thoracotomy in cattle & horses
DESCRIPTION
Thoracotomy (Rib resection) in cattle and horses for management of pericarditis and pleuritisTRANSCRIPT
RIB RESECTIONINDICATIONS & PROCEDURE
Dane Tatarniuk, DVM
Question 1
What are the two most common indications for rib resection?
Question 1
What are the two most common indications for rib resection? Pericarditis Pleuritis / Pleuropneumonia
Pericarditis more common indication in bovine
Pleuritis more common indication in equine
Pericarditis
Etiology Traumatic reticulitis
10cm between reticulum & pericardium Wire, nails, etc. Pointed objects 5 to 14cm in length
Trauma to external chest Cardiac neoplasia
Lymphoma
Pericarditis
Pathophysiology Bacteria inoculation septic inflammation
increased permeability fluid exudation influx neutrophils & fibrin
Fibrin bridges within 3 days Collagen replaces fibrin by day 6 Extensive fibrosis by 1 month Constrictive & restrictive pericarditis
Pericarditis
Clinical symptoms Jugular vein distension Brisket edema Submandibular edema Cardiac abnormalities
Pericarditis
Diagnostics Auscultation
Splash heart beats Muffled heart sounds
Ultrasound 4-6th intercostal spaces, level of elbow Effusion : anechoic Exudate : granular, waving strands Thickened sac : organized fibrin, collagen
Radiographs Cardiomegaly appearance
Pleuritis
Cows Pleuritis with pyothorax
or pleural fluid Daily lavage, maintain
drainage
Question 2
Do cattle have complete or incomplete mediastinum?
Question 2
Do cattle have complete or incomplete mediastinum? Complete
Complete mediastinum Only lung on affected side collapses following
thoracotomy Other lung unaffected Respiration usually stays normal
Horses Incomplete mediastinum Walled off – then OK
Pericarditis
Pericardiocentesis Higher risk Caudal to left elbow, sternum to mid-chest Tie left front forward 18 gauge, 6 inch needle Slowly advance needle Watch for needle to move synchronous with
heart beat Aspirate blood – back up Collect fluid for cytology, culture
Rumen bacteria
Pericarditis
Percutaneous pericardial drain Earlier stages of pericarditis
(mostly fluid, little fibrin) Large bore sterile chest tube Similar insertion as for
pericardiocentesis Egress fluid continuously Ingress lavage daily Pull tube once fluid flushes clear
Thoracotomy
Standing, local lidocaine block
Incision over 5th or 6th rib 6th rib
Preferred - posterior to shoulder
5th rib Adduction of limb during
movement Subcutaneous air under
forearm, scapula More prone to cellulitis
Thoracotomy
Incision started at costo-chondral junction Extend dorsally 20cm Lower than CC junction
Lateral thoracic artery & vein Overlying thoracic muscles incised
Dorsally Latissimus dorsi muscle Serratus ventralis muscle
Ventrally Pectoralis profundus muscle Aponeurosis of obliquus externus
abdominis muscle
Thoracotomy
Periosteum incised by scalpel Periosteum retracted cranially & caudally
with periosteal elevators
Thoracotomy
Gigli wire placed 18cm above CC junction Transect Rib wide and thin Disarticulate rib at CC junction
Thoracotomy
Incise pleura Carefully
Exteriorize pericardium and suture to skin edge Same principle as
rumenostomy Can drain pericardial fluid with
needle, suction Incise pericardial sac Manually remove fibrin, clots Lavage sac liberally with
saline Leave open or close with drain
Thoracotomy
Post-operative Cover thoracotomy site with
sterile towel or combine roll Held in place with umbilical
tape Broad spectrum antibiotics Incision examined, flushed
daily Wound kept open as long as
fetid material egresses Can take wound up to 1
month to close
Prognosis
Cattle 15% survival for pericarditis 71% survival for pleuritis
Horses 88% survived surgery 46% returned to intended use
QUESTIONS ?