On July 15, 2024, Sunny, a beloved family pet, was rushed to the OPVES emergency service after experiencing labored breathing and persistent coughing. The distressing symptoms emerged suddenly, alarming Sunny’s owner, who quickly noticed his pet’s breathing becoming increasingly labored.

Sunny had been his usual cheerful self over the weekend, enjoying time with the owner’s daughter. Despite a few coughs the previous day, Sunny seemed otherwise healthy. However, by Monday afternoon, his breathing became a concern. Recognizing the urgency, Sunny’s owner brought him into our hospital for immediate medical attention.

Upon examination, it was evident that Sunny was in critical condition. A chest radiograph revealed a severe pneumothorax, a condition where air accumulates in the space around the lungs, causing the lungs to collapse. The medical team discussed potential causes, including trauma, spontaneous pneumothorax from a ruptured bleb or bulla, lungworm, emphysema, neoplasia, and other possibilities. Given the severity, the team recommended thoracocentesis, a procedure to remove air from the chest cavity, along with further diagnostics and hospitalization for close monitoring.

Shortly after the initial consultation, Sunny’s condition worsened dramatically. His breathing became agonal, prompting immediate intubation and manual ventilation. During the emergency thoracocentesis, over 1 liter of air was removed from the right side and 900 mL from the left side of his chest, temporarily stabilizing him.

However, Sunny’s pneumothorax was persistent. Additional thoracocenteses were performed during the night, each time removing significant volumes of air. Despite these interventions, Sunny’s breathing remained labored, indicating the need for chest tubes to manage the continuous air accumulation.

Sunny’s battle was far from over. Multiple episodes of cardiopulmonary arrest occurred, necessitating CPR and administration of emergency medications. Each time, Sunny’s heart was successfully restarted, showcasing his remarkable resilience.

The on-call surgeons, Dr. Barillo and Dr. Friesen arrived to place chest tubes, a critical step to ensure continuous air evacuation. During the procedure, Sunny arrested again, but the medical team’s swift actions revived him each time. Despite the critical interventions, concerns arose about potential permanent brain injury due to Sunny’s lack of oxygen perfusion (insufficient blood flow to the brain). Sunny was then placed on a pleur-evac, a system that used suction to continuously remove air from the chest.

By the following morning, Sunny showed signs of improvement. He was successfully extubated, his oxygen levels stabilized, and he could breathe without supplementation. Despite the critical journey, Sunny’s will to fight remained strong.

Sunny was transferred to the surgery service Tuesday morning for continued care. Chest radiographs indicated a possible bulla abnormality in the right lung lobe, suggesting a source of the pneumothorax. Bullae are blister-like structures that form on the surface of the lung due to abnormalities in the tissue structure. The cause of this isn’t always known, but they often go unnoticed until they rupture, causing air to leak out of the lung.

To treat Sunny’s ruptured bulla, the surgery team drew blood from him and introduced it into the chest through his chest tubes. Referred to as a “blood patch,” this was done to provide platelets, clotting factors, and inflammatory stimulus to trigger the body to form a blood clot and essentially seal the hole caused by the ruptured bulla. This area then forms scar tissue to permanently close off the defect.

Over the next few days, Sunny continued to require vigilant monitoring. It is common for patients to require a second or third blood patch if the air leak is not fully sealed with the first patch. During this time, patients may experience increased breathing rate and effort- unfortunately, this was the case for sweet Sunny. His condition required two additional blood patches as well as another evacuation of the air in his chest.

The pneumothorax was monitored with repeat chest X-rays. It was noticeably improving with each blood patch and eventually began resolving on its own without further evacuation via the chest tubes.

Sunny’s behavior and clinical stability improved with each day he spent in our hospital, and he was able to go home one week after he was admitted with almost no residual air in his chest.

Despite facing life-threatening challenges, Sunny’s determination and the dedicated efforts of the team here at OPVES gave him a fighting chance. One week after Sunny was discharged, he reported for his re-check, where he looked great and revealed no signs of breathing difficulties—just eager to return to being a puppy! Sunny will report for one more recheck, where the team will perform repeat x-rays to ensure his lungs have returned to normal before he can officially graduate from our care.

At OPVES, we are committed to providing the highest level of care and ensuring that every pet receives the attention and treatment it deserves. Sunny’s case highlights the importance of immediate medical intervention and the expertise required to manage complex emergencies. We continue to monitor Sunny closely, and we are hopeful for his complete recovery. Join us in wishing this sweet boy all the best as he returns to his happy, healthy self!