Lecture 17 - Pleural space disease (specht)

Question 1

pleural space dz includes

Answer 1

fibrosis
pneumothorax
pleural effusion

Question 2

patients with mild pleural effusion often have __ CS

Answer 2

NO

Question 3

only dz in the chest that causes inspiratory distress

Answer 3

pleural effusion

Question 4

dx test for pleural effusion

Answer 4

thoracocentesis

CXR

Question 5

contraindication to thoracocentesis

Answer 5

coagulopathy

Question 6

things to do with pleural effusion collected

Answer 6

always do cytology 
\+/- culture (aerobic, anaerobic) 
gram stain 
cholesterol/TG levels
protein analysis; A:G, rivalta

Question 7

low protein ( less than 3g/dl) and low cellularity (less than 1000/mcL); priamry cell types are mononuclear (macs, lymphos, mesothelial cells)

Answer 7

pure transudate

Question 8

slightly higher protein contents (3.5g/dL) and cell counts (1000-5000/mcL); neutrophils may be present with mononuclear cells

Answer 8

modified transudate

Question 9

causes of transudate/modified transudate

Answer 9

increased hydrostatic pressure
decreased oncotic pressure
neoplasia
diaphragmatic hernia

Question 10

increased hydrostatic pressure can be caused by

Answer 10

RHF (dogs) R/LHF (cats)
pericardial dz
volume overload

Question 11

decreased oncotic pressure is caused by

Answer 11

severe hypoalbuminemia (less than 1.5g/dL) ; rarely the cause of pleural effusion esp if no other cavital effusions present

Question 12

higher protein contents (over 3g/dL) and/or cell count (over 5000/mcl)

Answer 12

exudate

Question 13

variable cell types with macs, lymphos (activated or not) and NON degenerative neuts; no organisms are seen

Answer 13

non-septic exudate

Question 14

extremely elevated cell counts (over 50k/mcl) with predominantly degenerative neuts. intra and/or extra cellular bacteria may be observed

Answer 14

septic exudate

Question 15

septic exudate with grossly visible white chunks in it

Answer 15

sulfur granules; seen with nocardia or actinomyces. On cytology will see these filamentous bacteria

Question 16

ddx for non-septic exudates

Answer 16

FIP (look for other CS like fever, chorioretinitis, ascites, very high globulins) 
neoplasia 
lung lobe torsion 
chronic diaphragmatic hernia 
resolving/tx septic exudate

Question 17

extremely elevated globulins is highly suggestive of

Answer 17

FIP

Question 18

TX for pyothorax

Answer 18

aggressive! chest tubes to establish drainage and ab asap. C&S.
+/- sx to find/remove cause (penetrating FB?)

Question 19

moderate protein content (over 2.5g/dl) with variable cell count (400-10000/mcl) with predominant cells being lymphocytes (acute) or non-degenerative neuts and macs (chronic cases) and high TG level

Answer 19

chylous effusion

Question 20

in chylous effusion __ is higher in effusion than in serum

Answer 20

triglyceride

Question 21

in chylous effusion the predominant cell type is

Answer 21

lymphocytes

Question 22

chylothorax ddx

Answer 22

often idiopathic 
trauma 
neoplasia 
cardiac dz 
HW 
torsion
diaphragmatic hernia 

usually grossly white and results from leakage of lymph from thoracic duct

Question 23

tx of chylothorax

Answer 23

intermittent thoracocentesis 
rutin? (may work in people) 
sx correction (50/50)

Question 24

prognosis for chylothorax

Answer 24

poor

Question 25

moderate protein (over 3g/dl) and over 1000 nucleated cells/mcl with similar distribution of cells to peripheral blood

Answer 25

hemorrhagic effusion

always check PCV

Question 26

hemothorax ddx

Answer 26

trauma
bleeding disorder
neoplasia
LL torsion

Question 27

__ in case of hemothorax may increase risk of bleeding and remove vital blood cells from patient

Answer 27

thoracocentesis; avoid if possible and only do PRN

Question 28

oxygen for patient with hemothorax isn’t as beneficial bc

Answer 28

O2 won’t help with hypoxia from anemia; need blood products to carry more O2

Question 29

__ in thorax can result in any type of effusion

Answer 29

neoplasia

Question 30

__ is the only tumor that readily exfoliates into effusions

Answer 30

lymphoma

Question 31

inflammation can cause reactive __ to appear dysplastic

Answer 31

mesothelial cells

Question 32

ddx for pneumothorax

Answer 32

sharp or blunt trauma
rupture of pulmonary lesions (bullae, tumors, paragonimus cysts)
idiopathic (husky dogs)

Question 33

tx for pneumothorax

Answer 33

cage rest
thoracocentesis PRN
O2
find cause and treat it, exploratory thoracotomy prn

Question 34

__ should be performed on all pleural exudates

Answer 34

aerobic and anaerobic culture and sensitivity

Question 35

chest tubes for pyothorax should be left in place until volume of fluid recovered is less than __ and the fluid is no longer suppurative/septic

Answer 35

2ml/kg/d

neuts will still be present but should not appear degenerative

Question 36

how long should ab therapy for pyothorax be continued after the chest tube is removed

Answer 36

8-12 weeks

2 weeks before and after d/c ab CXR should be taken

Question 37

recent studies for prognosis with pyothorax that is treated

Answer 37

86% survival in dogs and cats; this is highly variable in studies and there is also no consensus about when sx should be performed

Question 38

__ in cats can be palpated during compression of the cranial thorax (normally easily compressible in healthy cats)

Answer 38

mediastinal masses