Respiratory - Pleural Effusion + Pneumothorax Flashcards
5 types of effusion
transudate modified transudate exudate chylous hemorrhagic
What is a pleural effusion
abnormal accumulation of fluid in pleural space
Intrathoracic pressure is normally
negative
pleural effusion results in ______ ITP and _______ pulmonary compliance
increased, decreased
Transudate
non degenerative neutrophils, macrophages, mesothelial cells
low protein levels
low cellularity
Modified transudate
most common
intermediate protein and cellularity
non degenerative neutrophils, macrophages, mesothelial cells, neoplastic cells, lymphocyte
Exudate
high protein and high cellularity
cell types vary
Causes of hemorrhagic effusion
trauma, toxicity, neoplasia, lung lobe torsion
Causes of chylous effusion
trauma, neoplasia, CHF, cranial caval obstruction (mass, thrombus), HWD, idiopathic
Causes of transudate effusion
hypoalbuminemia (PLE, PLN)
Causes of modified transudate effusion in CATS
CHF or neoplasia
Causes of modified transudate effusion in DOGS
neoplasia or pericardial disease, or R sided CHF
Causes of exudate effusion in CATS
septic - pyothorax (bite, penetrating wound)
Nonseptic - neoplasia, FIP
Causes of exudate effusion in dogs
septic - prothorax (bite, penetrating wound)
Nonseptic - neoplasia
Signs of pleural effusion
tachypnea, dyspnea, lethargy, cough (dogs>cats), hiding (cats)
may show respiratory distress
lung and heart sounds can be muffled or absent if moderate to severe
murmur, gallop or arrhythmia if CHF present
pyothorax patients may have fever
A presumptive diagnosis of moderate to severe pleural effusion is often made from the
clinical exam
When should thoracic rads be done?
after thoracocentesis, once patient is stable
In what situation should a thoracocentesis be performed as soon as possible?
when there is large volume of fluid and it is life trheatening
Mild pleural effusion can be diagnosed with
rads or ultrasound
Diagnostic thoracocentesis
in any patient with a newly diagnosed pleural effusion
fluid analysis and cytology, can help narrow diagnosis
bacterial culture if infection suspected
NT-proBNP in cat pleural effusion highly sensitive for CHF vs nonCHF
Materials needed for thoracocentests
Butterfly needle or over the needle catheter extension tubing if not using butterfly syringe gloves aseptic prep materials collection bowl and tubes for samples \+/- local anesthetic and sedation
Long treatment of pleural effusion is aimed at
treating the underlying disease
Treat pyothorax
drainage of fluid via thoacostoy tube and antibiotics
may need Sx intervention for drainage and to resect severely damaged tissues
rapid dx and tx associated with better outcome
Mesothelioma
malignant neoplasm that originates from cells that line serosal surfaces
difficult to distinguish from reactive mesothelial cells, common in chronic effusions regardless of etiology
surgical biopsy to obtain definitive Dx
treat: intracavitary chemotherapy, periodic thoracocentesis
guarded to poor prognosis
Carcinomatosis
diffuse metastatic disease secondary to carcinoma
may be present in peritoneal cavity
tx; intracavitary chemo, periodic thoracocentesis, pleural port
grave prognosis
Idiopathic chylothorax
must rule out all other causes
accumulation of chyle in thoracic cavity due to abnormalities in the thoracic duct system
chyle - lymphatic fluid drained from intestines
small lymphocytes
pleural fluid triglycerides > serum triglycerides
Tz: surgical intervention, low fat diet, ruin, corticosteroid therapy
2 potential complications of pleural effusions
fibrosing pleurites (pleura becomes fibrotic and non compliant) lung lobe torsion
3 causes of pneumothorax
traumatic
spontaneous
iatrogenic
traumatic pneumothorax
blunt or penetrating, open or closed
skin wound may be several cm from site of penetration into thorax - must do thorough exam
cases of blunt trauma usually managed medically and resolved within a few days w supportive care, thoracocentesis, thoracostomy tube
penetrating wounds usually require surgical exploration
Spontaneous pneumothorax
primary - pulmonary blebs or bull that rupture
secondary - lung disease
tx = surgical resection of diseased lung
Iatrogenic pneumothorax
lung damage or laceration during thoracocentesis, positive pressure ventilation
mild - monitor
moderate or severe - thoracocentesis
recurrent - thoracostomy tube, blood patching, Sx
Pneumomediastinum
general anesthesia with endotracheal intubation and positive pressure ventilation = most common cause in cats
also caused by trauma, tracheal foreign body, esophageal tear
tachypnea, dyspnea, subcutaneous emphysema (crunchy skin), vomiting (cats)
treatment = support
secondary pneumothorax common, may require thoracocentesis
