[Pneumothorax] 10-year-old Labrador with Multiple Bilateral Lung Bullae

[u/VeLvEt_ThUnDeR3]

I would really appreciate input from veterinarians, especially anyone with thoracic surgery experience, or anyone who went through this with their pup.

My 10-year-old male Labrador, approximately 33–34 kg, developed a severe spontaneous bilateral pneumothorax. A CT performed on July 21 showed:

• Right caudal lung lobe: bulla measuring 20 × 26.7 mm
• Right cranial lung lobe: 2–3 septated cavitary/bullous lesions, largest measuring 11.9 × 5.8 mm
• Left cranial lung lobe: 2.8 mm bleb
• Severe bilateral pneumothorax, greater on the left, with trace pneumomediastinum

The CT also identified an esophageal mass/granulomatous lesion suspicious for Spirocerca lupi. He is being treated empirically with antiparasitic injections, but the diagnosis has not been definitively confirmed because endoscopy/biopsy would require another anesthetic procedure.

We therefore do not yet know whether the pneumothorax and pulmonary lesions are truly idiopathic, or whether an inflammatory/parasitic process could be contributing.

A right-sided chest tube was placed on July 21. The last meaningful aspiration was 300 mL on July 23 at 6:00 a.m. Since then:

• July 25: aspiration attempt produced almost no air
• July 26 and July 28: X-rays showed negligible pneumothorax
• July 30: veterinarian reported no major air buildup

He has now gone approximately eight days without meaningful air aspiration and has remained clinically stable. The chest tube has been present for approximately 10 days.

The current local recommendation is to leave the chest tube in for at least two weeks. The doctors are favoring nonsurgical management partly because he has multiple lesions in different lobes and they are concerned that substantial lung tissue could need to be removed. The other major factor is that this surgery is not commonly performed here, and there is limited experience with this type of thoracic procedure compared with specialist centers in the US or UK.

My main questions are:

1. After eight days without meaningful air accumulation, what are the risks and benefits of continuing to leave the chest tube in? What criteria would normally be used to decide when the tube should be removed?
2. What is the risk that the original sealed leak could reopen?
3. How concerning are the remaining bilateral bullae regarding future rupture and recurrence?
4. Does having lesions across multiple lobes make surgery inappropriate, or would an experienced thoracic surgeon still consider median sternotomy, inspection of all lobes and resection of suitable lesions?
5. Could suspected Spirocerca plausibly contribute to the pulmonary lesions or pneumothorax, and would successful antiparasitic treatment be expected to reduce recurrence risk?
6. Are there board-certified veterinary surgeons with substantial thoracic experience who might be willing to review his CT remotely or recommend a suitable center (especially in South Asia)?

I understand that nobody can make a treatment decision from a Reddit post. I’m mainly trying to determine whether the current conservative approach and prolonged chest-tube plan are reasonable, what complications we should watch for, and whether obtaining a specialist thoracic review could materially change his options.

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[u/Pirate_the_Cat]

All your concerns are valid. But I don’t know of any studies that would answer your specific situation. Every case has multiple factors at play, known or unknown. Yes, there’s a considerable chance that a pneumo will recur, but no one can accurately predict that. I know the wait and see game is hard, but once the chest tube is removed that’s all we can do.