Wednesday, July 3, 2013

Lung Torsion or Lobe Torsion

Good news....I have a twisted lung, but we think this is not lung cancer!

I was very unwell after my operation to remove the twisted lobe. We really thought this tumour was cancer, After the operation my legs started to swell up and I was crying because I could not move around and bend my legs. But walking around slowly was the best way of getting the fluid moving. Daddy did some lymphatic massage on me, to try and get the fluid moving nearer the heart and pumped away. However, once it was pushed past the shoulder, I just kept producing more and more fluid and I had like a small balloon on my chest but it was not seeping out of my chest wound. I started having all the same symptoms of not being able to lie down, scraping the carpet, not able to breathe or rest...I had to be propped up on lots of cushions in a semi sit position.

Anyway, Daddy took me to the vets at Animal Ark because I was in so much pain from the fluid and swelling that I was not eating, and not drinking and I was gaining weight from the  fluid but wasting away a bit underneath. Anyway, Daddy had the biggest and best news. I do not have cancer, the bit they removed is not a cancerous tumour. It is formed by a massively engorged and twisted lung lobe. Here is some information that Mummy gave me about my condition, and I have written down some of the symptoms I had.

Lung Torsion or Lobe Torsion (twisted lung)

Some deep chested dogs, for example Afghan hounds or a greyhound can be more susceptible to suffering from a twisted lung. AKA lung torsion, or lobe torsion.
Sometimes, one of the lobes of a dog''s lungs can become twisted. If it twists in such a way that blood is pumped in by an artery, but not pumped out because the vein is blocked then that lobe can become horribly distended and the lobe becomes necrotic. Basically that just means dying off and rotting away internally. it causes pleural effusion (which means fluid in the chest cavity which can be thick and full of mucous, or it can be pink and blood filled)

I wanted to post about this, because at some point in the future it could your owners who have similar problems with a similar chest condition.
I have found out that this particular condition although reasonably rare, is becoming more common amongst sighthounds, especially Afghan hounds, but this condition occurs more commonly in all deep chested breeds inc greyhounds. It can go undiagnosed, or like me be diagnosed as a mass or even cancer. Mummy and Daddy knew there was a mass, but they felt and the vet felt it was not fair to euthanize me unless we knew 100% what this was.
Our boy 9 yrs old has had breathing difficulties since Feb and was diagnosed with cancer after needle biopsy, with a teeny tiny % chance it could be a condition mimicking cancer 
I had xrays, needle biopsy, fluid drained off the chest repeatedly as well as chemo Vincristine but it made not a difference to the mass, although fluid draining relieved his pain and symptoms.
I went into a crisis last week and I have posted this under the thymoma, as we thought I had some sort of lung or thymus gland cancer, but after surgery the ‘tumour’ turns out not to be cancer at all. It is a lung lobe that has died off and twisted and become engorged, necrotic.
Here is a pic of what it looked like
My biggest problem has been the fluid building up in the chest cavity. I do have complications of lymph draining into my legs and they are horribly swollen at the moment.
Mummy and Daddy know exactly what sort of pain or problem I am getting now by my behaviour. I start sticking my neck right out and panting fast and hard, then I can't like down, and I start groaning in pain and standing all the time...and my belly is tight with my ribs pushed out.
So what wre my symptoms of pleural effusion (fluid building up in the chest) that is indicative of either this, or another chest problem?
Watch out for:
  • Uncharacteristically going off my solid food (i.e. not on chemo) even if it is cheese or meat and my fave stuff, or only wanting to slurp up liquids but not dry biccies or kibble
  • Difficulty swallowing, slight choking when swallowing
  • Distinctive, crowing straining single cough….coughs get closer together depending on how much fluid has built up. Here is me at the very mild beginning stages of this, I have been coughing like this for 6 mths and they get closer together. To see this cough on the vid, just start it at about 40 secs (unedited vid sorry!).

  • Not wanting to lie flat and only lying in Sphinx position. Eventually if much worse, not able to lie down at all. 
  • Groaning and kicking of legs grumpily when lying flat. 
  • Groaning or low growl of discomfort when trying to lie down.
  • Coughing up spots of blood, or blood coming from nose (without any chemo).
  • Pleural Effusion (fluid on the chest) which shows up normally as opaque milky areas on xray. The twisted lobe often looks opaque as it becomes engorged with blood that has no exit.
  • Sticky mucous at the back of my throat
  • Mesothelial, or other ‘thelial’ type tissues on needle biopsy. If fluid is drained off the chest, it can be characteristically pink and lab results do show evidence of cells dividing rapidly but often cannot confirm without a proper slice of the affected organ or tumour. We were told the cell results showed it was cancer like with only a tiny chance it was not cancer but could be a condition mimicking it.
  • Fluid build up anywhere else in the body. Swollen legs/joints with fluid. When pressed with a finger, leaves a depression that slowly fills up.
  • If lying down, holding myneck out straight and his head tilted up.
  • Pulling lips back to take in gasps of air (a bit like Popeye’s mouth).
  • Walking really slowly, needing to drag him along on the lead
  • Really tight abdomen, feels like a drum and if you tap it, it sort of resounds like a balloon filled with water.
  • Dipping spine….look at his normal posture and remember it, if the chest gets full of fluid, then the curve of the spine makes a camel hump at shoulders, then dips right down between shoulder and back end before coming up again, and the stomach bows down as well.
  • Becoming clingy….uncharacteristically sticking to you like velcro, not wanting to sneak up on the bed or sofa like normal.
  • Standing and doing a lot of vacant staring, especially with head facing a wall.
  • Digging, scratching or going to front door or back door to want to escape;
  • Hangdog expression. You might find that he doesn’t whine or vocalise apart from some groaning as if from indigestion.
  • Rapid fast breathing, panting hard and not stopping for hours.
  • Bad hot breath (more than usual) and sometimes a clicking or bubbling sound in the chest.

Treatment for lobe torsion

Normally it is surgical, and required the twisted lobe to be removed carefully (not untwisted in situ, as this releases toxins). This is called a lobectomy.
Normally there is a fairly long scar, or it might need a square section with a rib removed. My scar is quite neat on my side but fluid built up around it. There can be complications in surgery,my heart stopped and I died but was revived, but that could have been down to anaesthesia, age or condition as I was quite poorly…or it could be a release of toxins from the necrotic lobe flooding my heart or chest.
Post surgery complications can happen, I am having a few, but once over that hurdle (a couple of weeks after surgery) then prognosis is fair to guarded.
Sometimes the lobe twist can be present with other conditions, sometimes it is just ideopathic (no definitive cause seen) or could be from trauma.
There are conditions like chylothrax (milky fatty fluid in chest cavity) and I am not sure if it is that.....Mummy and Daddy pick me up from the vets today, so then we will know.

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