Information

Pyothorax in Cats


What is pyothorax?
Pyothorax, which is a fancy way of saying that pus is in the chest cavity, is a life-threatening, severe infection that can be seen in both dogs and cats. While rare, it can be devastating, as it requires aggressive treatment (including chest tube placement, surgery, etc.). Pyothorax is different from pneumonia, as it is caused by abnormal infection in the thorax, not in the lungs themselves (versus bacterial pneumonia, which is an infection within the lung). Note that this doesn’t mean that there is pus in the lungs, but rather in the sterile space surrounding the lungs. As more and more pus accumulates in the pleural cavity (which is the space surrounding your lungs and heart), it compresses the lungs, making breathing more difficult. Also, the pus can result in septic shock, an overwhelming bacterial infection in the bloodstream.

Pyothorax is seen more frequently in cats than dogs, and is due to an infection that progressed into the chest cavity. One study has shown that cats that come from multi-cat households are almost 4 times more likely to develop pyothorax than cats that live alone (this is likely due to fighting).1 Likewise, younger cats are often more likely to develop pyothorax than older cats.1 Cats that go outside and potentially fight with other cats are also at greater risk because a bite wound to the thorax can result in a pyothorax.

Symptoms of pyothorax
Unfortunately, clinical signs of pyothorax can be very subtle, so it’s important to be aware of signs of this problem in your cat. Signs of difficulty breathing make for an immediate trip to the emergency room – even if it’s in the middle of the night!
Signs of pyothorax in cats include:

  • Lethargy or not moving much
  • Drooling
  • Not eating/anorexia
  • Hiding in unusual places (e.g., under the bed, in the closet, etc.)
  • Warm to the touch
  • Fever
  • A slow heart rate1 or abnormally elevated heart rate
  • Vomiting
  • Dehydration
  • An increased respiratory rate > 40 breaths per minute (bpm) or constant panting
  • Seeming out of shape during a walk (e.g., exercise intolerance)
  • Hunched over in sternal
  • Open mouth breathing (unless it’s a stressful event like a car ride, this is always abnormal, as cats prefer to always breath through their nostrils)
  • Difficulty breathing
  • Blue-tinged gums (which indicates severe difficulty and possible death if not treated immediately)
  • Stretching the neck out to breath
  • Sitting up to breath, with the front legs/elbow spread out (like a English bulldog stance)
  • Using the abdomen to breath better (you’ll notice the sides of the belly heaving in and out more)

** Note that this list of signs isn’t all-inclusive, but if you notice any of these signs, a visit to the veterinarian or emergency veterinarian is a must.

Treatment of pyothorax
Certain tests and treatments need to be initiated as soon as your pet is diagnosed with a pyothorax. These include:

  • Life-saving stabilization, including oxygen therapy
  • Analysis (called “cytology”) of the fluid, to look for certain types of bacteria
  • Culture of the fluid to make sure the appropriate antibiotics are used
  • Blood work (to evaluate the white and red blood cells, platelets, kidney and liver function, electrolytes, and clotting ability)
  • Monitoring of the blood oxygen levels (e.g., with a pulse oximetry [a device that non-invasively monitors how much oxygen is being carried by the red blood cells] or an arterial blood gas [a sample of the blood from the artery])
  • A thoracocentesis, which is when a sterile needle is placed into the chest cavity to remove the pus from the chest cavity. This helps improve breathing difficulty immediately.
  • Chest x-rays (to look at the appearance of the trachea, ribs, lungs, diaphragm, etc.) after the abnormal fluid has been removed
  • Sometimes, a clotting test (called a prothrombin [PT] or activated partial thromboplastin time [aPTT]) may be necessary, particularly if there is the concern about anticoagulant mouse and rat poisoning causing internal bleeding
  • IV fluids to help hydrate
  • Aggressive antibiotics (ideally intravenously) to fight the overwhelming infection; this typically needs to be continued for weeks
  • Placement of chest tubes to drain the pus from the chest cavity
  • Pain medication (as chest tubes are very uncomfortable!)
  • A CT or MRI to look for underlying causes for the infection (e.g., looking for an abscess or source of infection)
  • Surgery to remove the source of infection

The prognosis for pyothorax is generally good, provided that aggressive medical or surgical management can take place immediately. However, once signs of septic shock have developed, the prognosis is poor. For this reason, the sooner you notice a problem, the sooner you want to seek veterinary attention!

If you have any questions or concerns, you should always visit or call your veterinarian -- they are your best resource to ensure the health and well-being of your pets.

Source:

  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;221(6):819-824.

Feline Pyothorax

Pyothorax is a bacterial infection that causes pus to build up in the chest cavity (the space between the lungs and the ribs). Normally, the chest cavity has the lungs and a small amount of liquid for lubrication. If fluid fills up the entire space, the lungs cannot expand, and your cat will have difficulty breathing. Left untreated, pyothorax is fatal.

  • Wounds to the chest
  • Wounds to the esophagus or trachea (usually after ingesting a foreign object)
  • A foreign object (for example: a grass seed) entering the body and travelling to the chest cavity
  • Infection of the lungs

After any one of these causes, bacteria will enter the chest cavity, resulting in inflammation. Soon the entire space fills with pus.

  • Open-mouthed, labored breathing
  • Use of the abdomen to expand the chest
  • Fever
  • Listlessness
  • Lack of appetite

To diagnose your cat with pyothorax, your veterinarian may perform the following:

  • Examination: listening to your cat's chest with a stethoscope to check for fluid
  • Chest x-rays
  • Chest Tap: draining some fluid and studying samples to determine the cause of infection to correctly treat it

You must treat pyothorax aggressively. Other, inexpensive treatments will usually not be effective. Treatment consists of:

  • Drainage of the infected fluid: Your veterinarian will place tubes into the cat's chest and pour fluid into its tubes a few times a day to drain out the pus. Your cat will have to stay in the hospital for monitoring of the tubes. Leaving your cat unattended can be very dangerous. If a tube opens, your cat's chest is open andit won't be able to breathe
  • Antibiotics through IV: Oral antibiotics, or antibiotics without chest drainage, are usually not effective
  • Surgery: If chest drainage and antibiotics fail, your veterinarian may suggest surgery to check the chest for foreign objects like sticks, plant seeds, etc.

When the pus has cleared and your cat's appetite returns, your veterinarian will remove the tubes andsend you home with antibiotics. It is very important to follow your veterinarian's instructions about the medication. Relapse is possible if the infection is not completely cleared.

Although it is not necessarily practical, most veterinarians agree the best preventative measure is refraining from participating in activities that may result in one of the common causes.

Without proper treatment, pyothorax is fatal. Treatment may be expensive, but generally has a high success rate.

The prognosis depends on the severity of the cause. If the pyothorax is not caused by a serious disease, your cat will have a better chance of healing completely.

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Pyothorax in Cats - pets

Pyothorax refers to the presence of inflammatory fluid or "pus" within the chest cavity, which is the area between the lungs and the inner walls of the ribs.

What causes pyothorax?

Pyothorax is usually caused by a bacterial infection in the chest cavity. In most cases, pus is present in both sides of the chest although occasionally only one side will be affected.

The source of the infection is rarely found although possible causes include:

1. Penetrating wounds to the chest wall.

2. Wounds to internal structures such as the esophagus or trachea (windpipe), especially following ingestion or inhalation of a foreign object.

3. A migrating foreign body such as a grass seed that entered the body elsewhere.

4. Spread of an infection from the lungs,

What are the clinical signs of pyothorax?

Rapid shallow breathing that may be painful, depression, lethargy, decreased appetite and other signs of illness are seen in most cats with pyothorax. These cats usually have a high temperature that contributes to some of the clinical signs. The rapid, open-mouth breathing or "breathlessness" is caused by the presence of fluid in the chest that prevents the lungs from expanding normally. The severity of these signs is extremely variable and cats may suddenly die without having had any previous signs of illness

How is pyothorax diagnosed?

Clinical examination by a veterinarian may provide some indication of fluid within the chest particularly on listening to the chest with a stethoscope. In mildly affected cases, chest radiographs (x-rays) will be performed to demonstrate the presence and location of fluid in the chest. In severe cases, it may be necessary to drain the fluid off of the chest immediately ( a procedure called a thoracocentesis or "chest tap") before taking x-rays. Sedation of the cat may be required to allow drainage of the chest. In many cases, the pus from both sides of the chest can be drained from one side, although it may be necessary to drain both sides in some cats. Sometimes, the fluid is present in "pockets" and multiple drainage procedures must be performed. Samples of the fluid should be sent to a laboratory for evaluation and bacterial culture so that the organism responsible can be found and an appropriate antibiotic given.

In cases of pyothorax where no obvious cause is determined, it is recommended that the cat be tested for Feline Leukemia (FeLV) and Feline Immunodeficiency Virus (FIV).

How is pyothorax treated?

Drainage of the infected fluid plays an important part in the treatment of this condition.

Drainage may be needed on multiple occasions during the initial treatment period. In most cases, a flexible catheter will be inserted into the chest to remove the fluid. Fluids can also be administered via the tube to "lavage" or flush out the chest. In some cases, a special chest drain may be inserted surgically, allowing drainage of the chest and administration of antibiotics into the chest cavity. The drain may be left in place for several days to allow these procedures to be repeated.

Treatment with oral antibiotics is essential and the cat may need to stay on these for several weeks. In very sick cats, supportive treatment with intravenous fluids may also be needed in the initial stages.

What is the long-term outlook for a cat with pyothorax?

This depends on the cause of the disease. In those cases where no underlying disease is found, the outlook is good, if the cat survives the critical initial stages. Unfortunately, a proportion of cats will die in the early stages of their disease.


Pyothorax

What is pyothorax?

Pyothorax refers to the presence of infected fluid and bacteria (pus) within the chest cavity.

What causes pyothorax?

Pyothorax is usually caused by a bacterial infection in the chest cavity. Usually, pus is present in both sides of the chest although occasionally only one side will be affected.

The source of the infection is rarely found although possible causes include:-

1. Penetrating wounds to the chest wall.

2. Wounds to internal structures such as the oesophagus (food pipe), trachea (wind pipe) for example following ingestion or inhalation of a foreign body.

3. Migrating foreign body such as a grass seed which entered the body elsewhere.

4. Extension of infection from a lung infection (pneumonia) - this is the most likely cause in the majority of cases.

What are the clinical signs seen with pyothorax?

Rapid shallow breathing which may be painful, depression, lethargy and other signs of ill health such as a reluctance to eat are seen in most cats with pyothorax. The severity of these signs is extremely variable and rarely cats may suddenly die without having had any previous signs of illness.

Cats with pyothorax usually have a high temperature which contributes to some of the clinical signs seen. The breathlessness is caused by the presence of fluid in the chest which prevents the normal expansion of the lungs.

How is pyothorax diagnosed?

Clinical examination by a veterinary surgeon may provide some indication of fluid within the chest particularly on listening to the chest with a stethoscope. As well, cats invariably have foetid (bad) breath because of the products of bacteria metabolism they exhale. In severe cases, it may be necessary to drain the chest immediately. In more mildly affected cases, x-rays or ultrasound may help to demonstrate the presence of fluid which will be found to be pus when drained. Sedation of the cat may be needed to allow drainage of the chest. In most cases the pus can be drained from one side of the chest although it may be necessary to drain both sides in some cats. Sometimes, the fluid is present in ?pockets? and so multiple drainage must be performed. Samples of the fluid may be sent to a laboratory for bacterial culture so that the organism responsible can be found and an appropriate antibiotic given.

How is pyothorax treated?

Drainage of the infected fluid plays an important part in the treatment of this condition. In nearly all cases, a permanent chest drain may be inserted surgically allowing drainage of the chest and administration of antibiotics into the chest cavity. Fluids can also be administered via the tube to ?lavage? or flush out the chest. This tube may be left in place for several days to allow these procedures to be performed. Treatment with antibiotics by injection and later by mouth is also essential and the cat may need to stay on these for several weeks. Supportive treatment with intravenous fluids may also be needed in the initial stages.

What is the long-term outlook for a cat with pyothorax?

This depends on the cause of the disease. In those cases where no underlying disease is found, the outlook is frequently very good provided that the cat survives the critical initial stages. Unfortunately, a proportion of cats will die in the early stages of their disease. In those cats that do survive, complications are seen rarely and the long-term outlook is excellent.


Watch the video: Clinical case: Pyothorax in cat (June 2021).