Dr. Federico Grosso, Clinical Associate Professor of Diagnostic Imaging at the University of Florida College of Veterinary Medicine, discusses the importance of x-rays in diagnosing the cause and consequences of trauma to the chest.

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All right, so just came out of a really great presentation

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and I have here with me Dr.

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Federico Grosso, that is gonna talk to us

a bit about his presentation, which was

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on diagnostic imaging of thoracic trauma.

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Right.

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Thank you so much for being here.

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Federico Grosso: No, thank you so much.

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For sure.

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So, uh, this is my pleasure to be here

in this, uh, podcast and, uh, I just

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came out from lecturing about thoracic

trauma and, uh, injuries to the neck.

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So it's a subject that I think is

very, uh, important for people working

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with forensics and as animal welfare.

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Especially for alive patients

because I was not talking a lot

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about a postmortem imaging indeed.

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But, uh, how to recognize the most

severe lesions and then, uh, how

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to recognize those radiographs.

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And then certainly when you

identify these type of lesions,

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then what to do after that.

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Which ones are really life threatening

for the patient and needs to be

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addressed very fast, and which others

they are like, not so important that

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can be addressed later on, like limb

fractures, stuff like that, that can

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certainly have surgery in a later time.

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However, some of the lesion that we

have been talking today that there are

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really a problem or more life-threatening

conditions will be pneumothorax in

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case of, uh, trauma, either, which

is blunt trauma or penetrating

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trauma, where we have gas going from

the outside into the pleural space.

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And the problem of this condition is that

that will cause retraction of the lungs.

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That will not allow the lungs to

be expanded, and then when they're

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not expanding is gonna decrease the

oxygenation, then certainly that

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could be the problem for the patient.

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And that's something that needs to

be treated very fast if it's severe.

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And in those cases, they either, they will

do what we call a thoracentesis that is

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a puncture of the chest just to remove

all these gaps from the pleural space

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or maybe just even placing a chest tube.

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So a tube preventing the pleural space

to keep on moving and removing that.

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Specifically from pneumothorax,

there is one of them that is even

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more life-threatening, which we

call the tension pneumothorax or

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the hypertensive pneumothorax.

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And, uh, in this case, what is gonna

happen is that, as I don't have gas

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in the pleural space, the injury in

the lung is gonna have a valve effect,

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and then every time the patient is

inspirating, then there will be more gas

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entering each time in the pleural space.

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Aggravating the compression,

the retraction of the lungs,

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and certainly compromising the

respiration very fast in that patient.

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So this type of pneumothorax

is the most aggressive that

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needs to be treated immediately.

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If not, you will lose

probably the patient.

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DrG: And it, and I guess it's

important to know what it, what

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we're seeing as far as treatment, but

then also based on the pathology, we

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can have an idea of what caused it.

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Right?

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Like what kind of trauma would cause it.

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Federico Grosso: Yes.

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So every time when we look at the

radiograph, depending what are the

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findings, which is changes in the

subcutis, uh, surrounding the, the

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chest, we can be thinking more about it.

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Or if we have wounds about a penetrating

trauma, either with an object, either with

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an animal that attacked another animal.

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And then if your changes is

coming mostly from the inside to

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the outside, then we're gonna be

thinking mostly about blunt trauma.

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And I would say vehicular trauma is the

most common that we see with these cases.

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Sometimes they can be also kicked

by a human, kicked by another

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animal, something like that.

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But in those cases, then likely you're

gonna see solutions more in the chest

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rather than outside of the chest.

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DrG: Recently, I had a case where

the, the story was that the animal

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died from strangulation, but the

witnesses said that the animal likely

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died from being kicked in the abdomen.

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And the findings during necropsy

were no injuries to the trachea and

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chest, and the dog had liver tears.

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So can the diagnostics not only

help find out what happened, but

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also rule out what didn't happen?

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Federico Grosso: Yes.

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That's a great question.

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And in this case, certainly.

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By obtaining just thoracic radiographs,

they could have determined if it was

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truly an strangulation case or not.

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Because in case of a strangulation

or choking, we know that they're

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gonna develop non cardiogenic

pulmonary edema and that has a very

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specific distribution in the lungs,

which loosely starts caudo-dorsally

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symmetrically or assymmetrically.

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So in that dog, if they would

have taken a thoracic radiographs.

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They will have seen that the lungs

probably they're completely normal.

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However, they would have seen abdominal

distention, decreased peritoneal

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detail or loss of serosal peritoneal

detail, likely compatible then with

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hemorrhage and a lot of effusion.

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DrG: I also, I believe that, as

veterinarians we are shown how

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to evaluate thoracic radiographs.

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But like I was telling you a little

bit earlier, like I myself find it

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difficult to look at radiographs.

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So what is the importance of

having a radiologist review

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the radiographs that we do?

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Federico Grosso: That's a good question.

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I would say certainly I'm gonna favorize

my market, but, but I would say that, uh.

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If, um, I mean if you feel confident

reading your radiographs, then

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probably you would not need to

send that for a telemedicine or

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have a radiologist next to you.

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But certainly if you work in a big

practice where you have radiologist

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in situ, in the same place, that

will be certainly the best tool

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because then you can go directly

talk to them, consult of the cases.

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So that would be ideal.

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The problem is that radiologists

they're not so, uh, available now and

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a lot of them they do to telemedicine.

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So, uh, is a huge amount of practices

and hospital that they don't have access

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to a radiologist in situ and in person.

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So, uh, I would say depends on the case,

but certainly if you need consultation

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and you don't have a radiologist

next to you and you use telemedicine,

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should be some type of telemedicine

that provides you the option for STAT

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cases and to get them very, very fast.

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Because in the light of trauma and

especially the clinical complaints

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of the dogs, that your bad, then

you need to know what's going on

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fast if you're not sure about it.

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If the patient is stable, then

certainly you can submit that to

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telemedicine and then wait hours,

one day because that's gonna be okay.

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But uh, if the patient is not

breathing okay or something like

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that, then certainly you need

to have a consultation fast.

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DrG: Excellent.

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Well, thank you so very much.

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Your lecture was amazing, your images were

great, and you know, thank you so much for

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your time and thank you for being here.

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Federico Grosso: Thank you so much.

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It's been a pleasure and, uh,

enjoying a little bit of Daytona.