Patient Profile
Running Out of Air!
Lais R.R. Costa, MV, MS
Clinical Instructor of Equine Medicine
Diplomate, American College of Veterinary Internal Medicine
Jill J. McClure Blackmer, DVM, MS
Professor of Veterinary Medicine
Diplomate, American College of Veterinary Internal Medicine

It had been a quiet Sunday night at the LSU Veterinary Teaching Hospital & Clinics (VTH&C) until the phone rang informing us that an emergency patient was on the way.  Before long, a truck and trailer carrying the patient pulled up to the Large Animal Clinic gate.  In the trailer was “Chris,” a 3-year-old intact Sicilian donkey, struggling to breathe with flared nostrils and an outstretched neck.

 

Mrs. Alexander, Chris’ new owner of only two weeks, had rescued the shaggy and unkempt critter from a livestock auction.  Before Mrs. Alexander’s intervention, Chris was bound for the slaughterhouse floor.  Mrs. Alexander dedicates a lot of her time, effort and money rescuing horses, ponies and donkeys from livestock auctions and taking them home to care for them.

 

Now Chris was in trouble again.  Mrs. Alexander was very concerned about the risk of losing him.  When Chris had first arrived at his new home, Mrs. Alexander noted he had a cough and poor appetite.  She had called Dr. Terry Swiderski, the veterinarian who regularly cares for her herd of formerly neglected animals.  The first time Dr. Swiderski had examined the little donkey, he heard abnormal lung sounds and diagnosed pneumonia.  Dr. Swiderski had instituted treatment with antibiotics and anti-inflammatory drugs.  Dr. Swiderski was concerned with Chris’ risk for developing hyperlipemia, a disease fatal in 60% of cases despite treatment.  But things seemed to go well for several days; Chris was eating well and was not coughing as much as before. 

 

Sunday evening, Mrs. Alexander found Chris having great difficulty breathing.  Dr. Swiderski received an emergency call and rushed to attend to the little critter. Reexamining the little donkey, Dr. Swiderski was unable to hear any lung sounds at all.  Concerned with this sudden change in Chris’ clinical status, Dr. Swiderski made arrangements to refer Chris to the LSU VTH&C. 

 

By the time they arrived at the LSU VTH&C, Chris had developed a distended or “puffed-up” appearance and was in obvious distress, with nostrils flaring and sides heaving.  Barely able to move, Chris was carried out of the trailer.  Examination revealed air pockets under his skin extending from his head to his flanks on both sides of his body, giving the so-called “Rice Crispy” effect.  He had a fast, shallow and labored respiration, and fast heart beat.  Where was the air coming from?  Because of air accumulation under the skin, ultrasound examination of the thorax could not be performed, so he was rushed to radiology.  Although Chris had several scars and healing injuries throughout his body, there were no fresh wounds or punctures to explain the air under the skin.

 

Chris did not object to being wheeled on a cart to radiology; all his effort appeared to be focused on getting a little air.  The x-rays showed that both lungs were partially collapsed by air in the chest cavity.  The air had leaked out of the lungs into the thorax (pneumothorax), as a result of the rupture of emphysematous bulla.  The air spread out dissecting between the neck muscles around the windpipe (pneumediastinum) and finally spread under the skin.  Recognizing that at least part of Chris’ difficulty in breathing was the result of pressure by the air around his lungs, we immediately prepared Chris’ chest for insertion of a tube through which the air could be evacuated.  Relief was rapid, and soon Chris’ breathing was improved, although not normal yet.  His blood work showed a marginal, however minimally adequate, oxygen content, so supplemental oxygen was not needed.  In addition, his blood work showed evidence of a resolving infection, so the antibiotic treatment instituted by Dr. Swiderski was continued.

 

Moreover, the chest x-rays showed evidence of marked pre-existing chronic lung disease, that may have predisposed him to the pneumonia and had weakened the walls of the airways, allowing them to rupture and leak air into the chest cavity causing Chris’ respiratory distress. Lung worms and allergies were the most likely causes for the chronic lung disease.  We worked with Dr. Swiderski to set up a deworming program and arranged to minimize dust and molds in Chris’ environment.

 

Within a few days Chris’ breathing was nearly back to normal.  He again had a great appetite and seemed to be feeling great.  Soon, little Chris was frisky and all boy again.  It didn’t take him long after recovering his breath to announce his presence with great regularity by braying incessantly.  He may have been the smallest in stature, but he was the biggest in attitude!  Despite our concern that the braying would bring on another air leakage, we could not stop him!  He had to tell everybody how happy he was. 

 

As all good stories, Chris’ had a happy ending.  After 10 days of confinement, Chris returned home to rejoin a unique herd of horses, ponies and donkeys.