Thoracoscopy pulmonary biopsy by two portals with a novel pre-tied loop ligature device in rabbits: an experimental study / Biópsia pulmonar por toracoscopia por dois portais com uma nova ligadura de alça pré-amarrada em coelhos: um estudo experimental

ABSTRACT: Thoracoscopy is replacing open lung biopsies because it is less invasive, usually the technique is done using three portals and intracorporeal suture technique. This study described the feasibility and efficacy of a novel pre tied loop ligature and to propose a thoracoscopic access strategy with two portals to perform lung biopsy in patients under 5 kg. Ten rabbits were positioned in dorsal recumbency. Total thoracoscopic lung biopsy was performed using a combined transdiaphragmatic approach and a right intercostal approach. A pre tied loop ligature was placed to perform a caudal lung lobe biopsy. Insufflation of the thoracic cavity was not performed. The total surgery time was 41.4 ± 14.5 min. The procedure was carried out free of complications that prevented slippage or tightening the knot or that made it come loose after the lung biopsy; there was no serious complication during the surgical procedure. The samples obtained averaged 1x0.64x0.45 cm (Length, Width, Depth) and were considered satisfactory according to the histopathologic evaluation. Thorax radiographs taken before and after the surgeries were compared and showed no pneumothorax or hemothorax. Necropsy confirmed no knot failure occurred at the biopsy site. The use of the novel pre tied loop ligature is a safe and effective technique, avoiding problems with the limited size of the thoracic cavity in small patients.

RESUMO: A toracoscopia está substituindo as biópsias pulmonares abertas por ser menos invasiva. Usualmente a técnica é feita utilizando três portais e ligaduras feitas intra corporalmente. O objetivo deste estudo foi descrever a viabilidade e eficácia de uma nova ligadura com alça pré-amarrada e propor uma estratégia de acesso toracoscópico com dois portais para realizar biópsia pulmonar em pacientes com menos de 5kg. Dez coelhos foram posicionados em decúbito dorsal. A biópsia pulmonar por toracoscopia total foi feita pela abordagem combinada transdiafragmática e abordagem intercostal direita. Uma nova ligadura pré-amarrada foi colocada para realizar uma biópsia do lobo pulmonar caudal. Não foi realizada insuflação da cavidade torácica. O tempo total de cirurgia foi de 41,4 ± 14,5 min. Os procedimentos foram realizados sem complicações que impedissem o escorregamento ou aperto do nó ou que o soltassem após a biópsia pulmonar; não houve nenhuma intercorrência grave durante o procedimento cirúrgico. As amostras coletadas tinham tamanho médio 1x0,64x0,45 cm e foram consideradas satisfatórias de acordo com a avaliação histopatológica. As radiografias de tórax feitas antes e depois das cirurgias foram comparadas e não mostraram pneumotórax ou hemotórax. A necropsia confirmou que não ocorreu falha do nó no local da biópsia. Conclui-se que uso da nova ligadura com alça pré-amarrada é uma técnica segura e eficaz, evitando problemas com o tamanho limitado da cavidade torácica em pacientes pequenos.

Thoracoscopy pulmonary biopsy by two portals with a novel pre-tied loop ligature device in rabbits: an experimental study / Biópsia pulmonar por toracoscopia por dois portais com uma nova ligadura de alça pré-amarrada em coelhos: um estudo experimental

Thoracoscopy is replacing open lung biopsies because it is less invasive, usually the technique is done using three portals and intracorporeal suture technique. This study described the feasibility and efficacy of a novel pre tied loop ligature and to propose a thoracoscopic access strategy with two portals to perform lung biopsy in patients under 5 kg. Ten rabbits were positioned in dorsal recumbency. Total thoracoscopic lung biopsy was performed using a combined transdiaphragmatic approach and a right intercostal approach. A pre tied loop ligature was placed to perform a caudal lung lobe biopsy. Insufflation of the thoracic cavity was not performed. The total surgery time was 41.4 ± 14.5 min. The procedure was carried out free of complications that prevented slippage or tightening the knot or that made it come loose after the lung biopsy; there was no serious complication during the surgical procedure. The samples obtained averaged 1x0.64x0.45 cm (Length, Width, Depth) and were considered satisfactory according to the histopathologic evaluation. Thorax radiographs taken before and after the surgeries were compared and showed no pneumothorax or hemothorax. Necropsy confirmed no knot failure occurred at the biopsy site. The use of the novel pre tied loop ligature is a safe and effective technique, avoiding problems with the limited size of the thoracic cavity in small patients.

A toracoscopia está substituindo as biópsias pulmonares abertas por ser menos invasiva. Usualmente a técnica é feita utilizando três portais e ligaduras feitas intra corporalmente. O objetivo deste estudo foi descrever a viabilidade e eficácia de uma nova ligadura com alça pré-amarrada e propor uma estratégia de acesso toracoscópico com dois portais para realizar biópsia pulmonar em pacientes com menos de 5kg. Dez coelhos foram posicionados em decúbito dorsal. A biópsia pulmonar por toracoscopia total foi feita pela abordagem combinada transdiafragmática e abordagem intercostal direita. Uma nova ligadura pré-amarrada foi colocada para realizar uma biópsia do lobo pulmonar caudal. Não foi realizada insuflação da cavidade torácica. O tempo total de cirurgia foi de 41,4 ± 14,5 min. Os procedimentos foram realizados sem complicações que impedissem o escorregamento ou aperto do nó ou que o soltassem após a biópsia pulmonar; não houve nenhuma intercorrência grave durante o procedimento cirúrgico. As amostras coletadas tinham tamanho médio 1x0,64x0,45 cm e foram consideradas satisfatórias de acordo com a avaliação histopatológica. As radiografias de tórax feitas antes e depois das cirurgias foram comparadas e não mostraram pneumotórax ou hemotórax. A necropsia confirmou que não ocorreu falha do nó no local da biópsia. Conclui-se que uso da nova ligadura com alça pré-amarrada é uma técnica segura e eficaz, evitando problemas com o tamanho limitado da cavidade torácica em pacientes pequenos.

Pneumotórax secundário a bolha pulmonar em cão / Pneumothorax secondary to a pulmonary bullae in a dog

Background: Pulmonary bullae are thin-walled cavitary lesions within the subpleural parenchyma. They are a result of thedestruction, dilatation and coalescence of bordering alveoli and their rupture is the most common cause of pneumothoraxin dogs. Radiographic and CT imaging are excellent tools for identifying and quantifying pneumothorax. Surgical treatment is considered standard for treatment of pneumothorax consequential to pulmonary bullae. The aim of this report wasto describe a case of pneumothorax secondary to pulmonary bullae in a dog.Case: A 5-year-old male crossbreed dog, weighing 11.5 kg, was presented to the Uberaba’s Veterinary Hospital due to becoming easily tired in the previous 3 weeks, and its worsening in the last 2 days by presenting panting. The dog’s guardiandid not witness any traumas, but informed that the animal resided with other 14 dogs and also that it frequently collidedthe thorax against the door when it came down from the bed. Physical examination showed diaphragmatic breathing,inspiratory dyspnea and stridor lung sound. Thoracocentesis revealed presence of air in the pleural cavity and pneumothorax. Radiographic images confirmed this condition. The dog stayed in the hospital and chest drains were placed. Sincethe amount of sucked air did not reduce with time and due to the emergence of subcutaneous emphysema, the dog wentthrough exploratory thoracotomy that revealed impairment of the right caudal lung lobe, proceeding to lobectomy. Thedog stayed in the hospital with chest drains until the contents of the suctions reduced significantly. With the removal ofthe drains, the dog was sent home and had a full recovery. Histopathology of the impaired lung revealed pulmonary bullae.Discussion: The dog from this report presented clinical signs consistent with pneumothorax, such as dyspnea, diaphragmaticbreathing and exercise intolerance. Radiography of the chest region revealed...

Pneumotórax espontâneo primário devido bolha pulmonar em cão / Primary spontaneous pneumothorax due to pulmonary bubble in dog

O presente trabalho relata um caso de pneumotórax espontâneo primário decorrente de bolha pulmonar em um cão. O paciente, fêmea, sem raça definida (SRD), de 25 kg e com dez anos de idade foi atendido com quadro de taquipneia e histórico de pneumotórax recorrente, a radiografia torácica confirmou o pneumotórax e a tomografia computadorizada realizada antes e após a toracocentese emergencial confirmou a presença de bolha pulmonar no lobo cranial esquerdo. O tratamento cirúrgico foi realizado com lobectomia parcial por toracotomia intercostal que, apesar de restrições, permitiu menor tempo cirúrgico e menor trauma. No acompanhamento pós-operatório de dez dias o paciente teve recuperação completa, sem complicações ou recidivas do quadro.

The present study reports a case of spontaneous primary pneumothorax due to a pulmonary bubble in a dog. The patient, female, without defined race (SRD), 25 kg and 10 years old, was treated with tachypnea and a history of recurrent pneumothorax, the chest radiography confirmed the pneumothorax and computed tomography performed before and after emergency thoracentesis confirmed the presence of a pulmonary bubble in the left cranial lobe. The surgical treatment was performed with partial lobectomy by intercostal thoracotomy, which is spite of some restrictions, allowed less surgical time and minor trauma. In the 10-day postoperative follow-up, the patient had complete recovery, without complications or recurrence of the condition.

Pneumotórax espontâneo primário devido bolha pulmonar em cão / Primary spontaneous pneumothorax due to pulmonary bubble in dog

O presente trabalho relata um caso de pneumotórax espontâneo primário decorrente de bolha pulmonar em um cão. O paciente, fêmea, sem raça definida (SRD), de 25 kg e com dez anos de idade foi atendido com quadro de taquipneia e histórico de pneumotórax recorrente, a radiografia torácica confirmou o pneumotórax e a tomografia computadorizada realizada antes e após a toracocentese emergencial confirmou a presença de bolha pulmonar no lobo cranial esquerdo. O tratamento cirúrgico foi realizado com lobectomia parcial por toracotomia intercostal que, apesar de restrições, permitiu menor tempo cirúrgico e menor trauma. No acompanhamento pós-operatório de dez dias o paciente teve recuperação completa, sem complicações ou recidivas do quadro.(AU)

The present study reports a case of spontaneous primary pneumothorax due to a pulmonary bubble in a dog. The patient, female, without defined race (SRD), 25 kg and 10 years old, was treated with tachypnea and a history of recurrent pneumothorax, the chest radiography confirmed the pneumothorax and computed tomography performed before and after emergency thoracentesis confirmed the presence of a pulmonary bubble in the left cranial lobe. The surgical treatment was performed with partial lobectomy by intercostal thoracotomy, which is spite of some restrictions, allowed less surgical time and minor trauma. In the 10-day postoperative follow-up, the patient had complete recovery, without complications or recurrence of the condition.(AU)

An experimental pleural drainage device in hypertensive pneumothorax

ABSTRACT Purpose To develop a specific device for pleural drainage in hypertensive pneumothorax. Methods The prototype was modeled from the free version of a 3D modeling application, printed on a 3D printer using ABS® plastic material, and tested in a pleural drainage simulator. Results Pleural drainage in the simulator using the prototype was feasible and reproducible. Conclusions While the prototype is functional in the simulator, it requires improvement and refinement for use in humans.

Recurrent spontaneous pneumothorax in a Maltese dog with endogenous lipoid pneumonia

Background: Pneumothorax is a clinical condition which can cause respiratory distress. It can have as its origin traumatic causes or even classified as spontaneous, mainly related to diseases of the lung parenchyma. Lipoid pneumonia is rarely described in dogs, and it is characterized by globules of lipid in the alveolar spaces. Endogenous lipoid pneumonia (EnLP) occurs when lesions on pulmonary cells release cholesterol and other lipids in the alveoli. There is no clinical approach established for EnLP in veterinary patients. The aim of this report is to describe a case of a young Maltese dog, with recurrent spontaneous pneumothorax in which EnLP was diagnosed post mortem. Case: A 2-year-old sexually intact male Maltese dog was evaluated for restrictive dyspnea. Clinicopathologic findings included cyanotic, muffled chest auscultation with hypersonic thoracic percussion. Chest x-ray demonstrated an increase in pleuropulmonary radio transparency and a floating-looking heart, indicating pneumothorax. Complete blood counts and biochemical panel results were normal. Dirofilaria immitis antigen test results were negative. Computed tomography demonstrated slightly hyper-expanded pulmonary fields, with slightly enlarged reticular marking with areas of mild multicentric panlobular emphysema and a fracture on the sixth left rib. The treatment was focused on improving the breathing pattern through sedation, supplementation with oxygen, and thoracentesis. Owing to the reserved prognosis of the case, the unknown etiology of the recurrent pneumothorax, and the clinical worsening of the patient, the owner opted for euthanasia. Necropsy displayed multiple, circular whitish areas in the lungs, distributed over the surface of all lobes. Histopathological examination revealed pulmonary tissue with the subpleural micronodular foci, multifocal to coalescent, with a moderate accumulation of foamy intra-alveolar macrophages, occasionally multinucleate, associated with cholesterol crystals compatible with endogenous lipid pneumonia. Discussion: The patient presented with clinical signs and physical examination characteristics of pneumothorax at the first visit. After the pneumothorax diagnosis, and clinical stabilization of the patient. No predisposing factor for the formation of the pneumothorax was identified as the radiography revealed only bronchitis and blood tests were normal, the patient was thus discharged after 24 h, with the recommendations for observing the breathing pattern. Initially, spontaneous pneumothorax was suspected. The antibiotics were administered since bacterial pneumonia, although not confirmed on chest x-ray, is the main cause of pneumothorax in dogs is lung parenchyma disease. With the worsening of the clinical condition of the patient, CT was performed and did not demonstrate any findings that would justify the presence of pneumothorax. Despite the placement of the chest tube for facilitating the management of thoracentesis, there was no stabilization of the condition, enhancing the frequency of centesis procedures, which led to the decision to euthanize. The microscopic examination of the pulmonary alterations was decisive for the diagnostic conclusion. The visualization of the accumulation of foamy intra-alveolar macrophages, occasionally multinucleate, associated with cholesterol crystals, was responsible for the diagnosis of EnLP. This condition is rarely described in dogs and as in the present report, it is a noninfectious inflammatory condition, characterized by intra- or extracellular globules of lipid in the alveolar spaces. In the present report, although it was not possible to determine the etiology of EnLP, we can conclude that although rare, it can affect dogs and can generate severe clinical repercussions.

Clinical, surgical, and radiographic aspects in a white-eared opossum (Didelphis albiventris) with traumatic diaphragmatic hernia / Aspectos clínicos, cirúrgicos e radiográficos em um Gambá-de-orelha-branca (Didelphis albiventris) com hérnia diafragmática traumática

This is the case of a specimen of Didelphis albiventris with signs of respiratory difficulty after a dog attack. Thoracic radiographic examination revealed pneumothorax, pulmonary contusion, and rib fracture, but no alteration compatible with diaphragmatic hernia was observed. Pneumothorax was reduced and the other alterations were treated. However, clinical manifestations persisted, and thus a contrast-gastrointestinal radiographic study was performed, showing abdominal organs in the thoracic cavity and loss of diaphragmatic line. The surgical approach was instituted, with access to the diaphragm through median laparotomy. Through the diaphragmatic rupture, present in the left antimere, there were herniated liver and gastric portions, intestinal segments, and omentum. After inspection and repositioning of the abdominal organs, the diaphragm raffia was performed with single sutures interrupted with 3-0 Nylon thread. The patient’s complete recovery occurred 14 days after the surgical procedure, with remission of clinical manifestations and normality of thoracic images in radiographic studies.

Esse é o caso de um espécime de Didelphis albiventris com sinais de dificuldade respiratória após ataque por cão. O exame radiográfico torácico revelou pneumotórax, contusão pulmonar e fratura de costelas, porém nenhuma alteração com-patível com hérnia diafragmática foi observada. O pneumotórax foi reduzido e as demais alterações tratadas. Contudo; houve a persistência das manifestações clínicas, e dessa forma um estudo radiográfico gastrointestinal contrastado foi realizado, sendo evidenciados órgãos abdominais na cavidade torácica e perda da linha diafragmática. A abordagem cirúrgica foi instituída, com acesso ao diafragma por meio de laparotomia mediana. Através da ruptura diafragmática, presente no antímero esquerdo, estavam herniadas porções hepáticas e gástricas, segmentos intestinais e omento. Após inspeção e reposicionamento dos órgãos abdominais, a rafia do diafragma foi realizada com suturas simples interrompidas com fio Nylon 3-0. A recuperação completa do paciente ocorreu 14 dias após o procedimento cirúrgico, com remissão das manifestações clínicas e normalidade das ima-gens torácicas nos estudos radiográficos.

Clinical, surgical, and radiographic aspects in a white-eared opossum (Didelphis albiventris) with traumatic diaphragmatic hernia / Aspectos clínicos, cirúrgicos e radiográficos em um Gambá-de-orelha-branca (Didelphis albiventris) com hérnia diafragmática traumática

This is the case of a specimen of Didelphis albiventris with signs of respiratory difficulty after a dog attack. Thoracic radiographic examination revealed pneumothorax, pulmonary contusion, and rib fracture, but no alteration compatible with diaphragmatic hernia was observed. Pneumothorax was reduced and the other alterations were treated. However, clinical manifestations persisted, and thus a contrast-gastrointestinal radiographic study was performed, showing abdominal organs in the thoracic cavity and loss of diaphragmatic line. The surgical approach was instituted, with access to the diaphragm through median laparotomy. Through the diaphragmatic rupture, present in the left antimere, there were herniated liver and gastric portions, intestinal segments, and omentum. After inspection and repositioning of the abdominal organs, the diaphragm raffia was performed with single sutures interrupted with 3-0 Nylon thread. The patients complete recovery occurred 14 days after the surgical procedure, with remission of clinical manifestations and normality of thoracic images in radiographic studies.(AU)

Esse é o caso de um espécime de Didelphis albiventris com sinais de dificuldade respiratória após ataque por cão. O exame radiográfico torácico revelou pneumotórax, contusão pulmonar e fratura de costelas, porém nenhuma alteração com-patível com hérnia diafragmática foi observada. O pneumotórax foi reduzido e as demais alterações tratadas. Contudo; houve a persistência das manifestações clínicas, e dessa forma um estudo radiográfico gastrointestinal contrastado foi realizado, sendo evidenciados órgãos abdominais na cavidade torácica e perda da linha diafragmática. A abordagem cirúrgica foi instituída, com acesso ao diafragma por meio de laparotomia mediana. Através da ruptura diafragmática, presente no antímero esquerdo, estavam herniadas porções hepáticas e gástricas, segmentos intestinais e omento. Após inspeção e reposicionamento dos órgãos abdominais, a rafia do diafragma foi realizada com suturas simples interrompidas com fio Nylon 3-0. A recuperação completa do paciente ocorreu 14 dias após o procedimento cirúrgico, com remissão das manifestações clínicas e normalidade das ima-gens torácicas nos estudos radiográficos.(AU)

Estrutura óssea exógena traqueal em um gato / Exogenous tracheal bone structure in a cat

Background: Acute dyspnea is a clinical emergency with a presentation similar to several etiologies. Cats are usually referred with complaints of anorexia, abdominal breathing, cyanosis, and open mouth breathing, and veterinarians should stabilize the animals as soon as possible. The incidence of aspiration of foreign bodies is low, particularly in this species. The diagnosis consists of observing the foreign structure in the lumen of the trachea, commonly performed using radiography or bronchoscopy. This report describes a case of a feline with a tracheal foreign body, with a detailed description of the clinical findings and successful treatment. Case: A 10-year-old female feline exhibited severe dyspnea and cyanosis. During the anamnesis, the owner stated that the clinical signs suddenly presented one day prior, after the animal ingested a piece of fish. Physical examination revealed changes in pulmonary auscultation, which was bilaterally muffled, and intense respiratory distress, as observed by the evident signs of exhaustion (sternal decubitus, reduced muscle tone), in addition to cyanotic mucous membranes. The animal was intubated and maintained under anesthesia with propofol infusion and respiratory support (ambu) for 1 h, during which complementary examinations were performed. Chest radiography showed the presence of a radiopaque structure (approximately 0.5 cm) in the tracheal region. Thus, we decided to remove the structure using bronchoscopy. The foreign body was located above the main bronchial bifurcation and was removed. There was an improvement in oxygenation after 20 min of maintenance of ventilatory support, followed by weaning of the animal's successful respiratory support. Antibiotic therapy and analgesia were prescribed at home, and the animal exhibited full recovery after 10 days. Discussion: Dyspnea is a clinical sign that should be treated as an emergency, as it is associated with high mortality. In these cases, positive pressure ventilation is indicated in three situations: persistent hypoventilation, severe hypoxemia unresponsive to oxygen therapy, and excessive respiratory effort or fatigue. Dyspnea may be due to impairment of the upper or lower airway or restrictive conditions. Clinically, felines with tracheal foreign bodies have a sudden onset of dyspnea, tachypnea, cough, and lethargy. In these patients, the reduction in lung sounds is a common finding, as observed in the present case. The occurrence of tracheal foreign bodies in cats is rare and, depending on the type of foreign body and its location in the airway, complete obstruction of the respiratory tract may occur. In the present case, it was possible to observe the foreign body in the trachea on radiographic images. Felines with tracheal foreign bodies generally present a structure located close to the carina, as observed in the present case. Bronchoscopy using a flexible or rigid tube is considered the gold-standard technique for removing foreign bodies from the respiratory tract, and the greatest difficulty during the removal procedure is ensuring that the airways are not obstructed by the instruments used. The use of these materials is not free of complications, as they may be responsible for the development of pneumothorax, pneumomediastinum, dyspnea, and respiratory failure. In the present case, there were no complications during or after the procedure, and the patient recovered completely.(AU)

Pulmonary adenocarcinoma in dogs: surgical treatment with real-time video-thermometry

Background: Pulmonary neoplasia is an abnormal proliferation of cells at the lung tissue, and may be classified as primary, secondary or metastatic, and multisystemic. However, primary neoplasia is rare in canids. Additionally, neoplasms may be classified according to their biological behavior as either malignant or benign. Malignant tumors are more prevalent. The diagnosis can be difficult due to nonspecific symptoms, taking into account that some affected patients do not have symptoms at all; thus, the real incidence of the disease might remain undiagnosed on certain occasions. Therefore, we aimed to report an unprecedented successful case of lung lobectomy surgery in dogs with the aid of infrared video thermometry, which showed real-time images during the surgical procedure. Case: A 10-year-old male dog, crossbreed with Cocker Spaniel, was attended with a history of lethargy, dullness, progressive weight loss, cough, and difficulty breathing. Due to the chronic severity of the clinical signs and the normal physiological clinical examination, complementary exams were requested, such as radiography of the cervical and thoracic regions, cranial and thoracoabdominal computed tomography (TCT). The results of the exams showed the presence of a nodule mass in the right caudal pulmonary lobe which caused a lateral deviation to the left hemithorax of the cardiac silhouette. The patient underwent a surgical procedure with an approach through the thoracic region, at the height of the seventh intercostal space, and a total lobectomy was performed. Throughout the surgical procedure, video thermometry in real-time through the MART station (Metabolic Activity in Real-Time FLIR SC325®) was used to determine the viability of adjacent tissues through temperature differences measured in degrees Celsius. The surgical fragment containing the direct caudal pulmonary lobe and the mass were sent to the pathology sector for anatomopathological evaluation. An abundant papillary epithelial proliferation was visualized through microscopy, presenting areas of necrosis and inflammatory polymorphonuclear infiltrate. The nodule was diagnosed as lung papillary adenocarcinoma. Discussion: Adenocarcinomas consist of papillary, acinar, solid, or mixed glandular structures. They may originate from the airways, bronchial glands, or bronchoalveolar region, and often show invasive growth presenting a rudimentary and irregular shape. The clinical signs are non-specific, including exercise intolerance, non-productive cough, chronic respiratory signs such as tachypnoea or dyspnea, reduced appetite, weight loss, lethargy, chest palpation pain, hemothorax, pneumothorax, and pleural effusion. The diagnosis is concluded through imaging diagnostic tests, of which chest radiography is the most important, followed by magnetic resonance and computed tomography. Also, histopathological examination is essential to determine a definitive diagnosis. The treatment of choice for adenocarcinoma nodules is a surgical excision of the tumor mass. However, the type of surgical approach is determined by different factors such as size, location, and involvement of adjacent structures. The ablation of pulmonary masses may be performed either via partial or total lobectomies. Nevertheless, partial lobectomy is more often performed on non-neoplastic masses or to obtain material for biopsy, whilst total lobectomy is recommended for a malignant neoplasm removal. The prognosis is always guarded, having a more favorable outcome in masses of the smaller diameter without the involvement of adjacent structures.(AU)

Endosurgery approach in a dog with thoracoabdominal injury

Background: Chest trauma is one of the main thoracic injuries in dogs and cats, reaching a high morbidity and mortality. The tissue damage, in thoracic trauma, can be underappreciated by visual exam and traditional radiography. The thoracoscopy can provide information for a precise definitive diagnosis, by this technique bleeding or air leakage can be identified and corrected immediately and the diaphragm can be completely evaluated. The aim of this work was to describe the thoracoscopic approach in a case of diaphragmatic perforation caused by penetrating trauma in a dog. Case: A 6-year-old male dog mixed-breed dog, weighing 14 kg with thorax perforation was presented to the Veterinary Hospital. Clinical examination of the animal revealed the following: pale mucous membranes, moderate dyspnea, open pneumothorax, abdominal distension, heart rate of 108 beats per minute and respiratory rate of 64 breaths per minute. Physical examination confirmed a 3 cm perforation hemorrhagic lesion in the left ninth intercostal space. As an emergency treatment, oxygen therapy, tramadol hydrochloride [Cronidor® 2%, 4 mg/kg, i.v, TID], tranexamic acid [Transamin® 25 mg/kg, i.v, TID], ceftriaxone [Rocefin® 50 mg/kg, i.v, BID] and fluid therapy with lactated Ringer's solution were administered. The hair was removed, and then, wound cleaning and obliteration of the wall injury with sterile gauze was performed. After the emergency stabilization, the animal was anesthetized, followed by preventive thoracocentesis by an approach close to thoracic perforation and thoracoscopy without pneumoperitonea through this thoracic perforation with 0-degree rigid endoscope. About 100 mL of blood and air was drained and diagnosed perforation in the diaphragm and pulmonary atelectasis in the caudal and left cranial lobes. the edges of the incisional wound were debrided, and the closure of thoracic incision was performed usual way. After that, the air was removed by a catheter and syringe system. A flexible plastic tube was inserted through the chest wall and into the pleural space for drainage every 2 h for 24 h. There were no intercurrences during the first 24 h after the surgical procedure. The patient was discharged 48 h after the surgery. Cephalexin [75 mg, 30 mg/kg, v.o, TID, during 5 days), Ketoprofen [20 mg, 2 mg/kg, v.o, SID, during 5 days], Tramadol Hydrochloride [50 mg, 4 mg/kg, v.o, SID, during 2 days] and Rifamycin spray at the wound site was prescribed. Ten days after surgery, the patient returned to the hospital for suture removal and reassessment. Discussion: The prognosis of chest perforation depends on the severity and number of internal and external thoracic lesions, as well as cardiovascular status at the time of initial patient care. In cases of penetrating chest trauma, it is essential to thoroughly examine the thoracic cavity for bleeding, tissue tears, and diaphragm perforation. The use of the endoscope allowed for a more detailed exploration of the chest without the need to increase the incision. When the diaphragm lesion was found, it was also possible to perform the abdominal examination by videoendoscopy, through this perforation. Laparotomy and thoracotomy cause postoperative pain and discomfort, in addition to increasing recovery time, however, even with trauma, not performing a larger incision favored the recovery of this patient, without any intercurrence in the first 24 h after the procedure. In conclusion, the endoscopic approach was efficient for diagnosis, avoiding greater trauma and contributing to a better clinical recovery of the patient.

Evisceração de lobo pulmonar direito após ferida por mordedura de cão / Evisceration of right pulmonary lobe after dog bite injury

Background: Pneumothorax is the presence of free air in the pleural cavity. Air in the thoracic cavity causes respiratorydiscomfort, severe hypoxemia, decreased venous return, and haemodynamic instability, and it may lead to death. Pneumothorax can be triggered by wounds from firearm projectiles, bladed weapons, or sharp or piercing objects, as well asbites and barotrauma. The diagnosis of open pneumothorax is based on anamnesis, in combination with clinical signsobserved on physical examination. The objective of this report is to discuss the relevance of clinical-surgical managementto adequately treat evisceration of the pulmonary lobe caused by a bite in the thoracic region of a female dog.Case: This report discusses a 15-year-old female canine weighing approximately six kg with a history of wounds in thethoracic region and respiratory difficulty after being bitten by another dog. On clinical examination, she presented with abruised wound in the right thoracic region and another in the scapular region. The examination revealed evisceration of theright cranial lung lobe, which exhibited atelectasis. The animal was immediately referred to the Surgical Center. Anaesthesia was induced using propofol 2.0 mg/kg combined with ketamine hydrochloride 2.0 mg/kg, followed by intubation andmaintenance under inhalation anaesthesia with isoflurane and 100% oxygen and fentanyl 2.5 mcg/kg every 15 min. Thetemperature, non-invasive blood pressure, cardiac and respiratory frequency, pulse oximetry, capnography and electrocardiogram were monitored. Tricotomy and antisepsis of the wound were performed with 0.9% NaCl and 2% chlorhexidine.The eviscerated pulmonary lobe was immersed in saline solution, and positive pressure insufflation was performed in theinhalation circuit to verify the presence of perforation of the eviscerated lung, which was not observed. The lobe was repositioned in the correct anatomical location in the thoracic region...

Evisceração de lobo pulmonar direito após ferida por mordedura de cão / Evisceration of right pulmonary lobe after dog bite injury

Background: Pneumothorax is the presence of free air in the pleural cavity. Air in the thoracic cavity causes respiratorydiscomfort, severe hypoxemia, decreased venous return, and haemodynamic instability, and it may lead to death. Pneumothorax can be triggered by wounds from firearm projectiles, bladed weapons, or sharp or piercing objects, as well asbites and barotrauma. The diagnosis of open pneumothorax is based on anamnesis, in combination with clinical signsobserved on physical examination. The objective of this report is to discuss the relevance of clinical-surgical managementto adequately treat evisceration of the pulmonary lobe caused by a bite in the thoracic region of a female dog.Case: This report discusses a 15-year-old female canine weighing approximately six kg with a history of wounds in thethoracic region and respiratory difficulty after being bitten by another dog. On clinical examination, she presented with abruised wound in the right thoracic region and another in the scapular region. The examination revealed evisceration of theright cranial lung lobe, which exhibited atelectasis. The animal was immediately referred to the Surgical Center. Anaesthesia was induced using propofol 2.0 mg/kg combined with ketamine hydrochloride 2.0 mg/kg, followed by intubation andmaintenance under inhalation anaesthesia with isoflurane and 100% oxygen and fentanyl 2.5 mcg/kg every 15 min. Thetemperature, non-invasive blood pressure, cardiac and respiratory frequency, pulse oximetry, capnography and electrocardiogram were monitored. Tricotomy and antisepsis of the wound were performed with 0.9% NaCl and 2% chlorhexidine.The eviscerated pulmonary lobe was immersed in saline solution, and positive pressure insufflation was performed in theinhalation circuit to verify the presence of perforation of the eviscerated lung, which was not observed. The lobe was repositioned in the correct anatomical location in the thoracic region...(AU)

Pneumotórax fechado em tamanduá mirim (Tamandua tetradactyla) / Closed pneumothorax in an injured southern tamandua (Tamandua tetradactyla)

Background: Pneumothorax is characterized by the accumulation of air in the pleural space, either due to trauma or secondary to other conditions. Typically, pneumothorax is correlated with blunt trauma of the pulmonary parenchyma or penetrating trauma of the thoracic cavity, such as on being trampled upon or bitten, respectively. The therapeutic approach of this condition is rarely described in wild animals; therefore, the present study aims to describe the clinical manifestations, diagnostic method, and therapeutic aproach in a specimen of Tamandua tetradactyla with closed pneumothorax received for emergency care after being hit by a vehicle.Case: A southern tamandua (T. tetradactyla) was received in our hospital after being hit by a vehicle. The patient presented with a state of stupor, nystagmus, a restrictive respiratory pattern, and muffling on auscultation of respiratory and cardiac sounds in the left antimer. Simultaneously with the physical examination, venous access was established, pain control was intravenously performed and oxygen therapy was started. After stabilization, the patient underwent abdominal ultrasound (abdominal-focused assessment with sonography for trauma) and thoracic radiographs. The abdominal ultrasound confirmed the presence of a small amount of free fluid in the evaluated recesses, i.e., hepatodiaphragmatic, splenorenal, cystocholic, and hepatorenal, suggesting the need for periodic ultrasonographic monitoring associated with the clinical evaluation of the patient because of suspicion of active hemorrhage. The thoracic radiographic image (ventrodorsal recumbency) revealed increased pulmonary opacity due to lobar retraction, marked by an enlarged gap between the pulmonary lobes and thoracic wall, and the formation of a radiolucent area between both structures. The lateral recumbency evidenced the dorsal displacement of the cardiac apex in relation to the sternum.[...]

Pneumotórax fechado em tamanduá mirim (Tamandua tetradactyla) / Closed pneumothorax in an injured southern tamandua (Tamandua tetradactyla)

Background: Pneumothorax is characterized by the accumulation of air in the pleural space, either due to trauma or secondary to other conditions. Typically, pneumothorax is correlated with blunt trauma of the pulmonary parenchyma or penetrating trauma of the thoracic cavity, such as on being trampled upon or bitten, respectively. The therapeutic approach of this condition is rarely described in wild animals; therefore, the present study aims to describe the clinical manifestations, diagnostic method, and therapeutic aproach in a specimen of Tamandua tetradactyla with closed pneumothorax received for emergency care after being hit by a vehicle.Case: A southern tamandua (T. tetradactyla) was received in our hospital after being hit by a vehicle. The patient presented with a state of stupor, nystagmus, a restrictive respiratory pattern, and muffling on auscultation of respiratory and cardiac sounds in the left antimer. Simultaneously with the physical examination, venous access was established, pain control was intravenously performed and oxygen therapy was started. After stabilization, the patient underwent abdominal ultrasound (abdominal-focused assessment with sonography for trauma) and thoracic radiographs. The abdominal ultrasound confirmed the presence of a small amount of free fluid in the evaluated recesses, i.e., hepatodiaphragmatic, splenorenal, cystocholic, and hepatorenal, suggesting the need for periodic ultrasonographic monitoring associated with the clinical evaluation of the patient because of suspicion of active hemorrhage. The thoracic radiographic image (ventrodorsal recumbency) revealed increased pulmonary opacity due to lobar retraction, marked by an enlarged gap between the pulmonary lobes and thoracic wall, and the formation of a radiolucent area between both structures. The lateral recumbency evidenced the dorsal displacement of the cardiac apex in relation to the sternum.[...](AU)

Pneumomediastino, pneumotórax e enfisema subcutâneo em cão com pneumopatia e infecção pelo vírus da cinomose: relato de caso / Pneumomediastinum, pneumothorax and subcutaneous emphysema in a dog with pneumopathy and infection by the canine distemper virus: case report

Relata-se um caso de pneumomediastino, pneumotórax e enfisema subcutâneo em um cão com pneumopatia associada à cinomose. As queixas principais eram tosse, secreção nasal purulenta, apatia e enfisema subcutâneo em face, região cervical e torácica. O exame radiográfico evidenciou pneumomediastino, pneumotórax e broncopneumopatia grave com áreas de consolidação pulmonar. Teste rápido imunocromatográfico para detecção de antígeno da cinomose foi positivo e houve melhora dos sinais respiratórios com antibioticoterapia, porém o quadro evoluiu para alterações neurológicas. De acordo com a revisão de literatura realizada, não há casos semelhantes relatados.(AU)

A case of pneumomediastinum, pneumothorax and subcutaneous emphysema in a dog with pneumopathy associated to distemper is reported. The main complaints were cough, purulent nasal discharge, lethargy and subcutaneous emphysema in the face, neck, and chest area. Radiographic examination showed pneumomediastinum, pneumothorax, and severe bronchopneumopathy with areas of pulmonary consolidation. Rapid test for canine distemper antigen detection was positive. After the antibiotic therapy there was an improvement of respiratory signs; however, the patient developed neurological symptomatology. As far as the author´s knowledge by literature review carried out, there are no similar cases reported.(AU)

Pneumomediastino, pneumotórax e enfisema subcutâneo em cão com pneumopatia e infecção pelo vírus da cinomose: relato de caso / Pneumomediastinum, pneumothorax and subcutaneous emphysema in a dog with pneumopathy and infection by the canine distemper virus: case report

Relata-se um caso de pneumomediastino, pneumotórax e enfisema subcutâneo em um cão com pneumopatia associada à cinomose. As queixas principais eram tosse, secreção nasal purulenta, apatia e enfisema subcutâneo em face, região cervical e torácica. O exame radiográfico evidenciou pneumomediastino, pneumotórax e broncopneumopatia grave com áreas de consolidação pulmonar. Teste rápido imunocromatográfico para detecção de antígeno da cinomose foi positivo e houve melhora dos sinais respiratórios com antibioticoterapia, porém o quadro evoluiu para alterações neurológicas. De acordo com a revisão de literatura realizada, não há casos semelhantes relatados.(AU)

A case of pneumomediastinum, pneumothorax and subcutaneous emphysema in a dog with pneumopathy associated to distemper is reported. The main complaints were cough, purulent nasal discharge, lethargy and subcutaneous emphysema in the face, neck, and chest area. Radiographic examination showed pneumomediastinum, pneumothorax, and severe bronchopneumopathy with areas of pulmonary consolidation. Rapid test for canine distemper antigen detection was positive. After the antibiotic therapy there was an improvement of respiratory signs; however, the patient developed neurological symptomatology. As far as the author´s knowledge by literature review carried out, there are no similar cases reported.(AU)

Ultrasound evaluation of lung fields in healthy dogs: scanning technic and aspects of normality / Avaliação ultrassonográfica dos campos pulmonares de cães sadios: técnica de varredura e aspectos da normalidade

Background: The ultrasound exam has always played a secondary role in pulmonary imaging, with its applicability restricted in emergency care to screen for pleural and/or pericardial effusion, pneumothorax and pulmonary contusion. The recognition of different reverberating artifacts arising from the normal aerated lungs (A lines) and in the presence of lungs with interstitial and/or alveolar infiltrates (B lines) led to wider application of the technique in patients with respiratory syndrome. The objective of this study was to describe the ultrasound imaging methodology and the aspects of the pleura, pleural space and lung fields in healthy dogs.Materials, Methods & Results: Twenty healthy dogs of different breeds and ages, males and females were evaluated in this study; good health status was confirmed by physical examination, electro and echocardiographic assessment, thoracic radiography and systemic arterial blood pressure measurements. Dogs were scanned by a single examiner experienced in diagnostic imaging and previously trained for 6 months in thoracic ultrasound image interpretation. A MyLab 40 with a microconvex multifrequency probe (5-8 MHz) was used in this study. Evaluation was performed in an orthopneic position (standing or sternal recumbecy) under manual containment. Ultrasound examinations were based on the VetBLUE (Veterinary Bedside Lung Ultrasound Exam) protocol. Lung fields were regionally scanned at the 2nd-3rd, 4-5th, 6-7th and 8-9th intercostal spaces in the right and left hemithorax. A subxiphoid window was added to screen for free fluid in the pleural space and/or pericardial sac. Pleural sliding and A lines, that are hyperechoic parallel equidistant lines arising from the visceral pleura-lung interface could be easily seen at all intercostal spaces in all dogs in this sample, with more difficult visualization at the 2nd-3rd intercostal space. B lines were observed in seven out of twenty dogs (35%).[...]

Ultrasound evaluation of lung fields in healthy dogs: scanning technic and aspects of normality / Avaliação ultrassonográfica dos campos pulmonares de cães sadios: técnica de varredura e aspectos da normalidade

Background: The ultrasound exam has always played a secondary role in pulmonary imaging, with its applicability restricted in emergency care to screen for pleural and/or pericardial effusion, pneumothorax and pulmonary contusion. The recognition of different reverberating artifacts arising from the normal aerated lungs (A lines) and in the presence of lungs with interstitial and/or alveolar infiltrates (B lines) led to wider application of the technique in patients with respiratory syndrome. The objective of this study was to describe the ultrasound imaging methodology and the aspects of the pleura, pleural space and lung fields in healthy dogs.Materials, Methods & Results: Twenty healthy dogs of different breeds and ages, males and females were evaluated in this study; good health status was confirmed by physical examination, electro and echocardiographic assessment, thoracic radiography and systemic arterial blood pressure measurements. Dogs were scanned by a single examiner experienced in diagnostic imaging and previously trained for 6 months in thoracic ultrasound image interpretation. A MyLab 40 with a microconvex multifrequency probe (5-8 MHz) was used in this study. Evaluation was performed in an orthopneic position (standing or sternal recumbecy) under manual containment. Ultrasound examinations were based on the VetBLUE (Veterinary Bedside Lung Ultrasound Exam) protocol. Lung fields were regionally scanned at the 2nd-3rd, 4-5th, 6-7th and 8-9th intercostal spaces in the right and left hemithorax. A subxiphoid window was added to screen for free fluid in the pleural space and/or pericardial sac. Pleural sliding and A lines, that are hyperechoic parallel equidistant lines arising from the visceral pleura-lung interface could be easily seen at all intercostal spaces in all dogs in this sample, with more difficult visualization at the 2nd-3rd intercostal space. B lines were observed in seven out of twenty dogs (35%).[...](AU)