Case Study: a chest full of pus!

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This month we had a very sick dog presented after being unwell for about a week. She had suddenly developed difficulty breathing and stopped eating. 

In consultation Dr Jack identified a problem in the chest with minimal breath sounds. X-rays then confirmed a fluid-filled chest. The picture attached shows the x-ray with no visible outline of the heart. This indicates that the chest if full of fluid. A small needle was placed into the chest and a sample of the fluid was obtained to help with definitive diagnosis of the problem. The fluid was found to be pus filling the space in the chest cavity surrounding the lungs and a severe chest infection was present. This is known as a pyothorax. 

The dog was hospitalised and antibiotics were given via an intravenous drip to quickly combat the infection. A chest tube was also surgically placed into the chest cavity to drain out the pus and allow flushing it with sterile saline. Over a few days in hospital, treatment with antibiotics, draining the pus and re-flushing the chest cavity, the pus fluid finally stopped forming and the drain was removed. 

At this point it was safe for her to be discharged and continue to recover at home where her owners have been diligently monitoring her breathing. To prevent the infection redeveloping the antibiotics need to be continued for a month. In some cases, the infection will return and a surgery to open up the chest fully is needed to find out what has happened to cause the infection and to remove the inciting cause. 

The causes of a chest infection or pyothorax like this are sometimes never found and just respond to initial treatment. Some possible causes include: 

- A bite wound or other cause of wound penetrating the skin and muscles into the chest cavity.  

- Severe pneumonia can damage a lung causing it to leak infected material into the chest cavity and cause the infection to fill up the chest 

- A tear in the oesophagus as it runs through the chest can leak food material into the chest cavity also and cause the infection to develop.  

- Migration of a foreign body such as a grass seed 

At this stage we are thankful that the treatment has controlled the infection and hopefully it won't return and require further surgery. 

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