Mediastinal disease

Buy now to access the full article, existing subscribers login

Sections available in full article Introduction, Presenting signs, Acute presentation, Age predisposition, Breed predisposition, Special risks (e.g. anesthetic), Pathogenesis, Etiology, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Gross autopsy findings, Differential diagnosis, Treatment, Initial symptomatic treatment, Standard treatment, Monitoring, Prevention, Control, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Mr Andrew Gardiner BVM&S, Cert SAS, MSc, MRCVS

Introduction

  • Cause : both neoplastic and non-neoplastic conditions.
  • Signs : attributable to the respiratory or upper gastrointestinal tracts.
  • Occasionally, mediastinal space-occupying lesions will cause head, neck or forelimb edema, or Horner's syndrome if the sympathetic ganglion is affected.
  • Diagnosis : ultrasonography.
  • Treatment : often symptomatic or surgical.
  • Prognosis : good for abscess, foreign bodies and granulomas; fair for thymoma; poor for lymphosarcoma.

Diagnosis

Clinical signs

  • Muffled heart sounds.
  • Moist rales.
  • Reduced compressibility of the anterior chest wall.
  • Decreased thoracic resonance on percussion.
  • Thoracic pain.
  • Tachypnea.
  • Pyrexia (if inflammatory disease).
  • Peripheral lymphadenopathy in neoplastic states.

Diagnosis

Differential diagnosis

  • Diaphragmatic hernia  Diaphragm: hernia  .
  • Cardiac disease (cardiomegaly).
  • Upper respiratory infection  Rhinitis  .
  • Hyperthyroidism  Hyperthyroidism  .
  • Esophageal lesions, eg megaesophagus  Megaesophagus  .
  • Pleural effusion  Pleural effusion  .
  • Bronchopneumonia  Pneumonia  .

Sequelae

Prognosis

  • Poor long-term for lymphosarcoma in FeLV-positive cats.
  • Fair for thymoma: surgery of these benign and slow-growing tumors can be curative/palliative.
  • Good for abscess/foreign bodies, granulomas and traumatic conditions if surgery is successful and supportive therapy sufficient.

Expected response to treatment

  • Resolution of respiratory signs.
  • Improvement in patient demeanor.
  • Weight gain, improved appetite, etc.

Reasons for treatment failure

  • Incorrect diagnosis, ie not mediastinal disease.
  • Severe or undiagnosed underlying pathology.
  • Insufficient surgical drainage or duration of antibiotic therapy in infectious conditions.

Sources

Publications

Refereed papers

  • Koutinas C Ket al(2003)Caudal mediastinal abscess due to a gras awn (Hordeum spp) in a cat.J Feline Med Surg.5(1), 43-46.
  • Tidwell A S (1998)Ultrasonography of the thorax (excluding the heart).Vet Clin NA28993-1015.
  • Day M J (1997)Review of thymic pathology in 30 cats and 36 dogs.JSAP38393-403.
  • Rogers K S and Walker M A (1997)Disorders of the mediastinum.Comp Cont Ed Pract Vet1969-83.
  • Roush J Ket al(1990)Diseases of the retroperitoneal space in the dog and cat.JAAHA2647-54.
  • Scott-Moncrueff J C, Cook J R and Lantz G C (1990)Acquired myasthenia in a cat with thymoma.JAVMA1961291-1293.
  • Parker N R, Walker P A and Gay J (1989)Diagnosis and surgical management of esophageal perforation.JAAHA25587-594.
  • Gruffydd-Jones T L, Gaskell C J, Gibbs C (1979)Clinical and radiological features of anterior mediastinal lymphosarcoma in the cat - a review of 30 cases.Vet Rec104304-307.

Sample content only, to unlock the full article login or buy now

Loading...