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9: Thorax > Chapter 105 Thoracic Cavity > Flashcards

Chapter 105 Thoracic Cavity Flashcards

1
Q

What is normal pleura fluid volume in dogs? and in cats?

A
  1. 1 ml/kg in dogs
  2. 3 ml/kg in cats
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2
Q

What side does the thoracic duct run on in dogs and cats? Where does it cross to contralateral side in dogs?

A

Runs along left in cats.

Runs along right in dogs, crossed to left at level of 5/6th vertebra.

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3
Q

Thoracic duct is drainage for most of body except what? Where does this region drain into instead?

A

Right thoracic limb, shoulder and cervical region drain into right lymphatic duct.

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4
Q

Where does the cisterna chyli live?

A

Dorsal to the aorta (and l in dogs), caudal to level of celiac and cranial mesenteric arteries, level with 1-4th lumbar vertebrae (usually 3rd in dogs)

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5
Q

Where does the thoracic duct terminate (i.e. drain into?)

A

L jugular or jugulosubclavian angle

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6
Q

Until what age does thymus keep growing?

A

4-5 months

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7
Q

What is seen histologically in a normal thymus (two features)

A
  • Small lymphocytes (same as those foudn elsewhere)
  • Spherical/oval corpuscles Hassall bodies (concentrically arranged cells with central degenerated cells)
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8
Q

What is the mean peak inspiratory and end expiratory pleural pressure in awake dogs?

A

Inspiratory -26 cm H2O

Expiratory -15 cm H2O

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9
Q

What is functional residual capacity?

A

FCR = volume of air remaining at end of normal exhilation (approx 45 ml/kg). Point at which forces of lung and chest wall are equal and opposite

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10
Q

What is the net movement of fluid across parietal and visceral pleura?

A

Overall, fluid moves out of parietal pleura, and in to visceral pleura

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11
Q

What is the main function of the thymus?

A

Maturation and selection of T-cells

(+ endocrine funtion suggested)

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12
Q

What are the TP, SG and TNCC (ug/L) values to classify an exudate, modified transudate and transudate?

List the 6 “clinically useful” classifications of pleural effusion (and 2 obscure ones)

A

Sanguineous, serosanguinous, inflammatory, chylous, transudate, neoplastic

Bilithorax and urothorax

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13
Q

how can CHF vs other feline pleural effusion be distinguished?

A

NT-proBNP in fluid >in cardiogenic effusion (1100 vs 100 pmol/L)

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14
Q

How is chylous effusion diagnosed (3 options)?

A
  • Effusion triglycerides > serum triglycerides and fffusion cholesterol < serum cholesterol (N.B. cholesterol effusion not related to lymphatics - usually due to chronic effusion in humans. Cholesterol effusion not reported in dogs/cats)
  • Presence of chylomicrons (stain with Sudan Black)
  • Positive ether clearance test
  • (on cyto lymphocytes usually predominate but may be taken over by degenerate neuts if chronic)
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15
Q

List 5 ddx for non-septic inflammatory pleural effusion

A
  • Hepatitis
  • Pancreatitis
  • Diaphragmatic hernia
  • FIP
  • LLT
  • Neoplasia
  • Chronic chylothorax
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16
Q

What is typical TP and SG values for FIP effusion?

A

TP 5-12 g/dL

SG >1.017

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17
Q
A
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18
Q

Up to what volume of air (pneumothorax) has been shown not to cause clinical signs in dogs

A

45 ml/kg

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19
Q

What are the lower volume limits for radiographic detection of pleural fluid indogs? and in cats?

A

100 ml in dogs and 50 ml in cats

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20
Q

List 3 radiographic features of pleural effusion

A
  • Pleural fissure lines
  • Retracion of lung borders from chest wall
  • Effacement of cardiac silhouette and diaphragm (loss of detail)
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21
Q

What % of CT guided FNAs, and of CT guided biopsies (of intrathoracic lesions) were diagnostic?

What is % of heamorrhage and % pneumothorax (n.b. most require no tx)

A

FNA 65%

Biopsy 83%

30% haemorrhage

27% pneumothorax

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22
Q

In ECVS exam style, what tests shoudl be run on effusion?

If suspect pancreatitis?

Differentiating transudate vs exudate in cats?

Differentiating transudate vs exudate in dogs?

A
  • Cytology
  • PCV
  • TP, SG, TNCC
  • Aureobic, anaerobic, fungal culture and susceptibiltiy
  • Triglycerides and cholesterol
  • Can run lipase and amylase if suspect panc.
  • Differentiating transudate vs exudate in cats? Effusion:serum TP ratio and effusion [lactate dehydrogenase]
  • Differentiating transudate vs exudate in dogs? [Effusion CRP]. (VEGF not useful for malignant vs non malignant)
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23
Q

At what level shoudl thoracostomy tube be inserted?

24
Q

What is recommended inspiratory:expiratory ratio during mechanical ventilation? why?

A

1:2 - 1:3, because mechanical ventilation –> increased pleural pressures (3-5 cm H2O) –> reduced venous return, pukmonary and coronary circulation.

25
Q

2 recommendations re securing thoracostomy tube, specific to finger trap suture

A

gapt between throws at leastas wide as tube, and at least 6 crossings.

(x-ray after if not placed surgically)

26
Q

what are recommended fluids levels for removal of thoracostomy tube?

A

previsouly 2 ml/kg/day

paper showed in dogs usually 3 ml/kg/day, cats 5 ml/kg/day

27
Q

list typical ‘dose; of intrapleural bupi and lidocaine and fentanyl CRIs

A

Intrapleural bupi 1.5mg/kg q6 hours

Fentanyl 1-5 mcg/kg/hr

Lidocaine 20-50 mcg/kg/min

28
Q

In animals undergoing thoracotomy, what was overall mortality rate? Loist 5 factors associated with non-survival

A

5.9% mortality

Pre-op oxygen requirement, use of NM blockade, surgical duration (>180m), blood product requirement (not ASA status)

29
Q

List 4 most common thoracic findings in bite wounds

A

Rib fractures > pneumothorax > contusions > pleural effusion

30
Q

In cats with high rise syndrome, what % have pneumthorax? and haemotorax?

A

20 - 60% pneumothorax, 10% haemothorax

31
Q

What 3 factors have been associated with non-survival in cats with thoracic trauma?

A

Flail chest, pleural effusion, diaphragmatic hernia

32
Q

Mortality rate for thoracic bite wounds?

33
Q

What are possible causes of spontaneous pneumothorax, in order of prevalence?

What breed over-represened for spontaneous pneumothorax?

A

Bullae/blebs/pulmonary emphysema (68% dogs) vs asthma in cats

Neoplasia (11% dogs, 14% cats)

pleuritis, migrating plant material, pulm abcessation, chronic pneumonia. heartworm.lungworm

Huskies over-represented

34
Q
  • In Howes 2020 JSAP, what was 2 and 5 year survival rate for dogs undergoing sx for spontaneous pneumothorax?
  • What was recurrence rate?
  • What were risk factors for recurrence (univariable)
  • In tobias, what was recurrence rate and mortality rate for medically managed dogs?
A

Howes:

  • 88% 2 year survival, 84% 5 year survival
  • 14% recurrence rate
  • Giant breed and increased BW risk factors

Tobias:

Recurrence rate 50%, mortality rate 53%

35
Q

List 5 ddx for underlying cause of chylothorax. What is most common cause?

A
  • Neoplasia (mediastinal masses)
  • Cardiomyopathy
  • Congenital abnormalities ( tetalogy, PPDH, tricuspid dysplasia, cor triatriatum dexter, DCRV, thoracic duct anomaly)
  • Cranial caval/jugular compression/thrombosis
  • Diaphragmatic hernia
  • Pericardial effusion
  • LLT
  • Trauma to thoracic duct
  • Heart worm
  • IDIOPATHIC MOST COMMON
36
Q

What dog breed and cat breed are predisposed to chylothorax?

A

Afghan hound and oriental cats

37
Q

Briefly outline pathophys of fibrosing pleuritis secondary to chylothorax

38
Q

Outline how to perform popliteal lymphangiography

39
Q

How is intestinal lymphagiography performed

A

Give oil/cream 3-4 hours pre-op.

Mesenteric lymphatic vessel or iliocolin LN.

Can use methylene blue to aid visualisation (max 0.5 mlkg)

40
Q

What is pathophysiological rationale behind pericardiectomy for chylothorax?

A

Decreases r heart and venous pressures –> eased flow + formation of lymphaticovenous anastomoses

41
Q

What are anatomical ventral and dorsal limits of thoracic duct ligation

A

Ventral limit = dorsal aorta

Dorsal limit = sympathetic trunk (i.e. can include azygous v if nec.)

42
Q
  • How long does it take for methylene blue colourisation to appear in the thoracic ducat after iliocolin LN injection?
  • How long does it persist for?
  • What are risks of methylene blue use?
A
  • 10 minutes to appear
  • Persists 60 mins
  • Complication of methylene = heinz body anaemia (oxidative) and renal damage.
43
Q

List 3 (broad) methods of thoracic duct ligation

A

Open sx liation

Thoracoscopic ligation

Cyanoacrylate embolisation (reported in 2 cases of recurrent chylothorax that already had TD ligation and pericardiectomy)

44
Q

List 5 possible sx interventions for chylothorax resolution

And options for ‘management’ of recurrent effusions

A

Initial sx

  • TD ligation
  • Pericardiectomy
  • Cisterna chyli ablation
  • Omentalisation
  • Pleurodesis (not proven useful in dogs)

Recurrent effusion management

  • Re-analyse fluid
  • Repeat lymphangiography
  • Try above options not done at initial sx
  • Per-cutaneous drainage (Pleural port)
  • Pleural-peritoneal drainage (owner pump operated 1 way valve = active shunt, or mesh in diaphargmatic defect = passive shunt)
45
Q

What medication can be given for chylothorax (unproved). What is proposed MoA?

A

Rutin 50-100mg po tid.

MoA: decreased lymphatic leakage, increased protein removal, increased macrophage phagocytosis, increased macrophage numbers, increased proteolysis

46
Q

What is resolution rate of chylothorax following TD ligation + subtotal pericardiectomy in dogs? and cats?

A

Dogs 55-100%

Cats 80%

(sl lower if just TD ligation + cisterna chyli)

47
Q

What two bacteria are associated with sulphur granules?

How do they look on cytology?

A

Actinomyces or Nocardia

Gram positive, acid fast, filamentous rods

48
Q

What proportion of dogs have polymicrobial pyothorax?

and cats

A

60% dogs

89% cats

49
Q

What was survivaly to discharge % in dogs with pyothorax who underwent

Thoracocentesis only

Thoracostomy (+- lavage)

Surgery

A

Thoracocentesis only: 29%

Thoracostomy (+- lavage): 77%

Surgery: 92%

50
Q

What is most common thymic mass in dogs?

And cats?

A

Dogs thymoma

Cats lymphoma

51
Q

How can thymoma be distinguished from lymphome following FNA

A

Flow cytometry. If >10% of lymohocytes have dual expression of CD4 and CD8 is consistent with thymoma

52
Q

List 2 paraneoplastic syndromes with thymoma

A

Myasthenia gravis

Hypercalcaemia

Also: polymyositis, myocarditis, feline exfoliative dermatitis,

53
Q

What proportion of dogs with thymoma have myasthenia gravis?

54
Q

How is myasthenia gravis diagnosed

A

acetylcholine–receptor antibody titre

Tensilon test (endrophonium chloride - risk parasymathetic ‘crisis’ have atropine on hand)

55
Q

What is MST following thymoma excision in dogs?

And cats?

What factors have been negatively associated with survival?

A

Dogs: 2 years

Cats: 6 years

Higher grade (3), tumour elsewhere, megaoesophagus and concurrent pneumonia

56
Q

List methods for performing lymphangiography for chylothorax

A

Contrast injection into:

  • Popliteal LN
  • SC metetarsal region (Kim VetSurg 2020)
  • Mesenteric LN (or lacteal vessel) (intra-op or US guided pre-op)
  • Rectal/vaginal mucosa or perianal SC tissues

Intra-op can also inject NMB to aid visualisation (or indocyanine green + near infra-red flouresence (Steffey VetSurg 2018)

9: Thorax (2 decks)

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