Pleural Space Disease Flashcards by jared Jensen

Does the pleural space actually exist

it is a potential space so it might not actually exist

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What is the pressure of the pleural space normally

-5 cm H20 (allows air to fill)

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Why might there be fluid accumulation in the pleural space

1) Hemorrhage
2) Increased vascular permeability
3) Impaired lymphatic drainage
4) Increased hydrostatic pressure
5) Decreased oncotic pressure

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What are the PE findings of pleural disease

Tachypnea
Dyspnea, open mouth
Restrictive pattern
Asynchronous
Orthopnea
Cyanosis
Dull/absent lung sounds

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What kind of fluid might end up in the pleural space

Blood
Exudate
Transudate
Chyle
Inflammatory

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How might air end up in the pleural space

Trauma
Bullae
Necrosis

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How might organs end up in the pleural space

Hernia (trauma or congenital)

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How might neoplasia infiltrate the pleural space

-Solid mass
-Diffuse

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What might cause abscess inflammation in the pleural space

Pneumonia
Foreign Body
FIP

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term for combination of opioid and midazolam

neuroleptanalgesia - really effective for sedation, anxiolytic,

works well with really old, really young and very sick in cats

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T/F: intubation and postive ventilation is helpful in animals with pleural space disease

False- the lungs are unable to inflate

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How can you remove pleural fluid

thoracocentesis
-butterfly catheter (for smaller volumes)

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After receiving pleural fluid from thoracocentesis, what do you do with the effusion?

-Visual insepction
-Smell test
-Specific gravity
-Cell count and protein quantification
-PCV /TS
-Cytology
-Culture

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What are the characteristics of a transudate pleural effusion

TP <2.5g/dL
TNCC < 1500/uL
low albumin

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What are the characteristics of a modified transudate pleural effusion

TP 2.5-7 g/dL
TNCC 1000-7000/uL

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What are the characteristics of an exudate pleural effusion

TP >3.0 g/dL
TNCC > 7000/uL

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Modified transudate pleural effusion has:
TP 2.5-7 g/dL and TNCC 1000-7000 uL. What are the causes

R CHF
Neoplasia
Lung torsion
Inflammation
Hernia

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An exudate pleural effusions has
TP >3 g/dL
TNCC >7000/uL

What are the causes

Septic
Nonseptic
Neoplasia
Chyle

What is your number one differential for a transudate pleural effusion

Low albumin

What might cause a chylous pleural effusion

1) Idiopathic
2) Mediastinal Mass
3) Heart disease
4) Lung lobe torsion
5) Obstructed thoracic duct
6) Heartworm
7) Thromboembolism
8) really high venous pressure

What are the characteristics of chylous effusion

White/opaque color
Protein >3.0 g/dL
high lymphocytes

high triglycerides in pleural fluid compared to that of the serum

How do you determine if the pleural effusion is chylous

Compare the triglycerides in the pleural fluid to the serum

should be way higher in the pleural effusion if it is from chylous effusion

T/F: chylous effusion might look serosanginous

true- if they havent eaten in a while might not have much fat in it

What might cause a hemorrhagic pleural effusion PCV >10% ; non-clotting

trauma
coagulopathy
neoplasia
pancreatitis
heartworm disease
iatrogenic

How do you treat feline pyothorax *

1) place bilateral chest tubes 2) evacuate the pleural space 3) lavage the pleural space 4) empiric antibiotics (IV) 5) Thoracic radiographs or CT - tube check and parenchymal check

What are the indications for placing a chest tube

1) Recurrent pnemo 2) Tension pneumo 3) Pyothorax 4) Postop thoracotomy 5) Rapid fluid accumulation

What are the contraindications of placing a chest tube incorrectly

1) Uncorrected 2) Coagulopathy 3) Organs 4) Masses

Ways to place a chest tube

-Intermittent suction: serial POCUS, clinical decline -One way valve -Continuous grenade suction -Pleur-evac continuous suction

How long should we keep in chest tubes when treating pyothorax

Once there is minimal fluid or 2ml/kg/day, radiographic appearance, 4-8 days, financial constraints about 4-8 days is rule but varies by case

When aspirating pus out of a chest, then what should you avoid

use different tubes for draining pus vs lavaging fluid in

What are common sources of bacteria for pyothorax in cats

1) Upper respiratory tract infection 2) cat bite wounds

What types of bacteria are typically causes of feline pyothorax

1) Mixed 2) Oropharyngeal anaerobes 3) Pasturella 4) Nocardia, Actinomyces

What are common empirical systemic antibiotic choices for feline pyothorax

Combination of 1) Parenteral enrofloxacin / marbofloxacin 2) Parenteral clindamycin or penicillin *NO intrapleural antibioitcs

T/F: intrapleural antibiotics are useful for pyothorax

FALSE - does more harm

Should you culture pleural fluid when exudate?

YEs - continue 3-6 weeks fastidious anaerobes may be present, despite a negative culture tailor empiric choices to culture reuslts

What is the importance of thoracic radiographs or CT when treating feline pyothorax

1) Tube check 2) Parenchymal check *is there pneumonia to explain pleural effusion or is there an abscess of lung lobe if you see abscess lung lobe then you might need surgery instead of just using systemic antibiotics

5% of cats with pyothorax need surgery why is this

1) Failed medical management 5-9% 2) Masses or foreign body or neoplasia on imaging (abscess on lung lobe)

What causes pyothorax in dogs?

Inhaled foreign body ie gras awn -mixed anaerobes and E coli need surgical debridement

What bacteria causes pyothorax in dogs

mixed anaerobes and E coli from inhaled foreign body

What is the prognosis of feline pyothorax

62% survival (range 8-100%) fair to good for those survivng >24 hours

What is the prognosis of canine pyothorax

83% survival (range 29-100%) more agressive with surgery, do better but might resolve with antibiotics long term alone (8-10 weeks)

What is a tension pneumothorax *

caused by injury to lung parenchyma causing gas to escape into the pleural space with every breathe in but cant exit on exhalation this causes the lungs to be in unable to fill up as much because of the air in the pleural space tx: stab incision into the pleura

How do you treat a tension pneumothorax

stab incision into the pleura and then ventilating the patient