Todayโs path rounds are on ๐ฉ๐ฒ๐จ๐ญ๐ก๐จ๐ซ๐๐ฑ!
๐๐ก๐๐ญ ๐ข๐ฌ ๐ข๐ญ?
๐๐ฒ๐จ๐ญ๐ก๐จ๐ซ๐๐ฑ is when pus (pyo-) accumulates within the thoracic cavity. Usually, this looks like large amounts of cloudy, yellow or red fluid that contains long strands of ๐๐ข๐๐ซ๐ข๐ง (one of the main clotting materials in the bloodstream).
๐๐ก๐จ ๐ ๐๐ญ๐ฌ ๐ข๐ญ?
Any species can get this! However, some of the most โclassicโ pyothorax lesions are seen in dogs and cats.
๐๐ก๐๐ญ ๐๐๐ฎ๐ฌ๐๐ฌ ๐ข๐ญ?
Anything that allows infectious agents, particularly bacteria, to reach the ๐ฉ๐ฅ๐๐ฎ๐ซ๐, the lining of the lungs and thoracic cavity. This can be due to ๐ก๐๐ฆ๐๐ญ๐จ๐ ๐๐ง๐จ๐ฎ๐ฌ ๐ฌ๐ฉ๐ซ๐๐๐ (through the blood stream), penetrating wounds into the chest like bite wounds, abscesses in the lungs rupturing, or even foreign bodies in the esophagus or stomach perforating through the organ wall.
๐๐ก๐ฒ ๐ข๐ฌ ๐ญ๐ก๐ข๐ฌ ๐ ๐ฉ๐ซ๐จ๐๐ฅ๐๐ฆ?
To make a long story short, the lungs do not like to be in water. They are not able to expand properly, leading to difficulty breathing. Because you have an infection running rampant as well, the animal will also have a fever, and may even develop ๐ฌ๐๐ฉ๐ญ๐ข๐๐๐ฆ๐ข๐, where the bacteria enters the bloodstream and spreads around the body.
๐๐จ๐ฐ ๐ข๐ฌ ๐ข๐ญ ๐๐ข๐๐ ๐ง๐จ๐ฌ๐๐?
Based on suspicion on clinical exam, the veterinarian will often take an X-ray or do an ultrasound. Both of these diagnostic methods will allow the veterinarian to see the fluid directly, furthering their suspicion. To confirm that it is a pyothorax instead of other types of fluid, they may do a ๐ญ๐ก๐จ๐ซ๐๐๐จ๐๐๐ง๐ญ๐๐ฌ๐ข๐ฌ, where they put a needle into the thorax to extract some of the fluid. From there, they can assess the fluid to show the inflammatory component.
At necropsy, we can see the characteristic cloudy fluid to be able to make our initial diagnosis. Sometimes, the fluid is somewhat creamy looking and red tinged, and you can occasionally see clumps of yellow bacterial nests within the fluid. This leads to some pathologists calling it a โtomato soup with croutonsโ appearance. Gross.
๐๐จ๐ฐ ๐ข๐ฌ ๐ข๐ญ ๐ญ๐ซ๐๐๐ญ๐๐?
Drainage of fluid via thoracocentesis is the main treatment for this condition. Sometimes, this will need to be done multiple times. On top of this, the animal will need antibiotics to get the infection under control, and often an ๐๐ง๐ญ๐ข๐ฉ๐ฒ๐ซ๐๐ญ๐ข๐ (a medication to reduce fever).
๐๐ก๐จ๐ญ๐จ๐ฌ
1-3) Some examples of tomato soup with croutons pyothorax.
4) An example of pyothorax caused by an esophageal rupture after an obstruction. Those little weird donuts floating around are whatever the dog ate that caused the obstruction!
๐๐จ๐ฎ๐ซ๐๐๐ฌ
Maxie, G. Jubb, Kennedy and Palmerโs Pathology of Domestic Animals, Volume 2. Sixth Edition.
Photos 1-4 courtesy of University of Calgary Diagnostic Services Unit.
