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SAM > Diseases of the lungs and thorax > Flashcards

Diseases of the lungs and thorax Flashcards

1
Q

UL of the thorax:

  • indications (favourable situations)
A
  • pleural fluid
  • superficial localization
  • Not contact with lungs
  • contact with the thoracic wall
  • contact with the diaphragm
  • contact with the heart
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2
Q

UL of the thorax

  • unfavourable situations
A
  • deep localization
  • lung artifact
  • rib artifact
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3
Q

History and clinical sign of the mediastial disease

A
  • History
  • trauma, foreig body ingestion, invasive diagnostic/therapeutic procedures (trachea, esophagus, cervical region)
  • Clinical signs:
  • dysphagia, regurgitation, cough, Horner´s syndrome
  • Physical examination:
  • poor compressibility of the cranial thorax
  • peripheral lymphadeopathy, PU/PD, weight loss
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4
Q

Diagnostic evaluation of the mediastinum

A
  • not easily accessible (location)
  • Survey radiography: LL and DV/VD
  • normal is difficult to evaluate (lack of contrasting tissue densities)
  • increased size (fat, inflammation, hemorrhage, edema, thymoma)
  • pneumomediastinum (visualization of aorta, esophagus)
  • UL
  • Mediastinal masses (thymoma), FNA
  • CT:
  • most detailed analysis
  • but: anaesthesia, mass or collpased lung lobe?
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5
Q

Diseases of the mediuastinum

A
  • mediastinitis
  • mediastinal neoplasia
  • pneumomediastinum
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6
Q

Mediastinitis

  • Causes, clinical signs
A
  • Acute, chronic: underlying disease
  • Causes:
  • tracheal-, esophageal perforation
  • infection (pleural space, lung, pericardium)
  • Clinical signs:
  • Head and neck edema, tachypnea (pain), dyspnea, cough, regurgitation, fever, voice change (recurrent laryngeal nerve)
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7
Q

Mediastinitis

  • diagnosis, treatment
A
  • Physical examination: decreased lung sounds
  • Radiography:
  • Focal or diffuse widening, PTX, pneumomediastinum, pleural effusion
  • Treatment:
  • antibiotics
  • perforation of trachea, esophagus
  • surgical resection of mediastinal masses
  • pyothrax (thoracostomy tube placement)
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8
Q

Mediastinal neoplasia

  • origin, clinical signs, physical examination
A
  • origin:
  • lumphoma, thyoma, chemodectoma, esophagus, trachea
  • Clinical signs:
  • Tachypnea,
  • neck-, head-, forelimb edema
  • regurgitation, PU/PD, Horners syndrome
  • Physical examination:
  • dislocation of the heart, compressibility of the cranial thorax decreases (cats)
  • dyspnea (mass, pleural effusion)
  • dull areas on percussion of chest
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9
Q

Disorders of the pleural cavity and mediastinum

  • sign, diagnosis
A

Pleural or mediastinal mass (neoplasm, abscess, lymph node)

  • Signs:
  • +/- edema of the forelimbs (if the vena cava is compressed)
  • +/- thoracal wall thickening (osteoma or osteosarcoma from the thoracic wall)
  • asymetric breathing movements and sound or circumscribed dullness
  • cardiac dislocation
  • cat: thorax is not to be compressed!
  • Diagnosis:
  • Radiography
  • thoracal ultrsonography
  • puncture or biopsy
  • Blood count, punctate cytology or histology of biopsy sample
  • diagnostic thoracotomy, thoracoscopy)
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10
Q

Symptoms of Unilateral mesothelioma in dog

A
  • asymetric thorax
  • The respiratoric movements wew asymatric as well
  • in addition, unilateral dullness was detected by thoracic percussion
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11
Q

what can cause Pneumomediastinum

A

Pneumomediastinum: presence of air within the mediastinum

  • secondary to:
  • Trauma of the neck, subcutaneous emphysema
  • rupture of the airways (bronchitis, pneumonia, transtracheal aspiration, tracheostomy, trauma)
  • Esophageal rupture
  • Normal communication:
  • between the neck, mediastinum retroperitoneal region of the abdomen
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12
Q

Pneumomediastinum

  • clinical signs, what do you see on x-ray, treatment
A
  • Clinical signs:
  • Tachypnea, dyspnea (PTX),
  • regurgitation (esophageal rupture),
  • emphysema of the neck
  • Radiography:
  • air within ght neck region and within the mediastinum
  • Pneumomediastinum, PTX, pneumoperitoneum
  • Treatment:
  • Sponteneous recovery
  • PTX (chest tubing?)
  • Underlying disease (esophageal, tracheal rupture)
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13
Q

Diseases of the pleural space

A
  • pleural effusion
  • pleural mass
  • pneumothorax
  • diaphragmatic hernia
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14
Q

Diagnostic aspects and clinical sign of pleural effusion (PE)

A
  • Clinical signs and physical examination:
  • inspiratory type dyspnea with delayed expiration
    • either pleural disorder or stenosis cranial from the thoracic inlet (laryngeal paralysis, bronchial collapse etc.)
  • tachypnoe, open mouth breahing, cyanosis
  • percussion: horizontal dullness (ALWAYS in case of fluid), Diernhofer-traingle will disappear
  • Auscultation: bronchial sounds above and zero sound under the fluid
  • thoracocentesis:
  • cytology, culture, biochemistry, blood count
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15
Q

Pleural effusion

  • types of fluid that can be found
A

Transudate (true), modified transudate, exudate (protein, cell count)

  • Hydrothorax:
  • hypoalbuminemia
  • congestive heart failure: mainly in cats
  • diaphragmatic hernia, portal hypertension
  • Pyothorax:
  • FIP, pleuritis exsudativa
  • Chylothorax
  • Hemothorax:
  • coagulopathy; dicumarol poisoning, hemophilia
  • trauma
  • thoracic neoplasm (haemangiosarcoma), thymus apoplexia (dog)
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16
Q

Pyothorax/pleuritis

  • caused by
A
  • obligate anaerobes, Actinomyces, Nocardia spp.
  • Penetrating thoracic wounds, migratory foreign material (grass awns), hematogenous metastasis (lung
17
Q

Pyothorax/pleuritis

  • diagnosis, therapy
A
  • Dignosis: cytology, culture
  • Therapy:
  • thoracocentesis, chest tubing, thoracic lavage
  • antiobiotics (in case om culture correction), analgetics
  • surgery (lobectomy, foreign body?)
  • NEVER give Ab before doing pleurocyntesis
18
Q

Exudative pleuritis

  • etiology
A
  • Anaerobe bacteria: e.g Actinomyces
  • Nocardia asteroides spp. canis:
  • both in dogs and cats, mainly via skin injuries (rarely aerogenic or enteral infection), reddish-brown, turbulent grits-like exudate; honey (peritonitis can also occur)
  • Thoracic traumas, wandering foreign bodies, esophageal perforation, haematogenous spread
  • FIP:
  • in cats, (honey-(resin-)like, viscous exudate (++ fibrinogen and glubulin)
  • more commonly peritonitis, or can be in body cavities
19
Q

Exudative pleuritis

  • diagnosis, treatment
A
  • diagnosis:
  • Total protein (FIP: > 35 G/l, globulin > 50%
  • FIT test (questionable result)
  • cytology, bacterial culture
  • Treatment:
  • thoracocentesis, drainage, lavage
  • antibacterial drugs, analgesic
  • surgery (lobectomy, removal of foreign body)
20
Q

Chylothorax

  • causes, diagnosis, therapy
A

Lymphatic vessels –> thoracic duct –> cranial venaa cava

  • causes:
  • decreased lymphatic drainage
  • diagnosis:
  • thoracocentesis, cytology,
  • truglyceride fluid: pleural fluid > blood plasma; lymphangiography (contrast into the spleen or ln. nodes, mostly used before surgery)
  • therapy:
  • thoracocentesis, underlying cause, low-fat dieet, surgery
21
Q

Reasons for chylothorax

A
  • congenital:
  • congential weakenss of the lymphatic vessels (lymphangiectasia)
  • idiopathic
  • non-traumatic (disturbed lymphatic drainage)
  • right sided cardiac failure
  • compression of the thoracic duct: tumor, inflammatory adhesion
22
Q

Classifications of Pneumothorax

A

Air accumulation on the pleural spcae (pneumomediastinum)

  • Classification:
  • Traumatic PTX - most common:
    • blunt trauma, penetrating injuries
  • Spontaneous PTX
    • Idiopathic: large, deep-chested dogs (huskies!)
    • Secondary rupture of airways (bullae?, inflammation?)
  • Simple/complicated/tensioned
  • Open/closed
23
Q

Pneumothorax

  • clinical signs
A
  • acute inspiratory dyspnea
  • cyanosis
  • decreased lung and heart sounds
  • decreased respiratory sounds
  • increased resonance
  • underlying disease (wounds, rib fractures, coughing)
  • high tympanic sounds in percussion!
24
Q

Pneumothorax

  • diagnosis, treatment
A
  • Diagnosis
  • thoracocentesis
  • Radiography is obligatory!
    • 3 typical findings on x-rays: Heart elevevated from the sternum. The respiratory organs can be seen very obvious due to the contrast effect of the air. Compression on the lung
  • treatment:
  • thoracocentesis/chest tubing
  • cage rest, oxygen
  • surgery (open chest wound, airway leaking)
  • control radiography
25
Q

Pneumothorax

  • radiographic differential diagnosis
A
  • “microcardia” due to dehydration: Addison disease, parvovirus enteritis
  • Improper recumbency positioning during laterolateral radiography
26
Q

Pneumothorax

  • treatment in case of simple/complicated, tension, open/closed, trauma/spontaneous
A
  • Simple: thoracocentesis +/-
  • Complicated: repeated accumulation of air –> thoracic drainage catheter
  • Tension: rapid decline in cardiopulmonary status and death if not recognized and treated immediatly!
  • tear in the lung or chest wall that creates a flap valve
  • Open/closed
  • Trauma/spontaneous: PTX (ruptured emphysema, neoplasia, abscess esophageal tears/foreign bodies, heartworm)
27
Q

Causes of Traumatic pneumothorax

A
  • pneumothorax (open/closed/tension)
  • rib fracture
  • airway obstruction
  • pulmonary contusion/hemothorax/cardiac temponade/diaphragmatic hernia
  • hypovolemic shock
28
Q

Treatment of open chest wound in PTX

A
  1. close the wound as quick as possible
  2. thoracocentesis/thoracostomy tube
  3. antibiotics
  4. if the patient is stable, the open chest wound can be surgically explored, lavaged and definitively corrected
  5. radiographs after stabilisation
29
Q

Classifications of Diaphragmatic hernia

A

Abdominal contents enter the thoracic cavity

  • Classification
  • Pleuroperitoneal (can be congenital( / Peritoneopericardial (PPDH)
  • Traumatic > congential (PPDHH > hiatal hernia)
30
Q

Diaphragmatic hernia

  • clinical signs
A
  • mixed or insiratory type dyspnea
  • shock, stomack distension
  • dullness, asymmetric rspiratory noises
  • cyanosis, arrythmia
  • Not possible to diagnose based on physical examination, you need x-ray!
31
Q

Diaphragmatic hernia

  • diagnosis. treatment
A
  • Diagnosis:
  • radiography, UL
  • Barium sukphate given before x-ray
  • Cave!
    • thoracocentesis: can be blood-tinged fluid (need UL so you dont puncture the liver!)
  • treatment:
  • surgery!

SAM (6 decks)

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