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Objectives: Performing autopsies in a pandemic scenario is challenging, as the need to understand pathophysiology must be balanced with the contamination risk. A minimally invasive autopsy might be a solution. We present a model that combines radiology and pathology to evaluate postmortem CT lung findings and their correlation with histopathology. Methods: Twenty-nine patients with fatal COVID-19 underwent postmortem chest CT, and multiple lung tissue samples were collected. The chest CT scans were analyzed and quantified according to lung involvement in five categories: normal, ground-glass opacities, crazy-paving, small consolidations, and large or lobar consolidations. The lung tissue samples were examined and quantified in three categories: normal lung, exudative diffuse alveolar damage (DAD), and fibroproliferative DAD. A linear index was used to estimate the global severity of involvement by CT and histopathological analysis. Results: There was a positive correlation between patient mean CT and histopathological severity score indexes - Pearson correlation coefficient (R) = 0.66 (p = 0.0078). When analyzing the mean lung involvement percentage of each finding, positive correlations were found between the normal lung percentage between postmortem CT and histopathology (R=0.65, p = 0.0082), as well as between ground-glass opacities in postmortem CT and normal lungs in histopathology (R=0.65, p = 0.0086), but negative correlations were observed between ground-glass opacities extension and exudative diffuse alveolar damage in histological slides (R=-0.68, p = 0.005). Additionally, it was found is a trend toward a decrease in the percentage of normal lung tissue on the histological slides as the percentage of consolidations in postmortem CT scans increased (R =-0.51, p = 0.055). The analysis of the other correlations between the percentage of each finding did not show any significant correlation or correlation trends (p ≥ 0.10). Conclusions: A minimally invasive autopsy is valid. As the severity of involvement is increased in CT, more advanced disease is seen on histopathology. However, we cannot state that one specific radiological category represents a specific pathological correspondent. Ground-glass opacities, in the postmortem stage, must be interpreted with caution, as expiratory lungs may overestimate disease.

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SUMMARY OBJECTIVE: This study aimed to determine the thoracic and extra-thoracic extension of the disease in patients diagnosed with lung cancer and who had whole-body F18-fluorodeoxyglucose positron emission tomography/CT imaging and to investigate whether there is a relationship between tumor size and extrathoracic spread. METHODS: A total of 308 patients diagnosed with lung cancer were included in this study. These 308 patients were first classified as group 1 (SPN 30 mm>longest lesion diameter ≥10 mm) and group 2 (lung mass (longest lesion diameter ≥30 mm), and then the same patients were classified as group 3 (nodular diameter of ≤20 mm) and group 4 (nodular size of >20 mm). Group 1 was compared with group 2 in terms of extrathoracic metastases. Similarly, group 3 was compared with group 4 in terms of frequency of extrathoracic metastases. F18 fluorodeoxyglucose positron emission tomography/CT examination was used to detect liver, adrenal, bone, and supraclavicular lymph node metastasis, besides extrathoracic metastasis. RESULTS: Liver, bone, and extrathoracic metastasis in group 1 was statistically lower than in group 2 (p<0.001, p<0.01, and p=0.03, respectively). Liver, extrathoracic, adrenal, and bone metastasis in group 3 was statistically lower than that in group 4 (p<0.001, p=0.01, and p=0.04, p<0.01, respectively). The extrathoracic extension was observed in only one patient in group 3. In addition, liver, adrenal, and bone metastases were not observed in group 3 patients. CONCLUSION: Positron emission tomography/CT may be more appropriate for cases with a nodule diameter of ≤20 mm. Performing local imaging in patients with a nodule diameter of ≤20 mm could reduce radiation exposure and save radiopharmaceuticals used in positron emission tomography/CT imaging.

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Resumen Objetivos: Describir los patrones tomográficos de afectación pulmonar en pacientes con SARS-CoV2 y SDRA. Materiales y Métodos: Estudio retrospectivo, transversal y analítico. Pacientes atendidos en Hospital Regional de Alta Especialidad de Ciudad Victoria "Bicentenario 2010" (HRAEV), con diagnóstico confirmado de COVID-19 por RT-PCR y que contaran con tomografía computarizada de tórax realizada en la institución en el periodo comprendido de 1 marzo de 2020 a 31 julio de 2020. Se realizó un análisis descriptivo y analítico. Resultados: Se analizaron estudios de tomografía de 44 pacientes hospitalizados en HRAEV que cursaron con SDRA y requirieron IOT, de los cuales el 72.7% fueron del sexo masculino, la edad promedio fue de 64 años, de los cuales 47.7% cursaba con Diabetes Mellitus, 63.6 % con Hipertensión Arterial Sistémica 43.1% y con algún grado de sobrepeso u obesidad. Conclusiones: El hallazgo tomográfico característico de los pacientes con SDRA fue mixto de tipo vidrio despulido y consolidación con una afectación severa y generalizada.

Abstract Objective: Describe the tomographic patterns of lung involvement in patients with SARS-CoV2 and ARDS. Materials and methods: Retrospective, cross-sectional and analytical study. Patients treated at the Regional High Specialty Hospital of Ciudad Victoria "Bicentenario 2010" (HRAEV), with a confirmed diagnosis of COVID-19 by RT-PCR and who had a chest computed tomography performed at the institution in the period from March 1, 2020 to July 31, 2020. A descriptive and analytical analysis was carried out. Results: Tomography studies of 44 patients hospitalized in HRAEV who had ARDS and required IOT were analyzed, of which 72.7% were male, the average age was 64 years, of which 47.7% had Diabetes Mellitus, 63.6% with Systemic Arterial Hypertension and 43.1% with some degree of overweight or obesity. Conclusions: The characteristic tomographic finding of patients with ARDS was a mixed type of ground glass and consolidation with severe and generalized involvement. A high mortality rate was observed in these patients with OTI up to 70%.

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Objetivo: evaluar efectividad de timectomía como alternativa de tratamiento a la Miastenia Gravis (MG) en nuestro centro, entre 2007 y 2019, y cómo ha impactado en calidad de vida y manejo farmacológico. Material y Método: cohorte retrospectiva de pacientes sometidas a timectomía por equipo Cirugía Torácica del Hospital Gustavo Fricke (HGF) entre 2007 y 2019. Las variables fueron el tratamiento médico y dosis de anticolinesterásicos pre y post timectomía, y la calidad de vida medida a través de la encuesta MG-QOL15. Se utilizaron medidas de desviación estándar y comparaciones estadísticas para el análisis de estas variables, considerando estadísticamente significativo un p < 0,05. Resultados: total de 20 pacientes, mayoría mujeres jóvenes, timectomía vía transesternal. Dosis de anticolinesterásicos mostró disminución estadísticamente significativa de 5,05 a 3,06 pre y post timectomía respectivamente (p < 0,05). Encuesta MG-QOL15 media de 11,9 puntos. Discusión: Se ha demostrado que la timectomía cumple un rol importante en el manejo de la MG, otorgando una superioridad frente al tratamiento médico exclusivo. La Fundación Americana para Miastenia Gravis, recomienda el uso de la encuesta MG-QOL15 como herramienta para evaluar la calidad de vida. Existe poca literatura nacional en relación a este tema. Conclusión: La timectomía, es un procedimiento que mejora la calidad de vida de los pacientes con MG y permite reducir en forma significativa la dosis de fármacos utilizados.

Objective: To evaluate effectivity of thymectomy as an alternative treatment of MG in our center, between 2007 and 2019 and to know how it has impacted in life quality and pharmacological management. Material and Method: cohort study patients treated with thymectomy by Thoracic Surgical team from Gustavo Fricke Hospital between 2007 and 2019. The study variables were medical treatment and anticholinesterases doses before and after the thymectomy, and life quality measured through MG-QOL15 survey. Standard deviation measures and statistics comparisons were used for the analysis of these variables, considering statistically significant a p < 0.05. Results: total of 20 patients, mainly young women, thymectomy through a Trans-sternal approach. Anticholinesterase doses, showed a statistically significant decrease from 5.05 to 3.06 before and after thymectomy (p < 0.05). Discussion: It has been demonstrated that thymectomy plays an important role on the management of MG, giving a mastery against medical exclusive treatment, The American Foundation for Myasthenia Gravis recommends the use of MG-QOL15 survey as an important tool to evaluate life quality. There is a limited amount of national literature related to this topic. Conclusion: Thymectomy is a life quality changing procedure for MG patients and it helps to significantly reduce the drug doses used.

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Resumen El mielolipoma es un tumor benigno no funcional, la mayoría de ellos son asintomáticos y descubiertos de forma incidental a través de estudios de imagen o en es tudios de autopsia. Aun cuando la mayoría de los casos se presenta en la glándula suprarrenal, también se han informado en sitios extra-adrenales. Presentamos el caso de una mujer de 65 años de edad con un mielolipoma primario mediastinal. La tomografía computarizada de tórax mostró un tumor ovoide de bordes bien definidos de 6.5 × 4.2 cm, localizado en el mediastino posterior. Se realizó biopsia transtorácica de la lesión y el estudio microscópico reveló elementos hematopoyéticos y tejido adiposo maduro. Aun cuando los estudios de imagen como la tomografía computarizada y la resonancia mag nética son efectivos en el diagnóstico del mielolipoma primario mediastinal, la evaluación histopatológica es esencial para el diagnóstico definitivo.

Abstract Myelolipoma is a benign non-functional tumor. Most of them are asymptomatic and discovered incidentally, either through imaging studies or at autopsy. While it most commonly occurs in the adrenal gland, it has also been reported at extra-adrenal sites. We present the case of a 65-year-old woman with a primary mediastinal myelolipoma. Computer tomographic scan of the thorax showed an ovoid tumor with well-defined borders of 6.5 × 4.2 cm, located in the posterior mediastinum. A transthoracic biopsy of the lesion was made, and the microscopic observation revealed hematopoietic cells and mature adipose tissue. Although computed tomo graphy and magnetic resonance imaging are effective in diagnosing mediastinal myelolipoma, histopathological examination is essential for the definitive diagnosis.

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Myelolipoma is a benign non-functional tumor. Most of them are asymptomatic and discovered incidentally, either through imaging studies or at autopsy. While it most commonly occurs in the adrenal gland, it has also been reported at extra-adrenal sites. We present the case of a 65-year-old woman with a primary mediastinal myelolipoma. Computer tomographic scan of the thorax showed an ovoid tumor with well-defined borders of 6.5 × 4.2 cm, located in the posterior mediastinum. A transthoracic biopsy of the lesion was made, and the microscopic observation revealed hematopoietic cells and mature adipose tissue. Although computed tomography and magnetic resonance imaging are effective in diagnosing mediastinal myelolipoma, histopathological examination is essential for the definitive diagnosis.

El mielolipoma es un tumor benigno no funcional, la mayoría de ellos son asintomáticos y descubiertos de forma incidental a través de estudios de imagen o en estudios de autopsia. Aun cuando la mayoría de los casos se presenta en la glándula suprarrenal, también se han informado en sitios extra-adrenales. Presentamos el caso de una mujer de 65 años de edad con un mielolipoma primario mediastinal. La tomografía computarizada de tórax mostró un tumor ovoide de bordes bien definidos de 6.5 × 4.2 cm, localizado en el mediastino posterior. Se realizó biopsia transtorácica de la lesión y el estudio microscópico reveló elementos hematopoyéticos y tejido adiposo maduro. Aun cuando los estudios de imagen como la tomografía computarizada y la resonancia magnética son efectivos en el diagnóstico del mielolipoma primario mediastinal, la evaluación histopatológica es esencial para el diagnóstico definitivo.

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Pectus excavatum is a deformity of the thorax characterized by ventrodorsal narrowing of the sternum bone and costal cartilages, which can lead to compression and cardiopulmonary alterations in dogs, presenting a high prevalence in brachycephalic breeds. The aim of this report was to describe two types of management for the noninvasive treatment of pectus excavatum in newborn puppies of the breeds French Bulldog and American Bully. The puppies presented dyspnea, cyanosis and substernal retraction during inspiration. The diagnosis was performed by physical examination and confirmed by chest X-ray. Two types of splints were performed (a circular splint with plastic pipe and a paper box splint on the chest), aiming at thoracic lateral compression and frontal chest remodeling. The management was effective for the conservative treatment of mild-grade pectus excavatum, resulting in the repositioning of the thorax and improvement of the respiratory pattern.

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ABSTRACT Introduction: Acute type A aortic dissection (AAAD) in late pregnancy is a rare but severe disease. Lack of clinical experience is the main cause of high mortality. This study tries to investigate the multidisciplinary therapeutic strategy for these patients. Case presentation: We reported three patients with AAAD in late pregnancy. Sudden chest pain was the main clinical symptom before operation. All three patients and their newborns survived through multidisciplinary approach in diagnosis and treatment. No serious complications occurred during the mid-term follow-up. Conclusion: Multidisciplinary diagnosis and treatment strategy play a crucial role in saving the lives of pregnant women with AAAD.

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INTRODUCTION: Acute type A aortic dissection (AAAD) in late pregnancy is a rare but severe disease. Lack of clinical experience is the main cause of high mortality. This study tries to investigate the multidisciplinary therapeutic strategy for these patients. CASE PRESENTATION: We reported three patients with AAAD in late pregnancy. Sudden chest pain was the main clinical symptom before operation. All three patients and their newborns survived through multidisciplinary approach in diagnosis and treatment. No serious complications occurred during the mid-term follow-up. CONCLUSION: Multidisciplinary diagnosis and treatment strategy play a crucial role in saving the lives of pregnant women with AAAD.

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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.

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