Feline pyothorax caused by tooth aspiration

A 3-year-old male entire Siamese cat presented with a 3-day history of lethargy, hyporexia and tachypnoea. There was no history of dental disease or dental procedures, nor any known trauma (although the cat was allowed outdoor access). Physical examination revealed tachypnoea, mildly increased respiratory effort, reduced right lung sounds, skin abrasions on the right shoulder region and a missing left maxillary premolar (tooth 207).

Venous blood gas, electrolyte and metabolite analysis were unremarkable. Point of care ultrasonography revealed pleural effusion, which was cytologically consistent with septic neutrophilic exudate (total nucleated cell count 22×10⁹/L). The patient was started on amoxicillin-clavulanate (20 mg/kg IV TID. Augmentin; GSK). Thoracic radiographs demonstrated right sided pleural effusion, collapse and consolidation of the right lung lobes and a single mineral foreign body likely within the right mainstem bronchus. The findings are consistent with tooth aspiration leading to right lung consolidation and pyothorax (Fig 1).

Bronchoscopic retrieval was attempted but was unsuccessful due to tooth migration. The patient underwent right fifth intercostal thoracotomy, right caudal lung lobectomy and thoracostomy tube placement. The tooth was retrieved from the excised right caudal bronchus following lobectomy. One day postoperatively, the patient suffered cardiac arrest (suspected to be due to sepsis), and cardiopulmonary resuscitation was unsuccessful. Culture of lung tissue showed growth of Pasteurella, Bacteroides and Enterococcus species (all susceptible to amoxicillin-clavulanate).

Tooth aspiration into the tracheobronchial tree is scarcely reported in veterinary literature. Tooth aspiration is a rare but documented complication in people, secondary to maxillofacial trauma, dental procedures or endotracheal intubation. Some tracheobronchial foreign bodies are amenable to bronchoscopic or fluoroscopic retrieval. In cases of parenchymal migration, pulmonary abscessation or pyothorax, surgical intervention may be necessary. This case demonstrates a rarely encountered bronchial foreign body in a cat, causing pyothorax, which has not been previously described in the veterinary literature.