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Pleural Space Dz (Pneumothorax (free air in pleural space, Primary eg.…
Pleural Space Dz
Pneumothorax
free air in pleural space
Primary eg. trauma
Secondary eg. spontaneous pneumothorax ← rupture of bleb, bullae, cyst, chronic airway dz
Tx : cage rest, removal of gas
Diagnostic Modalities
auscultation, percussion, 영상 진단, thoracocentesis, cytology(infection, inflammation, neoplasia), fluid analysis(TP, TNCC), biochemical analysis(LDH, glucose, pH), culture
Thoracocentesis : 주저하지 말 것. 7~8th ICS. 21 gauge 정도. 초음파로 보면서 찌르는 게 제일 좋음. complications rare
Obtaining samples
EDTA, serum tubes
Refrigeration of turbid samples may falsely increase TP.
TP should be measured using the supernatant of the turbid sample.
EDTA is bacteriostatic. → 배양에는 사용x
Fluid
Transudate
정수압 증가 또는 교질 삼투압 감소 → modify w/ time
Protein-poor : hypoalbuminemia(<1.5g/dl) ← the most common causes
Protein-rich : modified transudates eg. vena cava obstruction, 우심부전
Exudate
TP>3.0g/dl
Chylothorax
자주 뽑아주어야 함. 림프액에 남아 있으면 나중에 흉막염 유발
triglycerides in fluid > serum
often idiopathic
Known etiologies : HW, CHF, neoplasia, granuloma, trauma
Medical therapy : low fat diet, rutin, etc.
guarded prognosis
Surgical therapy : pericardectomy & ligation
Pyothorax
개보다 고양이에서 더 많음. 고양이는 상부 호흡기 감염으로 많이 생기고, 개는 이물에 의해 많이 생김.
Source of infection : oral cavity(dogs) and upper airway(cats)
Cytological diagnosis : intracellular bacteria(안 보일 수 있음), TNCC
Biochemical diagnosis : pH, glucose, lactate(not in cats)
고양이 연구
Risk factors : multi-cat household=3.8xsingle-cat household
혈중 콜레스테롤 수치 높을 때 비생존 가능성 증가
50% cats → sepsis
개 연구
sulfur granules(33%)
heparin(10U/ml) saline lavage → beneficial
Dx
turbid to opaque appearance, malodorous smell
bacterial identification
Light's criteria(human) : glucose, LDHp, pH
Tx : 항생제, drainage
Feline Infectious Peritonitis
mutation of common GI Coronavirus
wet or dry forms
Dx
not always simple(wet easier)
characteristic effusion(Rivalta's test) : one drop of acetic acid(98%)+5ml DW → 양성이면 콧물 흐르듯이 수직으로 내려감.
hyperglobulinemia, leukocytosis
Tx : usually fatal. 면역억제, 영양, drainage 등이 있으나 아직까지 성공률이 높은 치료법 없음.
Hemothorax
More than red looking
Signs result from anemia+effusion
auto-transfusion? ← 외상의 경우 가능하나 bite wound나 종양에는x
continuous evacuation not indicated
trauma, coagulopathies, neoplasia, lung lobe torsion, or infection
Acute hemorrhage(or iatrogenic) : including platelets, lacking erythrophagocytosis
Chronic hemorrhage : no platelets, erythrophagocytosis(>24h), hemosiderophages
Diaphragmatic Hernia
congenital or acquired
signs respiratory or GI (severe to none)
surgical repair +/-
Cats : peritoneal-pericardial
Bilothorax(rare) : bilirubin concentration 1>pleural effusion/serum
Neoplastic pleural effusion
Reactive mesothelium looks like neoplasia.
exudate 생기고 호흡곤란 유발
Pleural Effusion
: usually bilateral but unilateral is not uncommon
C/S
: exercise intolerance, restrictive breathing pattern(shallow inspiration), dyspnea(mostly inspiratory), altered or absent lung sounds, non-compliant chest wall(cats>dogs), precaval syndrome(edema of front of body)