Pleural Disease Flashcards
What are causes of a pneumothorax?
Iatrogenic - following bronchoscopy
Tension pneumothorax - rupture of bullae in lungs
Traumatic
What will you find on clinical examination in a pneumothorax?
Dysponea - restrictive inspiratory and expiratory
Barrel shaped thorax
Resonant on percussion of thorax
What will find on clinical exam in pleural effusion?
Reduce resonance on percussion ventrally
Reduced heart and lung sounds
Dysponea - restrictive inspiratory and expiratory dysponea
What will you see on a radiograph in pleural effusion?
Effacement of cardiac silhouette
Diffuse increased radio density throughout the pleural space
Scalloping of the lung lobes / pleural fissure lines
What are the benefits of using ultrasound to detect a pleural effusion?
Less stressful to the patient than radiographs
Easily obtained
How can you perform thoracocentesis in a patient with pleural effusion?
Patient in sternal, gentle restraint , receiving oxygen
+/- sedation - butorphanol and ACP
Clip and prepare the worse affected side of the thorax (caudal border of the scapula to behind the last rib)
- in most dogs and cats the mediastinum communicates
Use a 21g 1 inch butterfly catheter + 3 way tap or one way valve
Landmark - 7-8th intercostal space
Cranial aspect of the rib (nerves run along the caudal aspect)
Avoid the liver
As pirate - should get fluid or air, if you don’t the reposition
Place samples in tubes
EDTA - PCV, TP, cytology
Plain - culture
Continue to drain - therapeutic
Radiograph afterwards
Transudate
Clear and watery
Protein <25g/L
Cells <1.5x10^9
Cause: hypoalbuminaemia
Modified Transudate
Straw coloured, serosanguinous, slightly viscous
Protein - 25-35 g/L
Cells < 7x10^9
+/- neoplastic cells on cytology
Causes: right CHF (left too in the cat), diaphragmatic rupture, neoplasia
Exudate
Blood, straw coloured (non-septic), turbid viscous and purulent (septic inflammation), chylous
Protein >35g/L Cells >5x10^9 Blood Mesothelial cells Neutrophils, macrophages, bacteria (septic) High cholesterol (chyle)
Blood - trauma, neoplasia, coagulopathy
Non-septic - lobe torsion, chronic chylothorax, neoplasia
Septic - ruptured oesophagus, foreign body, pyothorax, fungal
Chylous - idiopathic, CHF, CrVC obstruction
How should you treat a pleural effusion?
Oxygen Thoracocentesis +/- chest drain when stable Pericardiocentesis if due to this CHF treatment - if cause Hypoproteinaemia - treat cause
Pyothorax - antibiotics based on C&S
- start on broad spectrum - Fluoroquinolones, metronidazole, potentiated amoxicillin
Insert Chest drain - lavage daily with 20ml/kg warmed saline
Ab continued for 2-3 months
What can cause a chylothorax?
Trauma Neoplasia CHF Pericardial disease Lung lobe torsion Idiopathic - bullmastiff, afghan hound
How should you treat a chylothorax?
Treat underlying cause - eg CHF
Low fat diet with added medium chain triglycerides
Rutin - reduces chyle production
Surgical management
What should you do before and after thoracocentesis?
Take radiographs
- draining the thorax improves visualisation eg lung masses
When should you remove a chest drain?
When there is no or minimal air aspirated in 24h
Less than 2 ml of fluid per kg per day
