Pleural Space Disease

Question 1

What structures make up the pleural space?

Answer 1

Question 2

What are 5 causes of fluid accumulation in the pleural space?

Answer 2

Decreased oncotic pressure
Increased hydrostatic pressure
Impaired lymphatic drainage
Increased vascular permeability
Hemorrhage

Question 3

What are the clinical signs of pleural space disease?

Answer 3

Tachypnea
Dyspnea, open mouth
Restrictive pattern (rapid, shallow)
Asynchronous
Orthopnea
Cyanosis
Dull/absent lung sounds

Question 4

What is the stabilization plan for a cat presenting with a restrictive breathing pattern, dull lung sounds ventrally, and dyssynchronous breathing?

Answer 4

Sedate: butorphanol, midazolam
Cannot inflate the lungs with intubation
Thoracocentesis with fluid analysis

Question 5

Characteristics and Causes: Transudate

Answer 5

TP < 2.5 g/dL
TNCC < 1500/uL
Low albumin

Question 6

Characteristics and Causes: Modified Transudate

Answer 6

TP 2.5 - 7 g/dL
TNCC 1000 - 7000/uL
R CHF, neoplasia, lung torsion, inflammation, hernia

Question 7

Characteristics and Causes: Exudate

Answer 7

TP > 3.0 g/dL
TNCC > 7000/uL
Septic, non-septic, neoplasia, chyle

Question 8

What are the main causes of chylous effusion?

Answer 8

Idiopathic
Mediastinal mass
Heart disease
Lung lobe torsion
Obstructed thoracic duct
Heartworm
Thromboembolism

Question 9

What are the main causes of hemorrhagic effusion?

Answer 9

PCV > 10%, non-clotting
Trauma
Coagulopathy
Neoplasia
Pancreatitis
Heartworm disease
Iatrogenic

Question 10

What is the treatment for feline pyothorax?

Answer 10

Place bilateral chest tubes
Evacuate the pleural space
Lavage the pleural space
Empiric antibiotics
Thoracic radiographs of CT

Question 11

What are indications for chest tube placement?

Answer 11

Recurrent pneumo
Tension pneumo
Pyothorax
Postop thoracotomy
Rapid fluid

Question 12

What are contraindications for chest tube placement?

Answer 12

Uncorrected coagulopathy
Organs
Masses

Question 13

How long should we keep in chest tubes when treating pyothorax?

Answer 13

• When no more fluid is left (<2 ml/kg/day)
• Radiographic improvement
• 4 - 8 days
• Out of money

Question 14

What are the most common sources of bacteria in feline pyothorax?

Answer 14

URT infection
Cat bite wounds

Question 15

What are the most common types of bacteria in feline pyothorax?

Answer 15

Mixed
Oropharyngeal anaerobes
Pasturella
Nocardia, actinomyces

Question 16

What are the empiric antibiotics of choice for feline pyothorax?

Answer 16

Parenteral enrofloxacin/marbofloxacin
Parenteral clindamycin or penicillin
3 - 6 weeks

Question 17

What are the most common bacteria in canine pyothorax? What is the treatment?

Answer 17

Mixed anaerobes and E. coli
Surgical debridement