Pleural Effusion, Pneumothorax, and Pneumomediastinum Flashcards
True or False: Pleural effusion results in increased intrathoracic pressure and decreased pulmonary compliance
True
Explain the breathing pattern that can be seen with pleural effusion
Restrictive - shallow and rapid breaths
What is the most likely cause of a pure transudate pleural effusion?
hypoalbuminemia (PLN, PLE, liver failure)
_________ is a more common cause of pyothorax in dogs than cats
migrating FB
_________ is a more common cause of pyothorax in cats than dogs
bite wounds and extension of bacterial pneumonia
Why are thoracic radiographs prior to thoracocentesis discouraged in a patient with moderate pleural effusion?
- too must stress
- Large amt of fluid is life threatening
- Fluid in pleural space will obscure the heart (same opacities).. waste of money + time
List 2 neoplastic causes of pleural effusion
- Mesothelioma
- Carcinomatosis - diffuse metastatic disease 2ndary to carcinoma
Clinical signs of pleural effusion are usually chronic except if the cause is due to _____________
trauma or toxicity
A patient with muffled lung sounds, fever, and dyspnea likely has
A. Protein loosing enteropathy
B. Pericardial effusion
C. Pyothorax
D. R-sided heart failure
C. Pyothorax
All can cause pleural effusion, which can cause muffled lung sounds and dyspnea
only pyothorax will cause fever
Which of the following causes of pleural effusion is associated with a rapid diagnosis, treatment, and better outcome compared to the others?
A. Protein loosing enteropathy
B. Pericardial effusion
C. Pyothorax
D. R-sided heart failure
C. Pyothorax
one of the few curable underlying causes of pleural effusion
_____________ is a malignant neoplasm originating from serosal surfaces, like the parietal pleura that is attached to the chest wall
mesothelioma
What is the prognosis in a patient with secondary pleural effusion from mesothelioma or carcinomatosis?
Grave prognosis for both
What is the treatment protocol for a patient presenting with a pyothorax?
- Drain fluid via thoracostomy tubes
- IV antibiotics (broad spectrum pending C&S)
- IV fluids
- Sx if pyothorax is from a penetrating FB (dogs>cats)
What is the treatment protocol for a patient presenting with a chylothorax?
usually requires surgical intervention
When is therapeutic thoracocentesis indicated?
- Necessary in patients with mod-severe effusion
- Relieve dyspnea + remove as much fluid as possible
save samples for diagnosis
When is diagnostic thoracocentesis indicated?
- Performed in any patient with newly diagnosed pleural effusion
- Collection of fluid helps aid in diagnosis
- Can submit for culture + sensitivity if suspect infection
- Can do proBNP of pleural effusion in cats if suspect cardiac cause
What is the treatment protocol for a patient presenting with pleural effusion from mesothelioma?
- Intracavitary chemotherapy w Cisplatin/Carboplatin
- Periodic thoracocentesis or pleural port
(guarded long term prognosis tho)
What is the treatment protocol for a patient presenting with pleural effusion secondary to metastatic carcinoma?
Same as mesothelioma
- Intracavitary chemotherapy
- Periodic thoracocentesis or pleural port
(guarded long term prognosis tho)
What is found in a fluid sample from a chylothorax that aids in diagnosis and helps R/O other causes of pleural effusion?
- Small lymphocytes
- Higher triglycerides in fluid vs in the blood
- Milky appearance
List potential complications of pleural effusion regardless of etiology
- Fibrosing pleuritis
- Lung lobe torsion (able to twist when floating in fluid)
True or False: Clinical signs and pulmonary auscultation of pneumothorax is similar to that of pleural effusion
true
What is tension pneumothorax?
volume of air is so significant that it depresses CO - fatal if not treated promptly
True or False: Tension pneumothorax is fatal if not treated promptly
True
- depresses CO
List the 3 types/etiologies of pneumothorax
- Traumatic
- Spontaneous
- Iatrogenic
List causes of traumatic pneumothorax
- Blunt trauma (Hit by car)
- Penetrating wound (Bite, fence)
What is the prognosis for a patient with pneumothorax from blunt force trauma (Ex: Hit by car)?
Blunt trauma pneumothorax usually managed medically & resolves in a few days
What is the treatment plan for a patient with pneumothorax from penetrating bite wounds?
- Requires surgical exploration after P is stabilized
What is the treatment plan for a patient with spontaneous pneumothorax ?
- Usually requires surgical resection of the diseased lung
List primary and secondary causes of spontaneous pneumothorax
Primary:
1. Pulmonary blebs or bullae that rupture (air filled cyst)
Secondary:
1. Lung disease (Ex: Neoplasia, asthma, PTE, pneumonia)
List causes of iatrogenic pneumothorax
Lung damage during thoracocentesis (our fault)
List causes of pneumomediastinum
- Tracheal trauma
- BDLD fight
- Tracheal FB
- Esophageal tear
What is the most common cause of pneumomediastinum in cats?
tracheal trauma associated with endotracheal intubation + positive pressure ventilation
Subcutaneous emphysema is a clinical finding in cats with
A. Pneumothorax
B. Pyothorax
C. Pneumomediastinum
D. Pleural effusion secondary to CHF
C. Pneumomediastinum
What is the treatment protocol for patients with pneumomediastinum?
Supportive care with analgesics, O2, and close monitoring
If 2ndary pneumothorax develops, thoracocentesis may be required
What clinical findings can be seen in a patient with pneumomediastinum?
- Subcutaneous emphysema (crunchy skin)
- Vomiting (cats)
- Tachypnea, dyspnea
