ISSN 2398-2969      

Thorax: masses

icanis

Introduction

  • Masses can potentially be located in any part of the thorax (esophagus, heart base, lung, trachea, chest wall, rib, mediastinum and thymus).
  • Signs: respiratory distress, chest wall mass, cough, lethargy, regurgitation, hypertrophic osteopathy.
  • Diagnosis: physical examination, laboratory investigation, radiography.
  • Treatment: disease dependent.
  • Prognosis: disease dependent.

Pathogenesis

Etiology

  • Masses can potentially be located in any part of thorax:
    • Esophagus (includingSpirocerca lupilesions).
    • Heart base.
    • Lung.
    • Trachea.
    • Chest wall soft tissue.
    • Rib.
    • Mediastinum.
    • Thymus.

Predisposing factors

General
  • Age, overall health status.

Pathophysiology

  • Space occupying lesion (extrapulmonary, intrapulmonary, mediastinal or pleural mass, but also hemothorax Hemothorax , chylothorax Chylothorax , pyothorax Pyothorax , pneumothorax Pneumothorax ) in the thorax causes restrictive respiratory failure, typically with inspiratory dyspnea, rapid shallow breathing and hypoxia.
  • Esophageal mass: difficulty swallowing, regurgitation, weight loss, aspiration pneumonia Lung: aspiration pneumoniaNBSpirocerca lupigranulomas and sarcomas in addition to other tumors from esophageal tissues Esophagus: granuloma 01 - pathology Esophagus: granuloma 02 - pathology.
  • Heart base mass Pericardium: neoplasia (heartbase tumor) : pericardial effusion, muffled heart sounds, decreased amplitude ECG, secondary ascites or pleural effusion Pleural: effusion.
  • Lung: dependent on size and/or location could be silent, cough, respiratory distress, dull lung sounds on side of mass, pleural effusion uncommon.
  • Trachea: cough, respiratory distress, increased upper airway sounds.
  • Chest wall soft tissue mass: variable sized external and/or internal chest wall mass, muffled lung and/or heart sounds, depending on location and size possible pleural effusion, spreading and/or invasion of ribs.
  • Rib mass: variably sized mass centered on rib, lytic and/or productive rib changes on thoracic radiographs, possible pleural effusion, muffled lung and/or heart sounds.
  • Mediastinum: silent, respiratory distress, difficulty swallowing, pleural effusion, elevated trachea on thoracic radiographs, tissue or fluid dense anterior mediastinum on ultrasound.
  • Any thoracic mass: hypertrophic osteopathy Hypertrophic osteopathy , a periosteal reaction of distal limbs thought to be secondary to increased blood flow mediated by vagus nerve.
    Also see HO with some renal or urinary bladder masses.
  • With Spirocerca lesions, hypertrophic osteopathy indicates Spirocerca-associated sarcoma rather than granuloma Canine spirocercosis.
  • Thymoma Thymoma may be associated with myasthenia gravis Myasthenia gravis.
  • Intrathoracic thyroid tumors Thyroid gland: neoplasia may cause hyperthyroidism.
  • Horners syndrome Horner's syndrome if lesion interferes with thoracic sympathetic pathways.

Timecourse

  • Variable, acute → chronic.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Dvir E, Kirberger R M, Mukorera V, van der Merwe L L, Clift S J (2008) Clinical differentiation between dogs with benign and malignant spirocercosis. Vet Parasitol 155 (1-2), 80-88 PubMed.
  • Oura T J, Rozanski E A, King R G, Sato A F (2008) What is your diagnosis? Traumatic pulmonary pseudocysts. JAVMA 232 (3), 357-358 PubMed.
  • Patterson C C, Perry R L, Steficek B (2008) Malignant peripheral nerve sheath tumor of the diaphragm in a dog. J Am Anim Hosp Assoc 44 (1), 36-40 PubMed.
  • Rizzo S A, Newmand S J, Hecht S, Thomas W B (2008) Malignant mediastinal extra-adrenal paraganglioma with spinal cord invasion in a dog. J Vet Diagn Invest 20 (3), 372-375 PubMed.
  • Stassen Q E, Voorhout G, Teske E, Rijnberk A (2007) Hyperthyroidism due to an intrathoracic tumour in a dog with test results suggesting hyperadrenocorticism. JSAP 48 (5), 283-287 PubMed.
  • Tseng L W, Waddell L S (2000) Approach to the patient in respiratory distress. Clin Tech Sm Anim Pract 15 (2), 53-62 PubMed.
  • Hawkins E C, DeNicola D B, Kuehn N F (1990) Bronchoalveolar lavage in the evaluation of pulmonary disease in the dog and cat: state of the art. JVIM (5), 267-274 PubMed.

Other sources of information

  • Ettinger S J, Kantrowitz B (2005):diseases of the trachea. In: Ettinger S J & Feldman E C, editorsTextbook of Veterinary Internal Medicine, St Louis, Elsevier.
  • Mertens M M, Fossum T W, MacDonald K A (2005)Pleural and extrapleural diseases. In: Ettinger S J & Feldman E C, editorsTextbook of Veterinary Internal Medicine, St Louis, Elsevier.
  • Moore L E, Biller D S (2005)Mediastinal disease.In: Ettinger S J & Feldman EC, editorsTextbook of Veterinary Internal Medicine, St Louis, Elsevier.
  • Nelson O L, Sellon R K (2005)Pulmonary parenchymal disease.In: Ettinger S J & Feldman E C, editorsTextbook of Veterinary Internal Medicine, St Louis, Elsevier.
  • Silverstein D, Drobatz K J (2005)Clinical evaluation of the respiratory tract.In: Ettinger S J & Feldman E C, editorsTextbook of Veterinary Internal Medicine, St Louis, Elsevier.

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