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Feline Pyothorax Accumulation of septic purulent effusion within the…
Feline Pyothorax
Accumulation of septic purulent effusion within the pleural space
Diagnostic
Primary diagnostic
Auscultation
Muffled heart sounds, lung sounds decrease ventrally and dorsally
Radiograph
Unilateral or bilateral pleural effusion with pleural fissures and scalloped lungs borders
Obscuring of the cardiac silhoutte and diaphragm
Clinical signs
Dyspnea and tachypnea , exercise intolerance
WIth restrictive pattern of respiratory rate
Some exhibit systemic signs of illness
Fever
Thoracocentesis
A few milliliters may be removed to confirm the presence of pleural effusion
Pleural Fluid analysis
Grossly the fluid appear turbid and opaque, may have fluocculent material and can have a malodorous smell if an anaerobic infection is present
Protein content greater than 35g/l and the specific gravity is greater than 1.025
Nucleated cell count is greater than 15X10(9)
Pleural fluid cytology
Degenerative neutrophils , macrophages and the causative organism are usually found
Gram stain provide information on the type of bacteria present and improve the choice of antibiotics while waiting for culture
Culture and sensitivity
Secondary diagnosis
Hemogram
Neutrophilic leucocytosis with a left shift
Sometimes degenerative left shift withleucopenia
Anemia of chronic disease
Serum Chemistry
:
Often normal but there may be increased protein with a decrease albumin to globulin ratio
non specific and include hypoalbuminemia , hyperglobulinemia, hypoglycemia or hyperglycemia , electrolyte imbalances and mild elevation in liver enzymes activities
Urinalysis
Proteinuria is present if glomerulopathy has developed
Etiology
Often unknown as it is normally chronic
Specific route of pleural infection or underlying cause reported in only 2-33% of dogs
Bite wound
Foreign body migration
parapneumonic spread from infected foci within lung tissue (ruptured pulmonary abscess)
Hematogenous spread
Oesophageal perforation
Introduction during surgical or thoracocentesis procedures
Pathophysiology
Through bite wound , penetrating injury , foreign body inhalation , direct puncture of the chest wall or esophageal rupture
Bacteria spread to the pleura from a pulmonary infection or hematogenously
Pyothorax
Restrictive respiration
Therapy
Primary therapy
2) Antibiotics
As soon as pyothorax is suspected ( Based on the historical and clinical signs , as well as purulent material from thoracocentesis)
Initial antibiotics should be based on cytology of the effusion , effective against obligate and facultative anaerobes
Should be administered IV at early treatment to achieve high serum concentration .Oral antibiotics to be administered after patient begun to show signs of response to therapy
3) Thoracostomy drainage
Should be placed under general anesthesia, intubated
Radiograph should be obtained after tube placement to access tube position
Intravenous fluid
To correct intravascular deficits , prevent dehydration and provide maintainance needs
-
Serum electrolytes
should be evaluated
Oxygen therapy
if there is still evidence of continued hypoxia after thoracocentesis.By putting nasal cannulas or into an oxygen chamber
Nutritional support
Feeding tube should be placed in cats that remain anorexic after 24 to 48 hours of appropriate therapy
or Esophageal tube