Pleural Diseases Flashcards
What disorders can cause or have been associated with chylothorax?
1 Idiopathic 60-70%
- Neoplasia - lymphoma, thymoma, pulmonary tumors
- Cardiac disease - HCM in cats, pericardial disease
What does fluid of chylothorax look like?
White to pink; mostly lymphocytes;
DX with serum/pleural fluid triglyceride concentration
DX with pleural fluid cholesterol/triglyceride ratio < 1
How do you treat chylothorax?
Resolves if you can find an underlying disease, however most is idiopathic. Soooo:
- Sx and Medical don’t work well
- Feeding low fat diet
- intermittent thoracocentesis
- Rutin for minimum of 2 months
- Thoracic duct ligation 20-60% efficacy
- pleuroperitoneal drainage is difficult to maintain
What are the clinical and diagnostic imaging findings of a patient with restrictive pleuritis?
suspected if respiratory distress persists after pleural fluid drainage.
-Post-thoracocentesis radiographs often show collapsed lung lobes
What neoplasms cause pleural effusion?
Lymphoma: lymphoblasts in pleural fluid - TX- chemo or radio
Carcinoma: aspiration or lung biopsy - TX - Sx excision
Thymoma: histo of mediastinal mass - TX - radio, sx, or chemo
Mesothelioma: histo of biopsy from thoracic cavity - no effective tx :(
What are the traumatic causes of pneumothorax in small animals?
HBC, gunshot, fight wounds
What are the non-traumatic causes of pneumothorax in small animals?
Pulmonary neoplasia Bacterial Pneumonia/abscess HW Idiopathic bulla Chronic bronchitis/asthma Paragonimus kellicotti
What are the clinical findings in an animal with pneumothorax?
- History or clinical signs of trauma
- Dyspnea
- Muffled heart sounds
- Absent dorsal breath sounds
- “silent chest”
How do you DX pneumothorax?
- stabilize! if in respiratory distress perform emergency thoracocentesis
- consider trauma
- if/when stable, perform Rads (looking for rib fracture, contusions, diaphragmatic herniation; if none and is spontaneous look for bullae, nodules, masses)
- if spontaneous and no evidence on rads do HW and fecal
How do you TX traumatic pneumothorax?
Conservative TX, cage rest, is indicated for 72 hours.
Traumatic pneumothorax will resolve w/o TX usually
How do you TX spontaneous pneumothorax?
SX almost always! Find and repair the leak.
Get biopsies while you’re inside. If you take the trouble to go in, never come out empty handed.
Most common neoplasia causing pleural effusion in cats
mediastinal lymphoma
what is Tension pneumothorax?
- flap of skin, soft tissue or lung acts as a one-way valve
- air enters pleural space on inspiration and can’t escape on expiration
- EMERGENCY, rapid CV deterioration
- occurs with both open and closed pneumo
What is open pneumothorax (traumatic)?
open communication between pleural space and external environment:
- gunshot, bite/stab wound, rib fracture
What is closed pneumothorax (traumatic)?
no communication with external environment
- most often result of blunt trauma (HBC*), iatrogenic
