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Animals will infrequently present on emergency with dyspnea due to metastatic disease, although cough and lethargy are common. Spontaneous pneumothorax may occasionally develop in a patient with pulmonary neoplasia. Treatment of suspected neoplastic disease is directed at supportive care. Common metastatic tumors include hemangiosarcoma and mammary gland adenocarcinoma. Occasionally, further imaging is indicated to attempt to localize a primary tumor; however, generally this is futile. Pulmonary lymphoma may respond well to therapy. It is also important to exclude a recent travel history in dogs with a nodular pulmonary pattern as the systemic mycoses can mimic metastatic disease. Other less common causes of pulmonary infiltrates include eosinophilic pneumonitis and pulmonary fibrosis. Pleural space disease will commonly result in marked respiratory distress. Common causes are pleural effusion, pneumothorax and diaphragmatic hernia. Pleural space disease may often be suspected clinically based upon a restrictive (short and shallow) breathing pattern. Thoracic radiographs are very useful in documenting the extent of the pleural space disease. Diaphragmatic hernia should be corrected as soon as the patient is considered stable enough for surgery. In traumatic injuries, concurrent pulmonary contusion may markedly worsen gas exchange, thus anesthesia and surgery may be postponed until clinical improvement. However, if significant herniation exists, including the presence of the stomach intra-thoracically, surgical repair becomes urgent. Anesthesia may still be safely performed with pulmonary contusions, although in addition to the positive pressure ventilation required due to the loss of diaphragmatic integrity, a small amount of positive end-expiratory pressure (PEEP) may be beneficial to help recruit collapsed alveoli. In chronic hernias, re-expansion pulmonary edema may result in severe respiratory failure. Thus, correction of chronic hernias should be undertaken with care and gradual re-inflation of the lung. Pneumothorax may be classified as either traumatic or spontaneous. Traumatic is the most common. For animals with a known history of injury, needle thoracocentesis may be performed as guided clinically. Due to the high density of tissue thromboplastin, the previously healthy injured lung will heal rapidly, thus chest tubes are not commonly required in the trauma patient. A good guideline is that three or more thoracocenteses (“Three strike rule”) within 24 hours is sufficient justification for placement of the chest tube in the traumatic pneumothorax. It is exceedingly rare to have a patient with trauma require a thoracotomy for resection of the traumatized lung. Conversely, most cases of spontaneous pneumothorax require surgical resection of the affected lobe. Spontaneous pneumothorax is defined as pneumothorax occurring without trauma. Common causes
include bulla/blebs and neoplasia (primary or metastatic). Additionally, cats with lower airway disease may occasionally develop spontaneous pneumothoraces. For affected dogs, rapid surgical exploration and resection has been associated with decreased morbidity and expense.
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References: 1.
Waddell LS, Brady CA, Drobatz KJ. Risk factors, prognostic indicators, and outcome of pyothorax in cats: 80 cases (1986-1999) J Am Vet Med Assoc 2002 Sep 15;221(6):819-24. 2. Puerto DA, Brockman DJ, Lindquist C, Drobatz K. Surgical and nonsurgical management of and selected risk factors for spontaneous pneumothorax in dogs: 64 cases (1986-1999) J Am Vet Med Assoc 2002 Jun 1;220(11):1670-4. 3. Drobatz KJ, Walker LM, Hendricks JC. Smoke exposure in cats: 22 cases (1986- 1997). J Am Vet Med Assoc 1999 Nov 1;215(9):1312-6. 4. Drobatz KJ, Walker LM, Hendricks JC. Smoke exposure in dogs: 27 cases (1988- 1997). J Am Vet Med Assoc 1999 Nov 1;215(9):1306-11. 5. Drobatz KJ, Saunders HM, Pugh CR, Hendricks JC. Noncardiogenic pulmonary edema in dogs and cats: 26 cases (1987-1993). J Am Vet Med Assoc 1995 Jun 1;206(11):1732-6. 6. White HL, Rozanski EA, Tidwell AS, Chan DL, Rush JE. Spontaneous pneumothorax in two cats with small airway disease. J Am Vet Med Assoc 2003 Jun 1;222(11):1573-5, 1547. 7. Clercx C, Peeters D, Snaps F, Hansen P, McEntee K, Detilleux J, Henroteaux M, Day MJ. Eosinophilic bronchopneumopathy in dogs. J Vet Intern Med 2000 May- Jun;14(3):282-91. 8. Corcoran BM, Cobb M, Martin MW, Dukes-McEwan J, French A, Fuentes VL, Boswood A, Rhind S. Chronic pulmonary disease in West Highland white terriers. Vet Rec 1999 May 29;144(22):611-6. 9. Powell L, Rozanski EA, Tidwell A, Rush JE. A retrospective analysis of pulmonary contusion secondary to motor vehicle accidents in 143 dogs: 1994-1997. J Vet Emerg Crit Care 9:127-136, 1999. 10. Stampley AR, Waldron DR. Reexpansion pulmonary edema after surgery to repair a diaphragmatic hernia in a cat. J Am Vet Med Assoc 1993 Dec 15;203(12):1699- 701. 11. Schmiedt CW, Tobias KM, Stevenson MA. Traumatic diaphragmatic hernia in cats: 34 cases (1991-2001). J Am Vet Med Assoc 2003 May 1;222(9):1237-40.
503A
503B
Type of Facility Product Purpose Regulatory Oversight Regulations Product Dating
FDA Registered Manufacturer Manufactured drugs in bulk quantities for hospitals FDA cGMP (current Good Manufacturing Processes) Expiration Date (proven)
Traditional Compounding Pharmacy Customized prescriptions for individual patients State Boards of Pharmacy USP
(United States Pharmacopeia) Beyond-Use Date (limited)
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