SAEVA Congress 2018 Proceedings | 12-15 February 2018 | ATKV Goudini Spa
Pleural fluid character
The sonographic pattern of pleural effusions includes anechoic, complex non-septated,
and complex septated fluid. Composite fluids are complex and more echogenic than
normal, containing fibrin, cellular debris, a higher cell count and total protein
concentration, and gas. Anechoic sonolucent fluid represents a transudate or modified
transudate with a relatively low cell count and total protein concentration. Increased
echogenicity of the fluid indicates an increased cell count or total protein concentration.
Blood within the pleural cavity (hemothorax), or within any body cavity often has a
hypoechoic to echogenic swirling pattern, may be septated, and can usually be
differentiated from a more purulent exudate by the latter's more homogeneous
echogenic appearance, and the tendency for layering to occur with pyothorax. Clotting
may be imaged in pleural fluid as soft, echogenic masses.
Hemangiosarcoma should always be considered in the differential diagnosis of
hemothorax in adult horses, as this is one of the more common thoracic neoplasms in
horses. The majority (79%) of 35 horses with disseminated hemangiosarcoma had
involvement of the lung and pleura. Large volumes of blood were present in the
pleural cavity in 20% of the 35 horses. Hemothorax has also been detected
ultrasonographically in the thorax of horses following a lung biopsy. Intense exercise
in one horse was associated with the development of hemothorax and
pneumothorax. Thoracic trauma should be considered in adult horses with hemothorax
and the ribs carefully evaluated for fractures. An ultrasonographic evaluation of the
thorax is indicated in all neonatal foals with known or suspected thoracic trauma to
look for pericardial, cardiac, pulmonary or diaphragmatic injury and hemothorax or
pneumothorax, as any of the preceding conditions can be life threatening.
Pulmonary contusion was the single most frequent complication in foals presenting
with rib fractures in one neonatal intensive care unit. Multiple rib fractures are
common in neonatal foals and thus a complete sonographic evaluation of the ribcage
is indicated.
Hemothorax in an adult
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