• Accumulation of fluid, air or tissue in the pleural space can lead to dyspnea and impede normal respiration.
• In rabbits, this technique is rarely used solely for diagnostic purposes and should follow imaging confirming a moderate to severe effusion.

• Therapeutic removal of excessive fluid (pleural effusion) or air (pneumothorax)in a dyspneic patient to aid respiration.
• Rarely used primarily for diagnosis in rabbits but can help investigate the etiology of an effusion and allow analysis of the aspirated fluid, including culture, cytology, specific gravity, and classification as transudate, modified transudate, or exudate.

Advantages

• Rapid relief of dyspnea Dyspnea associated with pleural effusion or pneumothorax.
• Aids in diagnosing the etiology of the effusion.
• Often done in the unsedated patient in sternal recumbency.

Disadvantages

• Can provide only temporary relief if underlying cause isn’t addressed, leading to redevelopment of effusion or air.
• Can be stressful, especially in the already dyspneic patient.
• Clip areas should be limited to avoid hypothermia.

• Risk of hemorrhage if accidental puncture of the blood vessels running caudal to the border of the ribs.
• Risk of inducing a pneumothorax with improper technique.
• Often recommended to be done with ultrasound guidance in rabbits due to their small thorax sizeBiopsy: ultrasound guided.

• Thoracostomy (insertion of a chest tube) is mostly recommended post-thoracotomy in a rabbit, and could be considered for persistent effusions or severe pyothorax non-responsive to medical management.

Preparation

• 5 min for site preparation.

Procedure

• 5-30 min, depending on patient temperament, equipment, and size of the effusion.

Criteria for choosing test procedure

• Should only be performed with radiographic, ultrasonographic or computed tomography evidence of a pleural effusion or pneumothorax.
• Indicated for large volume pleural effusion or pneumothorax causing dyspnea.

Risk assessment

• The potential benefits of relieving dyspnea must be weighed against the possible distress caused to the patient.
• Often only performed in rabbits with moderate to severe effusions.
• The need for sedation should be assessed based on patient temperament and stress.

Refereed papers

• Recent references from PubMed and VetMedResource.
• Levshin S, Eshar D & Naor A (2016) Idiopathic chylothorax in a pet rabbit (Oryctolagus cuniculus). Comp Anim 21 (9), 534-537 VetMedResource.
• Pariaut R (2009) Cardiovascular physiology and diseases of the rabbit. Vet Clin North Am Exotic Anim Pract 12 (1), 125-144 PubMed.
• Reuter J D, Fowles K J, Terwilliger G A & Booth C J (2005) Iatrogenic tension pneumothorax in a rabbit (Oryctolagus cuniculus). Contemp Top Lab Anim Sci 44 (4), 22-25 PubMed.

Other sources of information

• Richardson J & Keeble E (2014) Physical Examination and Clinical Techniques. In: Manual of Rabbit Medicine. Eds: Meredith A & Lord B. BSAVA, UK. pp 99.
• Varga M (2014) Cardiorespiratory Disease. In: Textbook of Rabbit Medicine. 2nd edn. Elsevier, USA. pp 390-404.
• Redrobe S (2013) Ultrasonography. In: BSAVA Manual of Rabbit Surgery, Dentistry and Imaging. BSAVA, UK. pp 94-106.
• Grint N (2013) Anaesthesia. In: BSAVA Manual of Rabbit Surgery, Dentistry and Imaging. BSAVA, UK. pp 17-19.