pleural disease Flashcards
what pleural space disease is found in equids?
equine pleuropneumonia
what is equine pleuropneumonia?
mixed bacterial infection with pharyngeal commensals and inhaled pathogens
what can put a horse at risk of developing pleuropneumonia?
transport over long distances with head tied up
what is the normal distribution of equine pleuropneumonia?
cranioventral
what are the signs of acute initial equine pleuropneumonia?
pyrexia lethargy nasal discharge shallow breathing guarded cough painful stilted gait pleurodynia (sharp pain in the side from inflammation of fibrous tissue)
what are the signs of late acute equine pleuropneumonia?
nostril flare tachycardia increased jugular pulse height toxic mm guarded soft moist cough foetid nasal discharge
what are the signs of chronic equine pleuropneumonia?
intermittent fever
weight loss
ventral and limb oedema
reduced appetite
How can you diagnose equine pleuropneumonia?
- absent airway sounds ventrally
- fluid in trachea
- US to see fluid, lung abscess and lung consolidation
- RADS - see consolidation, abscess, pneumothorax
how can you treat equine pleuropneumonia?
remove fluid - thoracocentesis culture and sensitivity on fluid obtained abx. NSAIDS , opioid supportive oxygen, IVFT, bronchodilators drain abscesses if chronic
what is the prognosis for equine pleuropneumonia?
mild cases can recover and return to previous career
severe cases can be salvaged for breeding
what are some possible complications of equine pleuropneumonia?
pulmonary abscess pleural adhesion bronchopleural fistula constrictive pericarditis thrombophlebitis laminitis diarrhoea
what is a pyothorax?
pus in thorax
- septic or non-septic
- exudate
what can cause a SA pyothorax?
penetrating injury
migrating FB
FIP
hyperglobinaemia
what are the signs associated with small animal pleural disease?
dyspnoea
dullness on auscultation
muffled heart sounds
how do you diagnose an exudate?
cells > 50x10^9/l
mainly neutrophils (degenerate or toxic)
protein >30g/l
how can you treat a small animal pyothorax?
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
how does a chylothorax form?
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
what can cause a chylothorax?.
neoplasia
heart failure
idiopathic
how do you diagnose chyle?
cell 1-5x10^9/l
protein 25-40 g/l
main cell is lymphocyte
appears milky with triglyceride conc higher than plasma
how can you treat a chylothorax?
- 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
what can cause a pneumothorax?
trauma
lung injury
chronic resp disease
spontaneous
how do you diagnose a pneumothorax?
thoracocentesis and get air
how do you treat a pneumothorax?
- 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
what can cause a hydrothorax?
hypoproteinaemia causing reduced oncotic pressure
