Pleural disease (Yr 4)

Question 1

how does a pneumothorax look on radiography?

Answer 1

black chest with well defined cardiac silhoutte and lungs
cardiac silhouette raised off of the sternum

Question 2

what can cause pleural effusions?

Answer 2

increased hydrostatic pressure
decreased plasma oncotic pressure
increased vascular or pleural permeability (inflammation)
increased fluid production
overwhelmed lymphatics

Question 3

how will pleural effusions appear on radiographs?

Answer 3

effacement of cardiac silhouette and lungs

Question 4

what imaging modality is good for visualising a plural effusion?

Answer 4

ultrasound

Question 5

how thoracocentesis of pleural effusions carried out?

Answer 5

clip, scrub, local, sedation
insert butterfly catheter in 7-8th intercostal space, connect to three way tap and then drain

Question 6

what are some types of pleural effusions?

Answer 6

transudate (clear/colourless)
modified transudate (straw coloured)
exudates (prothorax, chylothorax, haemothorax)

Question 7

what is the appearance of transudates?

Answer 7

clear and watery (low cells and protein)

Question 8

what is the appearance of a modified transudate?

Answer 8

straw colour, serosanguinous, slightly viscous

Question 9

what are some possible causes of modified transudate pleural effusions?

Answer 9

CHF
diaphragmatic ruptures
neoplasia

Question 10

what is the main cause of transudate plural effusions?

Answer 10

hypoalbuminaemia

Question 11

what is the most common cause of plural effusion in cats?

Answer 11

CHF

Question 12

what should be done following thoracocentesis of a pyothorax?

Answer 12

submit for culture and sensitivity (base antibiotics off this)
start initial broad spectrum antibiotics (amoxycillin, metronidazole…)
insert chest drain when stable and lavage daily until fluid is clear
antibiotics for 2-3 months

Question 13

what conditions are associated with a chylothorax?

Answer 13

trauma/mass disrupting thoracic duct
pericardial disease
CHF (especially cats)
lung lobe torsions
spontaneous/idiopathic

Question 14

how is a chylothorax treated after thoracocentesis?

Answer 14

treat underlying cause
low fat diet
rutin (reduce chyle production)
most cases require surgery

Question 15

what should always be done after thoracocentesis?

Answer 15

radiograph again (check for neoplasia now you can image things in the chest)