Incidental lung bullae on dog chest CT and anesthesia risks

Abstract

Ruptures of pulmonary blebs and bullae are the most common cause of spontaneous pneumothorax in dogs. Incidental bullae/blebs have been documented in otherwise healthy people, however information for veterinary patients is currently lacking. Objectives of this retrospective, observer agreement, analytical study were to characterize incidental bullae in thoracic CT studies of dogs, assess interobserver variability for characterizing the bullae, and assess anesthesia risks. Inclusion criteria were dogs presenting for non-pneumothorax related reasons that had a thoracic CT at a single specialty and emergency hospital from 2012 to 2021 and had a bulla listed in the CT report. Medical records for dogs meeting inclusion criteria were reviewed to collect data on signalment, weight, total number of general anesthesia procedures 2 years prior and 2 years following the CT scan, and adverse anesthesia events. In addition, the CT images were reviewed by three American College of Veterinary Radiology-certified veterinary radiologists to collect data on the location, size, number of bullae and thickness of the bulla wall. A total of 1119 dogs met initial inclusion criteria and 74 dogs were included in analyses. There was no sex predilection for incidental pulmonary bullae. Bullae were more commonly found in older (median age 11.3 years), large breed dogs (median weight 20.7 kg). A solitary bulla of less than 1 cm was the most common finding with no apparent predilection for a particular lung lobe. There was strong correlation among the three radiologists for bulla location, size, and number, but weak correlations for bulla wall thickness. No adverse anesthesia events were found following CT anesthesia or following repetitive anesthesia procedures.