pleural disease

Question 1

what pleural space disease is found in equids?

Answer 1

equine pleuropneumonia

Question 2

what is equine pleuropneumonia?

Answer 2

mixed bacterial infection with pharyngeal commensals and inhaled pathogens

Question 3

what can put a horse at risk of developing pleuropneumonia?

Answer 3

transport over long distances with head tied up

Question 4

what is the normal distribution of equine pleuropneumonia?

Answer 4

cranioventral

Question 5

what are the signs of acute initial equine pleuropneumonia?

Answer 5

pyrexia
lethargy
nasal discharge
shallow breathing
guarded cough
painful
stilted gait
pleurodynia (sharp pain in the side from inflammation of fibrous tissue)

Question 6

what are the signs of late acute equine pleuropneumonia?

Answer 6

nostril flare
tachycardia
increased jugular pulse height
toxic mm
guarded soft moist cough
foetid nasal discharge

Question 7

what are the signs of chronic equine pleuropneumonia?

Answer 7

intermittent fever
weight loss
ventral and limb oedema
reduced appetite

Question 8

How can you diagnose equine pleuropneumonia?

Answer 8

• absent airway sounds ventrally
• fluid in trachea
• US to see fluid, lung abscess and lung consolidation
• RADS - see consolidation, abscess, pneumothorax

Question 9

how can you treat equine pleuropneumonia?

Answer 9

remove fluid - thoracocentesis
culture and sensitivity on fluid obtained 
abx. NSAIDS , opioid
supportive oxygen, IVFT, bronchodilators
drain abscesses if chronic

Question 10

what is the prognosis for equine pleuropneumonia?

Answer 10

mild cases can recover and return to previous career

severe cases can be salvaged for breeding

Question 11

what are some possible complications of equine pleuropneumonia?

Answer 11

pulmonary abscess
pleural adhesion
bronchopleural fistula
constrictive pericarditis
thrombophlebitis
laminitis
diarrhoea

Question 12

what is a pyothorax?

Answer 12

pus in thorax

• septic or non-septic
• exudate

Question 13

what can cause a SA pyothorax?

Answer 13

penetrating injury
migrating FB
FIP
hyperglobinaemia

Question 14

what are the signs associated with small animal pleural disease?

Answer 14

dyspnoea
dullness on auscultation
muffled heart sounds

Question 15

how do you diagnose an exudate?

Answer 15

cells > 50x10^9/l
mainly neutrophils (degenerate or toxic)
protein >30g/l

Question 16

how can you treat a small animal pyothorax?

Answer 16

1) thoracocentesis and systemic abx but not likely to penetrate
2) indwelling drain and flush and drain for 5-7d breaking down infective material so systemic abx (4-6w)have more chance of penetration
3) exploratory thoracotomy and debridement/removal of FB if no resolution with other methods

Question 17

how does a chylothorax form?

Answer 17

failure of inestinal lymph to drain normally via the thoracic duct into venous circulation - the lymph accumulates in the pleural space as cant be drained

Question 18

what can cause a chylothorax?.

Answer 18

neoplasia
heart failure
idiopathic

Question 19

how do you diagnose chyle?

Answer 19

cell 1-5x10^9/l
protein 25-40 g/l
main cell is lymphocyte
appears milky with triglyceride conc higher than plasma

Question 20

how can you treat a chylothorax?

Answer 20

• medically - low fat diet, Rutin (enhance fluid resorption), supplement with medium chain triglycerides as they are absorbed via capillaries not lymph
• diuresis to reduce rate of formation
• surgically - ligate branches of thoracic duct and/or providing an alternative route for drainage of pleural fluid
• pleurodesis - induce an inflammatory reaction in pleural space so get adhesions and destroy the pleural space - a salvage procedure

Question 21

what can cause a pneumothorax?

Answer 21

trauma
lung injury
chronic resp disease
spontaneous

Question 22

how do you diagnose a pneumothorax?

Answer 22

thoracocentesis and get air

Question 23

how do you treat a pneumothorax?

Answer 23

• if small volume then rest for a few days and see
• enough to cause resp distress then drain and rest
• large volume or obvious lung lesions then surgical exploration and site of leak corrected

Question 24

what can cause a hydrothorax?

Answer 24

hypoproteinaemia causing reduced oncotic pressure

Question 25

what fluid would you expect to see with a hydrothorax?

Answer 25

transudate

Question 26

how do you diagnose a transudate?

Answer 26

very few nucleated cells - 0.5-1x10^9/l
5-10g/l of protein
appears watery

Question 27

what is a haemothorax?

Answer 27

haemorrhage into pleural space from systemic bleeding, trauma, local disease

Question 28

how do you diagnose a haemothorax?

Answer 28

blood on thoracocentesis

• cell count and PCV similar to whole blood
• protein 40-60 g/l

Question 29

what can cause a small animal modified transudate?

Answer 29

increased venous pressure obstructing drainage

-HF, neoplasia, diaphragmatic rupture

Question 30

how do you diagnose a modified transudate?

Answer 30

cell 1-5x10^9/l
mixed cell pop’n - neutrophils, macrophages, mesothelial cells
protein 25-40 g/l

Question 31

what signs are consistent with FIP?

Answer 31

pyothorax (effusion of pericardium and peritoneum too)
tachypnoea
icteric sclera
non-regenerative anaemia
neutrophilia
lymphopenia
hypoalbuminaemia
pyrexic
wt loss

Question 32

how can you diagnose FIP?

Answer 32

Post mortem

Question 33

what is the pathophysiology of FIP?

Answer 33

• feline coronaviurs and in a small number of cases becomes FIP either due to a virus mutation of abnormality in the immune response
• get chemotatic substances from infected macrophages – endothelial cell retraction – increased vascular permeability – exudation of plasma protein

non-septic fibrinous and protein rich fluids