Pleural Effusion

Question 1

how much pleural effusion is normally reabsorbed per day?

Answer 1

up to 1 liter by lymphatics

Question 2

what increases as tidal volume decreases in pleural effusion?

Answer 2

respiratory rate

Question 3

what can be found on physical exam with pleural effusion?

Answer 3

dull lung sounds
signs of underlying disease

Question 4

what diagnostics can be used for pleural effusion diagnosis?

Answer 4

thoracic radiography
ultrasonography/T-FAST
diagnostic thoracocentesis
CT

Question 5

where should you tap for thoracocentesis?

Answer 5

7th-9th intercostal space

Question 6

what are the signs of underlying disease you might see on physical exam with pleural effusion?

Answer 6

trauma
heart murmur/gallop/JVD
fever
ptyalism (cats)

Question 7

what should you do in a thoracocentesis?

Answer 7

remove all fluid and air
cytological examination
culture and sensitivity testing if warranted

Question 8

what volumes can be removed from the pleural space to result in marked improvement?

Answer 8

150-300 ml/cat
5-25 ml/kg in a dog

Question 9

what should you be careful of when tapping a chest?

Answer 9

iatrogenic pneumothorax

Question 10

what can cause pleural effusion (general)?

Answer 10

increased hydrostatic pressures
decreased lymphatic drainage
trauma (hemothorax)

Question 11

what types of fluid can be in pleural effusion?

Answer 11

transudate
modified transudate
exudate
hemorrhage

Question 12

how common is transudate as pleural effusion?

Answer 12

very rare

Question 13

what can cause modified transudate pleural effusion?

Answer 13

heart failure
neoplasia
chylothorax
lung lobe torsion

Question 14

what is minute ventilation?

Answer 14

respriatory rate x tidal volume

Question 15

what do rounded lung borders on thoracic radiographs indicate?

Answer 15

chronic effusion with chronic pleuritis
increased chances of iatrogenic pneumothorax

Question 16

when might a thoracostomy tube be indicated?

Answer 16

big pneumothorax
pyothorax
post-operatively

Question 17

what are the pathologies to pleural effusion?

Answer 17

increased hydrostatic pressures
decreased lymphatic drainage
trauma: hemothorax

Question 18

why is transudate as pleural effusion very rare?

Answer 18

pleural lymphatics very effective: usually only small volume with severe hypoproteinemia
less common than ascites or peripheral edema

Question 19

how can you treat pleural effusion from heart failure?

Answer 19

drain effusion
enalapril, furosemide, pimobendan
+/- spironolactone-hydrochlorthiazide if recurrent and lasix maxed

Question 20

what neoplasias can cause pleural effusion?

Answer 20

lymphosarcoma
carcinoma
soft tissue sarcoma

Question 21

how can lymphoma cause pleural effusion?

Answer 21

FeLV + cats

Question 22

what is the prognosis of carcinoma?

Answer 22

grave

Question 23

what soft tissue sarcomas can cause pleural effusion?

Answer 23

fibrosarcoma
chondrosarcoma

Question 24

why is surgery a bad idea if you find malignant pleural effusion?

Answer 24

will re-accumulate quickly
if mass seen: it has already spread

Question 25

are large or small volume effusions more likely to respond to therapy?

Answer 25

small volumes

Question 26

what can you infuse into the cavity for malignant pleural effusion?

Answer 26

carboplatin
bleomycin

Question 27

what can cause exudate pleural effusion?

Answer 27

feline infectious peritonitis
chylothorax: single or multiple organisms, anaerobic

Question 28

what is thee exudate like with feline infectious peritonitis?

Answer 28

high protein
low cellularity
treat with anti-viral

Question 29

how are dogs and cats best managed for pyothorax?

Answer 29

cats: medically?
dogs: surgically- early is better

Question 30

what is a pyothorax?

Answer 30

purulent material within pleural space

Question 31

what are some potential causes of pyothorax?

Answer 31

bite wound
penetrating wounds
lung abscesses
esophageal perforation