Respiratory - Pleural Effusion + Pneumothorax

Question 1

5 types of effusion

Answer 1

transudate
modified transudate
exudate
chylous
hemorrhagic

Question 2

What is a pleural effusion

Answer 2

abnormal accumulation of fluid in pleural space

Question 3

Intrathoracic pressure is normally

Answer 3

negative

Question 4

pleural effusion results in ______ ITP and _______ pulmonary compliance

Answer 4

increased, decreased

Question 5

Transudate

Answer 5

non degenerative neutrophils, macrophages, mesothelial cells
low protein levels
low cellularity

Question 6

Modified transudate

Answer 6

most common
intermediate protein and cellularity
non degenerative neutrophils, macrophages, mesothelial cells, neoplastic cells, lymphocyte

Question 7

Exudate

Answer 7

high protein and high cellularity

cell types vary

Question 8

Causes of hemorrhagic effusion

Answer 8

trauma, toxicity, neoplasia, lung lobe torsion

Question 9

Causes of chylous effusion

Answer 9

trauma, neoplasia, CHF, cranial caval obstruction (mass, thrombus), HWD, idiopathic

Question 10

Causes of transudate effusion

Answer 10

hypoalbuminemia (PLE, PLN)

Question 11

Causes of modified transudate effusion in CATS

Answer 11

CHF or neoplasia

Question 12

Causes of modified transudate effusion in DOGS

Answer 12

neoplasia or pericardial disease, or R sided CHF

Question 13

Causes of exudate effusion in CATS

Answer 13

septic - pyothorax (bite, penetrating wound)

Nonseptic - neoplasia, FIP

Question 14

Causes of exudate effusion in dogs

Answer 14

septic - prothorax (bite, penetrating wound)

Nonseptic - neoplasia

Question 15

Signs of pleural effusion

Answer 15

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

Question 16

A presumptive diagnosis of moderate to severe pleural effusion is often made from the

Answer 16

clinical exam

Question 17

When should thoracic rads be done?

Answer 17

after thoracocentesis, once patient is stable

Question 18

In what situation should a thoracocentesis be performed as soon as possible?

Answer 18

when there is large volume of fluid and it is life trheatening

Question 19

Mild pleural effusion can be diagnosed with

Answer 19

rads or ultrasound

Question 20

Diagnostic thoracocentesis

Answer 20

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

Question 21

Materials needed for thoracocentests

Answer 21

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

Question 22

Long treatment of pleural effusion is aimed at

Answer 22

treating the underlying disease

Question 23

Treat pyothorax

Answer 23

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

Question 24

Mesothelioma

Answer 24

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

Question 25

Carcinomatosis

Answer 25

diffuse metastatic disease secondary to carcinoma
may be present in peritoneal cavity
tx; intracavitary chemo, periodic thoracocentesis, pleural port
grave prognosis

Question 26

Idiopathic chylothorax

Answer 26

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

Question 27

2 potential complications of pleural effusions

Answer 27

fibrosing pleurites (pleura becomes fibrotic and non compliant)
lung lobe torsion

Question 28

3 causes of pneumothorax

Answer 28

traumatic
spontaneous
iatrogenic

Question 29

traumatic pneumothorax

Answer 29

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

Question 30

Spontaneous pneumothorax

Answer 30

primary - pulmonary blebs or bull that rupture
secondary - lung disease
tx = surgical resection of diseased lung

Question 31

Iatrogenic pneumothorax

Answer 31

lung damage or laceration during thoracocentesis, positive pressure ventilation
mild - monitor
moderate or severe - thoracocentesis
recurrent - thoracostomy tube, blood patching, Sx

Question 32

Pneumomediastinum

Answer 32

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