Pleural Effusion, Pneumothorax, and Pneumomediastinum Flashcards

1
Q

True or False: Pleural effusion results in increased intrathoracic pressure and decreased pulmonary compliance

A

True

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2
Q

Explain the breathing pattern that can be seen with pleural effusion

A

Restrictive - shallow and rapid breaths

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3
Q

What is the most likely cause of a pure transudate pleural effusion?

A

hypoalbuminemia (PLN, PLE, liver failure)

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3
Q

_________ is a more common cause of pyothorax in dogs than cats

A

migrating FB

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4
Q

_________ is a more common cause of pyothorax in cats than dogs

A

bite wounds and extension of bacterial pneumonia

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5
Q

Why are thoracic radiographs prior to thoracocentesis discouraged in a patient with moderate pleural effusion?

A
  1. too must stress
  2. Large amt of fluid is life threatening
  3. Fluid in pleural space will obscure the heart (same opacities).. waste of money + time
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6
Q

List 2 neoplastic causes of pleural effusion

A
  • Mesothelioma
  • Carcinomatosis - diffuse metastatic disease 2ndary to carcinoma
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7
Q

Clinical signs of pleural effusion are usually chronic except if the cause is due to _____________

A

trauma or toxicity

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8
Q

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

A

C. Pyothorax

All can cause pleural effusion, which can cause muffled lung sounds and dyspnea

only pyothorax will cause fever

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9
Q

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

A

C. Pyothorax

one of the few curable underlying causes of pleural effusion

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10
Q

_____________ is a malignant neoplasm originating from serosal surfaces, like the parietal pleura that is attached to the chest wall

A

mesothelioma

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11
Q

What is the prognosis in a patient with secondary pleural effusion from mesothelioma or carcinomatosis?

A

Grave prognosis for both

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11
Q

What is the treatment protocol for a patient presenting with a pyothorax?

A
  • Drain fluid via thoracostomy tubes
  • IV antibiotics (broad spectrum pending C&S)
  • IV fluids
  • Sx if pyothorax is from a penetrating FB (dogs>cats)
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12
Q

What is the treatment protocol for a patient presenting with a chylothorax?

A

usually requires surgical intervention

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12
Q

When is therapeutic thoracocentesis indicated?

A
  • Necessary in patients with mod-severe effusion
  • Relieve dyspnea + remove as much fluid as possible

save samples for diagnosis

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12
Q

When is diagnostic thoracocentesis indicated?

A
  • 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
12
Q

What is the treatment protocol for a patient presenting with pleural effusion from mesothelioma?

A
  • Intracavitary chemotherapy w Cisplatin/Carboplatin
  • Periodic thoracocentesis or pleural port

(guarded long term prognosis tho)

13
Q

What is the treatment protocol for a patient presenting with pleural effusion secondary to metastatic carcinoma?

A

Same as mesothelioma

  • Intracavitary chemotherapy
  • Periodic thoracocentesis or pleural port

(guarded long term prognosis tho)

14
Q

What is found in a fluid sample from a chylothorax that aids in diagnosis and helps R/O other causes of pleural effusion?

A
  • Small lymphocytes
  • Higher triglycerides in fluid vs in the blood
  • Milky appearance
15
Q

List potential complications of pleural effusion regardless of etiology

A
  1. Fibrosing pleuritis
  2. Lung lobe torsion (able to twist when floating in fluid)
16
Q

True or False: Clinical signs and pulmonary auscultation of pneumothorax is similar to that of pleural effusion

17
Q

What is tension pneumothorax?

A

volume of air is so significant that it depresses CO - fatal if not treated promptly

18
Q

True or False: Tension pneumothorax is fatal if not treated promptly

A

True

  • depresses CO
19
Q

List the 3 types/etiologies of pneumothorax

A
  1. Traumatic
  2. Spontaneous
  3. Iatrogenic
20
List causes of traumatic pneumothorax
1. Blunt trauma (Hit by car) 2. Penetrating wound (Bite, fence)
21
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
22
What is the treatment plan for a patient with pneumothorax from penetrating bite wounds?
- Requires surgical exploration after P is stabilized
23
What is the treatment plan for a patient with spontaneous pneumothorax ?
- Usually requires surgical resection of the diseased lung
24
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)
25
List causes of iatrogenic pneumothorax
Lung damage during thoracocentesis (our fault)
26
List causes of pneumomediastinum
1. Tracheal trauma 2. BDLD fight 3. Tracheal FB 4. Esophageal tear
27
What is the most common cause of pneumomediastinum in cats?
tracheal trauma associated with endotracheal intubation + positive pressure ventilation
28
Subcutaneous emphysema is a clinical finding in cats with A. Pneumothorax B. Pyothorax C. Pneumomediastinum D. Pleural effusion secondary to CHF
C. Pneumomediastinum
29
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
30
What clinical findings can be seen in a patient with pneumomediastinum?
1. Subcutaneous emphysema (crunchy skin) 2. Vomiting (cats) 3. Tachypnea, dyspnea