Thoracic Cavity Flashcards
McCarthy, VCOT, 2018:
Prognostication in canine rib fractures
Which score was correlated with risk factors?
Animal Trauma Triage (ATT) scores of non-survivors?
What ATT score had a 88% sensitivity and 81% specificity for predicting mortality?
McCarthy, VCOT, 2018:
Only the ATT score was correlated with risk factors
ATT scores of non-survivors was 5 or greater
ATT score of 7 or greater had a 88% sensitivity and 81% specificity for predicting mortality - a 1-point increase in ATT score corresponded to 2 times decreased likelihood of survival
Lux, JAVMA, 2018:
Thoracic trauma in dogs
What % of the dogs had flail chest?
What % of the dogs had 3 or more rib fractures?
What % of dogs required thoracotomy?
Mortality rate?
What was associated with outcome?
Mean Animal Trauma Triage (ATT) score of non-survivors?
What ATT score was associated with 5 times the odds of survival?
What % of dogs had SIRS pre-op vs post-op, and was SIRS associated with survival?
Mortality rate associated with SIRS?
Lux, JAVMA, 2018:
25% had flail chest
25% had 3 or more rib fractures
78% required thoracotomy
Mortality rate: 15%
ATT score was associated with outcome
Mean ATT score of non-survivors was 8
ATT score <7 had 5 times the odds of survival
55% had pre-op SIRS vs 34% had post-op SIRS; SIRS was not associated with survival
Mortality rate associated with SIRS was 24%
Lux, JAVMA, 2018:
Thoracic trauma in cats
What % of cats required intrathoracic surgery?
Overall peri-op mortality rate?
Mean Animal Trauma Triage (ATT) score for survivors vs non-survivors?
Lux, JAVMA, 2018:
65% required intrathoracic surgery
13% peri-op mortality rate
Mean ATT score was 6.4 for survivors vs 10 for non-survivors
Ranganathan, JAVMA, 2018:
Surgical ligation vs ductal occluder device
Which technique was associated with longer anesthesia and surgery durations?
Which technique was associated with hypotension and administration of vasopressors?
Which technique was associated with the need to administer antiarrhythmic and parasympatholytic medications?
Major complication rates for surgical ligation vs ductal occluder device?
Intra-op mortality rates for surgical ligation vs ductal occluder device?
Ranganathan, JAVMA, 2018:
Use of the ductal occluder device was associated with longer anesthesia and surgery durations
Use of the ductal occluder device was associated with hypotension and administration of vasopressors
Surgical ligation was associated with the need to administer antiarrhythmic and parasympatholytic medications, possibly due to arrhythmias caused by manual handling of the heart
Major complication rates: 10% for surgical ligation vs 0% for ductal occluder device
Intra-op mortality rates: 2% for surgical ligation vs 0% for ductal occluder device
Frykfros von Hekkel
Thoracic bite wounds in dogs
VetSurg 2020
Increased odds of surgery?
Mortality associated with?
increased odds for surgery
~Presence of pneumothorax
~Pseudoflail chest
~Rib Fx
Mortality
~Pleural effusion
~Positive bacterial culture
Level of wound management associated with length of hospitalization
Blondel
Migrating FB
VetSurg 2021
Pre-op imaging modality sensitivity?
Intra-op removal sucessessful in?
Preop ultrasound 88%
Pre-op CT/MRI 57%
Intra op removal success
~pre op imaging only 59%
~intraop AUS 90%
Thorsten
Enhanced US of intrathoracic mass
VetRadUS 2019
Neoplastic 63% bronchial artery
Non-Neoplastic 78% Pulmonary artery
Thymomas heterogeneously in centripetal
Lymphoma enhanced homogeneous centrifugal
McCarthy
Animal Trauma Triage Score for Prognosis of Canine Rib Fractures
VCOT 2018
Animal Trauma Triage
>7 sensitives for mortality
1 point increase corresponded to 2.1 x decreased likelihood of survival
Dog bite
~mean hospital stay 3d longer
Matiasovic
Impalement injuries
JSAP 2018
FB retrieval rate?
Survival to discharge?
FB retrieval 37%
Survival rate
~Overall 90%
~For thoracotomy 93%
Lux
Cats with thoracic trauma
JAVMA 2018
Sx rate?
Mortality rate?
Survival associated with?
Intrathoracic Sx 65%
Mortality peri-op 13%
Survival
~no cardiopulmonary arrest
~animal trauma triage score (6.4 vs. 10)
Lux
Dogs thoracic trauma
JAVMA 2018
Survival
~Female vs. male x 6
~No cardiac arrest x 102
ATT score
~for nonsurvivors was 8
~<7 had odds of survival 5 x of >7
Ranganathan et al JAVMA 2018 What were the major differences between suture ligation vs ductal occluder for treatment of PDA?
SL - more major intraoperative complications Occluder - more likely to need ACE inhibitor after surgery, this group had more significant cardiac changes prior to surgery
Claretti et al JSAP 2019 What was the cause of the majority of complications during catheter mediation PDA closure - technical or anatomic?
Technical complications 81% Anatomic complications 19% Overall mortality rate 0.76%
Bascunan et al Vet Surgery 2020 What percent of cats had persistent clinical signs following surgical correction of a vascular ring anolmaly?
69% of cats had persistent clinical signs 31% of cats had persistent megaesophagus
Carvajal Vet Surgery 2019 For dogs with idiopathic pericardial effusion, what is the difference in survival for pericarditis vs neoplasia?
No difference MST 66 days
Morgan et al VetSurg 2019 What percentage of dogs with PPDH had concurrent congenital abnormalities?
40%
Konig JFMS 2019
Causes of pleural effusion
and % of population
Cardiac disease 35%
Neoplasia 30%
Pyothorax 9%
FIP 8%
Chylothorax 5%
Frykfors von Heckel JFMS 2020
What was associated with penetrating chest injury
> 3 radiographic lesions
High index with
~pseudo-flail chest
~pneumothorax
Hennet JFMS 2022
Survival to discharge of median sternotomy?
Rate of closure related complications?
Survival to discharge of median sternotomy?
~ 81%
Rate of closure related complications?
~8%
Racette JVECC 2022
Fluid production at the time of thoracostomy tube removal was higher in?
What portion had pleural effusion w/in 2 weeks of tube removal?
Post tube removal effusion associated with?
Reintervention performed in?
Fluid production at the time of thoracostomy tube removal was higher in?
~Dogs with per-op effusion vs. w/o
~Median sternotomy vs. lateral thoracotomy
What portion had pleural effusion w/in 2 weeks of tube removal?
7%
Post tube removal effusion associated with?
~pre-op fluid
~lung lobe torsion
~chylothorax
Reintervention performed in?
4.7%
Kramer JSAP 2021
Overall recurrence rate for pyothorax in cats?
What % failed medical management?
Survival to discharge?
Overall recurrence rate for prothorax in cats?
6%
What % failed medical management?
15%
Survival to discharge?
72%
Diras-Diaz JSAP 2021
CT findings of canine pyothrorax cases
Survival to discharge Surgery vs. Medical
Majority of mortality occurred during which period?
CT findings of canine pyothrorax cases
-Pleural thickening 84%
-Pannus 67%
-Pneumothorax 61.4%
-Mediastinal effusion 29%
-Pulmonary abscess 13.8%
-Mediastinal absxcess 8%
-FB 8%
-FB tract 7%
-Pneumonia 7%
Survival to discharge Surgery vs. Medical
S: 90%
M: 72%
Majority of mortality occurred during which period?
48 hours of admission
Garcia-Pertierra JSAP 2022
Survival to discharge for explore following intrathoracic wooden skewer migration from stomach/duodenum
91%
Nutt Vet Surg 2021
The symmetry incidence for 3 d PO in the standard lateral thoracotomy was how much greater than the muscle sparing lateral thoracotomy?
The symmetry incidence for 3 d PO in the standard lateral thoracotomy was how much greater than the muscle sparing lateral thoracotomy?
3.1-fold greater
Pleural exudate
Protein: >3
Specific Gravity: >1.025
Nucleated Cell Count: >7000
Pleural Modified transudate
Protein: >2.5-<5
Specific Gravity: >1.015-<1.025
Nucleated Cell Count: >1500-<7000
Serosanguineous Effusion
-lung lobe torsion
-D-hernia w/hepatic entrapment
-Pericardial effusion leading to right sided heart failure
Chylus Effusion
-anything that increases hydrostatic pressure in the cranial vena cava
Pleural Transudate
Protein: <2.5
Specific Gravity: <1.015
Nucleated Cell Count: <1500
Secondary to hypoalbuminemia
-decreased production
-increased loss
-CHF
Chylous Effusion
Definitive Diagnosis
-Triglyceride higher in effusion > serum
-Cholesterol lower in effusion < serum
-chylomicrons in fluid stained with Sudan black
Radiographic threshold for pleural effusion
100 mL for dogs
50 mL for cats
Signs:
-interlobar fissure lines
-retraction of lung borders from chest wall
-loss of detail
Causes of chylothorax
Most common- idiopathic
-Cardiomyopathy
-Mediastinal masses
-Dirofilariasis
-Blastomycosis
-Jugular v or cranial vena cava thrombosis
-D-hernia
-Pericardial effusion
-Lung lobe torsion
-Heart-based tumors
Diagnostic for chylothorax
CBC
Chem
UA
HWT
TxR
AXR
AUS
Echo
Pleural fluid analysis
Pleural fluid culture and Sens
Definitive: lymphangiography
Popliteal Lymphangiography
Percutaneously with Iohexol
Appears in thoracic duct in 2-13 min
Intraoperative Intestinal Lymphangiography
Contrast to catheterized mesenteric lymph vessels
NMB 0.5 mg/kg- 10 min to colorization
Cream 3-4 hours b/f anesthesia
Approach for Thoracic duct ligation
Dogs: Right 10th ICS
Cat: Left 10th ICS
As far caudal/ close to diaphragm as possible
Dorsal to aorta
Procedures for Chylothorax
Thoracic duct ligation
Pericardiectomy
Cisterna Chyli Ablation
Omentalization
Pleurodesis
Cisterna Chyli Ablation
Left dorsal to aorta
Mobilize kidney to access
Lateral thoracotomy approach
Skin
SC
Cutaneous Trunci
Latissimus dorsi
Pectoralis
Scalenous/ ext abd oblique
Serratus ventralis separated
Intercostal m
Pleura
