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Brutus, is a sweet, but sometimes feisty 11 year old Chihuahua who presented to us for a routine dental cleaning last month. Brutus has had problems with periodontal disease and has had to have many teeth extracted over the years. As a result, the owner brings him in yearly for dental cleanings.
We've been treating Brutus for years, and when he came in, he just didn't look good. He had lost weight, his coat looked dull and scruffy and he was breathing rapidly. On physical exam, we found advanced periodontal disease in the mouth. His lungs sounded harsh and as a result, we suggested blood tests and chest radiographs prior to proceeding with the dental work. We always do blood tests prior to surgery and generally recommend chest films for all dogs over 7 years of age.
His blood tests were normal for a dog of his age. The chest radiographs, however gave us a big surprise. As you look at these films, you can see that the left side of the chest is all white while the right side is black (full of air).
Notice the white patch in the upper left corner of the chest. This is the mass
see the white patch overlying the heart, which is the tumor
Based on these findings we were highly suspicious of this being a tumor, however an abscess or granuloma was also possible. We examined the lesion with ultrasound and found it to be a solid mass measuring 2.5 x 4.5 inches. With ultrasound guidance, we were able to get a sample of the mass for analysis. The cytology slides were sent to the lab and 3 days later we got a finding of a primary lung tumor. Lung tumors are a relatively uncommon tumor in dogs. They can vary in their aggressiveness and the overall prognosis for treatment can only be determined after a full biopsy is examined and the local lymph nodes (around the heart) are inspected. Surgical excision of the mass is the treatment of choice for this type of tumor as response to chemotherapy and radiation therapy is very limited.
We took Brutus to surgery and opened his chest (thoracotomy) to find the entire front portion of the left lung involved in the tumor. This part of the lung was no longer performing the function of gas exchange, so there was no problem removing it from the standpoint of Brutus' ability to breath. We removed the lung lobe and sent it to the lab. After thoracotomy, we have to leave a chest tube in the thorax for 24 hours in case there is any leakage of air from the surgical site. Brutus was taken to the overnight emergency clinic for observation. He had an uneventful recovery and we removed the chest tube the next morning.
A few days later, we received the biopsy report indicating that this was a tumor arising from the bronchial and alveolar (gas exchange area of the lung) tissue. The borders of the biopsy did not show any sign of tumor cells. Because there is no strong evidence that chemotherapy would prolong Brutus' life, the owner opted not to pursue it. Statistically, dogs with this type of tumor which has been fully resected have an average survival time of 12 months, however some live as long as 3 years.
Brutus is back at home and is as feisty as ever. He is completely comfortable and he and his owner are enjoying their time together.