Section: Veterinary Care In-depth
Treatment In-depth
Treatment of pyothorax may require medical management alone or in combination with surgery, depending on the underlying cause.
Medical Management
The initial concern in treating your animal is to improve his ability to breathe. Your veterinarian will generally remove the fluid in your pet's chest cavity using a needle. Occasionally, sedation or anesthesia are required but a chest tap can often be performed with the animal awake. Depending on the degree of difficulty that your animal is experiencing when breathing, oxygen therapy may be required.
Further treatment will depend on whether or not an underlying disease was identified. If an underlying lesion is found, your veterinarian will need to treat it and the infection.
Medical management of pyothorax usually involves placing the animal on fluids to correct dehydration and other blood abnormalities and initiating antibiotics. Generally, broad-spectrum antibiotics, which are those effective against a wide variety of bacteria, are initiated until the results of the culture and sensitivity are obtained. Antibiotic therapy is generally continued for a total of 6 to 8 weeks.
Many times antibiotic therapy alone is not enough to rid the chest of the infection completely. In such animals, chest tubes are often inserted so that fluid can be placed into the chest via the tube and then removed. This helps to wash the bacteria and clots out of the chest cavity and may decrease the likelihood of the infection recurring. This procedure of thoracic lavage is generally done two to three times a day for 5 to 7 days or until there is clinical improvement.
If an underlying cause for the infection is identified, such as a lung tumor, abscess or a foreign body, then surgery is necessary. The foreign body or mass must be removed in order to clear the infection. Additionally, if there is no response to the medical management, surgery is often recommended despite a definitive mass or lesion not being readily identified on the radiographs.
Surgical Management
Several surgical approaches can be used for pyothorax depending on the lesion that has been identified. An incision may be made between the ribs if a lung mass has been identified, or the sternum may be opened so that both sides of the chest cavity can be evaluated. Many times it is not possible to find the foreign body that caused the infection, despite evidence that one was present previously.
The surgeon will remove as much of the infected tissues as possible and will submit it for histologic examination (under a microscope) and for culture.
Often a chest tube will be placed to allow lavage of the chest cavity to be continued after surgery.
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