Respiratory emergencies

32 Respiratory emergencies

Feline Pleural Effusion

Theory refresher

Pleural effusion is a relatively common cause of severe respiratory distress in cats. A rational and considered approach to the stabilization of these cats is essential as they are typically critical and very susceptible to stress. In many cases, the pleural effusion would have been present for some time with little or no clinical manifestation; eventually a point is reached where the ability of the lungs to expand becomes so compromised that the cat is no longer able to cope. In addition, depending on the underlying cause, there may also be other pathological abnormalities compromising respiration (e.g. pulmonary oedema in congestive heart failure).

Case example 1

Further case management

The cat’s respiration had improved to some extent following initial oxygen therapy but there was still a marked increase in respiratory effort. Given the suspicion of pleural effusion, it was decided to perform thoracocentesis for diagnostic and potentially therapeutic purposes (see p. 291). The procedure was only performed on the right side as a large volume of pleural fluid was removed (250 ml, approximately 50 ml/kg) and the cat’s breathing improved significantly almost immediately. The cat was returned to the oxygen cage following thoracocentesis after clipping the fur over both cephalic veins and applying topical local anaesthesia (EMLA® cream 5%, AstraZeneca – see Ch. 5) to both sites. The pleural effusion was grossly milky in appearance. In-house cytology revealed that more than half of the cells present were small lymphocytes, and no bacteria were seen. It was therefore presumptively classified as a chylous effusion but samples had also been collected into additional sterile containers for submission to an external laboratory.

The cat remained comfortable in the oxygen cage and a cephalic intravenous catheter was placed later using minimal restraint and gentle handling. Blood was obtained via the catheter for an emergency database to be performed that was essentially unremarkable. As congestive heart failure remained a possibility, the cat was not started on intravenous fluid therapy at this time and the catheter was kept patent by regular flushing. Morphine (0.1 mg/kg slow i.v. q 6 hr) was continued but no other medications were indicated at this stage.

The cat remained stable overnight and it was possible to wean him off oxygen therapy. He was referred the next morning for further investigations which revealed a cranial mediastinal mass that was confirmed to be due to lymphoma. The cat was started on chemotherapy and was doing well at his most recent follow-up examination.

Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Respiratory emergencies
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