Mesotelioma pleural em mediastino em uma cadela - remoção com esternotomia mediana / Mediastinal mesothelioma in a bitch - removal with median sternotomy

Background: Malignant pleural mesothelioma (MPM) is a neoplasm with low incidence in small animals, and the possible causes are poorly elucidated but may be related to contact with asbestos. In the thoracic cavity, MMP can be localized or generalized to all cavity structures, and its clinical signs depend on this localization. Although some alternative therapies are being discussed, few studies are conclusive, with surgical intervention as the leading therapeutic option. Given this context, this report aimed to describe a case of MMP located in the mediastinum of a bitch treated with radical excision through mediated sternotomy. Case: A 7-year-old bitch of the Shar-pei breed was referred for care due to progressive weight loss and intense dyspnea. During the physical examination, dyspnea and muffled lung sounds were noted. The patient underwent hemodialysis, which showed neutrophilic leukocytosis. An abdominal ultrasound was also performed and revealed mild abdominal effusion, and chest radiography revealed an extensive tumor covering the entire chest cavity. Thoracocentesis was performed, and the material analyzed was a malignant exudate; the patient was referred to median sternotomy for exploratory purposes, and afterward, total macroscopic extirpation of the tumor was performed. A sample was sent for histopathology, and malignant mesothelioma was confirmed. The patient was discharged after 8 days of hospitalization with home treatment and did not return to the hospital. Upon contacting the guardian, we were informed that the animal had died 154 days after the procedure due to unknown causes. Discussion: Malignant pleural mesothelioma affects humans and animals; it is associated with the risk factor of contact with asbestos and the use of flea antiparasitic drugs. In small animals, its incidence is rare, albeit mesotheliomas have been reported in wild and large animals. The clinical signs are related to the location of the neoplasm. When it is located in the thoracic region, dyspnea, muffled lung sounds, cyanosis, and pleural effusion are observed in most cases. Diagnosis is usually late and incidental, although some tests, such as ultrasonography, magnetic resonance imaging, tomography, radiography, and needle biopsy, can help in the diagnosis. Histopathology is the exam of choice for definitive diagnosis, as it helps one observe the proliferation of neoplastic mesothelial cells, atypical mitosis figures, and marked cellular pleomorphism. Many therapeutic options have been discussed, including chemotherapy, immunotherapy, and anti-tumor immunization, although there is little scientific proof of their efficacy in animals. The current treatment of choice is tumor excision by surgical procedure with a palliative objective since the prognosis of the disease is unfavorable. Minimally invasive video surgery has been gaining more and more space in veterinary medicine and has proven successful in numerous cases of thoracic masses. In the present report, we chose to perform median sternotomy for total excision due to the extension of the mass that occupied the thoracic cavity practically in its entirety. Further research should be conducted to help in palliative treatments and increase the survival of patients with mesotheliomas, given that most studies are done in humans and not animals. We conclude that median sternotomy is still the therapeutic option of choice for the palliative treatment of patients with extensive thoracic pleural mesotheliomas.

Use of computed radiology as a screening test for the identification of congenital heart disease in dogs / Utilização da radiologia computadorizada como exame de triagem na identificação de cardiopatias congênitas em cães

The objectives of this study were to evaluate the accuracy of thoracic radiology as a screening test for congenital heart diseases in dogs, to identify the main contributions and limitations of this modality, and to verify the reproducibility of the evaluations by three observers with different levels of training. An interobserver, observational, retrospective and prospective study was carried out, including ninety dogs: thirty healthy animals, thirty with acquired heart diseases and thirty with congenital heart diseases, which all had thoracic radiographs and a confirmed echocardiographic diagnosis. The cases were separated and randomized by a mediator who did not participate in the reading of the radiographic examinations, and no evaluator had access to the patients' data. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of each observer were calculated in relation to the correct classification of dogs to groups of normal or acquired and congenital heart diseases, as well as identification of enlargement of the cardiac silhouette and large vessels of dogs with congenital heart diseases. Finally, the Kappa coefficient was obtained between the observers to verify the reproducibility of the radiological evaluations performed. In general, sensitivity, PPV and accuracy were unsatisfactory ( 70%), and the agreement ranged from poor to reasonable (between 0 and 0.39). Although greater accuracy was achieved in the differentiation of healthy dogs from those with acquired and congenital heart diseases by thoracic radiography, when compared to the other studies, the modality was able only to identify healthy patients, and could not differentiate the individuals with different forms of heart disease or define the cardiac malformations. In addition, there was low reproducibility between observers, therefore, this technique should not be used as a sole screening method in dogs with suspected congenital heart diseases.(AU)

Os objetivos do estudo foram avaliar a acurácia da técnica radiográfica de tórax como exame de triagem nas cardiopatias congênitas em cães, identificar as principais contribuições e limitações dessa modalidade, e verificar a reprodutibilidade das avaliações realizadas por três observadores com diferentes graus de treinamento. Realizou-se um estudo interobservador, observacional, retrospectivo e prospectivo, o qual foram selecionados 90 cães, sendo 30 saudáveis, 30 com cardiopatias adquiridas e 30 com cardiopatias congênitas, que possuíam radiografia de tórax e diagnóstico ecocardiográfico confirmado. Os casos foram separados e randomizados por um mediador que não participou da leitura dos exames radiográficos, sendo que nenhum avaliador obteve acesso aos dados dos pacientes. Calculou-se os índices de sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN) e acurácia de cada observador em relação a identificação dos pacientes saudáveis, com cardiopatias adquiridas e congênitas, bem como para identificação de aumento da silhueta cardíaca e região de grandes vasos dos cães com cardiopatias congênitas. Por fim, foi obtido o coeficiente de Kappa entre os observadores a fim de verificar a reprodutibilidade das avaliações radiográficas realizadas. De modo geral, a sensibilidade, VPP e acurácia foram insatisfatórios (< 70%), enquanto a especificidade e VPN foram satisfatórios (> 70%), sendo que a concordância variou de ruim a razoável (entre 0 e 0,39). Apesar de ter sido alcançado acurácia maior na identificação de cães saudáveis, com cardiopatias adquiridas e congênitas pela radiografia de tórax quando comparado aos demais estudos, confirma-se que essa modalidade se mostrou capaz apenas de identificar o paciente saudável, não de diferenciar os indivíduos cardiopatas entre si ou de definir com maior detalhe as malformações cardíacas especificamente. Além disso, o exame radiográfico de tórax apresentou baixa reprodutibilidade entre os observadores, portanto, essa técnica não deve ser considerada como método único de triagem na suspeita de cães com cardiopatias congênitas.(AU)

Evaluation of electrocardiographic parameters, thoracic morphometry and vertebral heart size in clinically normal dogs

Background: The Vertebral Heart Size (VHS) method sets standards for the evaluation of dog’s heart size from the comparison of the cardiac dimension with the length of the thoracic vertebrae through radiographic study. Electrocardiogram(ECG) is widely used in veterinary medicine for the evaluation of electrical conduction system of the heart; however, theincrease of duration and amplitude of the ECG waves can suggest the increase of cardiac chambers in dogs. The scientificliterature presents electrocardiographic and VHS values for dogs of different breeds and sizes; however, there is little information on the correlation of these parameters. Therefore, the aim of this study was to evaluate the amplitude and durationof ECG waves, thoracic morphometry and VHS values, in order to correlate these parameters in clinically normal dogs.Materials, Methods & Results: Twenty healthy dogs (11 females and 9 males), without breed distinction, medium sized(14.46 ± 2.92 kg) and aged between 1 and 8 years, were evaluated through physical examination, digital ECG (frontaland precordial leads) and thorax X-ray in right lateral (RL), left lateral (LL) and ventrodorsal (VD) projections. Thoracicmorphometry and VHS measurements were determined as previously described. Clinical and ECG parameters were compatible with the references in all dogs evaluated. Dogs presented thorax intermediate (75%) with the depth and width ratio(D/W ratio) > 1.0. Some individual VHS values were higher than the references and the mean VHS values in VD projectionwas higher than in RL and LL projections (n = 20; P < 0.05). Female and male dogs did not differ among the evaluatedparameters. A positive correlation was observed between thoracic morphometry and body weight (r ≥ +0.70; P < 0.001)and a negative correlation was found between the D/W ratio and VD VHS (r = -0.62; P < 0.05). No significant correlationswere observed between the age, ECG parameters, thoracic morphometry and...

Evaluation of electrocardiographic parameters, thoracic morphometry and vertebral heart size in clinically normal dogs

Background: The Vertebral Heart Size (VHS) method sets standards for the evaluation of dogs heart size from the comparison of the cardiac dimension with the length of the thoracic vertebrae through radiographic study. Electrocardiogram(ECG) is widely used in veterinary medicine for the evaluation of electrical conduction system of the heart; however, theincrease of duration and amplitude of the ECG waves can suggest the increase of cardiac chambers in dogs. The scientificliterature presents electrocardiographic and VHS values for dogs of different breeds and sizes; however, there is little information on the correlation of these parameters. Therefore, the aim of this study was to evaluate the amplitude and durationof ECG waves, thoracic morphometry and VHS values, in order to correlate these parameters in clinically normal dogs.Materials, Methods & Results: Twenty healthy dogs (11 females and 9 males), without breed distinction, medium sized(14.46 ± 2.92 kg) and aged between 1 and 8 years, were evaluated through physical examination, digital ECG (frontaland precordial leads) and thorax X-ray in right lateral (RL), left lateral (LL) and ventrodorsal (VD) projections. Thoracicmorphometry and VHS measurements were determined as previously described. Clinical and ECG parameters were compatible with the references in all dogs evaluated. Dogs presented thorax intermediate (75%) with the depth and width ratio(D/W ratio) > 1.0. Some individual VHS values were higher than the references and the mean VHS values in VD projectionwas higher than in RL and LL projections (n = 20; P < 0.05). Female and male dogs did not differ among the evaluatedparameters. A positive correlation was observed between thoracic morphometry and body weight (r ≥ +0.70; P < 0.001)and a negative correlation was found between the D/W ratio and VD VHS (r = -0.62; P < 0.05). No significant correlationswere observed between the age, ECG parameters, thoracic morphometry and...(AU)

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...

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)

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)

Diffuse thoracic and peritoneal papillary mesothelioma in an adult cow: case report

Mesothelioma is a rare tumor of mesothelium and usually spread by implantation in the same cavity it arises. Regarding bovine mesotheliomas, the abdominal cavity is the most affected site. This article describes a case of diffuse papillary mesothelioma within both thoracic and abdominal cavity with nodal metastasis in an adult cow – based on cytology, histopathology, and immunohistochemical analysis. A 7-years-old cow, Nelore breed (Brazilian beef cattle), with clinical signs of tachypnea, abdominal distention, and positive jugular venous pulse was slaughtered and necropsied due to persistent weight loss. The main gross findings were several verrucous and yellowish nodules spread on pericardium, pleura, and peritoneum. Mediastinal lymph nodes were enlarged and hemorrhagic with multiples yellowish spots on cut surface. The diagnoses of diffuse mesothelioma with nodal metastasis was established and ratified by the microscopic analysis. Immunohistochemical results had strong positivity for cytokeratin and the Ki-67 showed proliferative index of 28%. Vimentin was positive only in the cells of fibrous tissue. In this case, the initial site of the mesothelioma was not recognized. Although it is a post-mortem study, cytology may be very helpful in vivo investigation. Equally important, is the IHC to better comprehend this tumor and its behavior.

Infrared video thermometry guidance for surgical correction of chylothorax in dogs

Background: Macroscopic identification of the extravasation site of chyle in patients with chylothorax is a major challenge. Current forms of identification are invasive and/or expose patients to radiation, as in computerized tomography and radiography. A prototype device that uses infrared video thermometry images to detect temperature increments of 0.1ºC has been developed. This device can process and show real-time images or video on a monitor during surgeries. Therefore, the aim of this work was to report the first successful case in which this innovative device was tested in the transoperative period to identify the thoracic duct and its tributaries in a chylothorax surgery performed in a dog.Case: A 2-year-old male dog of the Shiba Inu breed was presented to the veterinary hospital with exercise intolerance, cough, emaciation, and no history of trauma. Clinical examination was performed along with complete blood count, biochemical analysis, and thoracic radiography. The patient exhibited dyspnea and had diminished breath sounds on chest auscultation. Radiographic images revealed moderate pleural effusion. The dog was anesthetized and submitted to thoracotomy, which enabled visualization of a chylous effusion. A sample of the effusion was collected for cytological and biochemical analyses. Subsequently, pericardiectomy was carried out, and identification of the thoracic duct and its tributaries was guided by an innovative device that generates infrared video thermometry images in real time. The extravasation site of the chyle was visualized on the images shown on a monitor. Consequently, after ligation of the tributary vessel, interruption of chyle overflow could be noticed on the monitor. Thoracotomy was routinely closed, and a drain was placed through an intercostal space after incision. Thirty days after the surgery, the dog exhibited no signs of recurrence.[...]

Infrared video thermometry guidance for surgical correction of chylothorax in dogs

Background: Macroscopic identification of the extravasation site of chyle in patients with chylothorax is a major challenge. Current forms of identification are invasive and/or expose patients to radiation, as in computerized tomography and radiography. A prototype device that uses infrared video thermometry images to detect temperature increments of 0.1ºC has been developed. This device can process and show real-time images or video on a monitor during surgeries. Therefore, the aim of this work was to report the first successful case in which this innovative device was tested in the transoperative period to identify the thoracic duct and its tributaries in a chylothorax surgery performed in a dog.Case: A 2-year-old male dog of the Shiba Inu breed was presented to the veterinary hospital with exercise intolerance, cough, emaciation, and no history of trauma. Clinical examination was performed along with complete blood count, biochemical analysis, and thoracic radiography. The patient exhibited dyspnea and had diminished breath sounds on chest auscultation. Radiographic images revealed moderate pleural effusion. The dog was anesthetized and submitted to thoracotomy, which enabled visualization of a chylous effusion. A sample of the effusion was collected for cytological and biochemical analyses. Subsequently, pericardiectomy was carried out, and identification of the thoracic duct and its tributaries was guided by an innovative device that generates infrared video thermometry images in real time. The extravasation site of the chyle was visualized on the images shown on a monitor. Consequently, after ligation of the tributary vessel, interruption of chyle overflow could be noticed on the monitor. Thoracotomy was routinely closed, and a drain was placed through an intercostal space after incision. Thirty days after the surgery, the dog exhibited no signs of recurrence.[...](AU)