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Respiratory Pathophysiology > Disease of the Pleura and Mediastinum > Flashcards

Disease of the Pleura and Mediastinum Flashcards

1
Q

what are the pleural membranes and what is within them?

A

single layer mesothelial cells
fat, elastin, lymphatics, vessels

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2
Q

what is in the mediastinum?

A

thymus
lymph nodes
esophagus
large thoracic vessels
heart

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3
Q

what species has a complete mediastinum and what is it?

A

humans, ruminants, swine
thick fascia completely separates the two pleural cavities

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4
Q

what species has a fenestrated or incomplete mediastinum and what is it?

A

horses
very thin fascia that can be easily ruptured by changes in intra-thoracic pressure

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5
Q

what are some causes of pleural effusion?

A

increased hydrostatic pressure in the microvascular circulation
decreased oncotic pressure
changes in microvascular permeability
impaired lymphatic drainage

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6
Q

what caused pleural transudate?

A

imbalance in hydrostatic and oncotic pressures

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7
Q

what causes pleural exudation?

A

pleural inflammation and impaired lymphatic drainage of protein and fluid

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8
Q

what are the non-inflammatory pleural effusions?

A

hydrothorax
hemothorax
chylothorax

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9
Q

what are the inflammatory pleural effusions?

A

serous or serofibrinous pleuritis
pyothorax or empyema
hemorrhagic pleuritis

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10
Q

when is a hemothorax usually seen?

A

thoracic trauma or surgery
can occur with coagulation defect
erosion vascular wall due to neoplasia or aneurysm

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11
Q

when is chylothorax seen?

A

traumatic or surgical duct rupture
less commonly neoplasia with thoracic duct obstruction, dilation, rupture
idiopathic in some, especially afgans and borzois

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12
Q

what do serous or serofibrinous pleuritis describe?

A

progressively more inflammatory exudates with accumulation of protein, inflammatory cells, and finally fibrin within pleural fluid

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13
Q

when does a pyothorax most commonly occur in companion animals?

A

penetrating foreign bodies or bite wounds

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14
Q

when does a pyothorax occur in a horse?

A

complication primary pneumonia or pulmonary abscess

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15
Q

what bacteria most commonly causes pleuropneumonia in horses?

A

Streptococcus equi subspecies zooepidemicus

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16
Q

what is pleuropneumonia from?

A

devastating complication of pneumonia or pulmonary abscesses

17
Q

what are some risk factors of pleuropneumonia in horses?

A

long distance transportation
prior viral respiratory infection
exercise

18
Q

what are the clinical signs of a pneumothorax?

A

pain
dyspnea

19
Q

what is a flail chest?

A

2 rib fractures causing unstable segment of thoracic wall
moves in when breathe in and out when breathe out

20
Q

what are primary pleural tumors?

A

mesotheliomas arising for either visceral or parietal pleura
mesenchymal or epithelial

21
Q

what does pleural effusion cause?

A

restrictive disease pattern
V/Q inequality
reduced lung volumes
atelectatic lobes

22
Q

how do you tap a chest so that you do not cause a pneumothorax?

A

offset skin stab incision and site of parietal pleura

23
Q

is mediastinal disease usually primary?

A

no
usually sequela of systemic, thoracic, or cervical disorders

24
Q

what are some common entities of mediastinal space-occupying masses?

A

lipoma
abscesses
lymphoma
granuloma

25
Q

why can a pneumomediastinum lead to subcutaneous emphysema?

A

mediastinal space potentially communicates with the subcutaneous space via fascial planes

26
Q

what is commonly associated with a hydrothorax?

A

cardiac disease
decreased oncotic pressure

27
Q

what is commonly associated with a hemothorax?

A

trauma
rupture of large vessels

28
Q

what is commonly associated with hemorrhagic pleuritis?

A

penetrating foreign body
neoplasia

29
Q

what might non-fatal leakage of a smaller volume of blood in a hemothorax lead to?

A

development of pleural adhesions

30
Q

what clinical signs are associated with pyothorax?

A

pain
dyspnea
respiratory distress
fever
signs of systemic infection

31
Q

what is fibrinous pleuritis?

A

inflammation and thickening of the pleural membranes without effusion

32
Q

what should be performed when pleural fluid volume increases?

A

culture and cytologic examination for neoplastic cells

33
Q

when can a pneumomediastinum occur?

A

gas migration from deep neck wounds
esophageal or tracheal rupture
sequela of transtracheal aspirate
bronchial rupture

34
Q

what are sequelae of pneumomediastinum?

A

generalized subcutaneous emphysema
accumulation of air along aorta or in retroperitoneal space

35
Q

can a pneumothorax progress to a pneumomediastinum?

A

unlikely

Respiratory Pathophysiology (22 decks)

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