Cardiovascular indicators and mitral valve disease in dogs with spontaneous hypercortisolism - prospective evaluation

Background: Canine hypercortisolism (HC) is the most prevalent endocrinopathy in dogs in southern Brazil. The prognosis depends on several factors including the general health status, owners´ commitment, and the development of disease complications and comorbidities occurrence, such as cardiovascular complications including mitral valve disease (MVD), systemic arterial hypertension, and left ventricular hypertrophy. The main objective of the present study was to assess cardiovascular parameters in canine HC, based on investigating survival-related variables. The study also aimed to evaluate the influence of concurrent preclinical (MVD) on dogs` survival and the impact of HC on MVD progression. Materials, Methods & Results: A total of 25 dogs with spontaneous HC were enrolled and divided into 2 subgroups accordingly to their echocardiographic findings: group HC (normal echocardiography at first evaluation, n = 16); and group HC + MVD (concurrent presence of stages B1 and B2 MVD diagnosed at the first evaluation, n = 9). The patients were evaluated at diagnosis (T0); 6 months after treatment begging (T1); and after 12 months of treatment (T2). The owners were further contacted by phone or e-mail for 1 more year after T2 regarding survival information. A control group (CG, n = 20) was also evaluated at T0 and T1. At each evaluation, dogs were submitted to a complete clinical evaluation and physical exam, associated with a minimum database (CBC, serum biochemistry, and urine analysis) and cardiovascular evaluation composed of systolic blood pressure determination, electrocardiogram (ECG), and echodopplercardiography. In the HC group, 11/16 dogs underwent the evaluation at T2, while 4/9 dogs from the HC + MVD group and 17/20 dogs from the CG underwent the evaluation at T2. Five dogs (31.25%) from the HC group and 4 dogs (44.44%) from the HC + MVD group died before the end of the follow-up period. In the control group, only 1 dog (5.26%) died before the end of the study. Despite the higher mortality in the HC + MVD group during the follow-up period, there was no significant difference (P = 0.632) in survival when compared with the HC group. The MVD of 4 dogs included in the HC + MVD group was classified as stage B1, while the other 5 dogs were classified as stage B2. Only 1 dog from the CG developed stage B1 MVD in the period studied; however, progression of the MVD stage was documented in 1/4 of dogs in the HC + MVD group and MVD development was documented in 3/11 of dogs from the HC group from T0 to T2. The odds ratio (OR) and respective 95% confidence interval (95%CI) for HC as a risk factor for MVD progression were 4.267 (0.4268 - 42.65; P = 0.342). Exercise intolerance (12/16 dogs) and dyspnea (6/16 dogs) were the cardiorespiratory clinical signs with the highest incidence in the HC group at T0. When compared to the control group, both exercise intolerance (P < 0.001) and dyspnea (P = 0.03) occurrence were significantly higher in the HC group. The age (P = 0.001) and the occurrence of dyspnea (P = 0.036) at diagnosis were significantly higher in dogs with HC that died during the follow-up than those that remained alive. Regarding the occurrence of cardiac arrhythmias verified by ECG, no statistically significant differences were observed among groups. Discussion: The study suggests that systemic hypertension and altered echocardiographic measurements did not interfere with dogs' survival; however, dyspnea was associated with a worse prognosis. Finally, it is possible to conclude that mitral valve degeneration is a common comorbidity in dogs with HC, however, it was not evidenced their interference in the survival of dogs with this endocrine disease or even a role of the HC in the progression of the MVD.

Nasal leiomyosarcoma in a Quarter Horse / Leiomiossarcoma nasal em equino Quarto de Milha

ABSTRACT: We described the clinical and anatomopathological findings observed in a case of nasal leiomyosarcoma in a five-year-old male Quarter Mile horse, whose main complaints were decreased sports performance and bilateral purulent nasal discharge. The nodule was observed in the nasal cavity, obstructing the left nostril and associated with purulent drainage. The nodule was of irregular shape and yellow color, measuring 19.4 cm × 6.9 cm × 4.3 cm in size, with coalescent multifocal areas that were brownish, friable, opaque, and fetid. When cut, the surface was compact, grayish-white, and smooth with yellow, friable, irregular multifocal areas, measuring 1-3.2 cm in diameter. Histopathological examination showed spindle-shaped neoplastic cells, which was negative on Masson's trichromic stain. A diagnosis of leiomyosarcoma was established based on the morphotintorial aspects of neoplastic cells and confirmed through immunohistochemistry, with positive immunostaining for antibodies 1A4, HHF35, desmin, and S100. Leiomyosarcoma primarily affects the nasal cavity of horses and should be included in the differential diagnosis of diseases that affect the nasal cavity and cause nasal obstruction associated with dyspnea.

RESUMO: Descreve-se os achados clínicos e anatomopatológicos observados em um caso de leiomiossarcoma nasal em um equino, Quarto de Milha, macho, de cinco anos de idade, com queixa principal de diminuição do rendimento esportivo e secreção nasal purulenta bilateral. Na cavidade nasal, observou-se um nódulo obstruindo a narina esquerda associada à secreção purulenta. O nódulo era de superfície irregular, amarelada, brilhante, fibroelástica, medindo 19,4 x 6,9 x 4,3cm de tamanho, com áreas multifocais a coalescente acastanhadas, friáveis, opacas e fétidas. Ao corte, a superfície era compacta, branco-acinzentada e lisa com áreas multifocais amarelas, friáveis e irregulares, medindo 1-3,2 cm de diâmetro. No exame histopatológico foi observado proliferação de células neoplásicas fusiformes, que foram negativas na coloração de Tricrômico de Masson. O diagnóstico de leiomiossarcoma foi estabelecido com base nos aspectos morfotintoriais das células neoplásicas e confirmado através da imuno-histoquímica, no qual houve imunomarcação positiva para os anticorpos 1A4, HHF35, Desmina e S100. O leiomiossarcoma pode afetar primariamente a cavidade nasal de equinos, devendo ser incluído no diagnóstico diferencial de doenças que afetam a cavidade nasal e que provocam quadros de obstrução nasal associado a dispneia.

Nasal leiomyosarcoma in a Quarter Horse / Leiomiossarcoma nasal em equino Quarto de Milha

We described the clinical and anatomopathological findings observed in a case of nasal leiomyosarcoma in a five-year-old male Quarter Mile horse, whose main complaints were decreased sports performance and bilateral purulent nasal discharge. The nodule was observed in the nasal cavity, obstructing the left nostril and associated with purulent drainage. The nodule was of irregular shape and yellow color, measuring 19.4 cm × 6.9 cm × 4.3 cm in size, with coalescent multifocal areas that were brownish, friable, opaque, and fetid. When cut, the surface was compact, grayish-white, and smooth with yellow, friable, irregular multifocal areas, measuring 1-3.2 cm in diameter. Histopathological examination showed spindle-shaped neoplastic cells, which was negative on Masson's trichromic stain. A diagnosis of leiomyosarcoma was established based on the morphotintorial aspects of neoplastic cells and confirmed through immunohistochemistry, with positive immunostaining for antibodies 1A4, HHF35, desmin, and S100. Leiomyosarcoma primarily affects the nasal cavity of horses and should be included in the differential diagnosis of diseases that affect the nasal cavity and cause nasal obstruction associated with dyspnea.

Descreve-se os achados clínicos e anatomopatológicos observados em um caso de leiomiossarcoma nasal em um equino, Quarto de Milha, macho, de cinco anos de idade, com queixa principal de diminuição do rendimento esportivo e secreção nasal purulenta bilateral. Na cavidade nasal, observou-se um nódulo obstruindo a narina esquerda associada à secreção purulenta. O nódulo era de superfície irregular, amarelada, brilhante, fibroelástica, medindo 19,4 x 6,9 x 4,3cm de tamanho, com áreas multifocais a coalescente acastanhadas, friáveis, opacas e fétidas. Ao corte, a superfície era compacta, branco-acinzentada e lisa com áreas multifocais amarelas, friáveis e irregulares, medindo 1-3,2 cm de diâmetro. No exame histopatológico foi observado proliferação de células neoplásicas fusiformes, que foram negativas na coloração de Tricrômico de Masson. O diagnóstico de leiomiossarcoma foi estabelecido com base nos aspectos morfotintoriais das células neoplásicas e confirmado através da imuno-histoquímica, no qual houve imunomarcação positiva para os anticorpos 1A4, HHF35, Desmina e S100. O leiomiossarcoma pode afetar primariamente a cavidade nasal de equinos, devendo ser incluído no diagnóstico diferencial de doenças que afetam a cavidade nasal e que provocam quadros de obstrução nasal associado a dispneia.

Rhinitis in goat by Exserohilum rostratum (Setosphaeria rostrata) / Rinite em caprino por Exserohilum rostratum (Setosphaeria rostrata)

ABSTRACT: We described a case of rhinitis case caused by Exserohilum rostratum in a 3-year-old, mixed breed, afemale goat, presenting with decreased appetite, dyspnea, and face deformity, with evolution of approximately 2 months. Necropsy revealed an extensive brownish yellow, irregular, ulcerated, and friable focal lesion in the nasal cavity. Purulent secretion drained from the lesion, affecting the nasal vestibule and extending the caudal portion of the dorsal concha, associated with nasal meatus obstruction, destruction of the nasal septum, and nasal bone palatine and vomer. Histologically, the lesion was characterized as rhinitis and pyogranulomatous and necrotizing osteomyelitis (multifocal to coalescent, sharp, and chronic) and associated with a myriad of fungal structures. Morphologically, the hyphae were characterized by thin, slightly tortuous, and rarely septate walls (2-6 μm diameter), multiple chains of individual conidia or in groups (8-10 μm diameter), and pigmented chlamydoconidia (7.5-15 μm diameter). They showed positive results for the special histochemical techniques such as Fontana Masson, methenamine silver nitrate by Grocott, and periodic acid by Schiff. E. rostratum was identified as the causative agent using microbiological isolation associated with molecular identification. Pyrogranulomatous rhinitis caused by E. rostratum in goats is unprecedented, being the first isolation of the agent in animals in Brazil and the first case of nasal phaeohyphomycosis in the goats.

RESUMO: Descreve-se um caso de rinite por Exserohilum rostratum em um caprino, sem raça definida, fêmea, três anos, com diminuição do apetite, dispneia e deformidade facial, com evolução de aproximadamente dois meses. Durante a necropsia, observou-se que na cavidade nasal havia área focal extensa, amarelo acastanhada, irregular, ulcerada e friável, que drenava secreção purulenta acometendo o vestíbulo nasal e estendendo-se da porção caudal da concha dorsal, associada a obstrução do meato nasal, destruição do septo nasal e osso nasal palatino e vômer. Histologicamente, a lesão foi caracterizada como rinite e osteomielite piogranulomatosa e necrosante, multifocal a coalescente, aguda, crônica, associada a uma miríade de estruturas fúngicas. Morfologicamente, as hifas foram caracterizadas por paredes finas, discretamente tortuosas e septadas medindo 2 a 6 μm de diâmetro. Observamos algumas cadeias de conídios ou grupos com 8 a 10 μm de diâmetro e clamidoconídios pigmentados medindo de 7,5 a 15 μm de diâmetro. Foram positivos na histoquímica especial de Fontana Masson, Nitrato de Metenamina de Prata de Grocott e Ácido Periódico de Schiff. O agente foi determinado por meio de isolamento microbiológico associado à identificação molecular. A rinite piogranulomatosa causada por E. rostratum em caprinos é inédita, sendo o primeiro isolamento do agente em animais no Brasil e o primeiro caso de feo-hifomicose nasal na espécie caprina.

Rhinitis in goat by Exserohilum rostratum (Setosphaeria rostrata) / Rinite em caprino por Exserohilum rostratum (Setosphaeria rostrata)

We described a case of rhinitis case caused by Exserohilum rostratum in a 3-year-old, mixed breed, afemale goat, presenting with decreased appetite, dyspnea, and face deformity, with evolution of approximately 2 months. Necropsy revealed an extensive brownish yellow, irregular, ulcerated, and friable focal lesion in the nasal cavity. Purulent secretion drained from the lesion, affecting the nasal vestibule and extending the caudal portion of the dorsal concha, associated with nasal meatus obstruction, destruction of the nasal septum, and nasal bone palatine and vomer. Histologically, the lesion was characterized as rhinitis and pyogranulomatous and necrotizing osteomyelitis (multifocal to coalescent, sharp, and chronic) and associated with a myriad of fungal structures. Morphologically, the hyphae were characterized by thin, slightly tortuous, and rarely septate walls (2-6 µm diameter), multiple chains of individual conidia or in groups (8-10 µm diameter), and pigmented chlamydoconidia (7.5-15 µm diameter). They showed positive results for the special histochemical techniques such as Fontana Masson, methenamine silver nitrate by Grocott, and periodic acid by Schiff. E. rostratum was identified as the causative agent using microbiological isolation associated with molecular identification. Pyrogranulomatous rhinitis caused by E. rostratum in goats is unprecedented, being the first isolation of the agent in animals in Brazil and the first case of nasal phaeohyphomycosis in the goats.

Descreve-se um caso de rinite por Exserohilum rostratum em um caprino, sem raça definida, fêmea, três anos, com diminuição do apetite, dispneia e deformidade facial, com evolução de aproximadamente dois meses. Durante a necropsia, observou-se que na cavidade nasal havia área focal extensa, amarelo acastanhada, irregular, ulcerada e friável, que drenava secreção purulenta acometendo o vestíbulo nasal e estendendo-se da porção caudal da concha dorsal, associada a obstrução do meato nasal, destruição do septo nasal e osso nasal palatino e vômer. Histologicamente, a lesão foi caracterizada como rinite e osteomielite piogranulomatosa e necrosante, multifocal a coalescente, aguda, crônica, associada a uma miríade de estruturas fúngicas. Morfologicamente, as hifas foram caracterizadas por paredes finas, discretamente tortuosas e septadas medindo 2 a 6 µm de diâmetro. Observamos algumas cadeias de conídios ou grupos com 8 a 10 µm de diâmetro e clamidoconídios pigmentados medindo de 7,5 a 15 µm de diâmetro. Foram positivos na histoquímica especial de Fontana Masson, Nitrato de Metenamina de Prata de Grocott e Ácido Periódico de Schiff. O agente foi determinado por meio de isolamento microbiológico associado à identificação molecular. A rinite piogranulomatosa causada por E. rostratum em caprinos é inédita, sendo o primeiro isolamento do agente em animais no Brasil e o primeiro caso de feo-hifomicose nasal na espécie caprina.

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...

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.

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)

Linfoma de células T na cavidade nasal de caprino / T-cell lymphoma in the nasal cavity in goat

Background: Lymphomas are considered uncommon in goats, being the multicentric form with the highest number of cases for the species. Primary intranasal lymphomas are often diagnosed in dogs, cats, and humans. In the literature, there is only a description of a multicentric case involving the frontal sinuses and mucosa of the nasal cavity in a goat; therefore, it is important to describe unusual cases of this disease for the inclusion of new clinical and pathological characteristics in the ruminant clinic medicine. The objective of this work is to describe a case of T-cell lymphoma in the nasal cavity of a young goat. Case: The animal had dyspnea and respiratory noise for 15 days. Clinical examination showed nodulation in the right nasal cavity associated with serosanguinous secretion. Tracheostomy was performed; however, after 30 days the animal was euthanized. A sagittal plane of the head showed a pinkish-gray mass in the right and left nasal cavity, with a smooth, multilobulated surface, smooth adhering to the rostral portion of the dorsal concha and occluding the dorsal nasal meatus. Submandibular lymph nodes were slightly enlarged. Histopathological examination of the nasal cavity revealed a non-encapsulated, poorly delimited and ulcerated tumor composed of round cells arranged in a mantle supported by a discrete fibrovascular stroma extending the mucosa and lamina propria. Cells were round with sparse, eosinophilic and poorly delimited cytoplasm. Nuclei varied from round to elongated with condensed chromatin and evident nucleoli. Occasionally, aberrant nuclei, reniform shape and multinucleated cells were seen. Pleomorphism was moderate characterized by anisocytosis and anisocariosis. Typical and atypical mitosis were frequent (0-4 per field of highest magnification [400x]). Amidst the neoplasm, there were multifocal areas of necrosis and hemorrhage associated with a mild lymphocytic inflammatory infiltrate. Immunohistochemistry showed positive immunostaining for Vimentin antibodies and CD3, and negative for pan CK and CD20. Discussion: The lymphomas immunophenotyping is little used when it comes to farm animals, and there are few studies that use this technique for the definitive diagnosis of these neoplasms for small ruminants. The use of this technique must be considered in each case, in order to determine the pathogenesis, the accurate diagnosis and the origin of the neoplastic lymphocytes. In goats, T-cell lymphomas are the most diagnosed, although cases of multicentric B-cell lymphomas with ocular involvement have been diagnosed. In view of the clinical picture of the case described, infectious rhinitis already described in goats, such as aspergillosis and protothecosis, should be included as differential diagnoses. However, the anatomopathological findings facilitate the direction of the diagnosis, since infectious rhinitis presents as nodules / ulcerated masses or focal areas of necrosis associated with purulent secretion and in the histopathological examination it is possible to observe the intralesional etiological agents. In addition, the enzootic ethmoidal tumor must be included, as it has similar clinical signs and affects young animals, but they are adenomas/adenocarcinomas that affect the ethmoidal nasal shells induced by a retrovirus. Lymphomas in the caprine species are rare in the Northeastern semi-arid, but that in the present diagnostic routine occasionally occurs, being important the first description of its nasal shape for its inclusion in the differential diagnoses of diseases that present with clinical obstruction and dyspnea for the species.

Glossopharyngeal and vagus neuropathy associated to stylopharyngeus muscle compression in horse guttural pouch ­ case report / Neuropatia do glossofaringeo e vago associada à compressão pelo musculo estilofaringeo em bolsa gutural de equino ­ relato de caso

Neuropathies of pharyngeal branches of glossopharyngeal and vagus are often associated with guttural pouches diseases; however, these branches of injury due to stylopharyngeus muscle compression are not reported. A case was reported of a quarter horse mare, 8 years old, 450 kg, presenting dyspnea and respiratory noise associated with weight loss. Clinical examination observed mixed dyspnea, tachycardia, dysphagia, sialorrhea, lung crackles and submandibular and parotid lymphadenopathy. Endoscopic exam showed right arytenoid chondritis, nasopharyngeal collapse, generalized larynx edema and dorsal displacement of the soft palate. Right guttural pouch evaluation showed swelling in the origin of stylopharyngeus muscle with consequent compression of the XII, X and IX cranial nerves. Tracheotomy, systemic treatment with corticosteroids, beta lactams and aminoglycosides antibiotics were performed. No resolution was observed and, after 16 days, the animal showed clinical worsening, developed pleuropneumonia, uveitis, severe sepsis, acute renal failure and was euthanized. The mixed neuropathy resulted in rapid clinical deterioration of the animal, due to the difficulty in swallowing and consequent associated respiratory processes. This report emphasizes the importance of evaluating stylopharyngeus muscle origin in cases of nasopharyngeal collapse associated with dysphagia in horses, given the possibility that structural changes in this muscle can result in laryngeal neuropathy.(AU)

As neuropatias do glossofaríngeo e vago são frequentemente associadas com enfermidade das bolsas guturais. A ocorrência desta lesão secundária a compressão pelo músculo estilofaríngeo não é reportada. Relata-se o caso de uma égua quarto de milha, 8 anos de idade, 450 kg, apresentando dispneia, ruído respiratório e perda de peso. No exame clínico observou-se dispnéia mista, taquicardia, disfagia, sialorréia, crepitação pulmonar e linfadenopatia submandibular e parotídea. Ao exame endoscópico identificou-se condrite aritenóide direita, colapso nasofaríngeo, edema generalizado da laringe e deslocamento dorsal do palato mole. Na avaliação da bolsa gutural direita identificou-se aumento de volume na origem do músculo estilofaríngeo com consequente compressão dos nervos cranianos XII, X e IX. Foi realizada traqueotomia, tratamento sistêmico com corticosteróides e antibióticos. Nenhuma resolução foi observada, após 16 dias o animal apresentou piora clínica, pleuropneumonia, uveíte, sepse grave, insuficiência renal aguda e foi submetido à eutanásia. A neuropatia mista resultou em rápida deterioração clínica do animal, devido à dificuldade de deglutição e processos respiratórios associados. Salienta-se a importância de se avaliar a origem do músculo estilofaríngeo em casos de colapso nasofaríngeo associado a disfagia em cavalos, dada a possibilidade de que alterações estruturais nesse músculo possam resultar em neuropatia laríngea.(AU)

Glossopharyngeal and vagus neuropathy associated to stylopharyngeus muscle compression in horse guttural pouch ­ case report / Neuropatia do glossofaringeo e vago associada à compressão pelo musculo estilofaringeo em bolsa gutural de equino ­ relato de caso

Neuropathies of pharyngeal branches of glossopharyngeal and vagus are often associated with guttural pouches diseases; however, these branches of injury due to stylopharyngeus muscle compression are not reported. A case was reported of a quarter horse mare, 8 years old, 450 kg, presenting dyspnea and respiratory noise associated with weight loss. Clinical examination observed mixed dyspnea, tachycardia, dysphagia, sialorrhea, lung crackles and submandibular and parotid lymphadenopathy. Endoscopic exam showed right arytenoid chondritis, nasopharyngeal collapse, generalized larynx edema and dorsal displacement of the soft palate. Right guttural pouch evaluation showed swelling in the origin of stylopharyngeus muscle with consequent compression of the XII, X and IX cranial nerves. Tracheotomy, systemic treatment with corticosteroids, beta lactams and aminoglycosides antibiotics were performed. No resolution was observed and, after 16 days, the animal showed clinical worsening, developed pleuropneumonia, uveitis, severe sepsis, acute renal failure and was euthanized. The mixed neuropathy resulted in rapid clinical deterioration of the animal, due to the difficulty in swallowing and consequent associated respiratory processes. This report emphasizes the importance of evaluating stylopharyngeus muscle origin in cases of nasopharyngeal collapse associated with dysphagia in horses, given the possibility that structural changes in this muscle can result in laryngeal neuropathy.(AU)

As neuropatias do glossofaríngeo e vago são frequentemente associadas com enfermidade das bolsas guturais. A ocorrência desta lesão secundária a compressão pelo músculo estilofaríngeo não é reportada. Relata-se o caso de uma égua quarto de milha, 8 anos de idade, 450 kg, apresentando dispneia, ruído respiratório e perda de peso. No exame clínico observou-se dispnéia mista, taquicardia, disfagia, sialorréia, crepitação pulmonar e linfadenopatia submandibular e parotídea. Ao exame endoscópico identificou-se condrite aritenóide direita, colapso nasofaríngeo, edema generalizado da laringe e deslocamento dorsal do palato mole. Na avaliação da bolsa gutural direita identificou-se aumento de volume na origem do músculo estilofaríngeo com consequente compressão dos nervos cranianos XII, X e IX. Foi realizada traqueotomia, tratamento sistêmico com corticosteróides e antibióticos. Nenhuma resolução foi observada, após 16 dias o animal apresentou piora clínica, pleuropneumonia, uveíte, sepse grave, insuficiência renal aguda e foi submetido à eutanásia. A neuropatia mista resultou em rápida deterioração clínica do animal, devido à dificuldade de deglutição e processos respiratórios associados. Salienta-se a importância de se avaliar a origem do músculo estilofaríngeo em casos de colapso nasofaríngeo associado a disfagia em cavalos, dada a possibilidade de que alterações estruturais nesse músculo possam resultar em neuropatia laríngea.(AU)

Acquired diaphragmatic eventration in a dog

Background: Diaphragmatic eventration is characterized by weakness of the diaphragmatic muscle, which leads to cranialdislocation of the affected diaphragm and, ultimately, in dyspnea. This condition is rare in humans and even rarer in animals,and may be congenital or acquired. The acquired form is less commom and may be induced by trauma or inflammationand neoplastic invasion of the phrenic nerve. Here, we report a case of acquired diaphragmatic eventration in a dog, withthe aim of increasing the knowledge of this condition in animals and helping others to recognize and treat future cases.Case: A 12-year-old male dachshund presented with severe dyspnea, exercise intolerance and episodes of coughing. Basedon a physical examination and imaging, the main suspicion was a diaphragmatic hernia, and surgery was performed. Whenthe surgeon entered the thoracic cavity, an extremely thin - yet, intact - right hemidiaphragm was observed. The left sideof the diaphragm was normal. A polypropylene mesh was sutured to the affected diaphragm in an attempt to strengthenthe hemidiaphragmatic muscles and prevent further insinuations of viscera into the thoracic cavity. The dog developedbronchopneumonia, postoperatively, and was hospitalized and treated with antibiotics, analgesics and support medication.However, the dog died five days after surgery. A postmortem examination revealed that the right side of the diaphragmwas markedly thin and flaccid. Diaphragm samples were collected for histopathological examination. For comparison, asample of normal diaphragm was collected from a same age, matched dachshund that died due to an unrelated condition.This tissue was called “diaphragm control”, and it was collected in order to compare the histologic features of a normaldiaphragm muscle with the affected one. Histopathology revealed a marked reduction of muscle fibers...

Dioctophymatosis as cause of dyspnea in a dog / Dioctofimatose como causa de dispnéia em cão

Dioctophyme renale is a parasite of the nematode class that can infect various species, including humans and dogs. Usually, the parasite migrates to the right kidney of the definitive host. Although, aberrant migrations have been previously reported, they mainly occur without clinical manifestations. No reports of dyspnea secondary to D. renale infestation has been found in the reported literature. The aim of this paper is to report intense respiratory distress caused by the presence of the parasite in the thoracic cavity of a dog. Radiographic images revealed multiple circular structures with a cavity with a radiopaque, thick contour in the thorax, which raised the suspicion of pulmonary bullae. Ultrasound examination revealed nematode infestation in the right kidney, scrotum, and thoracic cavity. Subsequently, right nephrectomy, orchiectomy and trans-sternal thoracotomy were performed to remove the parasites. The patient exhibited recovery after the procedures.(AU)

Dioctophyme renale é um parasita da classe de nematoda que pode infectar diferentes espécies, incluindo humanos e cães. Normalmente, o parasita migra para o rim direito do hospedeiro definitivo. Embora migrações erráticas tenham sido relatadas anteriormente, estas geralmente ocorrem sem manifestações clínicas. Não foram encontrados relatos de dispnéia secundária à infestação de D. renale. O objetivo deste trabalho é relatar a presença do parasita na cavidade torácica de um cão, causando angústia respiratória. As imagens radiográficas revelaram a presença de múltiplas estruturas circulares com aspecto de cavidade e contorno espesso radiopaco no tórax, o que suscitou a suspeita de bullae pulmonar. O exame de ultra-som foi determinante na revelação de infestação múltipla por nematódeos, no rim direito, escroto e cavidade torácica. Posteriormente, como medida terapêutica, foram realizadas os procedimentos de nefrectomia direita, orquiectomia e toracotomia transesternal para remoçãodos parasitas. O paciente evoluiu clinicamente bem após os procedimentos.(AU)

Acquired diaphragmatic eventration in a dog

Background: Diaphragmatic eventration is characterized by weakness of the diaphragmatic muscle, which leads to cranialdislocation of the affected diaphragm and, ultimately, in dyspnea. This condition is rare in humans and even rarer in animals,and may be congenital or acquired. The acquired form is less commom and may be induced by trauma or inflammationand neoplastic invasion of the phrenic nerve. Here, we report a case of acquired diaphragmatic eventration in a dog, withthe aim of increasing the knowledge of this condition in animals and helping others to recognize and treat future cases.Case: A 12-year-old male dachshund presented with severe dyspnea, exercise intolerance and episodes of coughing. Basedon a physical examination and imaging, the main suspicion was a diaphragmatic hernia, and surgery was performed. Whenthe surgeon entered the thoracic cavity, an extremely thin - yet, intact - right hemidiaphragm was observed. The left sideof the diaphragm was normal. A polypropylene mesh was sutured to the affected diaphragm in an attempt to strengthenthe hemidiaphragmatic muscles and prevent further insinuations of viscera into the thoracic cavity. The dog developedbronchopneumonia, postoperatively, and was hospitalized and treated with antibiotics, analgesics and support medication.However, the dog died five days after surgery. A postmortem examination revealed that the right side of the diaphragmwas markedly thin and flaccid. Diaphragm samples were collected for histopathological examination. For comparison, asample of normal diaphragm was collected from a same age, matched dachshund that died due to an unrelated condition.This tissue was called “diaphragm control”, and it was collected in order to compare the histologic features of a normaldiaphragm muscle with the affected one. Histopathology revealed a marked reduction of muscle fibers...(AU)

Clinical and pathological aspects of idiopathic pulmonary fibrosis in cats / Aspectos clínicos e patológicos em felinos com fibrose pulmonar idiopática

Interstitial lung diseases are a group of diffuse parenchymal lung diseases that include interstitial lung fibrosis. The aim of this study is to characterize the clinical and pathological findings of idiopathic pulmonary fibrosis in three cats and to investigate possible etiological agents through bacteriological and mycological exams and immunohistochemistry. All three cats were female and aged from 10 to 14 years old, they presented with a clinical history of weight loss and dyspnea. The radiographic changes were similar in all cats and included increased pulmonary radiopacity with a mixed bronchointerstitial pattern progressing to an alveolar pattern. Two cats died during lung biopsy procedures. At necropsy, the lesions were limited to the pulmonary parenchyma and were firm, hypocrepitant with a multinodular appearance on the pleural surface; they failed to completely collapse when the thorax was opened. In the pleural region, there were multifocal star-shaped scarring lesions, with parenchymal retraction. Microscopically, all three cats had multifocal-to-coalescing fibrosis, type II pneumocyte hyperplasia, hypertrophy or hyperplasia of the smooth muscle tissue of terminal bronchioles and an accumulation of macrophages within the alveolar spaces. There was no growth on bacteriological or mycological cultures, and the immunohistochemical evaluations for the presence of viral etiological agents (FIV, FeLV, FCoV, FCV and FHV-1) were also negative.(AU)

As enfermidades pulmonares intersticiais são um grupo de doenças difusas do parênquima pulmonar, nas quais a fibrose pulmonar está incluída. O objetivo deste trabalho é caracterizar os achados clínicos e patológicos da fibrose pulmonar idiopática em três gatas, e avaliar possíveis agentes etiológicos através dos exames bacteriológicos, micológicos e imuno-histoquímicos. As três gatas tinham entre 10 e 14 anos de idade e histórico clínico de emagrecimento e dispneia. As alterações radiográficas observadas foram similares, com aumento de radiopacidade difuso dos campos pulmonares de padrão misto broncointersticial e eventualmente alveolar. Dois felinos morreram durante procedimento de biópsia pulmonar. No exame de necropsia as lesões eram exclusivas no parênquima pulmonar os quais estavam firmes, hipocreptantes, com aspecto levemente multinodular em superfície pleural e não colapsaram após a abertura da cavidade torácica. Em região pleural havia lesões cicatriciais de aspecto estrelar multifocais, com retração do parênquima. Microscopicamente, todos os gatos apresentaram fibrose multifocal a coalescente, hiperplasia dos pneumócitos do tipo II e hiperplasia e hipertrofia do músculo liso de bronquíolos terminais e acúmulo de macrófagos no interior de espaços alveolares. Não houve crescimento nas culturas bacteriana e micológica, e os exames de imuno-histoquímica para avaliação de possíveis agentes virais (FIV, FeLV, FCoV, FCV e FHV-1) foram negativos em todos os felinos.(AU)

Clinical and pathological aspects of idiopathic pulmonary fibrosis in cats / Aspectos clínicos e patológicos em felinos com fibrose pulmonar idiopática

Interstitial lung diseases are a group of diffuse parenchymal lung diseases that include interstitial lung fibrosis. The aim of this study is to characterize the clinical and pathological findings of idiopathic pulmonary fibrosis in three cats and to investigate possible etiological agents through bacteriological and mycological exams and immunohistochemistry. All three cats were female and aged from 10 to 14 years old, they presented with a clinical history of weight loss and dyspnea. The radiographic changes were similar in all cats and included increased pulmonary radiopacity with a mixed bronchointerstitial pattern progressing to an alveolar pattern. Two cats died during lung biopsy procedures. At necropsy, the lesions were limited to the pulmonary parenchyma and were firm, hypocrepitant with a multinodular appearance on the pleural surface; they failed to completely collapse when the thorax was opened. In the pleural region, there were multifocal star-shaped scarring lesions, with parenchymal retraction. Microscopically, all three cats had multifocal-to-coalescing fibrosis, type II pneumocyte hyperplasia, hypertrophy or hyperplasia of the smooth muscle tissue of terminal bronchioles and an accumulation of macrophages within the alveolar spaces. There was no growth on bacteriological or mycological cultures, and the immunohistochemical evaluations for the presence of viral etiological agents (FIV, FeLV, FCoV, FCV and FHV-1) were also negative.(AU)

As enfermidades pulmonares intersticiais são um grupo de doenças difusas do parênquima pulmonar, nas quais a fibrose pulmonar está incluída. O objetivo deste trabalho é caracterizar os achados clínicos e patológicos da fibrose pulmonar idiopática em três gatas, e avaliar possíveis agentes etiológicos através dos exames bacteriológicos, micológicos e imuno-histoquímicos. As três gatas tinham entre 10 e 14 anos de idade e histórico clínico de emagrecimento e dispneia. As alterações radiográficas observadas foram similares, com aumento de radiopacidade difuso dos campos pulmonares de padrão misto broncointersticial e eventualmente alveolar. Dois felinos morreram durante procedimento de biópsia pulmonar. No exame de necropsia as lesões eram exclusivas no parênquima pulmonar os quais estavam firmes, hipocreptantes, com aspecto levemente multinodular em superfície pleural e não colapsaram após a abertura da cavidade torácica. Em região pleural havia lesões cicatriciais de aspecto estrelar multifocais, com retração do parênquima. Microscopicamente, todos os gatos apresentaram fibrose multifocal a coalescente, hiperplasia dos pneumócitos do tipo II e hiperplasia e hipertrofia do músculo liso de bronquíolos terminais e acúmulo de macrófagos no interior de espaços alveolares. Não houve crescimento nas culturas bacteriana e micológica, e os exames de imuno-histoquímica para avaliação de possíveis agentes virais (FIV, FeLV, FCoV, FCV e FHV-1) foram negativos em todos os felinos.(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)

Immune humoral response of young lambs naturally infested by Oestrus ovis (Diptera: Oestridae) / Resposta imune humoral de cordeiros jovens naturalmente infestados por Oestrus ovis (Diptera: Oestridae)

Twenty-six newborn lambs were evaluated for 21 weeks, from birth to slaughter, to assess their plasma anti-Oestrus ovis immunoglobulin (IgG) using the ELISA technique. On the last day of sampling, all the lambs were slaughtered and O. ovis larvae were recovered, quantified and identified according to the larval stage. High levels of IgG were observed over the first three weeks of life, thus indicating that antibodies are transferred via colostrum from ewes to lambs. Afterwards, the antibody levels declined progressively until the lambs were 11 weeks of age and subsequently started to increase again when they were around 13 weeks of age, reaching the apex on the last week of sampling. All the lambs were parasitized with different larval stages of O. ovis, with an average of 39 larvae per lamb, and the intensity of the infestation ranged from 10 to 97 larvae. However, there was non-significant correlation coefficients between IgG levels and O. ovis larval burden (P > 0.05). In conclusion, although the lambs became infested with O. ovis at an early age, the larval burden was not associated with specific IgG levels.(AU)

Vinte e seis cordeiros recém-nascidos foram avaliados por 21 semanas, desde o nascimento até o abate, para avaliar os níveis plasmáticos de imunoglobulina (IgG) anti-Oestrus ovis utilizando-se a técnica de ELISA. No último dia de coleta, todos os cordeiros foram abatidos e as larvas de O. ovis foram recuperadas, quantificadas e identificadas de acordo com o estádio larval. Foram observados altos níveis de IgG nas primeiras três semanas de vida, indicando que os anticorpos são transferidos por meio do colostro das ovelhas para os cordeiros. Posteriormente, os níveis de anticorpos diminuíram progressivamente, até os cordeiros completarem 11 semanas de vida. Os níveis de IgG começaram a aumentar novamente a partir de 13 semanas de idade, atingindo o ápice na última semana de coleta. Todos os cordeiros estavam parasitados com diferentes estádios larvais de O. ovis com uma média de 39 larvas por cordeiro, e a intensidade da infestação variou de 10 a 97 larvas. Porém, não houve correlação significativa entre os níveis de IgG e a carga larval de O. ovis (P > 0,05). Em conclusão, embora os cordeiros tenham sido infestados com O. ovis ainda jovens, a carga larval não foi associada a níveis específicos de IgG.(AU)

Intrathoracic emergency tracheotomy for treatment of tracheal foreign body in a young cat / Traqueotomia intratorácica de emergência para o tratamento de corpo estranho em uma gata jovem

Tracheal foreign bodies are rare emergency events. Several noninvasive methods are described for removal, such as bronchoscopy combined with appropriate grasping equipment or Foley catheter and forceps guided by fluoroscopy. However, complications can occur like pneumothorax, pneumomediastinum and irresponsive dyspnea as well as failure. Thus, pre-sternal tracheotomy combined with endoscopy or thoracotomy are attempted. Female cat, 1 year old, 1.6 kg had diagnosis of foreign body (0.7 x 0.5cm) with morphology of bird cervical vertebra at carina area, presenting one week of dyspnea, worsening with radiographic exam. It was performed emergency thoracotomy at left fifth intercostal space, followed by tracheotomy between the tracheal rings immediately cranial to the carina, allowing forceps removal. No foreign body was observed at radiograph after eight days and the patient was clinically well. Although, less invasive methods are preferable, they are not always available and they are not free from failures, leading to emergency tracheotomy as described in the present case report.

Corpos estranhos traqueais são eventos raros e emergenciais. Vários métodos não invasivos são descritos para a sua remoção, como broncoscopia combinada com equipamento apropriado de preensão ou cateter de Foley e pinça guiados por fluoroscopia. Entretanto, complicações como pneumotórax, pneumomediastino e dispneia irresponsiva assim como insucessos podem ocorrer. Portanto, traqueotomia preesternal combinada com endoscopia ou toracotomia são tentativas viáveis. Gata, 1 ano, 1.6kg teve diagnóstico de corpo estranho (0.7 x 0.5 cm) com morfologia de vértebra cervical de ave na região da carina. Apresentava há uma semana, dispnéia, piorando durante exame radiográfico. Foi realizado toracotomia de emergência no quinto espaço intercostal esquerdo, seguida de traqueotomia entre os anéis traqueais imediatamente cranial à carina, permitindo remoção por fórceps. Após oito dias, foi realizada radiografia controle e o paciente apresentava-se clinicamente bem. Embora, métodos menos invasivos sejam preferidos, não são isentos de falhas, necessitando toracotomia emergencial como a descrita no presente relato.