Felis ISSN 2398-2950

Mediastinal disease

Contributor(s): Andrew Gardiner

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.

Pathogenesis

Etiology

  • Mediastinal disease may be caused by various processes:
    • Trauma, eg bites to the chest area.
    • Foreign bodies causing perforation of the thoracic trachea Trachea: foreign body or esophagus Esophagus: foreign body.
    • Endoscopic or endotracheal tube damage to the trachea causing perforation.
    • Bougienage of the esophagus resulting in perforation Esophagus: perforation.
    • Neoplastic processes arising in the mediastinum or extending to it.
    • Abscess, granuloma or infection, eg pyothorax Pyothorax.
    • Cysts, eg bronchogenic cyst (rare).
    • Lymphadenopathy.
  • Bacterial infection - higher bacteria, such as Actinomyces spp Actinomyces pyogenes  and Nocardia spp Nocardia spp are often implicated in mediastinal disease associated with pyothorax Pyothorax.
  • Viral infection (especially FeLV-associated neoplasia in young cats).

Pathophysiology

  • Mediastinal pathology leads to a space-occupying lesion, with displacement of thoracic contents and consequent clinical signs.
  • Pleural effusion is a frequent finding.
  • The mediastinal pathology may relate to an underlying systemic disease condition. The most common scenario is anterior mediastinal lymphosarcoma in young, FeLV-positive cats.
  • Respiratory symptoms elicited by space-occupying lesions, fluid accumulation or infective processes, eg abscess, in the mediastinum or thorax.
  • Dysphagia may result from displacement and occlusion of the thoracic esophagus.

Timecourse

  • Varies from peracute (fulminating mediastinitis secondary to puncture wounds, foreign bodies or esophageal rupture) to chronic (neoplasia).

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Koutinas C K, Papazoglou L G, Saridomichelakis M N et al (2003) Caudal mediastinal abscess due to a gras awn (Hordeum spp) in a cat. J Feline Med Surg (1), 43-46 PubMed.
  • Tidwell A S (1998) Ultrasonography of the thorax (excluding the heart). Vet Clin North Am 28 (4), 993-1015 PubMed.
  • Day M J (1997) Review of thymic pathology in 30 cats and 36 dogs. JSAP 38 (9), 393-403 PubMed.
  • Rogers K S & Walker M A (1997) Disorders of the mediastinum. Comp Cont Ed Pract Vet 19 (1), 69-83 VetMedResource.
  • Roush J K, Bjorling D E, Lord P (1990) Diseases of the retroperitoneal space in the dog and cat. JAAHA 26 (1), 47-54 VetMedResource.
  • Scott-Moncrieff J C, Cook J R Jr. & Lantz G C (1990) Acquired myasthenia in a cat with thymoma. JAVMA 196 (8), 1291-1293 PubMed.
  • Parker N R, Walker P A & Gay J (1989) Diagnosis and surgical management of esophageal perforation. JAAHA 25 (5), 587-594 VetMedResource.
  • 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 Rec 104 (14), 304-307 VetMedResource.


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