Pleural Effusion Flashcards
how much pleural effusion is normally reabsorbed per day?
up to 1 liter by lymphatics
what increases as tidal volume decreases in pleural effusion?
respiratory rate
what can be found on physical exam with pleural effusion?
dull lung sounds
signs of underlying disease
what diagnostics can be used for pleural effusion diagnosis?
thoracic radiography
ultrasonography/T-FAST
diagnostic thoracocentesis
CT
where should you tap for thoracocentesis?
7th-9th intercostal space
what are the signs of underlying disease you might see on physical exam with pleural effusion?
trauma
heart murmur/gallop/JVD
fever
ptyalism (cats)
what should you do in a thoracocentesis?
remove all fluid and air
cytological examination
culture and sensitivity testing if warranted
what volumes can be removed from the pleural space to result in marked improvement?
150-300 ml/cat
5-25 ml/kg in a dog
what should you be careful of when tapping a chest?
iatrogenic pneumothorax
what can cause pleural effusion (general)?
increased hydrostatic pressures
decreased lymphatic drainage
trauma (hemothorax)
what types of fluid can be in pleural effusion?
transudate
modified transudate
exudate
hemorrhage
how common is transudate as pleural effusion?
very rare
what can cause modified transudate pleural effusion?
heart failure
neoplasia
chylothorax
lung lobe torsion
what is minute ventilation?
respriatory rate x tidal volume
what do rounded lung borders on thoracic radiographs indicate?
chronic effusion with chronic pleuritis
increased chances of iatrogenic pneumothorax
when might a thoracostomy tube be indicated?
big pneumothorax
pyothorax
post-operatively
what are the pathologies to pleural effusion?
increased hydrostatic pressures
decreased lymphatic drainage
trauma: hemothorax
why is transudate as pleural effusion very rare?
pleural lymphatics very effective: usually only small volume with severe hypoproteinemia
less common than ascites or peripheral edema
how can you treat pleural effusion from heart failure?
drain effusion
enalapril, furosemide, pimobendan
+/- spironolactone-hydrochlorthiazide if recurrent and lasix maxed
what neoplasias can cause pleural effusion?
lymphosarcoma
carcinoma
soft tissue sarcoma
how can lymphoma cause pleural effusion?
FeLV + cats
what is the prognosis of carcinoma?
grave
what soft tissue sarcomas can cause pleural effusion?
fibrosarcoma
chondrosarcoma
why is surgery a bad idea if you find malignant pleural effusion?
will re-accumulate quickly
if mass seen: it has already spread
are large or small volume effusions more likely to respond to therapy?
small volumes
what can you infuse into the cavity for malignant pleural effusion?
carboplatin
bleomycin
what can cause exudate pleural effusion?
feline infectious peritonitis
chylothorax: single or multiple organisms, anaerobic
what is thee exudate like with feline infectious peritonitis?
high protein
low cellularity
treat with anti-viral
how are dogs and cats best managed for pyothorax?
cats: medically?
dogs: surgically- early is better
what is a pyothorax?
purulent material within pleural space
what are some potential causes of pyothorax?
bite wound
penetrating wounds
lung abscesses
esophageal perforation
