Pet of the month: Piper
Presenting Complaint: Respiratory Distress
Age: 1 year
Diagnosis: Idiopathic Pyothorax
Piper is a 1 year old female spayed domestic short hair. Piper was presented to Hickory Veterinary Hospital’s emergency service on August 13th, 2018 for evaluation of acute respiratory distress. Upon presentation Piper was QAR and had increased respiratory effort.
Radiographs were taken of her chest which revealed a large amount of fluid in both sides of her chest.
Radiographs on presentation
Blood work showed a decompensatory leukogram with bands. A thoracocentesis was performed which produced 50 ml of brown, thick, purulent discharge. The fluid was sent to the laboratory for cytology and cultures. Piper was placed in oxygen and monitored overnight for a surgical consult in the morning.
In the morning it was clear that Piper’s condition will continue to worsen without surgical intervention. Piper was placed under general anesthesia and bilateral chest tubes were placed. Another 150ml of purulent fluid was removed from the chest at the time of surgery. A chest wrap was placed to and Piper was returned to oxygen to recover.
Piper had a long recovery and was monitored very closely for the next 24 hours. The chest tubes were aspirated every 2 hours to ensure no more effusion had built up and her chest was flushed with warm saline every 8 hours.
Post chest tube placement and aspiration
Piper’s pain was controlled using a combination of Buprenorphine sublingually and Bupivicane infused through her chest tubes. The cytology of Piper’s chest fluid came back as “septic exudate” and the culture grew Prevotella sp. Piper was started on Unasyn, Metronidazole and Baytril IV while in the hospital.
By the third day of Piper’s hospitalization she was able to breathe easier and was starting to move around her cage on her own. The antibiotics, pain medications and chest tube aspiration were continued. Piper still refused to eat so she was syringe fed which she tolerated well. She continued to improve and the oxygen was discontinued. Her right chest tube was removed on August 16th.
The next day Piper began to eat on her own and started grooming herself again. Piper was switched to oral medications. The left chest tube was pulled on August 18th and Piper began eating normally and acting more like herself.
Piper was discharged from the hospital on August 19th with oral antibiotics and Mirtazapine. Piper has continued to do well at home on the antibiotics. She came in for suture removal on August 31st and according to her owner is completely back to normal at home!
Piper’s chest radiographs from August 24th
So what is a Pyothorax?
Pyothorax is the presence of a suppurative, septic effusion within the pleural space. There are many possible causes of this condition but a large number of cases are idiopathic. Possible causes include: penetrating wounds into the thorax, parasites, migrating foreign bodies and an extension of bacteria from pneumonia. Typically this condition is seen in younger cats around 3 years of age. The common presenting symptoms are difficulty breathing, lethargy, anorexia, weakness and weight loss. They may also rapidly decompensate and present in acute severe respiratory distress. There does not seem to be a correlation with indoor/outdoor status but cats that live in multiple cat households have been found to be affected more often.
Luckily the prognosis for this condition is good if early, aggressive treatment is instituted. The draining of the exudate (either by thoracocentesis or chest tube placement) and institution of the appropriate antibiotics is key in treating this disease. Most cats do not experience recurrence of Pyothorax if the patient is able to be stabilized and the owner is able to medicate the patient at home.