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 Pleural effusion

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تاريخ التسجيل : 25/01/2010
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مُساهمةموضوع: Pleural effusion   الإثنين يناير 17, 2011 4:40 pm

Pleural effusion





Signalment




Five-year-old MC Labrador
retriever weighing 56 kg ("Monty")


Presenting Complaint




Pleural Effusion


Pertinent History




Monty presented on emergency for
management of a pleural effusion.

The owners noticed that Monty was panting
more than usual about 6 days ago.

He has always been a finicky eater but
they felt that his appetite had decreased in the past few days.


He has been
less active for the past few days and was unwilling/unable to go running
with the owner three days ago (he usually goes running about once a week).


In the last few days he has had difficulty breathing when laying on his side
but seems comfortable when sternal or standing.

He was presented to the
referring DVM two days ago. Radiographs were taken which showed an enlarged
liver and pleural effusion. The heart could not be evaluated because it was
obscured by the fluid. Blood work was done. It was unremarkable except for a
mild monocytosis of 1296.

The chest was tapped and 70ml of fluid was
removed. The fluid was submitted for analysis which showed a lymphocytic
plasmacytic modified transudate, SpGr 1.026, WBC 2,950/ul, RBC
20,000/ul, protein 4.1 gm/dl.

Heart disease was suspected and Monty was
referred to the VMTH for further evaluation.

The
owners have had Monty since he was a puppy. He was neutered at six months of
age. He has had foxtails in the past but his medical history is unremarkable
otherwise.

He is current on his vaccinations.

He is a yard dog who is
allowed to roam freely (he usually remains in his yard).

He is fed a Pedigree kibble and canned food diet.

The owners have not noticed coughing,
sneezing, vomiting or diarrhea.

Current medication: Clavamox 375mg 2 tablets
PO BID (started two days ago).


Physical Examination



Alert. Hydrated. T=100.5, P=115,
R=pant.

Clean full coat. Eyes clear
bilaterally.

Ears clean.
Nose moist.
Symmetrically muscled with no gait
abnormalities.

Heart sounds muffled. Weak femoral pulses. Jugular pulses
present. Mucous membranes pink. CRT 1 second.

Increased lung sounds in
dorsal lung fields. Diminished lung sounds ventral to the costochondral
junction.

Abdomen full ventrally. Palpably enlarged liver. No fluid wave to
indicate ascites.

No peripheral lymphadenopathy.


Problems




Pleural effusion

Hepatomegaly with jugular
pulsation



Radiographs


Lateral





DV





VD






Two-dimensional Echocardiograms



Right parasternal long-axis view







Right parasternal short-axis view








The echocardiograms show a small amount of pericardial effusion (PE) and a
moderate amount of pleural effusion (PL). The heart itself appears normal. The hepatic
veins were distended on an abdominal ultrasound exam meaning that systemic venous pressure
is increased. LV - left ventricular cavity; RV - right ventricular cavity; LA - left
atrial cavity; RA - right atrial cavity.







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Pleural effusion
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