Felis ISSN 2398-2950

Chylothorax

Contributor(s): Serena Brownlie, Philip K Nicholls, Elizabeth Rozanski, Kim Willoughby

Introduction

  • Extravazation or leakage of chyle into pleural space.
  • Cause: trauma, neoplasia, cardiomyopathy Heart: dilated cardiomyopathy (DCM), Heart: hypertrophic cardiomyopathy, diaphragmatic hernia Diaphragm: hernia, obstruction of thoracic duct inflow to vena cava, dirofilariasis , idiopathic (trauma).
  • Signs: dyspnea, tachypnea, coughing.
  • Diagnosis: radiography, thoracocentesis and fluid analysis.
  • Treatment: identify underlying cause and treat if possible, otherwise medical or surgical treatment.
  • Prognosis: depends on cause and outcome of surgery.
  • Medical treatment is rarely successful in idiopathic cases.

Pathogenesis

Etiology

  • Idiopathic.

Predisposing factors

General

  • Idiopathic.
  • Diaphragmatic hernia Diaphragm: hernia.
  • Obstruction of thoracic duct.
  • Traumatic duct rupture.
  • Cranial mediastinal mass.
  • Lung lobe torsion.
  • Pacemaker implantation Heart: pacemaker.
  • Dirofilariasis.
  • Cranial vena caval thrombus.

Specific

  • Possible congenital abnormality of thoracic duct in young cats.

Pathophysiology

  • Development of cranial mediastinal lymphangectasia is the most common anatomical lesion.
  • Produced by functional or mechanical obstruction to thoracic duct flow.
  • Chyle accumulation   →   expansion of pleural space   →   compression of functional lung tissue   →   alveolar atelectasis and reduced vital capacity (may)   →   ventilatory failure.
  • Chylofibrosis   →   respiratory compromise.

Timecourse

  • Usually chronic.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Lafond E, Weirich WE, Salisbury SK (2002) Omentalization of the thorax for treatment of idiopathic chylothorax with constrictive pleuritis in a cat. J Am Anim Hosp Assoc 38 (1), 74-78 PubMed.
  • Fossum T W (2001) Chylothorax in cats - is there a role for surgery? JFMS (2), 73-79 PubMed.
  • Sturgess K (2001) Diagnosis and management of chylothorax in dogs and cats. In Practice 23 (9), 506-513 VetMedResource.
  • Thompson M S, Cohn L A & Jordan R C (1999) Use of rutin for medical management of idiopathic chylothorax in four cats. JAVMA 215 (3), 339, 345-348 PubMed.
  • Fossum T W, Miller M W, Rogers K S et al (1994) Chylothorax associated with right-sided heart failure in five cats. JAVMA 204 (1), 84-9 PubMed.
  • Kerpsack S J, McCloughlin M A, Birchard S J et al (1994) Evaluation of mesenteric lymphangiography and thoracic duct ligation in cats with chylothorax - 19 cases (1987-1992). JAVMA 205 (5), 711-715 PubMed.

Other sources of information

  • Smeak D D & Kerpsack S J Management of Feline Chylothorax. In: Current Veterinary Therapy XII. pp 921.


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