Granulomatöse Pleuritis und Chylothorax durch Kalzitinhalation bei einem Galgo Español

 

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Zusammenfassung

Ein 6-jähriger Galgo-Español-Rüde wurde aufgrund hochgradiger Dyspnoe vorgestellt. Nach röntgenologischer und sonografischer Diagnose eines Thoraxergusses erfolgte eine Thorakozentese, bei der 4 l milchig-rötliche Flüssigkeit abgesogen wurden. Die klinisch-chemische Analyse ergab ein modifiziertes Transsudat mit erhöhtem Triglyzeridgehalt, bei der zytologischen Untersuchung zeigten sich degenerierte neutrophile Granulozyten, einige Lymphozyten und Makrophagen sowie Chylomikronen. Es wurde eine Thoraxdrainage gelegt. Aufgrund des computertomografischen Befunds vergrößerter Sternallymphknoten und verdickter parietaler und viszeraler Pleuralblätter bei unauffälligem Lungengewebe fiel die Entscheidung zur Thorakoskopie, bei der disseminierte herdförmige Proliferationen an der Pleura auffielen. Die histopathologische Untersuchung von Bioptaten ergab eine granulomatöse Pleuritis mit Hinweis auf intraläsionales, polarisationsoptisch anisotropes Fremdmaterial. Durch die energiedispersive Röntgenmikroanalyse wurden rasterelektronenmikroskopisch stark kalziumhaltige Fremdmaterialien in den granulomatösen Herden nachgewiesen. Die erweiterte Anamnese ergab, dass der Hund 15 Monate zuvor einige Zeit in unmittelbarer Nähe einer Baustelle gelebt hatte und kalkzementhaltige Stäube eingeatmet haben könnte. Eine Behandlung mit Prednisolon wurde nach 10 Wochen wegen gastrointestinaler Nebenwirkungen abgesetzt. Nach weiteren 4 Monaten kam es zu einem Rezidiv des Chylothorax. Der erneute Versuch einer immunsuppressiven Therapie mit Prednisolon und Ciclosporin musste wieder wegen Nebenwirkungen abgesetzt werden. Im weiteren Verlauf entwickelte der Hund eine Pneumonie und wurde auf Wunsch der Besitzerin euthanasiert.

Abstract

A 6-year-old, male Galgo Español dog was presented with severe dyspnea. Radiography and ultrasonography revealed pleural effusion. Approximately 4 l of a milky and slightly reddish fluid were aspirated and drained from the thoracic cavity. Clinical chemistry examination of the fluid indicated a modified transudate with a high amount of triglycerides. On cytological examination, degenerated neutrophilic granulocytes, small lymphocytes, macrophages and chylomicrons were found. A chest tube was placed and computed tomography was performed, which indicated thickening of parietal and visceral pleura and enlargement of the sternal lymph node without abnormal findings in the lungs. During subsequent thoracoscopy disseminated proliferative masses, appearing as small white nodules, covering nearly the entire pleural surface were found and biopsies were taken for further analysis. Histopathologic diagnosis was a granulomatous pleuritis with intralesional birefringent foreign material. Energy dispensive x-ray emission analysis was used to determine the origin of the material. Scanning electron microscopy revealed high amounts of calcium containing foreign material (calcite) within the granulomas. An extended clinical history of the dog gave evidence that the animal had lived next to a construction site 15 months earlier and may well have inhaled the calcium-containing dust. Treatment with prednisolone was initiated, however the dog developed gastro-intestinal side effects and treatment was stalled after 10 weeks. Dyspnea and liquidothorax re-occurred 4 months later. A further attempt of immunosupressive treatment was commenced, using a combination of prednisolone and ciclosporine, which again was not tolerated by the patient. The dog finally developed pneumonia and was euthanized by the owner’s request.

Publication History

Received: 03 March 2020

Accepted: 15 May 2020

Article published online:
04 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• Literatur

• 1 Adrega da Silva C, Monnet E. Long-term outcome of dogs treated surgically for idiopathic chylothorax: 11 cases (1995–2009). J Am Vet Med Assoc 2011; 239 (01) 107-113
  CrossrefPubMedGoogle Scholar
• 2 Alakija W, Iyawe VI, Jarikre LN. et al. Ventilatory function of workers at Okpella cement factory in Nigeria. West Afr J Med 1990; 9 (03) 187-192
  PubMedGoogle Scholar
• 3 Ali BA, Ballal SG, Albar AA. et al. Post-shift changes in pulmonary function in a cement factory in eastern Saudi Arabia. Occup Med (Lond) 1998; 48 (08) 519-522
  CrossrefPubMedGoogle Scholar
• 4 Al Neaimi YI, Gomes J, Lioyd O. Respiratory illnesses and ventilator function among workers at a cement factory in a rapidly developing country. Occup Med 2001; 51: 367-373
  CrossrefPubMedGoogle Scholar
• 5 Aminian O, Aslani M, Sadeghniiat Haghighi K. Cross-shift study of acute respiratory effects in cement production workers. Acta Med Iran 2014; 52 (02) 146-152
  PubMedGoogle Scholar
• 6 Baur X, Clasen M, Fisseler-Eckhoff A. et al. Interdisziplinäre S2-Leitlinie der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin und der Deutschen Gesellschaft für Arbeitsmedizin und Umweltmedizin. Pneumologie 2011; 65: 1-47
  Article in Thieme ConnectPubMedGoogle Scholar
• 7 Birchard SJ, Bilbrey SA. Chylothorax associated with dirofilariasis in a cat. J Am Vet Med Assoc 1990; 189: 1462-1464
  PubMedGoogle Scholar
• 8 Birchard SJ, McLoughlin MA, Smeak DD. Chylothorax in the dog and cat: a review. Lymphology 1995; 28: 64-72
  PubMedGoogle Scholar
• 9 Böck P, Grabenwöger M, Aharinejad S. Entwicklungsgeschichte und Anatomie der Pleura. Atemw Lungenkrkh 1991; 17 (06) 220-225
  PubMedGoogle Scholar
• 10 Brooks AC, Hardie RJ. Use of the PleurtalPort device for management of pleural effusion in six dogs and four cats. Vet Surg 2011; 40 (08) 935-941
  PubMedGoogle Scholar
• 11 Carobbi B, White RA, Romanelli G. Treatment of idiopathic chylothorax in 14 dogs by ligation of the thoracic duct and partial pericardectomy. Vet Rec 2008; 163: 743-745
  PubMedGoogle Scholar
• 12 Chopra M, Tendolkar MS, Vardhan V. Case series of pulmonary alveolar microlithiasis from India. BMJ Case Rep 2019; 12 (03) e227406
  CrossrefPubMedGoogle Scholar
• 13 Costabel U, du Bois RM, Egan JJ. Diffuse Parenchymal Lung Disease. Prog Respir Res 2007; 36: 87-100
  PubMedGoogle Scholar
• 14 Drommer W, Kaup FJ. Morphologische Reaktionen der Lunge auf inhalierte Substanzen. Symposium International Society of Animal Hygiene. Tagungsbericht Dtsch Vet Med Ges. 1984
  PubMedGoogle Scholar
• 15 El Badri OA, Saeed AM. Effect of exposure to cement dust on lung function of workers at Atbara cement factory. Kharoum Med J 2008; 1 (02) 81-84
  PubMedGoogle Scholar
• 16 Epstein S. Exudative pleural diseases in small animals. Vet Clin North Am Small Anim Pract 2014; 44 (01) 161-180
  CrossrefPubMedGoogle Scholar
• 17 Forrester SD, Fossum TW, Rogers KS. Diagnosis and treatment of chylothorax associated with lymphoblastic lymphosarcoma in four cats. J Am Vet Med Assoc 1991; 198: 291-294
  PubMedGoogle Scholar
• 18 Fossum TW, Birchard SJ, Jacobs RM. Chylothorax in 34 dogs. J Am Vet Med Assoc 1986; 188: 1315-1317
  PubMedGoogle Scholar
• 19 Fossum TW, Jacobs RM, Birchard SJ. Evaluation of cholesterol and triglyceride concentrations in differentiating chylous and nonchylois pleural effusions in dogs and cats. J Am Vet Med Assoc 1986; 188 (01) 49-51
  PubMedGoogle Scholar
• 20 Fossum TW, Merens MM, Miller MW. et al. Thoracic duct ligation and pericardectomy for treatment of idiopathic chylothorax. J Vet Intern Med 2004; 18: 307-310
  PubMedGoogle Scholar
• 21 Gnirs K. Ciclopsorin treatment of suspected granulomatous meningoencephalitis in three dogs. J Small Anim Pract 2006; 47 (04) 201-206
  CrossrefPubMedGoogle Scholar
• 22 Grünbaum EG, Schimke E. Hrsg. Klinik der Hundekrankheiten. 3. Aufl.. Stuttgart: Enke; 2006: 358
  Google Scholar
• 23 Iyori K, Kinoshita M, Imai A. et al. Clinical and histopathological presentation and successful treatment with ciclosporin for canine sarcoidosis: a case report. Vet Dermatol 2019; 30: 438-441
  CrossrefPubMedGoogle Scholar
• 24 Kakooei H, Gholami A, Ghasemkhani M. et al. Dust exposure and respiratory health effects in cement production. Acta Medica Iranica 2012; 50 (02) 112-122
  PubMedGoogle Scholar
• 25 Killich M. Hrsg. Diagnose und Therapie von Herzerkrankungen bei Hund, Katze und Heimtieren. 2. Aufl.. Stuttgart: Thieme; 2019: 491
  Google Scholar
• 26 Kohn B, Schwarz G. Hrsg. Praktikum der Hundeklinik. 12. Aufl.. Stuttgart: Enke; 2017: 507-521
  Google Scholar
• 27 Maciejewska A, Bielichowska-Cybula G. Biological effect of cement dust. Med Pr 1991; 42 (04) 281-289
  PubMedGoogle Scholar
• 28 Mattenklott M, Höfert N. Stäube an Arbeitsplätzen und in der Umwelt – Vergleich der Begriffsbestimmungen. Gefahrstoffe – Reinhaltung der Luft 2009; 69 (04) 127-129
  PubMedGoogle Scholar
• 29 Mayhew PD, Fransson BA, Ameet S. et al. Long-term outcome of video-assisted thoracoscopic thoracic duct ligation and pericardectomy in dogs with chylothorax: A multi-institutional study of 39 cases. Vet Surg 2019; 48: 112-120
  CrossrefPubMedGoogle Scholar
• 30 McAnulty JF. Prospective comparison of cisterna chyli ablation to pericardectomy for the treatment of spontaneously occurring idiopathic chylothorax in the dog. Vet Surg 2011; 40: 926-934
  PubMedGoogle Scholar
• 31 Meo SA. Health hazards of cement dust. Saudi Med J 2004; 25 (09) 1153-1159
  PubMedGoogle Scholar
• 32 Merenu IA, Mojiminiyi F, Njoku CN. et al. The effect of chronic cement dust exposure on lung function of cement factory workers in sokoto, Nigeria. Afr J Biomed Res 2007; 10 (02) 139-143
  PubMedGoogle Scholar
• 33 Müller KM. Morphologie fibrosierender Lungenerkrankungen. Pneumologie 1991; 45: 466-469
  PubMedGoogle Scholar
• 34 Müller KM, Müller G. Morphologie unspezifischer Pleurareizungen. Atemw Lungenkrkh 1987; 13 (10) 468-472
  PubMedGoogle Scholar
• 35 Mukhopadhyay S, Gal AA. Granulomatous lung disease an approach to the differential diagnosis. Arch Pathol Lab Med 2010; 134: 667-690
  CrossrefPubMedGoogle Scholar
• 36 Mwaiselage J, Bråtveit M, Moen B. et al. Cement dust exposure and ventilatory function impairment: an exposure-response study. J Occup Environ Med 2004; 46: 658-667
  CrossrefPubMedGoogle Scholar
• 37 Mwaiselage J, Bråtveit M, Moen B. et al. Respiratory symptoms and chronic obstructive pulmonary disease among cement factory workers. Scand J Work Environ Health 2005; 31: 316-323
  CrossrefPubMedGoogle Scholar
• 38 Neghab M, Choobineh A. Work related respiratory symptoms and ventilatory disorders among employees of a cement industry in Shiraz, Iran. J Occup Health 2007; 49: 273-278
  CrossrefPubMedGoogle Scholar
• 39 Nelson RW, Couto CG. eds. Small Animal Internal Medicine. 4th ed.. Mosby: Elsevier; 2009: 323-340
  Google Scholar
• 40 Nkhama E, Ndhlovu M, Dvonch JT. et al. Effects of airborne particulate matter on respiratory health in a community near a cement factory in Chilanga, Zambia: Results from a Panel Study. Int J Environ Res Public Health 2017; 14 (11) 1351
  CrossrefPubMedGoogle Scholar
• 41 Noor H, Yap CL, Zolkepli O. et al. Effect of exposure to dust on lung function of cement factory workers. Med J Malaysia 2000; 55: 51-57
  PubMedGoogle Scholar
• 42 Peaston AE, Church DB, Allen GS. Combined chylothorax, chylopericardium and cranial vena cava syndrom in a dog with thymoma. J Am Med Assoc 1990; 197: 1354-1356
  PubMedGoogle Scholar
• 43 Poornajaf A, Kakooei H, Hosseini M. et al. The effect of cement dust on the lung function in a cement factory, Iran. Int J Occup Hyg (IJOH) 2010; 2: 74-78
  PubMedGoogle Scholar
• 44 Reeves LA, Anderson KM, Luther JK. et al. Treatment of idiopathic chylothorax in dogs and cats: A systematic review. Vet Surg 2020; 49 (01) 70-79
  CrossrefPubMedGoogle Scholar
• 45 Schiefer B, Rudolph R. Zur Frage der Penumokoniosen beim Hund. Zbl Vet Med 1967; 14: 167-188
  CrossrefPubMedGoogle Scholar
• 46 Schmitz I, Müller KM. Morphologische Reaktionsmuster akuter Silikosen. Pneumologie 2005; 59
  PubMedGoogle Scholar
• 47 Schulz L-C. Hrsg. Schadstoffinhalation im Hund, vergleichbares Reaktionsmuster Mensch/Hund. In: Pathologie der Haustiere, Teil I. 1. Aufl.. Jena: Fischer; 1991: 190-200
  Google Scholar
• 48 Stobie D, Carpenter JL. Lymphangiosarcoma of mediastinum, mesentery, and omentum in a cat with chylothorax. J Am Anim Hosp Assoc 1993; 29: 78-80
  PubMedGoogle Scholar
• 49 Stockham SL, Scott MA. eds. Cavitary effusions. In: Fundamentals of Veterinary Clinical Pathology. 2nd ed.. Ames: Blackwell; 2008; 832-865
  Google Scholar
• 50 Taioli E, Wolf AS, Flores RM. Meta-analysis of survival after pleurectomy decortication versus extrapleural pneumonectomy in mesothelioma. Ann Thorac Surg 2015; 99 (02) 472-480
  CrossrefPubMedGoogle Scholar
• 51 Thepaksorn P, Pongpanich S, Siriwong W. et al. Respiratory symptoms and patterns of pulmonary dysfunction among roofing fiber cement workers in the south of Thailand. J Occupational Health 2013; 55: 21-28
  PubMedGoogle Scholar
• 52 Unterer S, Schulz B. Chylothorax beim Kleintier – Pathophysiologie, Ursachen und Behandlungsmöglichkeiten. Kleintierprax 2009; 54 (03) 164-174
  PubMedGoogle Scholar
• 53 Yang CY, Huang CC, Chiu HF. et al. Effects of occupational dust exposure on respiratory health of portland cement workers. J Tox Environ Health 1996; 49: 581-588
  CrossrefPubMedGoogle Scholar
• 54 Zeleke ZK, Moen BE, Braviet M. Cement dust exposure and acute lung function: a cross shift study. BMC Pulmonary Medicine 2010; 10: 19
  CrossrefPubMedGoogle Scholar
• 55 Zeleke ZK, Moen BE, Braviet M. Lung function reduction and chronic respiratory symptoms among workers in the cement industry: a follow up study. BMC Pulmonary Medicine 2011; 11: 50
  CrossrefPubMedGoogle Scholar