5. Pleural Effusion

Question 1

What signs on a PE indicate pleural disease?

Answer 1

Tachynea, orthopenia, difficutly breathing
Rapid, shallow breathing
Abdominal effort
Muffled heart and ling sound
Heart mumur, gallop, mediastinal mass, fever, trauma

Question 2

What are some differentials for pleural space disease?

Answer 2

Pleural effusion
Pleural space/mediastinal mass
Diaphragmatic hernia
pneumothorax

Question 3

What are signs of pneumothorax?

Answer 3

Decreased lung sound dorsally
Less lung expansion and less return to heart
Leak air from lung from trauma/penetration

Question 4

What are signs of a diaphragmatic hernia?

Answer 4

Displacement abdominal organ through diaphram
tachypnea, respiratory distress, cyanosis, GI sign, fluid , injury or trauma

Question 5

What is pleural space/mediastinal mass?

Answer 5

Respiratory distress, compress intrathroacic structure, throacic wall mass

Question 6

What are the types of pleural effusion?

Answer 6

Pure transudate
modified transudate
Chylous Effusion
Hemorrhage
Exudate

Question 7

What are some diagnostics that help differentiate pleural effusion?

Answer 7

Diagnostic imaging - rad and ultrasound

Question 8

Define a Pure transudate:

Answer 8

Protein: <2.5 g/dl
Cells: <1500 cell/ul
Cytology: Macrophage, low neutrophil, lymphocyte and mesothelial
Color: Clear, light yellow, transparent
Causes: Increased venous pressure, lymphatic hypertension, low oncotic pressure

Question 9

Define modified transudate:

Answer 9

Protein: 2.5-7
Cells: 1000-7000
Cytology: Macrophage, neutrophil, low lymph and meso
Color: Clear, yellow, blood tinged
Causes: Increased venous or lymphatic pressure, inflammation or pleural vasculature

Question 10

Define Exudate:

Answer 10

Protein: >3
Cells: >7000
Cytology: Neutrophil mostly, low macs, few lymp
Color: Purulent, foul odor
Causes: Multiple, infectious

Question 11

Define Hemorrhage:

Answer 11

Protein: >2.5
Cells: Many RBC >0.1-1 mill
Cytology: RBC
Color: Red
Causes: Coagulopathy, bleed neoplasia, trauma

Question 12

Define Chylous:

Answer 12

Protein: >2.5
Cells: variable
Cytology: Small lymph, large, mac, neutro
Color: White, to pink, opaque
Causes: Triglyceride, cardiac disease, idiopathic, neoplasia, heartworm, cranial vena cava, thrombus

Question 13

What are some diagnostics for Effusion?

Answer 13

CBC, Chem, Thoracic rad, thoracocentesis

Question 14

How do you perform thoracocentesis?

Answer 14

7-8th intercostal, above costochondral junction

Cranial border rib

Question 15

What are differentials for chylothorax?

Answer 15

Idiopathic
neoplasia
crainial vena caval syndrome
heartworm
cardiac

Question 16

How do you treat chylothorax?

Answer 16

Medical
-thoracoentsis
-low fat
-rutin

Surgical
-ligate thoracic duct
pericardectomy
-ligate thoracic