studies contrasting the withdrawal of thoracostomy tubes during the latter stages of expiration versus inspiration for traumatic chest injuries. Analyzed outcomes are recurrent pneumothoraces, reinsertion of the thoracostomy tube, and hospital stay.
METHODS: We looked for papers comparing the withdrawal of the thoracostomy tube during the last stages of expiration and inspiration for the management of thoracic injuries on Embase, Pubmed, Cochrane Library and Google Scholar. Review Manager was used to determine mean differences (MD) and risk ratios (RR) using a 95% confidence interval (CI).
RESULTS: The primary outcomes showed no significant difference between the inspiration and expiration groups: recurrent pneumothorax (RR 1.27, 95% CI 0.83-1.93, P 0.28) and thoracostomy tube reinsertion (OR: 1.84, CI 0.50-6.86, P 0.36, I2 5%). However, the duration of hospital stay was significantly lower in patients in whom the thoracostomy tube was removed at the end of inspiration (RR 1.8, 95% CI 1.49-2.11, P < 0.00001, I2 0%). The implications of these findings warrant cautious interpretation, accounting for potential confounding factors and inherent limitations that may shape their significance.
CONCLUSIONS: The thoracostomy tube can be removed during both the end-expiratory and end-inspiratory stages of respiration with no appreciable difference. Nevertheless, caution should be exercised when ascertaining the implications of these findings, taking into account the potential limitations and confounding variables that may exert influence upon the outcomes.

Chest tubes are placed in the pleural space to evacuate abnormal fluid or air accumulations. Various types and sizes of chest tubes are available. Imaging including ultrasound, computed tomography, and fluoroscopy should be used to guide chest tube placement. Understanding the anatomy of the pleural space, along with the etiology and classification of pleural space disease, can help optimize chest tube management. This article will review the indications, contraindications, techniques, and postprocedure follow-up of chest tube placement as well as discuss the management and prevention of complications.

First-line therapy for cats with pyothorax consists of intravenous antibiotics, drainage of the septic pleural effusion and closed-chest lavage. Large-bore thoracostomy tubes are traditionally used for drainage, but case series indicate a comparable efficacy using small-bore tubes. In this retrospective study, we describe a new technique of sheath-guided small-bore (6 F) thoracostomy tubes in cats with pyothorax and evaluate their efficacy and complications. Additionally, we compare outcomes between two treatment groups. Placement and use of the small-bore thoracostomy tubes described here has a low complication rate of 4% (3/67 tubes), and 53% (24/45) of the cats could be treated with thoracostomy tubes and closed-chest lavage according to the protocol. The success rate is reduced by 18% (8/45) due to deaths caused mainly by sepsis, 16% (7/45) due to structural diseases requiring surgery and a further 14% (6/43) due to lavage failures that could only be cured after additive therapy (thoracotomy or fibrinolysis). The long-term prognosis was very good, with a survival rate one year after discharge of 94% (30/32). We detected no effect on survival by early placement of bilateral thoracostomy tubes or closed-chest lavage with a heparinised solution. In conclusion, therapy of pyothorax with small-bore thoracostomy tubes is as successful as therapy with large- or medium-bore tubes.

BACKGROUND: Ovarian cancer (OC) represent nearly 4% of gynecologic malignancies and it is often diagnosed at advanced stage. Diaphragmatic surgery, a fundamental step of advanced stage ovarian cancer (ASOC) debulking surgery, is associated with a high post-operative complication incidence, which is supposedly reduced with thoracostomy tube placement. We assessed the role of intra-operative thoracostomy tube placement, as a prevention measure for post-operative complications, after diaphragmatic resection.
METHODS: This was a single center prospective randomized trial. Ovarian cancer patients, who underwent mono-lateral diaphragmatic resection, were randomized 1:1 into two arms. Arm A included patients receiving intra-operative thoracostomy tube placement (TP); Arm B patients did not receive thoracostomy tube placement (NTP). After surgery, all patients underwent seriate chest x-ray and ultrasound to record thoracic complications. Statistical analysis included uni- and multivariable logistic regression model (proportional odds model).
RESULTS: Three hundred seventy-one patients were screened and 88 patients were enrolled: 44 in arm A and B, respectively. No statistically significant differences for intra-operative (p = 0.291) and any grade of post-operative complication (p = 0.072) were detected, while 6.8% of patients in arm A and 22.7% in arm B experienced severe respiratory symptoms (p = 0.035); 18.2% of patients in arm A had a moderate/large pleural effusion versus 65.9% in arm B (p < 0.0001). At multivariable analysis, results confirmed that the NTP-group had a higher risk to receive post-operative thoracostomy tube placement due to pleural effusion than the TP-group (odds ratio [95% Confidence Interval] = 14.5 [3.7-57.4]).
CONCLUSIONS: Thoracostomy intra-operative tube placement after diaphragmatic resection is effective to prevent post-operative thoracic complications. The extension of resection does not influence outcomes and the risk of post-operative thoracentesis or TP remain elevated.

OBJECTIVE: The purpose of this study was to determine if routine chest X-rays (CXRs) performed after chest tube (CT) removal in pediatric patients provide additional benefit for clinical management compared to observation of symptoms alone.
METHODS: A single-center retrospective study was conducted of inpatients, 18 years or younger, who had a CT managed by the pediatric surgery team between July 2017 and May 2019. The study compared two groups: (1) patients who received a post-pull CXR and (2) those who did not. The primary outcome of the study was the need for intervention after CT removal.
RESULTS: 102 patients had 116 CTs and met inclusion criteria; 79 post-pull CXRs were performed; the remaining 37 CT pulls did not have a follow-up CXR. No patients required CT replacement or surgery in the absence of symptoms. Three patients exhibited clinical symptoms that would have prompted intervention regardless of post-pull CXR results. One patient had an intervention guided by post-pull CXR results alone. Meanwhile, another patient had delayed onset of symptoms and intervention. No patients required an intervention in the group that did not have a post-pull CXR.
CONCLUSIONS: Chest X-ray after CT removal had a very low yield for changing clinical management of asymptomatic patients. Clinical symptoms predict the need for an intervention.