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1.
BMJ Case Rep ; 14(4)2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33811090

RESUMO

Pfeiffer syndrome is a rare inherited craniofacial disorder. Upper airway obstruction is common among patients with Pfeiffer syndrome due to craniosynostosis. They may also present with lower respiratory tract obstruction due to a rare congenital airway malformation called tracheal cartilaginous sleeve (TCS). We report the case of a patient with Pfeiffer syndrome who presented with recurrent bronchopneumonia, discovered incidentally to have TCS via direct visualisation during tracheostomy. Relevant literature for this rare clinical condition are reviewed and discussed. Clinicians should be aware of TCS when encountering patients with craniosynostosis who present with recurrent lower respiratory tract infections. Careful and meticulous investigations should be performed to look for TCS, especially in patients with craniosynostosis.


Assuntos
Acrocefalossindactilia , Craniossinostoses , Traqueia , Cartilagem , Criança , Pré-Escolar , Craniossinostoses/cirurgia , Humanos , Lactente , Masculino , Traqueia/diagnóstico por imagem , Traqueostomia
3.
Medicine (Baltimore) ; 100(13): e25349, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787636

RESUMO

RATIONALE: Videofluoroscopic swallowing study (VFSS) is a noninvasive radiographic procedure that examines the oral, pharyngeal, and cervical esophageal stages of swallowing. Tracheoesophageal fistula (TEF) is difficult to diagnose depending on its size and location. However, how VFSS can be of benefit in the diagnosis of TEF has not been reported yet. PATIENT CONCERNS: A 64-year-old man who had been tracheostomized post spinal tumor resection surgery at the cervical level 1 to 2, had his tracheostomy tube removed approximately 25 years ago. After decannulation, he reported coughing while swallowing food, foreign sensation in the neck and repeated bouts of pneumonia ever since. DIAGNOSIS: VFSS revealed, for the first time, acquired TEF after tracheostomy decannulation as the cause of repetitive aspiration pneumonia. INTERVENTION: VFSS was performed in this case. OUTCOMES: In the background of suspected TEF based on VFSS results, the patient underwent a computed tomography scan of the chest and airway in the prone position, followed by bronchoscopy, which confirmed the existence of a TEF. He then underwent primary closure of the fistula. The patient had an uneventful recovery and is currently symptom-free 10 months after the surgery. LESSONS: This case alerts clinicians to the possibility of TEF as a diagnosis when the aspirate leaks from the upper esophagus and through the posterior wall of trachea in the esophageal phase of VFSS.


Assuntos
Deglutição/fisiologia , Fístula Traqueoesofágica/diagnóstico , Traqueostomia/efeitos adversos , Broncoscopia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Esôfago/diagnóstico por imagem , Esôfago/fisiologia , Fluoroscopia/métodos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Traqueia/diagnóstico por imagem , Traqueia/fisiologia , Fístula Traqueoesofágica/etiologia , Fístula Traqueoesofágica/fisiopatologia
4.
BMJ Case Rep ; 14(2)2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33579799

RESUMO

Ectopic or supernumerary parathyroid tissue has been generally described in the literature in cases found during workup for parathyroid adenoma. We present two unique cases of intratracheal parathyroid gland, a rare occurrence that has not yet been described in the literature. In both cases, the masses were found incidentally and showed no clinical or laboratory evidence of hyperparathyroidism. In both cases, surveillance was chosen as the method of treatment. We present this case series to increase awareness of this potential diagnosis.


Assuntos
Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/fisiopatologia , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/fisiopatologia , Neoplasias das Paratireoides/cirurgia , Traqueia/diagnóstico por imagem , Traqueia/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Masculino , Resultado do Tratamento
5.
J Thorac Cardiovasc Surg ; 161(3): 1112-1121.e7, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33419543

RESUMO

OBJECTIVES: Airway anomalies are common in children with cardiac disease but with an unquantified impact on outcomes. We sought to define the association between airway anomalies and tracheal surgery with cardiac surgery outcomes using the Society of Thoracic Surgery Congenital Heart Surgery Database. METHODS: Index cardiac operations in children aged less than 18 years (January 2010 to September 2018) were identified from the Society of Thoracic Surgery Congenital Heart Surgery Database. Patients were divided on the basis of reported diagnosis of an airway anomaly and subdivided on the basis of tracheal lesion and tracheal surgery. Multivariable analysis evaluated associations between airway disease and outcomes controlling for covariates from the Society of Thoracic Surgery Congenital Heart Surgery Database Mortality Risk Model. RESULTS: Of 198,674 index cardiovascular operations, 6861 (3.4%) were performed in patients with airway anomalies, including 428 patients (0.2%) who also underwent tracheal operations during the same hospitalization. Patients with airway anomalies underwent more complex cardiac operations (45% vs 36% Society of Thoracic Surgeons/European Association for Cardiothoracic Surgery Congenital Heart Surgery Mortality category ≥3 procedures) and had a higher prevalence of preoperative risk factors (73% vs 39%; both P < .001). In multivariable analysis, patients with airway anomalies had increased odds of major morbidity and tracheostomy (P < .001). Operative mortality was also increased in patients with airway anomalies, except those with malacia. Tracheal surgery within the same hospitalization increased the odds of operative mortality (adjusted odds ratio, 3.9; P < .0001), major morbidity (adjusted odds ratio, 3.7; P < .0001), and tracheostomy (adjusted odds ratio, 16.7; P < .0001). CONCLUSIONS: Patients undergoing cardiac surgery and tracheal surgery are at significantly higher risk of morbidity and mortality than patients receiving cardiac surgery alone. Most of those with unoperated airway anomalies have higher morbidity and mortality, which makes it an important preoperative consideration.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Cardiopatias Congênitas/cirurgia , Anormalidades do Sistema Respiratório/cirurgia , Procedimentos Cirúrgicos Torácicos/mortalidade , Traqueia/cirurgia , Adolescente , Fatores Etários , Canadá , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/mortalidade , Humanos , Lactente , Masculino , Anormalidades do Sistema Respiratório/diagnóstico por imagem , Anormalidades do Sistema Respiratório/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Fatores de Tempo , Traqueia/anormalidades , Traqueia/diagnóstico por imagem , Resultado do Tratamento , Estados Unidos
6.
Clin Imaging ; 74: 10-14, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33421697

RESUMO

AIM: To assess the tracheal volume and the effect of respiration through segmentation on CT-scans in children. MATERIAL AND METHODS: Chest-CT of 100 patients divided into males and females, aged 3-16 years, were retrospectively assessed. Subjects underwent inspiratory and expiratory CT-scans. Tracheal volume was segmented through ITK-SNAP software. Volume, length, anteroposterior, laterolateral diameters, and T1-T10 distance were measured. The percentage ratio between expiratory and inspiratory phases was calculated: significant differences according to sex for inspiratory and expiratory measurements were assessed through a one-way ANCOVA test using T1-T10 distance as covariate (p < 0.05). Differences in percentage changes according to sex and age were assessed through Mann-Whitney test and calculation of Pearson's correlation coefficient, respectively (p < 0.05). RESULTS: No statistically significant difference according to sex was found for any measurement (p > 0.05). For the percentage ratio between inspiratory and expiratory phase, no difference was found according to sex for any measurement (p > 0.05). The percentage ratio of tracheal volume and length between expiratory and inspiratory phases showed a negative correlation with age (p < 0.05). CONCLUSIONS: This study provides a novel contribution to the assessment of tracheal size in healthy children: future studies will verify the same measurements in patients affected by tracheomalacia to improve diagnosis.


Assuntos
Respiração , Traqueia , Adolescente , Criança , Pré-Escolar , Expiração , Feminino , Humanos , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Traqueia/diagnóstico por imagem
7.
Intern Med ; 60(3): 473-477, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33328406

RESUMO

We experienced two cases of post-intubation laryngotracheal stenosis (PILS) occurring in patients after acute coronavirus disease (COVID)-19 in a relatively narrow time period. The patients required mechanical ventilation for 9 days in one and 28 days in the other. In both cases, the patients were discharged but later developed symptoms of cough and dyspnea, which were later diagnosed as PILS. Persistent cough and dyspnea are common symptoms in both PILS and the recovery phase of severe COVID-19. For this reason, PILS should be considered in the differential diagnosis post-COVID-19 patients. In addition, the prevalence of PILS may be greater than that of other critical diseases in severe COVID-19 patients.


Assuntos
/complicações , Intubação Intratraqueal/efeitos adversos , Estenose Traqueal/etiologia , Adulto , Tosse/etiologia , Dispneia/etiologia , Feminino , Humanos , Laringoscopia , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Respiração Artificial , Tomografia Computadorizada por Raios X , Traqueia/diagnóstico por imagem , Estenose Traqueal/diagnóstico , Estenose Traqueal/diagnóstico por imagem
8.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370965

RESUMO

Tracheal tear after endotracheal intubation is extremely rare. The role of silicone Y-stent in the management of tracheal injury has been documented in the previous studies. However, none of the studies have mentioned the deployment of silicone Y-stent via rigid bronchoscope with the patient solely supported by extracorporeal membrane oxygenation (ECMO) without general anaesthesia delivered via the side port of the rigid bronchoscope. We report a patient who had a tracheal tear due to endotracheal tube migration following a routine video-assisted thoracoscopic surgery sympathectomy, which was successfully managed with silicone Y-stent insertion. Procedure was done while she was undergoing ECMO; hence, no ventilator connection to the side port of the rigid scope was required. This was our first experience in performing Y-stent insertion fully under ECMO, and the patient had a successful recovery.


Assuntos
Oxigenação por Membrana Extracorpórea , Complicações Intraoperatórias/terapia , Intubação Intratraqueal/efeitos adversos , Lacerações/terapia , Traqueia/lesões , Broncoscopia , Falha de Equipamento , Feminino , Humanos , Doença Iatrogênica , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Intubação Intratraqueal/instrumentação , Lacerações/diagnóstico , Lacerações/etiologia , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/terapia , Ventilação Monopulmonar/instrumentação , Stents , Simpatectomia/efeitos adversos , Simpatectomia/métodos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Traqueia/diagnóstico por imagem , Adulto Jovem
9.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(11): 947-952, 2020 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-33137861

RESUMO

Objective: To explore the clinical characteristics of non-tuberculous mycobacterium(NTM) pulmonary disease complicated with tracheobronchial lesions. Methods: From January 2014 to December 2018, there were 1 006 patients who were admitted to Guangzhou Chest Hospital for the first time and received examination by bronchoscopy. A total of 89 patients with complete data were selected, including 40 males and 49 females, aged 20 to 85 years, with 46 patients (52%) aged 60 years or older. The clinical symptoms and signs of the patients were analyzed with chest imaging, bronchoscopy and pathological examination results. Comparisons between groups were made by Chi-square test and t test. Results: The number of patients with NTM complicated with tracheobronchial lesions accounted for 8.9%(89/1 006) of those hospitalized with NTM and received bronchoscopy during the same period. Clinical symptoms included cough and sputum (89/89), different degrees of hemoptysis or blood sputum (52/89), and shortness of breath (50/89). Chest CT showed that 72 cases (72/89, 81%) had lung lesions involving more than 3 lung fields, and 83 cases (93%) had bronchiectasis and 63 cases (63/89, 71%) with cavities. Pulmonary atelectasis was shown in 45 cases (45/89, 51%). By bronchoscopy, 39 cases (39/89, 44%) were diagnosed as tuberculous lesions involving bilateral upper bronchi, while lesions of the right lower bronchus was found in 27 cases (27/89, 30%).The percentage of patients with multilobar bronchial involvement was 50.6%(45/89). The morphological characteristics of the bronchial lesions included scar stenosis or atresia in 63 cases (63/89, 71%), hyperemia and edema in 46 cases (46/89, 52%), and multiple types of lesions in 48 cases (48/89, 54%). Conclusions: Patients with NTM lung disease complicated with tracheobronchial inflammatory lesions did not have specific manifestations clinically. Lung lesions are extensive, often accompanied by bronchiectasis and cavity formation. Endoscopic changes were mostly manifested as multilobar tracheobronchial involvement characterized by scar stenosis, congestion and edema, mainly involving bilateral upper bronchi and the right lower bronchus.


Assuntos
Brônquios/patologia , Infecções por Mycobacterium não Tuberculosas/patologia , Traqueia/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brônquios/diagnóstico por imagem , Broncoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Micobactérias não Tuberculosas , Traqueia/diagnóstico por imagem , Adulto Jovem
12.
Rev. patol. respir ; 23(3): 114-116, jul.-sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-194923

RESUMO

El síndrome de distrés respiratorio del adulto por SARS-CoV-2 ha sido una de las causas de requerimiento de intubación orotraqueal (IOT) en pacientes con insuficiencia respiratoria grave. En los pacientes ingresados en la Unidad de Cuidados Intensivos (UCI) con dificultad para la desconexión de ventilación mecánica invasiva, se considera la traqueostomía como una opción terapéutica para la progresión respiratoria. La traqueostomía percutánea es una técnica que ofrece varias ventajas en comparación con la quirúrgica, es más rápida, más barata y tiene menos complicaciones de forma global, si bien es cierto que presenta mayor riesgo de laceración o rotura traqueal. Presentamos un caso de rotura traqueal en paciente con neumonía grave SARS-CoV-2 tras traqueostomía percutánea resuelta con manejo conservador y una revisión de la literatura


SDRA secondary due to SARS-Cov 2 infection is one of the causes of tracheal intubation. In patients with acute respiratory failure. In ICU patientes with difficcult weaning of mechanical ventilation tracheostomy is one of the therapeutic approach. Percutaneous tracheostomy have so many advantages instead of surgical tracheostomy wiht less complications rate, cheaper and quicker. One of the complications of this technique is the risk of tracheal rupture. We present a case of tracheal rupture in a patient with severe SARS- Cov-2 pneumonia secondary a percutaneous tracheostomy solved with conservative management and a literatura review


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Doença Iatrogênica , Traqueia/lesões , Betacoronavirus , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Traqueia/diagnóstico por imagem , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Ruptura/etiologia , Radiografia Torácica , Traqueotomia/métodos , Tomografia Computadorizada por Raios X
14.
Artigo em Chinês | MEDLINE | ID: mdl-32536069

RESUMO

Objective: To investigate the measurement of small airways by high-resolution CT and image post-processing software. Screen and analyze the reconstructed airway parameters in order to find the best imaging biomarker parameters of small airway changes and calculate the reference value range; meanwhile, explore its influencing factors. Methods: From a water plant and a medical school, 169 cases of the general population aged 20 to 60 were selected as research objects, and questionnaire surveys and CT tests were performed, and CT data were reconstructed with image post-processing software. The reference value range of the general population was evaluated, and a linear mixed effect model was used to adjust the age, gender, height, BMI, and smoking status, and analyze the influencing factors of airway parameters. Results: The ratio of sixth-grade tracheal wall area to total tracheal area in the Left B1+2 to carina was (53.01±13.35) %, Left B9 to carina was (50.44±12.98) %, Right B1 to carina was (52.73±12.22) %, and Right B9 to carina was (52.93±11.85) %. The ratio of nineth-grade tracheal wall area to total tracheal area in the Left B1+2 to carina was (44.08±14.66) %, Left B9 to carina was (42.44±15.89) %, Right B1 to carina was (46.51±14.03) %, and Right B9 to carina is (43.54±15.87) %. BMI affect the area of the tracheal wall, all p value<0.05. Conclusion: High-resolution CT small airway morphology can make a preliminary assessment of the susceptible population of small airway-related diseases based on a range of reference values, and prevent and control it in combination with influencing factors.


Assuntos
Brônquios , Traqueia , Adulto , Brônquios/anatomia & histologia , Brônquios/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Pessoa de Meia-Idade , Valores de Referência , Tomografia Computadorizada por Raios X , Traqueia/anatomia & histologia , Traqueia/diagnóstico por imagem , Adulto Jovem
17.
J Cardiothorac Surg ; 15(1): 130, 2020 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-32517719

RESUMO

BACKGROUND: Salvage surgery has been frequently performed, increasing the opportunity to actively perform surgery for recurrence after a function-preserving operation. However, re-operation after airway reconstruction surgery on the proximal side and the effect of prior treatment, such as radiotherapy and/or chemotherapy, make the operation more difficult. In addition, cases of sleeve pneumonectomy after sleeve lobectomy with bronchoplasty are uncommon. CASE PRESENTATION: A 71-year-old lung cancer patient underwent right upper sleeve lobectomy with bronchoplasty combined with perioperative chemotherapy in 2007. A new undiagnosed right hilar mass that appeared 9 years post-operation showed a temporary response to radiotherapy but progressed thereafter. Sleeve pneumonectomy was completed 14 months after radiotherapy by the following procedures: dividing the right pulmonary artery at the proximal site under median sternotomy and then reconstructing the bronchus by telescoping the left main bronchus into the distal trachea after pneumonectomy under posterolateral thoracotomy. CONCLUSIONS: Sleeve pneumonectomy for recurrent lung cancer could be safely performed under good vision using a two-stage approach as salvage surgery, even in high-risk patients who received various treatments and proximal airway reconstruction.


Assuntos
Brônquios/cirurgia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Recidiva Local de Neoplasia/cirurgia , Pneumonectomia , Idoso , Brônquios/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Recidiva Local de Neoplasia/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Terapia de Salvação , Traqueia/diagnóstico por imagem , Traqueia/cirurgia
18.
Orv Hetil ; 161(25): 1063-1068, 2020 06.
Artigo em Húngaro | MEDLINE | ID: mdl-32516125

RESUMO

Tracheobronchial injury is an uncommon, but often life-threatening condition. It is mostly caused by blunt thoracic or neck trauma, difficult or prolonged intubation associated with nasogastric tube insertion. An early diagnosis and treatment can be lifesaver. The diagnosis is often late because of atypical symptoms and unspecific radiological signs, and due to the presence of severe coexistent injuries. Generally, the classic hallmark during physical examination is a progressive, extensive surgical emphysema. Radiological signs are often atypical, which makes the diagnosis more difficult. The most frequent signs found on computed tomography are also unspecific, mostly surgical emphysema, pneumomediastinum or pneumothorax may be noted. We present three patients suffering from airway laceration caused by car accident, difficult intubation, and prolonged utilization of nasogastric and endotracheal tube. All the patients had an overdistended endotracheal balloon herniated outside the extratracheal space along the rupture of the tracheal wall. These external balloons were all detected on radiography. This is a direct and pathognomic sign of airway injury, suggesting complete rupture in the tracheal wall. In our report, we would like to highlight the diagnostic role of an overinflated cuff. Orv Hetil. 2020; 161(25): 1063-1068.


Assuntos
Intubação Intratraqueal , Pneumotórax , Tomografia Computadorizada por Raios X/métodos , Traqueia/lesões , Humanos , Radiografia , Ruptura , Traqueia/diagnóstico por imagem
20.
Arq. bras. med. vet. zootec. (Online) ; 72(3): 799-806, May-June, 2020. ilus, tab
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1129181

RESUMO

The purpose of this study was to verify the applicability of the compressive radiographic technique (pressures of 5, 10, 15 and 20mmHg) in the diagnosis of tracheal collapse in small breed dogs, in lateral cervicothoracic radiography. Out of the 50 dogs evaluated, 25 presented tracheal collapse (TG group), 23 did not present tracheal collapse (CG) and two were excluded because they did not tolerate a pressure of 20 mmHg. The TG group presented a smaller internal diameter of the trachea in the region of the fourth cervical vertebra (D4) and at the entrance of the thorax (TDE) compared to the CG group, in all the radiographic projections performed, as well as within the TG group where the compressive technique differed from conventional. Furthermore, there was a correlation between the clinical sign of coughing during cervical collar use and the presence of radiographic tracheal collapse at a pressure of 20 mmHg. It was concluded that the compressive radiographic technique was feasible and efficient in confirming the diagnosis of tracheal collapse in dogs, especially in the pressure of 20 mmHg, where it was associated with clinical signs, and can be used in isolation or complementary to the conventional technique.(AU)


O objetivo deste trabalho foi verificar a aplicabilidade da técnica radiográfica compressiva no diagnóstico do colapso de traqueia em cães de raças pequenas, por meio da comparação do diâmetro da traqueia durante a radiografia cervicotorácica lateral convencional e sobre influência da compressão externa com pressões de 5, 10, 15 e 20mmHg (técnica compressiva). Dos 50 cães avaliados, 25 apresentaram colapso de traqueia (grupo TG), 23 não apresentaram o colabamento traqueal (grupo controle - CG) e dois foram excluídos por não tolerarem a pressão de 20mmHg. Os diâmetros internos da traqueia na região da quarta vértebra cervical (D4) e na entrada do tórax (DET) foram menores no grupo TG em relação ao CG, em todas as projeções radiográficas realizadas, bem como dentro do grupo TG, no qual a técnica compressiva diferiu da convencional. Houve correlação entre o sinal clínico de tosse durante o uso de coleira cervical e a presença do colapso de traqueia radiográfico, na pressão de 20mmHg. Concluiu-se que a técnica radiográfica compressiva foi exequível e eficiente na confirmação do diagnóstico do colapso de traqueia em cães, especialmente na pressão de 20mmHg, em que houve associação com sinais clínicos, podendo ser utilizada de forma isolada ou complementar à técnica convencional.(AU)


Assuntos
Animais , Cães , Traqueia/patologia , Traqueia/diagnóstico por imagem , Tosse/veterinária , Radiografia/métodos , Radiografia Torácica/veterinária , Medula Cervical/diagnóstico por imagem
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