Avaliação ultrassonográfica torácica em cães com efusão pleural e/ou periocárdica / Thoracic ultrasonographyc evaluation of dogs with pleural and/or pericardial effusion

Com o objetivo de avaliar a ultrassonografia torácica (incluindo a ecocardiografia) como método de exame complementar em pacientes portadores de efusão pleural e/ou pericárdica, realizou-se a ultrassonografia torácica em 30 cães, machos e fêmeas de raças e idades variadas. Animais atendidos nos serviços de Pronto-Atendimento, Clínica Médica ou Clínica Cirúrgica do HOVET/USP com efusão pleural e/ou pericárdica, detectadas por meio de exame radiográfico, ultrassonografia emergencial ou toracocentese exploratória foram incluídos no estudo. Observou-se efusão pleural em 12 cães (40%), efusão pericárdica em oito (26,66%) e efusão pleural e pericárdica em outros dez cães (33,33%). A causa da efusão pleural e/ou pericárdica foram avaliadas ultrassonograficamente como sendo: nódulo/tumor cardíaco (5 - 16,66%), nódulo/tumor intratorácico (5 – 16,66%), insuficiência cardíaca congestiva por cardiomiopatia dilatada (4 – 13,33%) ou endocardiose de mitral e tricúspide (3 – 10%), efusão pericárdica idiopática (3 - 10%), li fossarcoma (2 - 6,66%), piotórax (2 – 6,66%), ruptura diafragmática (1 – 3,33%), hérnia peritônio-pericárdica (1 –3,33%), pneumonia e pleurite (1 - 3,33%), tumor de ovário com metástases torácicas (1 – 3,33%), pericardite infecciosa (cinomose) (1 – 3,33%) e hipoalbuminemia (1 – 3,33%).

To evaluate diagnostic accuracy of thoracic ultrasonography (including echocardiography) of patients with pleural and/or pericardial effusion, thoracic ultrasonography was performed in 30 dogs, males and females, of different breeds and ages. The animals were admitted to the Emergency, Internal medicine or Surgery department of the Faculty of Veterinary Medicine, University of São Paulo, presenting with pleural and/or pericardial effusion, diagnosed by thoracic radiography, emergency thoracic ultrasonography or exploratory thoracocentesis. Twelve (40%) dogs had pleural effusion, 9 (30%) had pericardial effusion and 9 (30%) had both pleural and pericardial effusions. The definitive cause of effusion were obtained by thoracic ultrasonography as follows: heart mass (5 –16,66%), intrathoracic mass (5 – 16,66%), congestive heart failure by dilated cardiomyopathy (4 – 13,33%) or mitral and tricuspid insufficiency (3 – 10%), idiopathic pericardial effusion (3 – 10%), lymphosarcoma (2 – 6,66%), pyothorax (2 - 6,66%), traumatic diaphragmatic hernia (1 – 3,33%), congenital peritoneopericardial hernia (1 – 3,33%), pneumonia and pleuritis (1 – 3,33%), ovarian neoplasia and thoracic metastasis (1 – 3,33%), infectious pericarditis (distemper) (1 – 3,33%) and hypoalbuminemia (1 – 3,33%). The conclusion was that thoracic ultrasonography was an excellent auxiliary exam in animals with pleural and/or pericardial effusion, and it’s not invasive and safe for the patient, allowing to guide biopsies and perform the exam in different decubits, avoiding patient stress.

Inflammation and clinical repercussions of pleurodesis induced by intrapleural talc administration

Although reports on pleurodesis date back to the beginning of the 20th century, the search for the ideal sclerosing agent is ongoing. Several agents have been studied and used, but talc continues to be the most popular. However, potentially harmful systemic side effects have been associated with talc pleurodesis. In this article we discuss the likely mechanisms of pleural inflammation and pleurodesis with emphasis on the systemic response due to the instillation of talc into the pleural space.

Apesar dos relatos sobre pleurodese remontarem ao início do século XX, ainda hoje se busca o agente esclerosante ideal. Diversos agentes foram estudados e utilizados, mas o talco é considerado o mais popular. No entanto, efeitos sistêmicos potencialmente tóxicos tem sido associados à pleurodese pelo talco. Neste artigo discutimos os prováveis mecanismos de inflamação pleural e pleurodese, com ênfase na resposta sistêmica produzida pela instilação intrapleural de talco.