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Y4 SA - Respiratory > Pleural space disease > Flashcards

Pleural space disease Flashcards

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1
Q

4 broad causes for dyspnoea

A
  • URT obstruction
  • loss of thoracic capacity
  • pulmonary parenchymas disease
  • non-CRS conditions
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2
Q

Pleura - definition

A
  • the membranes/sacs around each lung
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3
Q

Pleural effusion - what is it, what does it cause?

A
  • fluid in the pleural space
  • doesn’t allow enough space on inspiration to fill the lungs
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3
Q

What is between the pleural membranes? And what is it’s function?

A
  • A small amount of fluid, which helps breathing
  • Without the fluid the pleural membranes would stick together and on chest expansion there wouldn’t be a nice flow
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4
Q

Types of pleural effusion

A
  • blood
  • pus
  • chyle
  • true/modified transudate
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5
Q

Pneumothorax - what does it cause?

A
  • too much air in the pleural space / air leaking into the pleural space
  • not enough on inspiration to fill the lungs due to loss of thoracic capacity
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5
Q

Causes for loss of thoracic capacity (+/- cyanosis)

A
  • pleural effusion
  • pneumothorax
  • neoplasia
  • ruptured diaphragm
  • abdominal abnormality (severe ascites/mass)
  • gross cardiomegaly
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6
Q

Mediastinum - what is it?

A
  • the space between the right and left pleural sac
  • continuous in most species
  • more delicate and discontinuous(?) in horses
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6
Q

Why does a ruptured diaphragm cause dyspnoea?

A
  • the pleural space touches the diaphragm, so if the diaphragm ruptures abdominal contents will get into the pleural space, decreasing inspiration
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7
Q

What does the mediastinum contain?

A
  • blood vessels
  • nerves
  • oesophagus
  • heart
  • trachea
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8
Q

Pleural space disease is an accumulation of…

A
  • fluid (pleural effusion)
  • air (pneumothorax)
  • soft tissue mass (e.g. abdominal organs)
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8
Q

Problems caused by pleural space disease

A
  • direct compression of the lungs, and also loss of negative pressure can cause the lungs to collapse
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9
Q

Restrictive lung disease - why does it cause a problem?

A
  • fluid etc restricting the ability of the lungs to inflate
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9
Q

Clinical signs of pleural space disease

A
  • restrictive breathing pattern
  • tachypnoea
  • open mouth breathing
  • resp distress (dyspnoea)
  • orthopnoea
  • cyanosis
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10
Q

Examples of orthopnoea / how to spot it

A
  • elbow abduction
  • sternal recumbency
  • essentially using their entire body to breathe
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10
Q

Which species is orthopnoea normal in? Why?

A
  • normal for tortoises as they don’t have a diaphragm
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11
Q

Clinical exam - specific to pleural space disease

A
  • observe resp pattern
  • possible muffled heart/lung sounds
  • percussion
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12
Q

Pleural effusion chest auscultation

A
  • dulling of lung and heart sounds especially ventrally when standing
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13
Q

Pleural effusion chest percussion

A
  • increased dullness (fluid ‘line’)
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14
Q

Pleural fluid normal dynamics

A
  • fluid produced many from parietal pleural vessels by capillary filtration. fluid reabsorbed mainly by parietal lymphatic vessels
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14
Q

Pleural effusion dynamics

A
  • effusion occurs if there’s decreased pleural absorption or increased fluid formation
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15
Q

Causes of increased fluid formation - for pleural effusion

A
  • leaky capillaries (e.g. pleural inflammation)
  • increase in intravascular pressure (e.g. CHF)
  • increase in lung interstitial fluid (e.g. CHF)
  • decrease in pleural pressure
  • increase in pleural fluid protein (increases oncotic pressure)
  • disruption of thoracic duct or blood vessels
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16
Q

Causes for decreased fluid absorption - for pleural effusion

A
  • obstruction of draining lymphatics (e.g. neoplasia, inflammation)
  • increased systemic vascular pressures (RSHF)
  • reduced vascular oncotic pressure (hypoalbuminaemia)
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16
Q

Most common cause of pure transudate

A
  • due to decreased oncotic pressure due to hypoalbuminaemia
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17
Causes of hypoalbuminaemia
- PLE (losing it from the gut) - leaky gut from IBS/IBD - low dietary protein - liver disease (as albumin is made in the liver)
18
Most common cause of modified transudate
- due to increased hydrostatic pressure secondary to RSHF (e.g. pericardial disease, cardiomyopathy, pulmonary hypertension, pulmonic stenosis)
19
Other common causes of modified transudate
- diaphragmatic hernia - lung lobe torsion - neoplasia
20
Why does lung lobe torsion cause modified transudate pleural effusion?
- twisting damages the capillaries, making them leaky
21
Why does pulmonary neoplasia cause modified transudate pleural effusion?
- it causes irritation and damage to the capillaries, making them leaky
21
Types of exudative pleural effusion
- non-septic effusion - septic effusion (pyothorax) - chyle (chylothorax) - blood (haemothorax)
22
Causes of non-septic exudative effusion
- FIP - neoplasia - chronic chylothorax - chronic lung lobe torsion - fungal infection
23
Causes of pyothorax
- penetrating chest wound - FB inhalation (e.g. grass seed) - ruptured oesophagus - ruptured pulmonary abscess/tumour - haematogenous bacterial spread
24
Causes of chylothorax
- disruption of the thoracic duct - lymphangiectasia - cranial vena cava obstruction - neoplasia - heart disease - fungal infection - lung lobe torsion - diaphragmatic hernia - trauma of the thoracic duct
25
Causes of haemothorax
- trauma - coagulopathy - neoplasia - lung lobe torsion
25
Why do chronic chylothorax and chronic lung lobe torsion cause a non-septic exudative effusion?
- if they have been there a while the body will have cells there to try and sort it out
26
Lymphangiectasia - what is it?
- superficial lymphatic dilatation caused by a wide range of scarring processes - occurs as a consequence of lymphatic drainage by an external cause, leading to obstruction of local lymph drainage
27
Pleural effusion diagnosis
- clinical findings - radiograph - US - thoracocentesis
28
Case triage - initial management
- oxygen supplementation - emergency thoracic US to make diagnosis - severe dyspneic pts DON'T radiograph - immediate thoracocentesis
28
Why is thoracocentesis so important?
- immediate relief of clinical signs - diagnostic (cytology, cell counts, protein content, bacterial culture) - stabilises the pt prior to further investigations
29
Indications for thoracostomy
- pts that will need multiple thoracentesis over a short period of time - if large volumes of effusion - pneumothorax - chest wall injuries (flail chest/flail segment) - bite wounds - most pyothorax cases - following chest surgery
30
Why send pts with chylothorax for ct?
- to find out what is pressing/damaging the thoracic duct
31
Causes of pneumothorax
- rupture of major airways / lung parenchyma - thoracic trauma - perforation of the oesophagus - bullous/necrotising/neoplastic lung disease which leak air into pleural space iatrogenic (e.g. prolonged ventilation under GA causing rupture of the lungs, bronchoscopy) - gas producing bacterial infection in pleural space
31
Pneumothorax clinical findings
- restrictive breathing (slow-rapid breaths) - dull lung sounds dorsally and increased sounds ventrally (bronchovesicular) on auscultation - increased resonance on percussion
32
Diagnosis of pneumothorax
- physical exam - assessment of resp status - thoracic radiographs (if stable enough) - routine haem/biochem - blood gases and pulse ox to assess severity
32
Pathophysiology of pneumothorax
- loss of negative pressure in pleural space means that the lungs aren't effectively 'coupled' to rib cage - as the rib cage is raised the lungs don't inflate - the lungs collapse and tidal volume is very low
33
Tension pneumothorax
- lesion in lung parenchyma or airway acts as a 1-way valve - pleural pressure rises causing severe lung compression - pressure can exceed central venous pressure, reducing venous return and cardiac output - rapidly life threatening
34
Treatment of traumatic pneumothorax
- oxygen - drain pneumothorax as necessary (avoid over drainage) - approx 90% recovery w strict cage rest for up to 2wks - if no improvement then surgical exploration and correction will be required - if open wounds then sterile dressings and surgery as soon as patient is stable - essentially waiting for whatever has caused the problem to heal
35
Spontaneous pneumothorax history
- dyspnoea - anorexia - vomiting - most present with rapid progression of respiratory distress - can occur with chronic asthma in cats
36
Most common cause of spontaneous pneumothorax
- ruptured pulmonary bulla or sub-pleural bleb
36
Pulmonary bulla - what is it?
- an air filled space (>1cm diameter) within the lung which has developed because of emphysematous destruction of the lung parenchyma
36
Emphysema - what is it?
- damage to the alveoli
36
Diagnosis for spontaneous pneumothorax
- as for traumatic pneumothorax
37
Management of spontaneous pneumothorax
- medical management to stabilise until diagnostic tests decide whether surgical intervention is needed - lobectomy as necessary
38
Prognosis of spontaneous pneumothorax
- dependent on underlying cause
39
Mediastinal disease examples
- may be benign/malignant tumours - cystic lesions - enlarged mediastinal LN - haematomas
40
What can mediastinal disease be hidden behind?
- pleural effusion -> so check tracheal position (pushed up?)
41
What animals are mediastinal lymphomas most common in?
- young cats (possible predisposition for siamese) - also seen in dogs with multi centric or stage 3-5 lymphoma
42
Clinical signs/findings for mediastinal lymphoma
- tachypnoea - inspiratory hyperpnoea - dull heart sounds - pleural effusion
43
Differential diagnosis for mediastinal lymphoma
- thymoma
43
Diagnosis of mediastinal lymphoma
- cytology ± flow cytometry
43
Which animals is a thymoma most common in?
- younger dogs
44
Are mets common for thymoma?
- no
44
Presentation of thymoma
- respiratory distress - +/- cranial caval syndrome - +/- myasthenia gravis - megaoesophagus also common if focal MG or disrupted due to presence of mass
44
Cranial caval syndrome - cause and signs
- mass pressing on the cranial vena cava - so causes problems where the return of the blood is building up in the body -> the only way it can go is leak out of the vessels - so get effusion around the face -> looks like it's had an anaphylactic reaction
45
Good prognosis for thymoma if...
- full surgical resection
46
Poor prognosis for thymoma if...
- old - megaoesophagus - invasive
47
Pleural tumours
- mesothelioma (rare), from epithelial lining cells (pleural, abdominal, pericardial), major link with asbestos inhalation. causes large volume effusions and pain ++. multifocal small masses -hard to image, US & CT useful.
48
Mesothelioma diagnosis
- hits ideal, thorascopy best as non-invasive
48
Mesothelioma treatment
- via intra-cavitary carboplatin/cisplatin - but painful and poor prognosis
49
Rib osteosarcoma and chondrosacromas
- OSAs aggressive in this location. what's visible on the outside may be only 20-30% of total
50
Rib osteosarcoma and chondrosarcoma tx
- rib resection -> thoracotomy + post-op chemo if osteosarcoma
51
Prognosis of osteosarcoma vs chondrosarcoma
- chondrosarcoma > osteosarcoma

Y4 SA - Respiratory (12 decks)

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