Close this window to return to IVIS

www.ivis.org

International Congress of
the Italian Association of Companion
Animal Veterinarians
May 19 21 2006
Rimini, Italy

Next Congress :
62nd SCIVAC International Congress
&
25th Anniversary of the SCIVAC Foundation
May 29-31, 2009 - Rimini, Italy

Reprinted in IVIS with the permission of the Congress Organizers

15

Pleural effusion in the dog and cat

Leah A. Cohn
DVM, BS, PhD, Dipl ACVIM, Columbia, USA

Pleural effusion is a relatively common cause of respiratory distress in the dog and cat. Both species are affected by
a variety of types of effusion with numerous causes and variable prognosis. Pleural effusion may be discovered incidentally or may cause respiratory distress. Small amounts of
effusion may not result in changes on physical examination.
If fact, it requires approximately 10 ml/kg off effusion to
result in radiographic detection of pleural fluid, and more
than 30 ml/kg of effusion to result in altered physical examination. Respiratory distress may not be severe until more
than 50-60 ml/kg of effusion have accumulated. Clinical
signs related to pleural effusion include tachypnea, respiratory distress (primarily on inspiration), shallow respiration,
decreased bronchovesicular lung sounds in dependant portions of the thorax and/or increased bronchovesicular sounds
in the remainder of the thorax, and hyporesonance on percussion of the dependant portions of the thorax (detection of
fluid line). Cough is uncommonly associated with pleural
disease but is found in association with disease extension to
or from the lungs or airways. Because pleural effusion may
be associated with systemic illness, clinical findings may be
related to systems other than the respiratory system or may
be related to an underlying respiratory pathology (eg, infectious pneumonia, lung cancer).
Confirmation of pleural effusion may be obtained radiographically or via thoracocentesis. Animals presenting with
inspiratory distress and quiet dependent lung sounds may be
harmed by the restraint required to obtain radiographs; in
such cases, thoracocentesis may prove life-saving as well as
providing crucial diagnostic information. Even if radiographs are obtained first to document pleural fluid, an
aliquot of the fluid will be required for further diagnosis.
Analysis of the collected fluid varies with differential diagnosis. In general, samples should be submitted for fluid and
cytologic analysis with aliquots saved for aerobic and anaerobic culture if needed. Other tests may be appropriate
depending on signalment, clinical signs, and ancillary evidence of disease.
Pleural fluid may be classified as hemorrhagic, transudative, or exudative. Frank hemorrhage in the pleural space is
most often associated with trauma or defects in secondary
hemostasis (eg, vitamin K antagonist rodenticide exposure).
Transudates are poorly cellular fluids (<500 TNC/ul) with
low protein content (<3 g/dl); modification of these fluids
(often with time) may increase either cell number (5005,000 TNC/ul) or protein content (3-5 g/dl). There is tremendous variability in exudate type (eg, cell count and type, protein content). Important causes of exudate include infection,
neoplasia, and lymphatic/vascular disruption.

Chylothorax
Chylothorax in dogs or cats may be due to heart failure,
trauma, heart worm disease, or thoracic granuloma but the
condition is most often idiopathic. The defining characteristic is that triglyceride content of the fluid is higher than that
of serum. When an underlying disease can be identified and
corrected the prognosis is good, but idiopathic chylothorax
carries a guarded prognosis. Neither medical nor surgical
management is always successful. Recent descriptions of
thoracic duct ligation accompanied by pericardectomy may
offer additional benifit. Medical treatment including a low
fat diet supplemented with MCT oil, rutin, and even
octreotide have been described but are not associated with a
high success rate. Chyle itself may be irritating and lead to
fibrotic pleuritis.

Pyothorax
Bacterial infection of the pleural space leading to accumulation of purulent fluid occurs in both dogs and cats. In
dogs, infection often follows entry of foreign material such
as grass awns into the thoracic cavity while in cats pyothorax is associated with cat fights. Often, no cause is ever identified in either cats (C) or dogs (D). The most common
pathogens identified in pyothorax are Pasteurella (C), Bacteroides (D&C), Actinomyces (D&C), Clostridium (C),
Nocardia (D); infections are often mixed. The purulent fluid
is usually off white, beige, pink, or red (cream of tomato
soup color) and malodorous. With Nocardia or Actinomyces infections, it may contain white or yellow granular
material (sulfur granules). Both aerobic and anaerobic cultures should be requested from the fluid. Animals with
pyothorax are usually systemically ill and may have complications of sepsis. Although aggressive, broad spectrum
antibiotics including anaerobic coverage is mandatory for
therapy of pyothorax, it is not adequate. The purulent fluid
must be drained, ideally by continuous evacuation. In dogs,
surgical thoracotomy has been demonstrated to provide a
survival benefit as well.

Feline Infectious Peritonitis (FIP)

FIP results from mutation of an enteric coronavirus in an
individual cat. Disease is related to the immune response to
infection, and can occur in either an effusive or dry granulomatous form. In the effusive form, pyogranulomatous

16

inflammation centered around vessels leads to leakage of a

high protein fluid. Effusion may occur in the peritoneal
cavity, pleural space, or both. Cats are frequently systemically ill with fever, hyperglobulinemia, and neutrophilia.
The effusive fluid is often clear straw or yellow in color
and viscous. Polymerase chain reaction performed on the
effusive fluid is supportive but not diagnostic of FIP; PCR
cannot discriminate between the enteric corona and its
mutated virulent form. Serology is seldom useful as it may
be negative in an infected cat or positive in a cat that does
not have FIP. The gold standard method of diagnosis relies
on tissue biopsy, but the combination of classical signalment and history (young cat from a cattery or shelter setting) with compatible signs, supportive laboratory findings,
and typical effusion is persuasive evidence of disease. Supportive care, immune suppression, and therapies such as
pentoxifylline or IFN omega are often used in treatment
but prognosis remains very poor.

Transudate/modified transudate
Transudates are typically due to increased hydrostatic
pressure or less commonly, decreased oncotic pressure. With
time the mesothelial cells become proliferative and both protein and cell content of the transudate may increase.
Increased hydrostatic pressure resulting in pleural transudate
is most often associated with heart failure. In cats, both right
and left heart failure may cause pleural effusion but in dogs
only right heart failure does so. Decreased oncotic pressure
(albumin of <1.5 g/dl) may also result in pleural transudate.
Typically, hypoalbuminemia results in more profound
ascites than pleural effusion. Intravenous fluid administration in an animal with hypoalbuminemia or compromised

cardiac function can precipitate pleural effusion when none

was apparent prior to fluid therapy. Ideally, transudate fluids
are addressed by treating the underlying cause.

Neoplastic effusion
Both dogs and cats are susceptible to thoracic neoplasia
resulting in pleural effusion although prevalence of tumor
type varies with species. Lymphoma and thymoma predominate in cats, while carcinoma and thymoma predominate in
dogs. Mesothelioma is rare in either species, and a variety of
other tumor types might lead to neoplastic effusion on occasion. Young FeLV + cats are more likely to have mediastinal
lymphoma, but most other tumor types tend to occur in older animals. The effusive fluid itself may be clear, cloudy, or
hemorrhagic. Protein content is often moderately increased,
as are total nucleated cell counts. The cell type varies with
the neoplastic process, but it may be very difficult to differentiate carcinoma, mesothelioma, or reactive mesothelial
hyperplasia cytologically. Supportive therapy is combined
with appropriate chemotherapy or radiation therapy to treat
the neoplastic condition. The prognosis for most causes of
neoplastic pleural effusion is poor.

References available on request

Authors Address for correspondence:

Leah Cohn
University of Missouri
College of Veterinary Medicine, Columbia, MO, USA, 65211

This manuscript is reproduced in the IVIS website with the permission of the Congress Organizing Committee