Thoracotomy (Rib resection) in cattle and horses for management of pericarditis and pleuritis

1. RIB RESECTION
INDICATIONS & PROCEDURE
Dane Tatarniuk, DVM

2. Question 1
 What are the two most common indications for rib
resection?

3. Question 1
 What are the two most common indications for rib
resection?
 Pericarditis
 Pleuritis / Pleuropneumonia
 Pericarditismore common indication in bovine
 Pleuritis more common indication in equine

4. Pericarditis
 Etiology
 Traumatic reticulitis
 10cm between reticulum & pericardium
 Wire, nails, etc.
 Pointed objects 5 to 14cm in length
 Trauma to external chest
 Cardiac neoplasia
 Lymphoma

5. Pericarditis
 Pathophysiology
 Bacteria inoculation  septic inflammation 
increased permeability  fluid exudation  influx
neutrophils & fibrin
 Fibrin bridges within 3 days
 Collagen replaces fibrin by day 6
 Extensive fibrosis by 1 month
 Constrictive & restrictive pericarditis

6. Pericarditis
 Clinical symptoms
 Jugular vein distension
 Brisket edema
 Submandibular edema
 Cardiac abnormalities

7. Pericarditis
 Diagnostics
 Auscultation
 Splashheart beats
 Muffled heart sounds
 Ultrasound
 4-6th intercostal spaces, level of elbow
 Effusion : anechoic
 Exudate : granular, waving strands
 Thickened sac : organized fibrin, collagen
 Radiographs
 Cardiomegaly appearance

8. Pleuritis
 Cows
 Pleuritiswith pyothorax or
pleural fluid
 Daily lavage, maintain
drainage

9. Question 2
 Do cattle have complete or incomplete
mediastinum?

10. Question 2
 Do cattle have complete or incomplete mediastinum?
 Complete
 Complete mediastinum
 Only lung on affected side collapses following thoracotomy
 Other lung unaffected
 Respiration usually stays normal
 Horses
 Incomplete mediastinum
 Walled off – then OK

11. Pericarditis
 Pericardiocentesis
 Higher risk
 Caudal to left elbow, sternum to mid-chest
 Tie left front forward
 18 gauge, 6 inch needle
 Slowly advance needle
 Watch for needle to move synchronous with heart beat
 Aspirate blood – back up
 Collect fluid for cytology, culture
 Rumen bacteria

12. Pericarditis
 Percutaneous pericardial drain
 Earlier stages of pericarditis (mostly
fluid, little fibrin)
 Large bore sterile chest tube
 Similar insertion as for
pericardiocentesis
 Egress fluid continuously
 Ingress lavage daily
 Pull tube once fluid flushes clear

13. Thoracotomy
 Standing, local lidocaine block
 Incision over 5th or 6th rib
 6th rib
 Preferred - posterior to shoulder
 5th rib
 Adductionof limb during movement
 Subcutaneous air under forearm,
scapula
 More prone to cellulitis

14. Thoracotomy
 Incision started at costo-chondral
junction
 Extend dorsally 20cm
 Lower than CC junction
 Lateral thoracic artery & vein
 Overlying thoracic muscles incised
 Dorsally
 Latissimus dorsi muscle
 Serratus ventralis muscle
 Ventrally
 Pectoralis profundus muscle
 Aponeurosis of obliquus externus
abdominis muscle

15. Thoracotomy
 Periosteum incised by scalpel
 Periosteum retracted cranially & caudally with
periosteal elevators

16. Thoracotomy
 Gigli wire placed 18cm above CC junction
 Transect
 Rib wide and thin
 Disarticulate rib at CC junction

17. Thoracotomy
 Incise pleura
 Carefully
 Exteriorize pericardium and
suture to skin edge
 Same principle as rumenostomy
 Can drain pericardial fluid with
needle, suction
 Incise pericardial sac
 Manually remove fibrin, clots
 Lavage sac liberally with saline
 Leave open or close with drain

18. Thoracotomy
 Post-operative
 Cover thoracotomy site with
sterile towel or combine roll
 Held in place with umbilical tape
 Broad spectrum antibiotics
 Incision examined, flushed daily
 Wound kept open as long as
fetid material egresses
 Can take wound up to 1 month
to close

19. Prognosis
 Cattle
 15% survival for pericarditis
 71% survival for pleuritis
 Horses
 88% survived surgery
 46% returned to intended use

20. QUESTIONS ?