Page 32 - Feline Cardiology

Chapter 3: Pleural Effusion 23

however, the risk increases as greater volumes of effusion
are removed. Therefore, some clinicians prefer to mini-
mize this risk by removing large volumes of pleural effu-
sion over separate thoracocentesis procedures (for
example, removal of 120 ml at a time and allowing the
cat to rest for several hours or overnight before repeating Clinical Entities
the procedure).
Chronic therapy to address pleural effusion is depen-
dent on the underlying cause. For example, manage-
ment of heart disease and congestive heart failure is
crucial in those patients with underlying heart disease
Figure 3.4. as a cause. Neoplasia may be addressed with chemo-
therapy, radiation therapy, surgical removal, or debulk-
ing, or some combination of these modalities. Similarly,
underlying liver disease or protein losing nephropathy
should be addressed when present. Occasionally an
underlying cause of pleural effusion is not found and
empirical therapy with low-dose diuretics (to slow fluid
accumulation) and periodic thoracocentesis is neces-
sary. Several palliative surgical treatments are available
if refractory pleural effusion persists in spite of these
therapies. These procedures attempt to provide addi-
tional thoracic fluid drainage or decrease pleural effu-
sion production (Sanders and Sleeper 2004).

REFERENCES
Figure 3.5. Boldface font indicates key references.
Davies C, Forrester SD. Pleural effusion in cats: 82 cases (1987 to
1995). J Small Anim Pract 1996;37:217–224.
Fife WD, Côté E. Vet Med Today: What is your diagnosis? J Am Vet
before progressing to an emergent situation in most
Med Assoc 2000;216:1215–1216.
cases. Chronic pleural effusion may lead to pleural fibro- Mandell DC. Respiratory distress in cats. In: Textbook of Respiratory
sis and development of clinical signs with less fluid accu- Disease in Dogs and Cats, King LG. St. Louis, 2004, Saunders,
mulation (Fife and Côté 2000). Additionally, fluid may 12–17.
become loculated and more difficult to remove by tho- Rush JE, Freeman LM, Fenollosa NK, et al. Population and survival
racocentesis over time. Medical management of conges- characteristics of cats with hypertrophic cardiomyopathy: 260
cases (1990–1999). J Am Vet Med Assoc 2002;220:202–207.
tive heart failure is discussed in Chapter 19. Sanders NA, Sleeper M. Pleural transudates and modified transu-
Although thoracocentesis is a low-risk procedure dates. In: Textbook of Respiratory Disease in Dogs and Cats,
when performed by a skilled operator and with a coop- King LG. St. Louis, 2004, Saunders, 588–597.
erative patient, there are several possible risks including Silverstein DC. Pleural space disease. In: Textbook of Respiratory
lung puncture and pneumothorax, reexpansion pulmo- Disease in Dogs and Cats, King LG. St. Louis, 2004, Saunders,
49–52.
nary edema, hemodynamic collapse secondary to vagally Weiner-Kronish JP, Goldstein R, Mathay RA, et al. Lack of association
mediated sinus bradycardia, and bronchopleural fistula of pleural effusion with chronic pulmonary arterial and right atrial
(Fife and Côté 2000). These sequelae are uncommon; hypertension. Chest 1967;92:967–970.