Pyothorax

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Sections available in full article Introduction, Presenting signs, Acute presentation, Special risks (e.g. anesthetic), Pathogenesis, Etiology, Predisposing factors, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Gross autopsy findings, Histopathology findings, Differential diagnosis, Treatment, Initial symptomatic treatment, Standard treatment, Monitoring, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Kim Willoughby BVMS PhD MRCVS
Dr Serena Brownlie BVM&S PhD CertSAC MRCVS
Dr Philip K Nicholls BVSc BSc PhD MRCVS FRCPath
Ms Penny Watson MA VetMB CertVR DSAM DipECVIM MRCVS
Dr Elizabeth Rozanski DVM DACVIM DACVECC

Introduction

  • Cause : bacterial or fungal infection in pleural space.
  • Signs : respiratory distress, lethargy, inappetance/anorexia, pyrexia.
  • Diagnosis : cytological evaluation and bacterial culture of pleural fluid.
  • Treatment : antibiotics, thoracic drainage, occasionally surgery.
  • Prognosis : guarded.

Diagnosis

Clinical signs

  • Depression.
  • Pyrexia.
  • Dyspnea.
  • Tachypnea.
  • Muffled heart sounds.
  • Dull lung sounds.
  • Dehydration.
  • Reduction in thoracic resonance on chest percussion.

Diagnosis

Differential diagnosis

Other causes of pleural effusion
  • Pleural effusion  Pleural effusion  .
  • Transudate, eg congestive heart failure  Congestive heart failure  , hypoproteinemia  Hypoproteinemia  .
  • Hemothorax  Hemothorax  .
  • Chylothorax  Chylothorax  .
  • Pyogranulomatous effusion, ie FIP  Feline infectious peritonitis  .
  • Neoplasia  Lung: pulmonary neoplasia  .

Other causes of dyspnea

  • See decision support.
  • May find foreign body.
  • May find bite wound.

Sequelae

Prognosis

  • Guarded.

Expected response to treatment

  • Repeated thoracocentesis  Drainage: thorax  and lavages producing diminishing amounts of purulent effusion.
  • Improving demeanor.
  • Repeated radiographs/ultrasound showing resolution of effusion.

Reasons for treatment failure

  • Walled-off lung abscessation  Airway abscessation  .
  • Fibrinous pleuritis which may require decortication.
  • Systemic toxemia or septicemia, eg disseminated Actinomyces .

Sources

Publications

Refereed papers

  • Waddell L S, Brady C A & Drobatz K J (2002)Risk factors, prognostic indicators, and outcome of ptothorax in cats: 80 cases (1986-1999).JAVMA221(6), 819-824.
  • Demetriou J Let al(2002)Canine and feline pyothorax: a retrospective study of 50 cases in the UK and Ireland.J Small Anim Pract.43(9), 388-394
  • Davies Cet al(1996)Pleural effusion in cats - 82 cases (1987-1995).JSAP37(5), 217-224.
  • Love D Net al(1990)The obligate and facultatively anaerobic bacterial flora of the normal feline gingival margin.Vet Microbiol22(2-3), 267-275.
  • Love D Net al(1989)Bacteroides species from the oral cavity and oral-associated diseases of cats.Vet Microbiol19(3), 275-281.
  • Dickie C W (1979)Feline pyothorax caused by a Borrelia-like organism and Corynebacterium pyogenes.JAVMA174(5), 516-517.

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