Lecture 17 - Pleural space disease (specht) Flashcards
pleural space dz includes
fibrosis
pneumothorax
pleural effusion
patients with mild pleural effusion often have __ CS
NO
only dz in the chest that causes inspiratory distress
pleural effusion
dx test for pleural effusion
thoracocentesis
CXR
contraindication to thoracocentesis
coagulopathy
things to do with pleural effusion collected
always do cytology \+/- culture (aerobic, anaerobic) gram stain cholesterol/TG levels protein analysis; A:G, rivalta
low protein ( less than 3g/dl) and low cellularity (less than 1000/mcL); priamry cell types are mononuclear (macs, lymphos, mesothelial cells)
pure transudate
slightly higher protein contents (3.5g/dL) and cell counts (1000-5000/mcL); neutrophils may be present with mononuclear cells
modified transudate
causes of transudate/modified transudate
increased hydrostatic pressure
decreased oncotic pressure
neoplasia
diaphragmatic hernia
increased hydrostatic pressure can be caused by
RHF (dogs) R/LHF (cats)
pericardial dz
volume overload
decreased oncotic pressure is caused by
severe hypoalbuminemia (less than 1.5g/dL) ; rarely the cause of pleural effusion esp if no other cavital effusions present
higher protein contents (over 3g/dL) and/or cell count (over 5000/mcl)
exudate
variable cell types with macs, lymphos (activated or not) and NON degenerative neuts; no organisms are seen
non-septic exudate
extremely elevated cell counts (over 50k/mcl) with predominantly degenerative neuts. intra and/or extra cellular bacteria may be observed
septic exudate
septic exudate with grossly visible white chunks in it
sulfur granules; seen with nocardia or actinomyces. On cytology will see these filamentous bacteria
ddx for non-septic exudates
FIP (look for other CS like fever, chorioretinitis, ascites, very high globulins) neoplasia lung lobe torsion chronic diaphragmatic hernia resolving/tx septic exudate
extremely elevated globulins is highly suggestive of
FIP
TX for pyothorax
aggressive! chest tubes to establish drainage and ab asap. C&S.
+/- sx to find/remove cause (penetrating FB?)
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
chylous effusion
in chylous effusion __ is higher in effusion than in serum
triglyceride
in chylous effusion the predominant cell type is
lymphocytes
chylothorax ddx
often idiopathic trauma neoplasia cardiac dz HW torsion diaphragmatic hernia
usually grossly white and results from leakage of lymph from thoracic duct
tx of chylothorax
intermittent thoracocentesis rutin? (may work in people) sx correction (50/50)
prognosis for chylothorax
poor
moderate protein (over 3g/dl) and over 1000 nucleated cells/mcl with similar distribution of cells to peripheral blood
hemorrhagic effusion
always check PCV
hemothorax ddx
trauma
bleeding disorder
neoplasia
LL torsion
__ in case of hemothorax may increase risk of bleeding and remove vital blood cells from patient
thoracocentesis; avoid if possible and only do PRN
oxygen for patient with hemothorax isn’t as beneficial bc
O2 won’t help with hypoxia from anemia; need blood products to carry more O2
__ in thorax can result in any type of effusion
neoplasia
__ is the only tumor that readily exfoliates into effusions
lymphoma
inflammation can cause reactive __ to appear dysplastic
mesothelial cells
ddx for pneumothorax
sharp or blunt trauma
rupture of pulmonary lesions (bullae, tumors, paragonimus cysts)
idiopathic (husky dogs)
tx for pneumothorax
cage rest
thoracocentesis PRN
O2
find cause and treat it, exploratory thoracotomy prn
__ should be performed on all pleural exudates
aerobic and anaerobic culture and sensitivity
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
2ml/kg/d
neuts will still be present but should not appear degenerative
how long should ab therapy for pyothorax be continued after the chest tube is removed
8-12 weeks
2 weeks before and after d/c ab CXR should be taken
recent studies for prognosis with pyothorax that is treated
86% survival in dogs and cats; this is highly variable in studies and there is also no consensus about when sx should be performed
__ in cats can be palpated during compression of the cranial thorax (normally easily compressible in healthy cats)
mediastinal masses
