Cover Journal of the American Veterinary Medical Association
Journal of the American Veterinary Medical Association
ISSN:
0003-1488
Publication Date:
01 Feb 2022
  • 1.

    Sturgess K. Diagnosis and management of chylothorax in dogs and cats. In Pract. 2001;23(9):506–513.

  • 2.

    Fossum TW. Section V: cardiology and respiratory disorders. In: August JR, ed. Consultations in Feline Internal Medicine. 5th ed. Elsevier; 2006:369–375.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    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.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    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.

    • Search Google Scholar
    • Export Citation
  • 5.

    Melis SM, de Rooster H, Waelbers T, Polis I. Anesthesia Case of the Month. J Am Vet Med Assoc. 2014;245(11):1230–1234.

  • 6.

    Mahfood S, Hix WR, Aaron BL, Blaes P, Watson DC. Reexpansion pulmonary edema. Ann Thorac Surg. 1988;45(3):340–345.

  • 7.

    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.

    • Search Google Scholar
    • Export Citation
  • 8.

    Kopko SH. The use of rutin in a cat with idiopathic chylothorax. Can Vet J. 2005;46(8):729–731.

  • 9.

    Willauer CC, Breznock EM. Pleurovenous shunting technique for treatment of chylothorax in three dogs. J Am Vet Med Assoc. 1987;191(9):1106–1109.

    • Search Google Scholar
    • Export Citation
  • 10.

    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.

    • Search Google Scholar
    • Export Citation
  • 11.

    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.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Fossum TW. Chylothorax in cats: is there a role for surgery? J Feline Med Surg. 2001;3(2):73–79.

  • 13.

    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.

    • Search Google Scholar
    • Export Citation
  • 14.

    Stewart K, Padgett S. Chylothorax treated via thoracic duct ligation and omentalization. J Am Anim Hosp Assoc. 2010;46(5):312–317.

  • 15.

    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.

  • 16.

    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.

    • Search Google Scholar
    • Export Citation
  • 17.

    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.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    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.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    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.

  • 20.

    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

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    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.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    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

    • Search Google Scholar
    • Export Citation
  • 23.

    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.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    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.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Greenberg MJ, Weisse CW. Spontaneous resolution of iatrogenic chylothorax in a cat. J Am Vet Med Assoc. 2005;226(10):1667–1670.

  • 26.

    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.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    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.

    • Search Google Scholar
    • Export Citation
  • 28.

    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.

    • Search Google Scholar
    • Export Citation
  • 29.

    Worth AJ, Machon RG. Traumatic diaphragmatic herniation: pathophysiology and management. Compendium. 2005;27(3)178–191.

  • 30.

    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.

  • 31.

    Huggins JT. Chylothorax and cholesterol pleural effusion. Semin Respir Crit Care Med. 2010;31(6):743–750.

  • 32.

    Nair SK, Petko M, Hayward MP. Aetiology and management of chylothorax in adults. Eur J Cardiothorac Surg. 2007;32(2):362–369.

  • 33.

    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.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Jardine OS. Reexpansion pulmonary edema. Am J Dis Child. 1991;145(10):1092–1094.

  • 35.

    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

    • Search Google Scholar
    • Export Citation

Advertisement

Decortication, thoracic omentalization, and pericardiectomy for treatment of severe fibrosing pleuritis in a cat

Danny Sack DVM1, Philip Hyndman BVSc, MVM2, Melissa Milligan VMD3, and Daniel Spector DVM2
View More View Less
  • 1 Animal Medical Center, New York, NY
  • | 2 Department of Surgery, Animal Medical Center, New York, NY
  • | 3 Department of Internal Medicine, Animal Medical Center, New York, NY
DOI:
https://doi.org/10.2460/javma.21.01.0018
Volume/Issue:
Volume 260: Issue 3
Online Publication Date:
30 Nov 2021
Restricted access
Reprints and Permissions Purchase Article

Abstract

CASE DESCRIPTION

A 5-year-old spayed female domestic shorthair cat was evaluated because of an acute onset of dyspnea and open-mouthed breathing.

CLINICAL FINDINGS

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.

TREATMENT AND OUTCOME

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.

CLINICAL RELEVANCE

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.

Abstract

CASE DESCRIPTION

A 5-year-old spayed female domestic shorthair cat was evaluated because of an acute onset of dyspnea and open-mouthed breathing.

CLINICAL FINDINGS

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.

TREATMENT AND OUTCOME

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.

CLINICAL RELEVANCE

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.

Contributor Notes

Corresponding author: Dr. Spector (Daniel.Spector@amcny.org)