Case 12: Pleural Fluid

Case 12 — Pleural Fluid

Mark D. Kittleson, D.V.M., Ph.D., DACVIM (Cardiology)

Lucky was adopted at 6 months of age. She has lived in Fresno, CA and every summer goes to Fish Camp near Yosemite (alt = 5000′). This summer she did not go because the referring DVM advised against it.
Approximately 6 months ago, the owner noticed she was not eating as well, becoming lethargic, and panting more frequently. Three weeks ago she began refusing kibble.
Nine days ago she was taken to the emergency hospital for “gurgling” sounds. Radiographs revealed severe pleural effusion and possibly pulmonary edema. ECG showed tachycardia (HR = 270 bpm). 1500 ml of serosanguinous fluid was drained. She had a fever (105.0°F) and was mildly dehydrated. Fluid SG was 1.015, protein 1.0 g/dL (most consistent with a transudate). Sent home on Lasix 12.5 mg (1½ tabs SID), enalapril 20 mg (¼ tab q12h), and digoxin 0.125 mg (1½ tabs SID).
Yesterday she returned for “gurgling” sounds. 1500 ml of clear straw-colored fluid removed. Found 5% dehydrated. Digoxin reduced to 1 tab SID (0.125 mg). Referred to UC Davis.

T = 101.5°F; HR = 240; RR = 52
QAR, mild dehydration, emaciated.
Integument: Full, dry, and coarse coat. No alopecia. Two ticks seen and removed.
Eyes: Clear corneas and anterior chambers; small amount of clear-greenish discharge OU. Ears: clean.
Nose: Moist, no discharge. Mouth: 4+ tartar with moderate gingivitis.
MS: Emaciated with general muscular atrophy. No gait abnormalities.
GI: Palpated a 2-cm soft mass in the ventral abdomen (may be fat or intestine). Hepatomegaly, small spleen.
GU: No vaginal discharge; empty bladder. Nervous: Not evaluated. LN: All WNL.
CV: Tachycardia fluctuating in rate and rhythm. No murmur auscultated. MM pink; CRT = 2 sec. Weak to fair pulses. Pulse deficits noted. Positive hepatojugular reflux test.
Respiratory: Dyspnea (panting and increased chest movements). Prefers to remain standing or sternal (orthopnea).