Cardiovascular/Pulmonary Flashcards
What are common CT findings of eosinophilic pulmonary granulomatosis?
CT characteristics of eosinophilic pulmonary granulomatosis in 5 dogs: VRU 55.1
Large pulmonary masses and nodules that are smoothly marginated, without mineralization, bronchiectasis Post-contrast CT: honeycomb affect - hyperattenuating rims surrounding centrally hypoattenuating regions.
Where at eosinophilic pulmonary granulomas most commonly found on CT? What differentiates these masses from neoplasia?
CT characteristics of eosinophilic pulmonary granulomatosis in 5 dogs: VRU 55.1
caudal lung lobes. Most neoplasias have heterogeneous contrast enhancement, as do granulomas. However, in this study - 8/9 masses had honeycomb enhancement pattern (hyperattenuating rims surrounding hypoattenuating central regions).
Eosinophilic bronchopneumopathy has a breed predilection for what two breeds?
VRU CT findings in 15 dogs with bronchopneumopathy.
Siberian Huskies and Alaskan Malamutes.
What are the most common CT findings associated with eosinophilic bronchopneumopathy?
VRU CT findings in 15 dogs with bronchopneumopathy.
Pulmonary parenchymal involvement (ground glass pattern) with concurrent bronchiectasis and thoracic lymphadenopathy. Not all of these signs have to be present.
What are some important differentials for pulmonary nodules?
VRU CT findings in 15 dogs with bronchopneumopathy.
Secondary/Primary neoplasia, pulmonary lymphoma, intrathoracic histiocytic sarcoma, lymphomatoid granulomatosis, abscess, granulomas of other origins and hematoceles.
What are Radiographic vs CT characteristics (primary and secondary) of bronchiectasis?
Quantitative and qualitative CT characteristics of bronchiectasis in 12 dogs. VRU 54.4
Radiographs: non-tapering airways, pulmonary consolidation, bronchial wall thickening
CT features: Primary - abnormal bronchial dilation, lack of peripheral bronchial tapering, identification of distinct airways within 1cm of pleural surface. Bronchial:arterial ratio >2.
Secondary - bronchial wall thickening, mucus plugging, peripheral air trapping
What are congenital and acquired disorders that predispose a patient to bronchiectasis?
Quantitative and qualitative CT characteristics of bronchiectasis in 12 dogs. VRU 54.4
Acquired: primary ciliary dyskinesia, Kartagener’s syndrome (sidus inversus)
Congenital: chronic bronchitis (most common cause), chronic infectious pneumonia, eosinophilic bronchopneumopathy, bronchial obstruction.
What is common bronchial:arterial ratio for dogs with bronchiectasis, and how does this compare to unaffected lungs?
Quantitative and qualitative CT characteristics of bronchiectasis in 12 dogs. VRU 54.4
Bronchiectasis: >2.0. (23/28 dogs)
Normal: 1.6, but was greater than 2 in 11/42 lobes. Another study showed ratio of 1.45.
What is the reason for an increased bronchial: arterial ratio in dogs with bronchiectasis?
Quantitative and qualitative CT characteristics of bronchiectasis in 12 dogs. VRU 54.4
This ratio assumes a normal pulmonary artery.
Pulmonary arterial blood flow may be decreased in diseased lungs.
However, chronic lower airway disease can result in pulmonary hypertension (increased arterial size) which would alter the ratio.
Give a brief description of these thoracic CT features:
Linear and reticular opacities: Interface sign, peribronchovascular interstitial thickening, parenchymal bands, subpleural interstitial thickening, subpleural lines
Thoracic high-resolution CT in diagnosis of metastatic carcinoma. JSAP 45 (2004)
Interface sign: irregular interface at edge of pulmonary parenchymal structures
Peribronchovascular interstitial thickening: abnormal thickening of the peribronchovascular interstitium that maybe smooth, nodular, or irregular.
Pringle bands: nontapering reticular opacity, usually several millimeters thick and several centimeters long often peripherally located.
Subpleural interstitial thickening: abnormal thickening of the subpleural interstitium-most easily seen adjacent measures.
Subpleural lines: curvilinear line, a few millimeters thick, parallel and close to the pleural surface.
Give a brief description of the CT thoracic features:
increase one opacity: Graham glass opacity, crazy paving, consolidation, calcificatio
Thoracic high-resolution CT in diagnosis of metastatic carcinoma. JSAP 45 (2004)
Graham glass opacity: easy increase among opacity without obscuration of the underlying vessels.
Crazy paving: similar to Graham glass opacity, but with superimposition of a reticular pattern
Calcification: high attenuation deposits, usually interstitial, the cannonball said the bronchials and arteries.
Consolidation: increase on attenuation with obscuration of the underlying pulmonary vessels; air bronchograms maybe present.
Give a brief description of these thoracic CT features:
Decreased lung opacity: honeycombing, lung cysts, emphysema, bronchiectasis, traction bronchiectasis, mosaic perfusion
Thoracic high-resolution CT in diagnosis of metastatic carcinoma. JSAP 45 (2004)
Honeycombing: air- filled cystic spaces several millimeters to several centimeters in diameter, often peripherally located
Lung cysts: thin-walled, well-defined round and circumscribed lesions with uniform thickness wall, usually containing air or fluid. These include bulla, pneumatocele’s and lung cysts.
Emphysema: permanent abnormal enlargement of air spaces distal to the terminal bronchial the company by destruction of their walls
Bronchiectasis: bronchodilation
Traction bronchiectasis: bronchiectasis that is irregular contour
Mosaic perfusion: regional attenuation differences. Vessels in the lucent region’s are smaller than those in the dense regions
What were each of the CT findings correlated with on histopathology?
Subpleural lines, subpleural interstitial thickening, parenchymal bands, ground glass opacity,
Thoracic high-resolution CT in diagnosis of metastatic carcinoma. JSAP 45 (2004)
Subpleural lines: interstitial fibrosis and tumor cell infiltrate
Subpleural interstitial thickening: deposition of tumor cells in the interstitium and increased interstitial connective tissue (nonspecific finding that can be seen with carcinomatosis pulmonary edema and idiopathic pulmonary fibrosis)
Parenchymal bands: fibrous or neoplastic tissu, which can also be seen with atelectasis
Ground glass opacity: combination of tumor cells, Hemorrhage and alveolar necrosis.
How do a vitamin K related anti-coagulants work?
Thoracic radiographic features of anticoagulant rodenticide toxicity in 14 dogs. VRU 34.6
Vitamin K is responsible for activation of clotting factors 2, 7, 9, 10)
Anti-coagulants inhibit vitamin K epoxide reductase enzyme needed for recycling of vitamin K in liver by inhibiting activation of vitamin K to the active form.
What are radiographic features of anticoagulant toxicity?
Thoracic radiographic features of anticoagulant rodenticide toxicity in 14 dogs. VRU 34.6
Diffuse pulmonary hemorrhage (patchy, alveolar pulmonary pattern), mediastinal/pleural fluid
Increase in mediastinal soft tissue opacity (widening on DV view), narrowing of the trachea due to fluid accumulation, intraluminal wall thickening of the trachea (submucosal hemorrhage)
What is target heart rate for coronary CTA?
Effects of 2 different anesthetic protcools on 64-MDCT coronary angiography in dogs. VRU 56.1
60-65bpm
2 different protocols were discussed in the article Effects of 2 different anesthetic protcools on 64-MDCT coronary angiography in dogs. VRU 56.1. What were those protcools? How are those drugs thought to work?
1) Fentanyl and midazolam
Fentanyl - mu-opioid receptor agonist decrease HR when dog is anesthetized with isoflurane
Midazolam - GABA agonist-anesthetic sparing effect
2) Dexmedetomidine - cardiovascular depression and bradycardia
Using the 2 protocols in the article:
Effects of 2 different anesthetic protcools on 64-MDCT coronary angiography in dogs. VRU 56.1
Were they able to achieve target heart rate?
No.
Target HR was 60-65bpm
Decreased from 120 –> 80bpm
What drugs have been previously tried to attempt to decrease HR?
What drugs were tested in this article: Effects of 2 different anesthetic protcools on 64-MDCT coronary angiography in dogs. VRU 56.1
What were major differences?
Previous drugs: esmolol, nitroprusside
MAJOR hypotension
Drugs in this study: fentanyl/midazolam combo CRI, dexmedetomidine CRI
Which was main artifact seen in assessing coronary CTA in the article:
Effects of 2 different anesthetic protcools on 64-MDCT coronary angiography in dogs. VRU 56.1
Blur - 70% of the cases
Motion/stair step - 20-30%
What are published lengths for the: Left coronary artery Right coronary artery Left circumflex Left paraconal interventricular
Effects of 2 different anesthetic protcools on 64-MDCT coronary angiography in dogs. VRU 56.1
Left coronary: 0.5cm
Right coronary artery: 5cm
Left circumflex: 8cm
Left paraconal interventricular: 7cm
In the article:
Measurements of the pulmonary vasculature on thoracic radiographs in healthy dogs compared to dogs with mitral regurgitation. VRU 56.3
What % of healthy dogs had caudal arterial/venous enlargement?
67.5% - arterial
65% - venous
What ratios were significantly different when evaluated pulmonary vasculature in healthy dogs versus dogs with mitral valve disease? What were ratios?
Measurements of the pulmonary vasculature on thoracic radiographs in healthy dogs compared to dogs with mitral regurgitation. VRU 56.3
Caudal pulmonary vein : 9th rib
Healthy dogs 1.07
Mitral valve dogs - 1.43
Caudal pulmonary vein : artery
Healthy dogs: 1.04
Mitral valve dogs: 1.35
What is proposed cutoff value for caudal pulmonary vein: 9th rib to help detect mitral regurgitation?
Measurements of the pulmonary vasculature on thoracic radiographs in healthy dogs compared to dogs with mitral regurgitation. VRU 56.3
1.22
Sensitivity/specificity: 73/73
What is proposed cut off value for the caudal pulmonary vein: artery ratio to help determine mitral regurgitation?
Measurements of the pulmonary vasculature on thoracic radiographs in healthy dogs compared to dogs with mitral regurgitation. VRU 56.3
1.18
Sensitivity/specificity: 80/82.5
What measurement was significantly larger between healthy dogs and dogs with mitral regurgitation in the article:
Measurements of the pulmonary vasculature on thoracic radiographs in healthy dogs compared to dogs with mitral regurgitation. VRU 56.3
right caudal pulmonary vein diameter
The valentine shaped heart seen on feline radiographs is due to which chamber enlargement?
Left atria
A valentine shaped cardiac silhouette in feline thoracic radiographs is primarily due to left atrial enlargement. VRU 56.3
Does the right side of the heart contribute to valentine shaped cardiac silhouette in felines?
No. EXCEPT in the case of severe left atrial dilation.
A valentine shaped cardiac silhouette in feline thoracic radiographs is primarily due to left atrial enlargement. VRU 56.3
Fill in the blank:
There was a ____, _____ correlation between radiographic and echocardiographic changes when evaluating moderate/severe ____ dilation on feline thoracic radiographs.
With _____ severity of dilation, radiographic interpretatoin was ____ accurate (higher sensitivity)
Strong, positive correlation
left atrial
With increasing severity of dilation, radiographic interpretation was more accurate (more sensitive)
A valentine shaped cardiac silhouette in feline thoracic radiographs is primarily due to left atrial enlargement. VRU 56.3
Did underlying disease process correlate with degree of left atrial dilation?
A valentine shaped cardiac silhouette in feline thoracic radiographs is primarily due to left atrial enlargement. VRU 56.3
No - HCM/HOCM or other misc diseases made no difference
What is smallest size of pulmonary nodule a CT can detect versus radiography?
CT characteristics of eosinophilic pulmonary granulomatosis in 5 dogs: VRU 55.1
1mm (CT) vs 3mm (radiography)
Was there an association between heartworm and eosinophilic granulomatosis?
CT characteristics of eosinophilic pulmonary granulomatosis in 5 dogs: VRU 55.1
NO - none of hte dogs tested positive for heartworm
What CT ratio was described for patients with chronic bronchitis vs unaffected dogs?
Bronchial wall: pulmonary arterial wall ratio of 0.6 in the cranial lung lobes - suggestive of bronchitis.
Between patients with bronchitis and unaffected dogs - what was there significance in evaluating the bronchial wall: pulmonary arterial ratio?
Accuracy of a CT bronchial wall thickness to PA diameter ratio for assessing bronchial wall thickening in dogs. VRU 56.3
Dogs with bronchitis - had a higher ratio (>0.6 in cranial lungs) in both the cranial and caudal lung lobes
Cranial had significantly higher ratio than the caudal lungs in both groups
Bronchitis dogs had significantly greater ratios in both cranial and caudal lungs. But the difference in the cranial was greater than the caudal.
How may pulmonary hypertension affect the bronchial wall thickness; pulmonary arterial diameter ratio?
Accuracy of a CT bronchial wall thickness to PA diameter ratio for assessing bronchial wall thickening in dogs. VRU 56.3
Pulmonary hypertension may lead to a decreased ratio due to enlargement of the pulmonary arteries. Needs more studies
Using the ratio of bronchial wall: pulmonary artery ratio of 0.6 - resulted in a sensitivity and specificity and NPV/PPV of…
Accuracy of a CT bronchial wall thickness to PA diameter ratio for assessing bronchial wall thickening in dogs. VRU 56.3
Sensitivity - 77% -
Specificity - 100% - no false positives
Positive predictive value - 100%
Negative predictive value - 95%
What are differentials for right sided cardiomegaly, enlargement of MPA, and dilation of pulmonary arteries?
Imaging diagnosis - multiomodality findings in an adult dog with primary sarcoma of PA and myocardial metastases. VRU Pre-published 2016
Pulmonary hypertension: Heartworm, TE disease, neoplasia of pulmonary artery, DIC, lungworm, Cushing’s, pancreatitis
Differentials for a diffuse unstructured bronchointerstitial pattern in the lungs?
Imaging diagnosis - multimodality findings in an adult dog with primary sarcoma of PA and myocardial metastases. VRU Pre-published 2016
Aging change, fibrosis secondary to chronic insult, diffuse metastases, bronchopneumonia, TE diseae, ischemia
Where does the bronchoesophageal artery originate?
Imaging diagnosis - multimodality findings in an adult dog with primary sarcoma of PA and myocardial metastases. VRU Pre-published 2016
5th intercostal space
Differentials for Pulmonary artery neopalsia?
Imaging diagnosis - multimodality findings in an adult dog with primary sarcoma of PA and myocardial metastases. VRU Pre-published 2016
hemangiosarcoma
leiomyosarcoma
chondrosarcoma
hamartoma
