Page 12 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 1 · Surgical principles and instrumentation

• Progressive post-traumatic dyspnoea may be present Thoracic inspection and palpation
with pneumothorax, pulmonary contusions or Thoracic palpation may reveal:
VetBooks.ir incarceration of a liver lobe with resulting pleural • Fractured ribs
progression of a diaphragmatic rupture (e.g.
effusion or gastric tympany).
• Chest wall mass
• A hyperinflated, expanded chest with little or no
movement may be seen in tension pneumothorax. • Subcutaneous emphysema
• Pectus excavatum
• Paradoxical movement of a segment of chest wall is • Sternal anomalies associated with peritoneal–
seen in flail chest.
pericardial diaphragmatic hernia
• Decreased expansion of the hemithorax may be seen • Apex shift of the heart (e.g. ruptured diaphragm or
with mainstem bronchus obstruction or a unilateral
lateralized cranial mediastinal mass)
ruptured diaphragm.
• Central nervous system (CNS) respiratory centre • Precordial thrill (e.g. patent ductus arteriosus)
• Non-compressible cranial thorax (e.g. cranial
disturbance may result in slow, feeble, irregular mediastinal mass).
breathing, or periods of normal respiration or
hyperventilation followed by apnoea (Cheyne–Stokes
breathing). Thoracic percussion
• Deep sighing movements (Kussmaul’s hyperventilation) Findings on thoracic percussion may be hyporesonance,
may indicate metabolic acidosis, diabetic acidosis or hyperresonance or normal.
renal disease.
Hyporesonance may indicate:
Abnormal mucous membrane colour • Pleural effusion
The colour of the mucous membranes may be altered in • Pulmonary consolidation
certain diseases: • Ruptured diaphragm
• Peritoneal–pericardial diaphragmatic hernia
• Pale: seen with anaemia, hypothermia, hypovolaemia • Thoracic cavity/thoracic wall neoplasia
and sympathetic response • Marked cardiomegaly.
• Cyanotic: seen with upper respiratory tract obstruction
and tetralogy of Fallot Hyperresonance may indicate:
• Differential cyanosis: seen with reverse-shunting patent
ductus arteriosus • Pneumothorax
• Brick red: seen with sepsis. • Gas-filled viscus in the thoracic cavity (e.g. ruptured
diaphragm and gastric tympany).
Abnormal peripheral pulses
The peripheral pulse should be assessed for: ther ndin s
Other signs of cardiovascular disease that may be found
• Rate on physical examination include:
• Quality
• Rhythm • Hepatosplenomegaly
• Deficits between peripheral pulse rate and heart rate • Ascites
(from auscultation).
• Jugular distension or pulsation.
Thoracic auscultation
Clinical pathology
Auscultation of the lungs may reveal:
Laboratory data are not commonly required for the diag-
• Change in the quality of normal lung sounds (e.g.
nosis of disorders of the ear or upper respiratory tract.
harsher in chronic bronchitis) However, even in these patients, routine blood screens
• Areas where no sound is heard (e.g. pneumothorax,
are of use to detect underlying diseases or diseases
pleural effusion, diaphragmatic rupture, mass lesion) secondary to the primary disorder, and to assess the
• Abnormal distribution (e.g. bronchial sounds
general fitness for anaesthesia and postoperative
peripherally indicate lung consolidation) therapy. In patients with systemic disease, an assess-
• Adventitious sounds.
ment of routine haematological and biochemical para-
meters along with urinalysis is essential to identify
Adventitious sounds may be:
haematological and metabolic derangements that may
• Crackles (e.g. pulmonary fibrosis, oedema) require management prior to anaesthesia and surgery.
• Wheezes (e.g. narrowing of the airway) Poor jugular venepuncture technique may result in
• Pleural friction rub (e.g. inflammatory disease of the iatrogenic damage to vital structures in the neck. In addi-
pleural space). tion, the resulting haematoma may interfere with the
surgical approach. In patients scheduled for unilateral
Auscultation of the heart may reveal: procedures involving the neck (e.g. arytenoid lateraliza-
tion, thyroidectomy, parathyroidectomy) it may be
• Murmurs prudent to collect blood from the contralateral jugular
• Additional heart sounds creating a gallop rhythm vein or another peripheral vessel. Arterial blood gas
• Arrhythmias analysis forms an important part of the assessment of
• Muffling of heart sounds and displacement of the apex the respiratory system and the adequacy of ventilation
beat. and oxygenation.

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