Complete history and signalment: A 12-year-old male mixed breed dog was presented for acute depression, lameness and seizures. On admission the patient was depressed, showed abdominal pain and neurological abnormalities suggestive of right prosencephalon lesion. Initial diagnostic test included CBC, biochemistry, PT and aPTT, thoracic radiographs, abdominal ultrasound, cPL snap test, pancreatic and prostatic FNA, MRI and CSF analysis. Changes on pancreatic and prostatic parenchyma were present on AUS; FNA was compatible with pancreatitis and benign prostatic hyperplasia respectively; cPL snap test was positive; on MRI an intracranial hemorrhage was present. Over the following days a mild tachypnea that progressed to marked dyspnea was noted and a hydropneumothorax was diagnosed on thoracic radiographs. CT scan confirmed multiple wedge shaped peripheral parenchymal lesions compatible with pulmonary thromboembolisms (PTE), lung hemorrhages and right cranial vena cava, brachiocephalic and subclavian vein thrombosis.

Complete diagnostic investigation: Diagnostic test looking for an underlying hypercoagulable condition included T4-TSH, UP/C ratio, 4dx snap test, leishmanial serology and ACTH stimulation test. All results were within normal limits. Since thromboelastography was not available PT, aPTT, fibrinogen and platelet count were performed several times. Results were within normal limits. Echocardiographic examination revealed mitral valve disease B1 along with pulmonary hypertension.

Therapy: Supportive treatment along with a continuous drainage chest system (Pleurevac) was placed. Anticoagulant therapy was initiated with enoxaparin (0,8 mg/kg/SC/6 h) and clopidogrel (2 mg/kg/PO/24 h). Patient’s condition improved and continuous drainage was removed after 72 hours and discharged sixteen days after admission.

Discussion: Acute and chronic pancreatitis have been related to thrombosis. Proposed mechanisms include systemic inflammatory response syndrome with procoagulant activity and perivascular inflammation of the splenic vein adjacent to the peripancreatic tissues among others. PTE and pneumothorax have been well described in veterinary medicine although there is little report on association between them. In this case, PTE caused an acute pneumothorax and this might have been related to a hypercoagulable state secondary to pancreatitis. Although PTE is a rare cause of pneumothorax, it should be considered as a differential diagnosis in patients with pancreatitis and other underlying hypercoagulable disease who develop acute respiratory distress.