Remi Burke is a gentle 4-year-old dog who has become a cherished member of our veterinary family. Remi's journey with us began in May of 2023 when he was presented at our Mission location with a lack of appetite and respiratory distress. His case has involved a series of critical interventions and expert consultations to manage a complex condition known as idiopathic chylothorax. This case study provides a detailed overview of Remi's condition, his procedures, and the specialized care provided by our veterinary team, including anesthesiologist Dr. Charlotte Marquis, cardiologist Dr. Shane Murphy, and surgeon Dr. Dave Allen.
Initial Presentation and Emergency Intervention
In late April of 2023, Remi presented to his primary care veterinarian with breathing difficulties and fluid in his chest. He was started on Baytril, an antibiotic, and scheduled for a recheck. However, as his condition worsened, he was presented at our Mission location for lack of appetite and respiratory distress.
Remi was immediately triaged to the ICU, where a tFAST ultrasound revealed a large amount of pleural effusion (an accumulation of excess fluid between the layers of the pleura outside the lungs). Congestive Heart Failure often causes pleural effusions. Given this, our cardiologist, Dr. Shane Murphy, intervened to perform an echocardiogram to rule out congestive heart failure. The echocardiogram showed normal heart function, but significant pleural thickening was noted, raising concerns for chylothorax.
His Condition required immediate attention, and he was transferred to our Overland Park location for further evaluation and treatment.
Advanced Diagnostics and Hospitalization
Under the expert care of Dr. David Allen, Remi underwent a diagnostic thoracocentesis to drain fluid in his chest and allow him to breathe easier. It was discovered that Remi was suffering from an accumulation of chyle, or lymphatic fluid, in his chest. With Dr. Murphy’s extensive examination, the common causes of chylothorax, such as congestive heart failure, heartworm infection, fungal disease, and chest tumors, were ruled out. Consequently, Remi was officially diagnosed with idiopathic chylothorax, a condition characterized by the buildup of chyle in the thoracic cavity without a known cause.
Surgical Interventions
Remi’s condition continued to fluctuate, and he underwent thoracic surgery including: a subtotal pericardectomy, cisterna chyli ablation, and thoracic duct ligation. In addition, a pleural port was placed in his chest and under his skin to allow periodic drainage of the chylous fluid.
Postoperative Care and Management
Remi's postoperative care was intensive. He was closely monitored for respiratory distress, and his medications were adjusted based on his response to treatment. His care included:
Antibiotics: Enrofloxacin, Unasyn, and Clavamox to manage the infection.
Pain Management: Gabapentin and Cerenia to control pain and nausea.
Supportive Care: IV fluids, oxygen therapy, and regular thoracocentesis to manage fluid accumulation.
Thanks to the consistent care of our surgery team, Remi’s loving family began bringing him in once a week for nine months straight to have the fluid drained from his chest. With routine port draining, the fluid became thinner and more watery, and Remi’s weekly drainage sessions became bi-weekly.
Over time, fluid production decreased significantly. After nearly a year of routine draining sessions and monitoring, the surgery team decided it was time to remove Remi’s pleural port.
Current Status and Future Plans
Last week, the surgery team successfully removed Remi's pleural port! Needless to say, this was a very exciting and rewarding day for Remi and the team members who have cared for him since the beginning of his journey. Third-year surgery resident Dr. Annie Marquiss successfully removed the port, and Remi is scheduled for routine checkups over the next 2-3 months so that our team can continue to monitor his progress closely and provide the appropriate care if necessary.
Conclusion
Remi's journey through diagnosis, surgical intervention, and intensive care highlights the complexities of managing chylothorax in dogs. Our veterinary team's collaborative efforts have provided the best possible care. Remi's case underscores the importance of advanced diagnostics, timely surgical intervention, and comprehensive postoperative care in managing complex veterinary conditions.
