Washington State University veterinary surgeon Dr. Boel Fransson fixed her eyes on a monitor screen displayed above her anesthetized patient, a shepherd-lab mix named Wolfie diagnosed with a rare and life-threatening condition.

Wolfie's disease, known as chylothorax, causes an abnormal tangle of lymph vessels and leakage of lymphatic fluid into the chest cavity. The leakage was making it extremely difficult for Wolfie to breathe and posed a risk of irreversible damage to the heart and lungs.

The monitor above Wolfie provided a real-time image detailing the intricacies of his thoracic system. Slowly, Fransson injected a special dye into her patient. Traces of Wolfie's thoracic duct - responsible for carrying lymph fluid to the blood stream - began to turn green as the dye spread.

"Dogs that have this disease, they have what looks like a worm's nest of lymph vessels, which is not normal. There should just be one or two ducts," Fransson said.

Over the next three hours, Fransson and her surgical team, which included surgery resident Dr. Peter Welsh and fourth-year veterinary student Thomas LeClair, would perform delicate and complex procedures, aided by technology available at only a handful of veterinary institutions, to save Wolfie's life.

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In the spring of 2022, a stray dog wandered into the yard of Hayden, Idaho, residents Curt and Caroline Potter. As dog lovers, it didn't take much convincing for the couple to add the stray to their pack, which already included a pair of canines.

"We joke he's the dog we never wanted, but now he's our dog and we are his people," Carolyn said. "We love that dog."

In early July of this past summer, the Potters noticed Wolfie appeared to be having difficulty breathing. Soon after, when he refused food - even his favorites - they had no doubts something wasn't right. It would take multiple trips to veterinary clinics across north Idaho and eastern Washington and a brief scare that he might have terminal cancer before the Potters learned Wolfie had chylothorax.

While it was a relief to learn it wasn't cancer, chylothorax could still be fatal, and most veterinary clinics lacked the resources to handle such a complex condition. The Potters were informed that the WSU Veterinary Teaching Hospital was Wolfie's best option for treatment.

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Chylothorax can often be successfully treated with a procedure known as thoracic duct ligation. In many cases, the procedure is performed as an open surgery, however, WSU offers a minimally invasive surgical approach using thoracoscopy - a procedure that can be completed by guiding a fiberoptic endoscope and specialized surgical tools through tiny incisions - with higher success rates and quicker recovery times.

The minimally invasive procedure requires highly skilled and experienced surgeons like Fransson and technology not available at most facilities.

Wolfie was scheduled for surgery just one week after the onset of his symptoms. The first step in his surgery involved injecting fluorescent dye that quickly traveled through lymphatics into the chest to highlight the thoracic duct. A recently acquired near-infrared imaging system was then used to highlight the dye, enabling Fransson to precisely locate the leaking ducts, which were subsequently closed with metal clips guided through the chest incisions.

"The near-infrared imaging is a pretty new technology that not all surgeons have," Fransson said. "I'm grateful we can offer it here at WSU - this technology shows how far veterinary medicine has come and how important these tools are for saving lives."

Once the leaks were closed, the surgical team completed the procedure by removing Wolfie's pericardium, a membrane that surrounds the heart. In some cases, the leaking lymphatic fluid can cause the pericardium to thicken and constrict the heart.

The surgery was a success, and after a few days in the intensive care unit for monitoring, Wolfie was cleared to return home to his family in Hayden, Idaho. His owners say he has recovered well and has returned to being his normal self.

"We were in awe of the level of care that is available at WSU," Carolyn said. "We later learned that most veterinarians don't have the equipment or the expertise to perform this procedure. We are so lucky to live within a half-day's drive of WSU."

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