Canine Spontaneous Pneumothorax and Bullae

Today I’m going to stray from my usual topic of travel and instead share the story of my dog Audi and our experience with spontaneous pneumothorax, bullae, surgery and what came next. We’ve spent the past few weeks going through tests, x-rays and surgery without any clear answers on what caused this, what we could do about it and if it would happen again.

There is very little information on bullae in canines available on the internet and I came across another blogger who shared their story (back in 2010) and I was astounded by the number of people still commenting in 2013 saying they were going through the same thing and wondering where the answers were.

Here’s our story, I hope it helps:

Audi is a 3.5 year old spayed female Labrador, Border Collie and who-knows-what mix. She weighs about 50 pounds and has a history of ear infections but otherwise has always been very healthy and active.

One night, I noticed her breathing was abnormally fast and shallow. The next day, a Sunday, she was coughing and continued to breath very fast but was not showing signs of any severe respiratory distress (gasping, blue tongue, etc..). I took her to see my normal vet first thing Monday morning. My vet listened to her lungs, heard some concerning lack of lung noise and decided to take a chest x-ray. She found the pneumothorax. She prescribed antibiotics because Audi had a slight fever and because there wasn’t an obvious traumatic cause she wanted to give it a week and see if the issue resolved itself.

A week later, we had another x-ray and the pneumothorax had not changed. My vet referred me to Michigan State University Veterinary Teaching Hospital, one of the best in the nation. They took blood samples and performed more x-rays which showed the pneumothorax and the possible existence of bullae. Blebs or bullae are simply air pockets in the lungs that can burst and release air into the chest causing the spontaneous pneumothorax. Her blood gas results came back normal.

I dropped her off the next day for a CT scan. It confirmed the existence of multiple small accumulations of gas in her lung tissue and one large ruptured and leaking bleb.  Surgery is the best and most successful treatment for bullae. Since she was already under anesthesia from the CT I gave the OK for her to go right into surgery to remove the tissue. They also inserted a chest tube to drain and monitor any air or fluids left in her chest cavity after surgery.

I was able to take her home two days after surgery and she is supposed to be breathing better but it was going to be a long recovery from the sternotomy. She was on two types of pain killers, Tramadol and Rimadyl. Her incision, 20 staples long, was clean and healing well.

Audi

Five days after surgery I called the surgeon with concerns about her continued rapid breathing and she told me to bring her in that day. The results of the biopsy were in and they needed to speak to me anyways about what she called a chronic and asthmatic condition.

They listened to her lungs and didn’t hear anything abnormal so I decided to forego another x-ray. The cause of rapid breathing after surgery was most likely pain or discomfort so she was given a third pain killer, Gabapentin. She had some fluid accumulation around her incision, they said this was normal and could be helped by applying a heat pack to it for a few minutes a day.

The biopsy results showed inflammation, remodeling and allergen trapping in her airways. Typically, allergens leave the lungs when you exhale but they were attaching to hers, adding to the severity of the inflammation and remodeling. When remodeling occurs, it can weaken the walls of the lungs and lead to pulmonary blebs (of bullae) formation. The remodeling of the lung tissue is permanent but by reducing and controlling the inflammation we can prevent further damage.

We have to wait until she is off of her post-surgery pain medication before we can perform a blood allergen test to see which allergens are causing the inflammation. The next step is to start her on pill-form steroids for a month to correct the inflammation. After that she will have to be administered steroids through an inhaler twice a day for the rest of her life.

Audi is so young and has been an amazing companion and borderline-perfect dog. I’m going to keep doing everything I can to make sure she has a long HAPPY life. I’ll be sure to update this post with any future developments on her condition.

UPDATE (September 2013)

Audi is a week into oral steroid treatment. She has most of the side effects we were warned about; increased appetite, thirst, panting.  Her allergen test came back and turns out she is allergic to just about everything. The allergens they found in her lung tissue included grass, trees, plants, dust mites  and cat dander. The most significant reaction coming from dust mites and grass. There’s no way to avoid all of these things so the inhaler is really our best hope at controlling her condition.

I attempted to switch to an Internal Medicine Specialist in Chicago, where I now live, but after the consultation they set me on a different treatment plan and gave me perscriptions for a nebulization unit, Albuterol and Flonase. They weren’t able to view Audi’s scans and allergen test so I was at first slightly, and then increasingly, concerned about this plan of action.

I spoke with my Internal Medicine Specialist at MSU again and she also had concerns about the nebulization and the use of flonase. After a few failed attempts to reach the Chicago IMS to get my questions answered I decided to say “screw it” and continue Audi’s treatment at MSU, drive be damned.

UPATE (October 2013)

Audi has been on the oral steroid for over a month. The side effects have remained the same, mostly increased thirst and appetite. I have the Aerodawg chamber and I’m just waiting to receive the inhaler medication. I ordered them from CanadaDrugs.com. It was recommended by my veterinarian that I look into getting the prescription filled in Canada because it would be a lot more cost effective.  CanadaDrugs.com had the best reviews of the online Canadian pharmacies that I looked at and I was able to take 25% off my first order. Once I recieve the inhalers and will start giving Audi a few “poofs” a day and begin tapering off the oral steroid.

UPDATE (November 2013)

Audi has been receiving two ‘poofs’ a day for almost a week. When she initially started the oral steroid she lost a few pounds but since then has gained them all back, plus a few extra. She is still ravenously hungry all the time and drains her water dish as soon as I set it down. This has led to a few unfortunately accidents and extra loads of laundry to wash her dog bed. We have begun to taper off her oral steroid so I’m hopeful that her outrageous hunger and thirst will be coming to an end soon. There hasn’t been any significant increase in her respiratory rate so that would indicate that her disease isn’t flaring up again…yet.

UPDATE (February 2014)

It’s been about 3 months since our last Audi update. She is doing really well. She has been completely weened off of the oral steroid for a while now and I slowly noticed a decrease in her hunger and thirst. She had a check-up about a month ago and our Internal Medicine Specialist said everything looked great and that Audi seemed to be recovery very well, probably because of her young age. Her personality is definitely back to normal. I hadn’t noticed it at first but over time she started to act happier and more energetic. She is still on two ‘poofs’ a day and will continue that way for at least 6 months. It’s been an extremely cold winter in Chicago but it doesn’t appear to be affecting her condition. She turns 4 next week and the fact that she is happy and semi-healthy starts to make up for all of the drama we’ve gone through  these past 5 months.

UPDATE (February 2015)

One year later and Audi is still going strong. I have her down to one poof of the inhaler per day. She seems to be doing well and more importantly she seems happy. Tomorrow, she will be 5 YEARS OLD! Can’t believe she’s already 5 and after what we’ve been through I’m so glad she’s reached this milestone.

UPDATE (MAY 2017)

Audi is still in good health and has officially made it to her “senior” years.

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21 thoughts on “Canine Spontaneous Pneumothorax and Bullae

  1. My golden retriever went through the same thing as yours in October 2013. He started having trouble breathing, chest xrays showed that he had a pneumothorax. The vet tapped his chest to remove the air, but it didn’t correct it. The vet was convinced that it was caused from trauma, like getting hit by a car, but nothing had happened like that. So a few days later we were at a vet hospital in st Louis having the exact same surgery yours did. He was even on the same medicines. We have no idea what caused this, and he hasn’t had any issues since then. But summer is almost here and he spends a lot of time in the river, fishing, and gulping lots of water and air. I’m concerned that maybe this had something to do with it, and I’m almost afraid to let him swim.
    Have you found any helpful information explaining what may cause this or any prevention?

    1. At first my regular vet thought the pneumothorax was caused by trauma as well because spontaneous pneumothorax caused by anything else is very rare. After a biopsy of my dog’s lung tissue, we confirmed that her’s was caused by a chronic condition or lung “disease” if you will. Allergens get stuck in her lungs and irritate until bullae form which can burst and create a hole. My vet commented that if a human had this lung condition they would receive a transplant. This will be our first summer (and allergy season) since the incident so with continued use of an inhaler we’re hoping to avoid any further lung reconstruction.

      I asked my vet if changes to her environment could help (i.e. not letting her run around in the woods, roll in grass, interact with cats) but because Audi is allergic to practically everything, and I can’t keep her in a bubble, the inhaler is really all I can do. Right now, Audi receives two poofs of Flixotide a day and probably will for the rest of her life. I also make an effort to reduce dust mites in the house by vacuuming, dusting and washing her and my bedding frequently.

      I’m sorry to hear that you and your dog have had to go through this too. I would love for you to share any different information you may have received or updates on your dog’s condition.
      Best,
      Casey

  2. My six year old Cocker Spaniel was just diagnosed with the same. It started with a cough and then she started having difficulty breathing. Today we took her to the UW Madison Hospital and we found out that the one she has is getting larger and she now has developed a second one. We are looking at the same type of surgery, but the risks seem so high. I would like to know if both of your dogs are still alive and if you would do it again?

    1. Audi is still alive and acts like a normal healthy dog. We can’t be certain that her bullae aren’t getting worse but hopefully the inhaler is keeping them at bay.
      In two weeks it will have been one year since her diagnosis and surgery. A year ago I was asking myself that same question. Would it be worth it to put her through this invasive surgery? Am I being selfish and will she suffer just because I don’t want to lose her? Putting thoughts of money and cost aside, I went with my vet’s recommendation that surgery was the best/only way to treat her pneumothorax. Audi was just 3 years old at the time and in very good shape. I think this contributed to her swift and smooth recovery.
      It’s been a very expensive journey but at the moment, because I was able to have another happy year with her, I would say it was worth it.
      I hope this helps you make this very tough decision and I wish you and your pup the best of luck! I would love to hear updates on your dog’s condition. The more information we have the better we can help our furry best friends live happy lives!

  3. My ten year old mix breed was just diagnosed with pulmonary bullae. My vet had never treated a case such as this. He put him on three meds. an antibiotic, a cough suppressant, and a bronchodilator. With a recommendation for a follow up x-Ray in three weeks. What we want to see in the next three weeks is a decrease in the size of the bullae. Has anyone had an experience such as this? If so, please share.

    1. I haven’t had any follow-up x-rays or scans done to see if the bullae are decreasing in size. I was told by my internal medicine specialist that the reconstruction of the lungs that has occurred is irreversible and we can only treat the inflammation that creates more bullae or causes the existing ones to worsen.

      Please feel free to update us with any news you receive. I’m curious to hear how the bronchodilator treatment works out for your dog.

      Best,

      Casey

  4. After about a week of prescribed treatment I still wasn’t able to shake the nagging mommy voice in my head. I took Bruce to a local vet ER for a second opinion. The Doctor that examined Bruce was very close to my regular vets treatment plan. She did a full blood work up on him, additional chest X-ray and found him with an elevated temp. She left him on the same meds and prescribed him an antihistamine. So it’s just a waiting game at this point.

    Thank you so much for your quick response. I have to tell you when I saw the pic of Audi it touched my heart. She and Bruce could have come from the same litter. I will find a good pic of him and post it if I can.

    Thanks again,
    Linda

  5. Hi:

    I have a 9 year old saluki male, Khari, who has just had surgery to his left lung where the surgeons have removed the lower left lobe and a bit of lung tissue from the right lower lobe. Khari’s first symptoms were shallow breathing, almost gasping for air, rapid heartbeat. I rushed him to our local vet, where they did two chest taps to remove the air and stabilized him. We were sent to Calgary Care Animal Hospital, where he was analyzed. They performed the CT scan which revealed the bullae blowing a hole through his lung. They did open him up from top to bottom on the sternum. He has done fine so far after his surgery as it amazing how resilient our canine companions can be. My vet called today with the results of the lung tissue. Apparently there is risk of bullae forming again anywhere in the period of 2 months to 2 years. My vet will continue to monitor him and watch for any changes.
    Your postings about allergies seem very interesting to me as Khari does have some food allergies but may have more allergies that could be underlying to have caused his condition. I will present this to my vet when we go have the staples removed on the 25th of August. As it sounds like something to consider, as there is not enough information in the medical world about this condition.
    Khari has done amazing well through the surgery and tests and is recovering at home comfortably right now.
    He is currently on Tramadol, Gabapentin, Cephalexin and Metacam. Also had a Fentanyl Patch for pain.

    Will keep up with this post to see how things are progressing for everyone here.

    Audrey Haas
    Red Deer, Alberta
    Canada

    1. Hi Audrey,

      Thanks for sharing! It sounds like you’re going through the same things that Audi and I experienced and I’m happy to hear that Khari’s surgery was also a success. It’s been a year since Audi’s surgery and she’s still doing well, so stay positive and enjoy every moment with Khari. Please feel free to update us on his condition or let us know if you learn anything else about what may have caused his bullae.

      Best of luck,

      Casey

  6. My 9 year old lab was just diagnosed with this today. His breathing is fast and hard but he seems otherwise to enjoy his food and the family. I do not feel that I would want to do this surgery on an older dog especially seeing that it can come back. I just wonder whether I will know when his breathing is too difficult and his quality of life is too bad. The vet put him on asthma meds but it’s too soon to know if that will help. comments anyone?

  7. I had a 5 year old Labrador Retriever who was diagnosed with a ruptured pulmonary bullae on 8/9/14 at the emergency vet where we live. She exhibited labored breathing and just didn’t look right. We were leaving on vacation with our 2 dogs the following day so I knew I needed to get her looked at before we left. Unfortunately the x-ray showed what they thought was a large ruptured pulmonary bullae and they scheduled her for surgery on the following Monday 8/11 because they needed to first do a CT scan to make sure exactly what it was. We sadly had to leave her behind with our personal vet looking after her in our absence. After the CT Scan, the surgeon called to tell me that her lungs were so full of the bullae that they couldn’t tell which one had ruptured and that they couldn’t recommend performing the surgery. Needless to say they recommended that she be euthanized. I was devastated, but felt we had no other options. She had no trauma. She was a Guide Dogs for the Blind career change puppy that I raised but didn’t make it as a Guide Dog. The vet thought that she must have been born with this defect. I am absolutely heartbroken. :-(

  8. We just went through the surgery . Our goldendoodle Ginger started having labored breathing but otherwise seemed fine. After 5 days I became worried and brought her to the vet . An X-Ray showed a collapsed lung and we went right to the vet hospital where they diagnosed a spontaneous pneumothorax and a bullae. After 3 days of chest tubes (and $3000) we brought her home- they said sometimes it can clear itself. 2 days later she had an attack- really difficult breathing- and we rushed her to the vet hospital . They performed surgery the next day. ($10,000) luckily we have pet insurance that paid 90%. Trupanion is the company. Anyway , we are in love with our dog and she is recovering well from surgery. It was quite the ordeal since it is such a “rare” occurrence.

    1. Thanks for sharing Tracy! I’m glad to hear Ginger is doing well post-surgery. I never would have thought I would be someone who needed pet insurance (especially for a rescue dog) but looking back, it probably would have helped me immensely!

  9. We have two Samoyeds…Brother & Sister from the same litter. Ginger, the female, had surgery 2 1/2 yrs ago (at age 3 1/2). Conner, the male, had surgery a few weeks ago. (Age 6). We share your pain. We’re hoping that whatever causes this doesn’t reoccur. Conner is feeling his oats…we’ve got to keep him calm until we get the sternum xrayed next week to make sure it’s fused properly before letting him get rambunctious again.

    1. Wow, sorry to hear that you had to go through this (TWICE) but I’m glad they both seem to be doing well post-surgery! I haven’t heard many people say they had a spontaneous pneumothorax recurrence and I’m hoping it stays that way!

      Best of luck to you, Ginger and Conner!

      Casey

      1. Thanks for sharing. Tommy is a six year old shih tzu Maltese mix. He is5 weeks post op for the same surgery. So far so good. We had many thoracentesis done which worked the first couple times a year apart but this time the leak was too quick. He had an entire lung lobe removed along with the bullae. The surgeon showed me pictures. It’s amazing what they can do. His sternum is wired together and I’m so glad it’s over.

      2. Thanks for stopping by! Tommy might be the first smaller sized dog I’ve heard of with this condition. I’m so glad his surgery went well. What’s also amazing is how resilient our pets are! It’s been about a year and a half since Audi’s surgery and she’s still doing great. Best of luck to you and Tommy :)

  10. Im in the process of all of this right now. My 3 year old mallamute has air in her chest and and an xray shows what the sergical vet says is bullae. They said the surgery costs 8000 but that there’s always a chance more will grow back or that she has more than the one the xray showed. 2000 just for a ct scan to tell me if the surgery is even possible and if it is i cant afford 8000. I see someone got lucky with pet insurance covering 90 percent guess signing up is a loss cause once they are diagnosed with something? Im laying on the couch with my pooch right now hoping she is a miracle case and heals. Any advice?

    1. Hi Michelle,

      I’m not sure about the pet insurance, I didn’t have it before this whole ordeal either. I’m fairly certain the entire process didn’t cost me anywhere near $10,000 though. I just trusted the Internal Medicine specialist when she put together this plan of action and decided it was worth the couple thousand I had to initially spend on the CT and surgery. I was also told that Audi may develop more bullae in the future, that’s why we are using a daily inhaler (which isn’t cheap either). Some people might call me crazy but Audi is 5 years old now and I don’t have any regrets about spending an obscene amount of money on her but I also don’t let the money I spend affect my ability to pay rent, bills etc…

      I really hope everything works out for you!

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