Fluid protein electrophoresis is a reliable diagnostic indicator of FIP when gamma globulin composes more than 32% of the protein, albumin is less than 48% of the protein, and the albumin-to-globulin ratio is less than 0.81. The concentration of protein often approaches that of serum, ranging from 4 to 10 g/dl. The fluid of FIP may seem viscous, tenacious, and sticky, and it may contain flecks, strands, or clots of fibrin. It is typically pale yellow to golden in color, is nearly translucent because of its relatively low cell count (usually 1,000-10,000 nucleated cells/μl), and is foamy because of its high protein content. The fluid of FIP is a nonseptic exudate, often described as pyogranulomatous or fibrinous. The diagnosis can usually be established by analysis of a specimen of pleural fluid obtained by thoracentesis. Most gram-negative and gram-positive aerobes Hypovascularity of lung blunted pulmonary arteries right-sided heart enlargementĪnaerobes, * Pasteurella and some other gram negativesĪnaerobes, † Pasteurella and many other gram negativesĪnaerobes, † gram-positive and gram-negative aerobes Mediastinal mass (similar appearance to mediastinal neoplasia)Ībdominal ultrasound serum pancreatic lipase immunoassay Neoplastic (variable): modified transudate nonseptic exudate Opaque lung lobe (right middle or either cranial lobe) If nontraumatic: coagulation tests evaluate for underlying causes
Other signs of thoracic trauma loss of diaphragm shadow displaced abdominal organs concurrent abdominal effusion Rounded or collapsed lung lobes (constrictive pleuritis) effusion may be unilateralįluid triglyceride lymphangiogram evaluate for underlying causes Ultrasound fine-needle aspiration cytology thoracotomy Neoplastic (variable): modified transudate nonseptic exudate chylous effusion hemorrhage Ultrasound fine-needle aspiration cytology Neoplastic: modified transudate nonseptic exudate chylous effusion
Mediastinal mass (widened mediastinum dorsally displaced trachea caudally displaced heart and carina esophageal compression) Mediastinal neoplasia (lymphoma, thymoma) Prominent pulmonary arteries right-sided heart enlargement Pure transudate modified transudate chylous effusionĮchocardiography electrocardiography angiocardiography The major causes of pleural effusion in dogs and cats are listed in Table 164-1Įffusion may be unilateral or encapsulated rounded or collapsed lung lobes (constrictive pleuritis)Ĭoncurrent abdominal effusion in some cases rounded or collapsed lung lobes (constrictive pleuritis)įluid protein electrophoresis Serology PCR, immunostainĬardiomegaly pulmonary edema and venous congestion dilated caudal vena cava abdominal effusion (rare) Pleural effusion may also result from lymphatic insufficiency caused by thoracic duct obstruction, intrathoracic neoplasia, pleural thickening, or lymphatic hypertension secondary to CHF. Inflammation of the pleura may increase the formation of pleural fluid because of increased blood flow (hydrostatic pressure) and permeability of the pleural capillaries along with increased intrapleural colloidal osmotic pressure due to a higher concentration of protein in the fluid. Extreme hypoalbuminemia may lower systemic colloidal osmotic pressure sufficiently to cause increased formation and decreased absorption of pleural fluid.
For example, pleural effusion is often associated with congestive heart failure (CHF) because increased capillary hydrostatic pressure results in increased pleural fluid formation. Pleural effusion occurs when one or, more often, a combination of the factors that determine pleural fluid dynamics are altered so as to increase fluid formation, decrease fluid absorption, or both.
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