Lung: pulmonary hemorrhage in Cats (Felis) | Vetlexicon
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Lung: pulmonary hemorrhage

ISSN 2398-2950


Introduction

  • Cause: pulmonary contusion, coagulopathies, thrombocytopenia, rodenticide toxicity, neoplasia.
  • Signs: cough, may be hemoptysis, may be normal unless severe blood loss and secondary bacterial bronchopneumonia. Also tachypnea / respiratory distress.
  • Diagnosis: history, signs, radiography, endoscopy, coagulation studies.
  • Treatment: oxygen / blood transfusion, plasma volume expanders, treat underlying pathology.
  • Prognosis: fair to good if response to treatment.

Presenting signs

  • Cough.
  • Hemoptysis.
  • Tachypnea.
  • Collapse.
  • May be asymptomatic.

Acute presentation

  • Collapse with marked respiratory distress.
  • Fatal hemoptysis.

Cost considerations

  • Radiography.
  • Intravenous fluids.

Special risks

Pathogenesis

Etiology

Predisposing factors

General

Specific

  • Congenital coagulopathies rare but may cause profound bleeding especially after trauma.

Pathophysiology

  • Pulmonary contusion, eg post-trauma   →   bleeding   →   hemoptysis in some rare cases (most cats hit hard enough to have contusions are killed).
  • Coagulopathy or thrombocytopenia   →   intrapulmonary hemorrhage.
  • Metastatic/invasive neoplasia   →   destroying blood vessels   →   bleeding into lung   →   hemoptysis.

Timecourse

  • Usually sudden onset with history of trauma.

Diagnosis

Presenting problems

  • Cough.
  • Tachypnea.
  • Dyspnea.

Client history

  • External evidence of trauma.
  • Cough.
  • Lethargy.
  • Tachypnea.
  • Hemoptysis.

Clinical signs

  • Cough.
  • Tachypnea.
  • External signs of trauma.
  • Muffled heart sounds.
  • Dyspnea.
  • Pale mucous membranes.
  • Hemoptysis.
  • Other evidence of DIC or coagulopathy:
    • Petechiae.
    • Melena.
    • Hematuria.
    • Cavity bleeds.

Diagnostic investigation

Endoscopy

  • Blood may be seen in airways in some cases.

Hematology

Radiography

  • See radiography of the thorax Radiography: thorax.
  • May be no changes initially as contusion may not be visible until 24 hours after incident (may worsen over 12-24 hours).
  • Localized areas of opacity, may be restricted to ventral regions of isolated lobes; sometimes hemothorax Hemothorax  Thorax: pleural effusion - radiograph DV .

Confirmation of diagnosis

Discriminatory diagnostic features

  • History.
  • Clinical signs.
  • Hematology.
  • Radiography.
  • Endoscopy.

Definitive diagnostic features

Gross autopsy findings

  • Check for evidence of trauma.

Histopathology findings

  • Fix lung, spleen, liver, kidney, bone marrow (including smear).
  • Consider samples for toxicology (liver).

Differential diagnosis

Treatment

Initial symptomatic treatment

  • Prophylactic antibiotics Therapeutics: antimicrobial drug may be the only treatment required with mild pulmonary contusion. May not be warranted for isolated pulmonary contussion.
All Of Oxygen supplementation Nasal oxygen administration.
And Vitamin K1 analogues if appropriate Anticoagulant rodenticide poisoning.
And Antibiotics Therapeutics: antimicrobial drug.

Standard treatment

  • Continue initial medication, eg oxygen, antibiotics and Vitamin K analogues if required.
  • Fluid therapy Fluid therapy: for hemorrhage - if blood loss to maintain normovolemia.
    Care not to overtransfuse trauma cases as can   →   edema. Transfuse to maintain adequately PCV and intravascular volume.
  • Plasma transfusion - if clotting defect.
  • Whole blood transfusion Anemia: transfusion indications if severe anemia.
  • Diuretics may be given but monitor for drying of airway secretions which can   →   reduced pulmonary clearance. Avoid diuretics if dehydrated or hypovolemia is present.
  • Corticosteroids may be effective to minimize fibrous reaction.
    Do not use corticosteroids until risk of pneumonia passed.

Monitoring

  • Clinical signs.
  • Hematology.
  • Clotting studies, eg rodenticide toxicity Anticoagulant rodenticide poisoning which will result in prolonged PT (initially) and eventually APT and ACT.
  • Radiography.

Subsequent management

Monitoring

  • Continued clotting studies if dealing with coagulopathy.
  • Hematology for resolution of anemia.
  • Radiography.
    May take less than 5 days in most cases for contusions to resolve.

Prevention

Control

  • Prevent access to rodenticides/rodents.
  • Keep cats indoors.
  • Do not breed from animals with hereditary clotting defects (rare).

Outcomes

Prognosis

  • Good: if mild pulmonary contusion - will resolve spontaneously.
  • Good: if cause identified and treated.
  • Poor: if cause is neoplasia, DIC, or if hemorrhage persists.

Reasons for treatment failure

  • Severe underlying disease, eg DIC or neoplasia.
  • Extensive pulmonary trauma or hemorrhagic.
  • Serious sequelae, eg fibrosis, bronchopneumonia.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Sigrist N E, Doherr M G, Spreng D E (2004) Clinical findings and diagnostic value of posttraumatic thoracic radiographs in dogs and cats with blunt trauma. J Vet Emerg Crit Care 14 (4), 259-268 Wiley Online Library.
  • Hackner S G (1995) Emergency management of traumatic pulmonary contusions. Comp Cont Ed Pract Vet 17 (5), 677-686 VetMedResource.
  • Caylor K B (1994) Pulmonary contusion in a cat - case report. JAVMA 205, 561-562.
  • Murtaugh R J (1994) Acute respiratory distress. Vet Clinic North Am 24 (6), 1041-1055 PubMed.