Diseases of the pleural space and chest wall Flashcards
What is the pleural cavity?
The pleural cavity is a potential
compartment separating the
chest wall, lungs, diaphragm and
mediastinum
Name 5 initial treatments for a patient with dyspnoea
- Oxygen therapy
- IV access
- Pain relief
- Butorphanol
- Thoratocentesis
What are the three sites for a TFAST ultrasound?
- Chest Tube Site 7th – 9th intercostal space on
dorsolateral thoracic wall - Pericardial site 5th – 6th intercostal space on
ventrolateral thoracic wall - Diaphragmatic view- just behind the xiphoid process with the probe directed cranially
What are the indications for thoracocentesis?
Used to remove fluid or air from pleural space.
* Can be diagnostic or therapeutic
What are the differentials for pneumothorax?
- Trauma or spontaneous
- Open, Closed, Tension
What are the differentials for haemothorax?
- Trauma
- Coagulopathy
- Neoplasia
What are the differentials for chylothorax?
- Idiopathic
- Trauma
- Congestive heart failure
What are the differentials for pyothorax?
- Foreign body
- Penetrating trauma
- Secondary to pneumonia
Name two space-occupying lesions that are differentials for pleural space disease
- Diaphragmatic hernia
- Neoplasia
What is pneumothorax?
Air in the pleural space
(usually originates from the oesophagus)
How might you treat pneumothorax?
Thoracocentesis / Thoracotomy tube.
* Pain medication / sedation.
* Oxygen therapy.
* Antibiotics if penetrating trauma.
* Radiographs to confirm resolution
What surgery would you use to treat thoratocentesis?
Prognosis for conservative management of closed: guarded.
* Thoracotomy following CT to confirm location lesions
What are the three types of pneumothorax?
- Closed
- Open
- Tension
What is haemothorax?
Blood in the pleural space
What are the main causes of haemothorax?
- Trauma
- Coagulopathy
- Neoplasia
What further diagnostics would you need for haemothorax?
Need to identify underlying cause as will affect prognosis.
* Biochemistry / haematology.
* Coagulation testing.
* Look for signs bleeding elsewhere like petechiae
How would you treat haemothorax?
Treat hypothermia / hypovolaemia.
* Blood transfusion?
* Pain relief.
* Treat underlying cause
What is chylothorax?
- Milky effusion.
- Fat droplets, lymphocytes, neutrophils.
- Cholesterol similar to serum levels.
- Triglyceride higher than serum levels
What are the causes of chylothorax?
Idiopathic.
* Damage to thoracic duct – traumatic rupture, obstruction.
* Lung lobe torsion, mediastinal masses.
* Heart disease.
* Diaphragmatic rupture
What breeds are over-represented in terms of chylothorax?
Siamese, Himalayan cats and Afghan hounds overrepresented
How would you treat chylothorax?
Thoracocentesis.
* Often idiopathic but can treat underlying cause.
* Low fat diet?
* Surgical duct ligation
What are the main causes of pyothorax?
Foreign body (grass seed, penetrating wound).
* Bite wound (cats).
* Pneumonia (uncommon)
How would you diagnose pyothorax?
Appearance and smell!
* Degenerate neutrophils and intracellular bacteria
How might you treat pyothorax?
Thoracic drainage (thoracostomy tube) and lavage.
* Surgical FB removal.
* Antibiotics.
* Long and expensive.
* Prognosis Guarded
What are the indications for a thoracostomy tube?
Frequent drainage chest required.
* Medical management of pyothorax.
* Following thoracic surgery
What are the main management practices for a thoracostomy tube?
- Constant monitoring
- Drain every 4 hours for 24-48 hours then 2-3 times daily
- Use a thoracic lavage with 0.9% sodium chloride or Hartmanns solution
- Change dressing and check connectors daily
- if it appears non-functional will need to flush
- remove once fluid production = 2-4ml/ kg a day
- cover sterile dressing once removed
What is a diaphragmatic hernia?
Displacement of organs into the thoracic cavity
Empty appearance in the abdomeb
Intestinal content in the thorax
What are the clinical signs of a diaphragmatic hernia?
- Dyspnoea
- Muffled heart and lung sounds
- Intestinal sounds in teh chest
- ‘empty abdomen’ abnormal on palpation
How might you treat a diaphragmatic hernia?
- Stabilise the patient
- Surgery- Abdominal approach, Will need IPPV, must drain pneumothorax
What are the differentials for chest wall injury?
- Trauma
- Flail chest
- Open pneumothorax
- Penetrating trauma
- Bite wounds
What is flail chest?
Free moving section of chest wall secondary to consecutive rib fractures
What are the clinical signs of flail chest?
Tachypnoea, dyspnoea
* Thoracic pain
* Paradoxical movement of flail segment
* Subcutaneous emphysema
How would you treat flail chest?
Emergency stabilisation
* Chest bandage
* Aggressive pain management
* Surgical stabilisation
What are the potential complications of a dog bite?
- Crushing of thorax
- Rib fractures
- Lung laceration
- Intercostal muscle avulsion
- Bacterial innoculation into wound
How might you stabilise a dog post bite?
Start antimicrobials early.
* Protective dressing until definitive treatment.
* TFAST to ensure no pleural effusion/pneumothorax.
* Radiography to assess for fractures.
How might you treat a dog post dog bite?
Surgical exploration.
* Flush wound for culture and sensitivity.
* Pain relief.
* May require thoracic drainage
