Pyothorax and chylothorax

Pyothorax and chylothorax with differential diagnosis and treatment

1. PYOTHORAX OR
EMPYEMIA
Diseases of Respiratory system
By
Prof Dr. Mohamed Ghanem

2. PYOTHORAX OR EMPYEMIA
Definition:
it is the accumulation of pus and infected
material and fluids within the pleural
sac characterized clinically by fever,
shortness of breath and loss of weight.
History: of surgery, hospitalization due
to other disease or being out home for
several days

3. Causes
Incubation period 5-10 days:
1.Direct introduction
By penetrating trauma.
Surgery
Thoracocentesis or thoracostomy.
2. Haematogenous:
Systemic sepsis, which reaches the pleural sac
via lymphatics or blood
3.by extension:
From rupture of oesophagus
Penumonia with bronchopleural
communication
Mediastinitis or subphrenic infection

4. Clinical symptoms:
It usually occurs in acute or subacute form
1.Fever
2.Anorexia - Loss of weight
3.Shortness of breath,
4.Abduction of forelimbs, arched back
5.Microbiological examination of effusion
by acid- fast stain or Gram stain or by
culture reveals presence of
1.mycobacterium, bacteroids, actinomycetes,
2.E. coli or pasteurella.

5. Hemogram
1.Leucocytosis 27000 in cats and 32000 in
dog patients.
2.Elevated serum globulin N: 3.7% it
reaches 5.2 mg % 
3.PCV may be elevated N: 37 % in dogs, 26
% cats .
4.These animals may show normocytic,
normochormic anaemia.

6. Radiography
The X-ray reveals:
Moderate to large pleural effusion.
Obscure cardiac silhouette (shadow)
and a large portion of pulmonary and
pleural details.

7. Normal graph of cat
chest
Pleural effusion in cat
chest
Heart silhouette

8. Diagnosis:

1.By history
2.Symptoms
3. Special examinations:
1.Laboratory tests:
1.WBCs, PCV
2.Culture and stain examination.
3.Radiograph

9. Treatment:
I-Hygienic treatment:
Complete rest.
Easily digestible food such as boiled
rice or jelly
II- Medicated treatment:
1- Tube thoracostomy to make chest
drainage treated as an abscess which
must be evacuated to reach complete
and rapid recovery.
A dog can drain 490 ml in the first day with
a total amount of 2850 ml till recovery,
while that for cats is 320 in the first day and
490 ml till recovery.

10. The technique for drainage
include:
1.No general anaesthesia because respiration is
minimal and any decrease in respiration is
fatal.
2.Prepare the area for surgical operation by
clipping, washing, and antiseptic solutions.
3.Make a small skin incision over the dorsal half
of the last rib.
4.Advance or introduce the chest tube S/C to the
level of 7th or 8th intercostal space. At this level
introduce it into the chest.
5.A purse string suture is made at the site of
introduction and the tube is fixed to the skin.

11. Treatment pyothorax
(continued)
2. Moderate or high doses of parental antibiotics
especially penicillin.
oral doses may be used after complete
drainage and when there is clinical
improvement.
Use olindomycine if the bacteria isolated is
penicillin resistant in nature. 50 mg/kg every 6-8
h in dogs and every 12 h in cats.
Ampicillin may be used in a dose 1gm every
4 hours for 2 days followed by 1 gm every 6
hours for next 5 days then every 8 hours till
complete recovery.
2-Parentral fluid therapy.
3- Antipyretic (analgin –novalgin IM)

12. CHYLOTHORAX

Definition
It is accumulation of lymph in the
pleural sac due to rupture of the
thoracic duct. The lymph fluid contains
high concentration of triglycerides,
lymphocytes, protein, fat-soluble
vitamins .

13. Etiology

Rupture of thoracic duct due to
Congenital disorder.
Surgical trauma during thoracotomy.
Non-surgical trauma by car accident.
Neoplasia in cats is a common cause

14. Clinical signs

Respiratory distress especially during
inspiration.
Anorexia.
Exercise intolerance.
Weight loss.
Cough may occur.

15. Diagnosis

History
Clinical signs.
Radiography. To document the fluid
Examination of pleural fluid collected
by thoracocentesis
Blood test: lymphopenia and
panhypoproteinemia in peripheral
blood

16. Treatment:

A-Hygienic Treatment
Rest
Fluid therapy
B-Medicated therapy:
by draining the chyle by chest tube using a
constant suction.
This drainage may maintain direct contact
between the parietal and visceral pleura
that may decrease leakage of chyle from
the chest.

17. Medicated steam inhalation