SA thorax and diaphragm

CASE

• 10 yr FS miniature poodle

• 4 week history of intermittent goose honking cough

• worse when active

• auscultation- slight wheeze, no crackles

• grade 2/6 systolic heart murmur

tracheal collapse

* c shaped tracheal cartilage weakens/ collapses progressively over

where to listen for the heart

left side:

• aortic valve- between 4th or 5th intercostal

• mitral valve- between 5th or 6th intercostal

right side:

• tricuspid in the 4th intercostal

how do you diagnosis a tracheal collapse

• diagnose by xrays

• but better by scoping

how to fix a tracheal collapse

• put a metal and stent it to widen and pushes airway out

• only have only shot of doing it

• only do it as a last resort

  • cant breathe anymore and turn blue

what is significant about the great coronary vein

seperates the atrium with ventricle

whats significant about the paraconal interventricular groove

it is a landmark of the right and left ventricle

which ventricle is more muscular

left

which valve has common murmurs

* mitral valves

what do the papillary muscles prevent

inversion or prolapse of the valves

CASE

• 6 months Male australian shepherd

• continuous machinery heart murmur

• otherwise happy, normal puppy

patent ductus arteriosus (PDA)

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describe PDA

• failure of the ductus arteriosus to close just after birth

  • should immediately close right after birth

• classic machinery murmur

• cough, labored breathing, runt of the litter

• very common

• during a puppy exam the first thing you want to listen is this

• earlier diagnosis the better

• pulmonary arteries are getting overflowed

how to fix a PDA

* we can ligate it or put a ductal occuluder safer

identify the artery vein and bronchus

1. artery

2. bronchus

3. vein

what does the size of the artery tell us in an xray

tells us if its in heart failure

* artery should not be bigger than a rib

identify lung aorta trachea heart

1. trachea

2. aorta

3. lung

4. heart

what does each lung have

and artery

bronchus

and vein

case

\-14 yr old chihuahua

progressive coughing

grade V/VI heart murmur

pulmonary congestion

• vein is huge

  • used mostly to compare to the artery

• a lot of congestion in the lungs

• right sided heart failure

CASE

• 7 yr old MC golden retriever

• acute collapse in the backyard

• weak

• tachycardia

  • increased heart rate

• tachypnea

  • increased respiratory rate

• significant muffled heart sounds

  • barley hear heart rate

• pericardial effusion

• fluid in pericardium

  • heart isn’t big its the fluid surrounding it

  • heart cant pump with fluid around it

• most common cause is neoplasia

  • rodenticide

  • idiopathic

  • cancer

  • more common a tumor

• can cause cardiac tamponade

  • decreased venous return

  • ventricular filling

  • cardiac output

• results in cardiogenic shock

where do you do a pericardiocentesis

• tapping pericardium

• most commonly performed right 4th and 6th intercostal space

• right side of the thorax

• cardiac notch

  • Between right middle and right cranial of the lung

    • heart sits away from the lungs

what the fix for pericardial effusion is

subtotal pericardectomy

• we dont take out the whole pericardium because of the phernic nerve

• if the phernic nerve is taken out then the diaphargm wont expand anymore

what is the thymus and location

• its in puppies

• lymphatic grandular organ

  • responsible for t cell production

• t cells migrate away from the thymus to lymph nodes and speel as pet matures

• located in the chest cavity cranial to the heart

what is this

often referred to sail sign

thymus

* cranial to the heart

describe thoracocentesis

• removal of fluid or air from the pleural space for diagnostic or therapeutic purposes

• typically in the middle of the chest due to the expaxial muscles dorsally

• dont want to go through 4th and 6th intercostal bc thats where the heart is

• you want to go through 7-9 and you dont want to go high

why do you need a thoracostomy tube

• management of pleural effusion or pneumothorax

• post op

• placed tunneled to prevent air from coming in and out

what does -ostomy mean

making an incision

create an opening (stoma) in an organ or space

what are the three parts of the diaphragm

• lumbar

  • forms the left and right crura

  • tendinous attachments to bodies of L3 and L4

• costal

  • from medial surface of 8th-13th ribs

  • interdigitates with transversus abdominal muscle

  • fans back

• sternal

  • from the dorsal surface of sternum

  • cupula is dome shaped- bulges into thorax

  • v shaped tendinous center

what are the left and right crus important

bc you can see in an xray

how many openings are in the diaphargm

3

what goes through the diaphragm

• caval foramen

• aortic hiatus

  • aorta

  • azygos vein

  • thoracic duct

    • lymphatic drains

• esophageal hiatus

  • esophagus

  • vagal trunk

CASE

• 5yr MN Lab

• missing for 3 days

• came home and has been dyspenic

• muffled heart sounds

• muffled caudal ventral lung sounds

• painful abdomen

might be fluid in there

• no wall something is wrong with diaphargm

• you should be able to see the cupula and crus

diaphragmatic hernia

can be traumatic or congenital

what is wrong with this xray

bowl stomach jejunum way up way front

CASE

• 5 yr FS DLH

• chronically tachypneic (rapid breathing) when excited

• recently has gotten worse

• muffled heart sounds

• abdomen feels soft

peritoneopericardial diaphgragmatic herina (PPDH)

• can be chronic

• congenital communication between the pericardial and peritoneal spaces

• abnormal development of the transverse septum of the diaphragm

• can be clinically silent depending on size of defect and what is herniated

  • you may never know