Pulmonary 2, and Pleural Space Disorders

Question 1

What are the primary types of pulmonary neoplasia?

Answer 1

adenocarcinoma

squamous cell carcinoma

Question 2

What are the clinical signs of pulmonary neoplasia?

Answer 2

• crackles, wheezes, or muffled sounds
• cough, dyspnea, tachypnea, hemoptysis
• weight loss, inappetance, lameness
• dysphagia/regurg (megesophagus)
• edema of head/neck (venous obstruction)

Question 3

How do you diagnose pulmonary neoplasia?

Answer 3

• radiographs, 3 views

- cytology: FNA of mass, bronchoscopy, biopsy

Question 4

What is the treatment for pulmonary neoplasia?

Answer 4

if primary: surgery removal

if metastatic: treat primary mass, chemotherapy

Question 5

What is pulmonary edema?

Answer 5

accumulation of fluid in alveoli or pulmonary interstitium

Question 6

What are the four mechanisms of non-cardiogenic pulmonary edema?

Answer 6

• vascular overload/increased hydrostatic pressure
• decreased plasma oncotic pressure
• increased alveolar-capillary membrane permeability
• lymphatic obstruction

Question 7

What is seen on thoracic radiographs with pulmonary edema?

Answer 7

alveolar pattern on caudo-dorsal lung fields

Question 8

What is the treatment for pulmonary edema?

Answer 8

• control of primary disease
• cage rest and oxygen therapy
• supportive care (sedation, IV fluids, positive pressure ventilation)

Question 9

What is ALI?

Answer 9

• acute lung injury

- pulmonary inflammation and edema resulting in acute respiratory failure

Question 10

What is ARDS?

Answer 10

• acute respiratory distress syndrome
• severe manifestation of acute lung injury
• severe hypoxemia

Question 11

What is a pulmonary contusion?

Answer 11

leakage of blood into the lungs as a result of trauma

Question 12

What is the treatment for pulmonary contusions?

Answer 12

• oxygen therapy
• IV fluids
• pain medication for trauma

Question 13

What is eosinophilic bronchopneumopathy?

Answer 13

• inflammation of the lungs

- due to hypersensitivity to unknown antigen

Question 14

Who is predisposed to eosinophilic bronchopneumopathy?

Answer 14

siberian huskies

young to middle-aged animals

Question 15

What are the clinical signs of eosinophilic bronchopneumopathy?

Answer 15

• harsh cough
• progressive respiratory difficulty
• exercise intolerance
• nasal discharge
• anorexia/lethargy

Question 16

How do you diagnose eosinophilic bronchopneumopathy?

Answer 16

• auscultation: crackles, exp wheezes
• hematology: eosinophilia
• pulse ox and blood gas: hypoxemia
• radiographs: diffuse bronchointerstitial patterns, alveolar infiltrates
• cytology, TTW, BAL

Question 17

What is the treatment for eosinophilic bronchopneumopathy?

Answer 17

• Treat underlying disease
• if parasitic: Fenbendazole
• prednisone
• other immunosuppressives

Question 18

What is pulmonary thromboembolism?

Answer 18

• obstruction of pulmonary arteries and arterioles

- ventilation/perfusion abnormalities

Question 19

What diseases predispose to pulmonary thromboembolism?

Answer 19

• heartworm
• immune-mediated hemolytic anemia
• nephrotic syndrome
• hyperadrenocorticism
• pancreatitis
• DIC
• endocarditis

Question 20

How do you treat pulmonary thromboembolism?

Answer 20

• oxygen supplementation
• treat underlying disease
• bronchodilators
• prednisolone in IMHA and heartworm
• low dose heparin if DIC

Question 21

What are the general clinical signs of pleural space disorders?

Answer 21

• rapid shallow breathing
• dyspnea
• possible open mouth breathing
• cyanosis
• exercise intolerance

Question 22

Describe the auscultation of an animal with pleural effusion and pneumothorax

Answer 22

both: muffled heart sounds and muffled lung sounds ventrally
effusion: increased lung sounds dorsally
pneumothorax: decreased lung sounds dorsally

Question 23

What is pleural effusion?

Answer 23

accumulation of excessive amounts of fluid within the pleural space

Question 24

Do cats get pulmonary edema due to CHF?
Why or why not?
Do dogs?

Answer 24

• cats do not often get pulmonary edema because pleural veins drain into the left atrium
• dogs often get pulmonary edema because pleural veins drain into the right atrium

Question 25

How do you diagnose pleural effusion?

Answer 25

• pulmonary sounds auscultated dorsally
• severe, shallow breaths due to inability to expand lungs
• radiographs

Question 26

When do dog get pyothorax?

Cats?

Answer 26

Dogs: secondary to inhaled foreign bodies or penetrating injury, pneumonia
Cats: secondary to penetrating bite wounds, oropharyngeal aspiration, or URTI

Question 27

How is pyothorax diagnosed?

Answer 27

• signs: tachypnea, shallow breathing
• cytology: degenerative neutrophils/bacteria
• radiographs, CT

Question 28

How do you treat pyothorax?

Answer 28

• drainage and lavage through thoracotomy tube (bilateral in cats)
• lavage of warm saline
• long term antibiotics based on culture/cytology (amoxyclav, metronidazole)
• surgery if not improvement

Question 29

What causes chylothorax?

Answer 29

• any disease that increases systemic venous pressure

- rupture of thoracic duct

Question 30

How do you diagnose chylothorax?

Answer 30

thoracocentesis: white to pink opaque fluid

- triglycerides in fluid > in serum

Question 31

What is the treatment for chylothorax?

Answer 31

• treat underlying cardiomyopathy if present
• thoracic drainage
• Rutin (stimulates macrophages to carry away fat)
• ligation of thoracic duct

Question 32

What is the sequel to chylothorax?

Answer 32

restrictive pleuritis

Question 33

What is pneumothorax, and what is the most common cause?

Answer 33

• air in the pleural space

- blunt force trauma

Question 34

Describe the radiograph of an animal with pneumothorax

Answer 34

• absence of pulmonary vasculature to chest wall
• dorsal displacement of heart and trachea
• retraction of lung from chest wall
• increased density in collapsed lobe

Question 35

What is the treatment for pneumothorax?

Answer 35

• emergency thoracocentesis
• analgesia
• oxygen therapy
• surgery

Question 36

Explain the procedure of a thoracocentesis

Answer 36

• sternal or lateral recumbency
• surgical prep at 7-8th ICS
• insert needle at cranial border of rib
• advance needle in ventral direction
• open stopcock and use suction