Pleural Space Disease Flashcards
Does the pleural space actually exist
it is a potential space so it might not actually exist
What is the pressure of the pleural space normally
-5 cm H20 (allows air to fill)
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
What are the PE findings of pleural disease
Tachypnea
Dyspnea, open mouth
Restrictive pattern
Asynchronous
Orthopnea
Cyanosis
Dull/absent lung sounds
What kind of fluid might end up in the pleural space
Blood
Exudate
Transudate
Chyle
Inflammatory
How might air end up in the pleural space
Trauma
Bullae
Necrosis
How might organs end up in the pleural space
Hernia (trauma or congenital)
How might neoplasia infiltrate the pleural space
-Solid mass
-Diffuse
What might cause abscess inflammation in the pleural space
Pneumonia
Foreign Body
FIP
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
T/F: intubation and postive ventilation is helpful in animals with pleural space disease
False- the lungs are unable to inflate
How can you remove pleural fluid
thoracocentesis
-butterfly catheter (for smaller volumes)
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
What are the characteristics of a transudate pleural effusion
TP <2.5g/dL
TNCC < 1500/uL
low albumin
What are the characteristics of a modified transudate pleural effusion
TP 2.5-7 g/dL
TNCC 1000-7000/uL
What are the characteristics of an exudate pleural effusion
TP >3.0 g/dL
TNCC > 7000/uL
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
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
