Sturgess K. Diagnosis and management of chylothorax in dogs and cats. In Pract. 2001;23(9):506–513.
Fossum TW. Section V: cardiology and respiratory disorders. In: August JR, ed. Consultations in Feline Internal Medicine. 5th ed. Elsevier; 2006:369–375.
Mayhew PD, Culp WTN, Pascoe PJ, Vapniasky Arzi N. Use of the Ligasure vessel-sealing device for thoracoscopic peripheral lung biopsy in healthy dogs. Vet Surg. 2012;41(4):523–528.
Stampley AR, Waldron DR. Reexpansion pulmonary edema after surgery to repair a diaphragmatic hernia in a cat. J Am Vet Med Assoc. 1993;203(12):1699–1701.
Melis SM, de Rooster H, Waelbers T, Polis I. Anesthesia Case of the Month. J Am Vet Med Assoc. 2014;245(11):1230–1234.
Mahfood S, Hix WR, Aaron BL, Blaes P, Watson DC. Reexpansion pulmonary edema. Ann Thorac Surg. 1988;45(3):340–345.
Thompson MD, Carr AP. Hyponatremia and hyperkalemia associated with chylous pleural and peritoneal effusion in a cat. Can Vet J. 2002;43(8):610–613.
Kopko SH. The use of rutin in a cat with idiopathic chylothorax. Can Vet J. 2005;46(8):729–731.
Willauer CC, Breznock EM. Pleurovenous shunting technique for treatment of chylothorax in three dogs. J Am Vet Med Assoc. 1987;191(9):1106–1109.
Fossum TW, Evering WN, Miller MW, Forrester SD, Palmer DR, Hodges CC. Severe bilateral fibrosing pleuritis associated with chronic chylothorax in five cats and two dogs. J Am Vet Med Assoc. 1992;201(2):317–324.
Fossum TW, Mertens MM, Miller MW, et al.. Thoracic duct ligation and pericardectomy for treatment of idiopathic chylothorax. J Vet Intern Med. 2004;18(3):307–310.
Fossum TW. Chylothorax in cats: is there a role for surgery? J Feline Med Surg. 2001;3(2):73–79.
Thompson MS, Cohn LA, Jordan RC. Use of rutin for medical management of idiopathic chylothorax in four cats. J Am Vet Med Assoc. 1999;215(3):345–8, 339.
Stewart K, Padgett S. Chylothorax treated via thoracic duct ligation and omentalization. J Am Anim Hosp Assoc. 2010;46(5):312–317.
Fossum TW, Forrester SD, Swenson CL, et al.. Chylothorax in cats: 37 cases (1969–1989). J Am Vet Med Assoc. 1991;198(4):672–678.
Kerpsack SJ, McLoughlin MA, Birchard SJ, Smeak DD, Biller DS. Evaluation of mesenteric lymphangiography and thoracic duct ligation in cats with chylothorax: 19 cases (1987–1992). J Am Vet Med Assoc. 1994;205(5):711–715.
LaFond E, Weirich WE, Salisbury SK. Omentalization of the thorax for treatment of idiopathic chylothorax with constrictive pleuritis in a cat. J Am Anim Hosp Assoc. 2002;38(1):74–78.
Talavera J, Agut A, del Palacio JF, Martínez CM, Seva JI. Thoracic omentalization for long-term management of neoplastic pleural effusion in a cat. J Am Vet Med Assoc. 2009;234(10):1299–1302.
Williams JM, Niles JD. Use of omentum as a physiologic drain for treatment of chylothorax in a dog. Vet Surg. 1999;28(1):61–65.
Bussadori R, Provera A, Martano M, et al.. Pleural omentalisation with en bloc ligation of the thoracic duct and pericardiectomy for idiopathic chylothorax in nine dogs and four cats. Vet J. 2011;188(2):234–236. doi: 10.1016/j.tvjl.2010.05.010
Haimel G, Liehmann L, Dupré G. Thoracoscopic en bloc thoracic duct sealing and partial pericardectomy for the treatment of chylothorax in two cats. J Feline Med Surg. 2012;14(12):928–931.
Brooks AC, Hardie RJ. Use of the PleuralPort device for management of pleural effusion in six dogs and four cats. Vet Surg. 2011;40(8):935–941. doi: 10.1111/j.1532-950X.2011.00901.x
Clendaniel DC, Weisse C, Culp WTN, Berent A, Solomon JA. Salvage cisterna chyli and thoracic duct glue embolization in 2 dogs with recurrent idiopathic chylothorax. J Vet Intern Med. 2014;28(2):672–677.
Stockdale SL, Gazzola KM, Strouse JB, Stanley BJ, Hauptman JG, Mison MB. Comparison of thoracic duct ligation plus subphrenic pericardiectomy with or without cisterna chyli ablation for treatment of idiopathic chylothorax in cats. J Am Vet Med Assoc. 2018;252(8):976–981.
Greenberg MJ, Weisse CW. Spontaneous resolution of iatrogenic chylothorax in a cat. J Am Vet Med Assoc. 2005;226(10):1667–1670.
Enwiller TM, Radlinsky MG, Mason DE, Roush JK. Popliteal and mesenteric lymph node injection with methylene blue for coloration of the thoracic duct in dogs. Vet Surg. 2003;32(4):359–364.
Glennon JC, Rothwell JT, Flanders JA, et al.. Constrictive pleuritis with chylothorax in a cat: a case report. J Am Anim Hosp Assoc. 1987;23(5):539–543.
Macho RG, Worth AJ. Prevention of reexpansion pulmonary edema and ischemia-reperfusion injury in the management of diaphragmatic herniation. Compendium. 2006;28(7):531–540.
Worth AJ, Machon RG. Traumatic diaphragmatic herniation: pathophysiology and management. Compendium. 2005;27(3)178–191.
Perikleous P, Rathinam S, Waller DA. VATS and open chest surgery in diagnosis and treatment of benign pleural diseases. J Vis Surg. 2017;3:84.
Huggins JT. Chylothorax and cholesterol pleural effusion. Semin Respir Crit Care Med. 2010;31(6):743–750.
Nair SK, Petko M, Hayward MP. Aetiology and management of chylothorax in adults. Eur J Cardiothorac Surg. 2007;32(2):362–369.
Bagheri R, Haghi SZ, Dalouee MN, et al.. Effect of decortication and pleurectomy in chronic empyema patients. Asian Cardiovasc Thorac Ann. 2016;24(3):245–249.
Jardine OS. Reexpansion pulmonary edema. Am J Dis Child. 1991;145(10):1092–1094.
Belliraj L, Lakranbi M, Lahlou A, et al.. Acute unilateral reexpansion pulmonary edema after pleuropulmonary decortication. OAJ Case Rep. 2019;1:010. doi: 10.33118/oaj.rep.2019.01.010
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A 5-year-old spayed female domestic shorthair cat was evaluated because of an acute onset of dyspnea and open-mouthed breathing.
Thoracic radiography revealed pleural effusion and signs consistent with restrictive pleuritis, and results of preoperative CT were consistent with diffuse, severe restrictive pleuritis, bilateral pleural effusion, and pulmonary atelectasis. Thoracocentesis yielded a red, turbid fluid that was identified as chylous effusion with chronic inflammation.
Exploratory thoracotomy revealed diffuse, severe fibrous adhesions between the mediastinum, heart, lung lobes, and thoracic wall, with a thick fibrous capsule enveloping all lung lobes. Surgical treatment consisted of complete pleural decortication, pericardiectomy, and thoracic omentalization. The cat remained hospitalized for 6 days, receiving oxygen supplementation, multimodal analgesia, and supportive care. Long-term home care consisted of prednisolone administration, rutin supplementation, and provision of a low-fat diet. At recheck examinations 3-, 7-, and 20-weeks postoperatively, the cat remained tachypneic, but was otherwise clinically normal without dyspnea or respiratory distress. Follow-up thoracic radiography revealed improved pulmonary expansion, decreased pleural effusion, and resolved pneumothorax.
Surgical management of fibrosing pleuritis secondary to idiopathic chylothorax in cats has historically resulted in poor outcomes. This report details the first successful use of complete decortication in the surgical management of severe fibrosing pleuritis in a cat.