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
What is the sensitivitiy of radiographs for detection of pneumothorax?
Sensitivity for bulla? (not a number)
Use of CT for evaluation of lung lesions associated with spontaneous pneumothorax in dogs - 12 cases JAVMA 228.5
100% sensitivity for detection of pneumothorax
Poor sensitivity for detection of bulla
Which imaging modality is more sensitive for detection of pulmonary bulla?
Use of CT for evaluation of lung lesions associated with spontaneous pneumothorax in dogs - 12 cases JAVMA 228.5
CT
Rads - Detected in 4/17 affected lobes
CT - 13/17 affected lobes
What is reason for missing bulla on CT?
Use of CT for evaluation of lung lesions associated with spontaneous pneumothorax in dogs - 12 cases JAVMA 228.5
Atelectasis
Reasoning for not seeing bulla on histopath, when they were clearly seen on CT?
Use of CT for evaluation of lung lesions associated with spontaneous pneumothorax in dogs - 12 cases JAVMA 228.5
Bleb or bulla may have collapsed after surgical removal
What is a way to better improve the likelihood of visualizing pulmonary bulla?
Use of CT for evaluation of lung lesions associated with spontaneous pneumothorax in dogs - 12 cases JAVMA 228.5
Continuous suction
What is non-selective angiography?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
Peripheral IV injection of contrast medium
What are disadvantages of non-selective aniography?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
superimposition artifacts
inadequate opacification due to dilution
What two categories of disease cannot be visualized with non-selective angiogrpahy?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
valvular insufficiency permitting retrograde flow of blood
left to right shunts at atrial, ventricular or PA levels
What is selective angiography?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
Positioning of the tip of a catheter into a specific chamber or vessel with aid of fluroscopy
What are normal systolic/diastolic pressures in each of the chambers and major vessels?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
systolc/diastole
Right atria: 0-5 Right ventricle: 15-25/0 PA: 15-25/5-15 Left atria: 0-5 Left ventricle: 120/0-10 Aorta: 120/80
When is a vena caval selective study useful?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
Heartbase or cranial mediastinal tumor - will often see dorsal and right sided displacement of hte CrVC
What diseases are you looking for with right atrial injection?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
atrial septal defect (right –> left)
right atrial tumor
tricuspid stenosis
What diseases are you looking for with right ventricular injection?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
Tricuspid insufficiency
pulmonic stenosis
ventricular septal defect with right to left shunt
heartworm
What would tricuspid insufficiency appear as on angiography?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
Contrast injected into right ventricle with regurgitation into right atria during systole
usually other changes: enlargement of right atrium
What would heartworms appear as on angiography?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
Dilated, tortuous pulmonary arteries with streaking int he ventricle and arteries due to presence of worms
tricuspid insufficiency can occur due to severe dilation of the right ventricle or mechanical interference from worm burden
What diseases would you be interested in if you were performing a PA angiography?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
Suspected pulmonic insufficiency
atrial or ventricular septal defect with left to right shunting
What disease would you be interested in if you were performing a left atrial angiography?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
Atrial septal defect (left to right)
mitral stenosis
left atrial thrombi or tumor
Which vessel are commonly used to perform a left sided selective angiography?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
Carotid artery
Or a trans-septal atrial puncture through jugular or femoral
What would you see in a dog with a left to right atrial septal defect?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
Appearance of contrast medium int he right atrium following left atrial injection
What diseases would you be looking for with a left ventricular angiography?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
Mitral insufficiency
Subaortic stenosis
Ventricular septal defects
What would you see with a mitral insufficiency on angiography?
Contrast medium injected into left ventricle and then immediately opacifies the left atrium
What could cause mitral insufficiency?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
1) congenital clefts or perforations
2) thickened leaflets that prevent perfect apposition
3) retracted, fibrotic or hypoplastic leaflets
4) greatly dilated orifice which can’t be occluded by normal leaflets
5) shortened chordae tendinae which prevent apposition
6) ruptured chordae tendinae that allows for reflux of leaflets into atrium
7) distortion of valve edges by tumors, blood, vegetations
What diseases are you looking for with an aortic injection angiography?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
Aortic insufficiency Spirocerca lupi infestations PDA Anomalous coronary vessels AV fistulas
What would aortic insufficiency look like on angiography?
Why would this occur?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
aortic root regurgitates through aortic valve and opacifies the left ventricle
Endocarditis is most common cause for aortic insufficiency
In theory, where should you select to inject contrast if you are worried about valvulra insufficiency?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
You should place catheter in the chamber from which the contrast medium would regurgitate (immediately downstream from the affected valve)
If you are worried about obstruction to blood flow - where should you place catheter for a contrast study?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
In the vessel or cardiac chamber immediately proximal (upstream) to the affected area.
In shunt dogs - where should you inject the contrast in a selective angiography?
Selective angiography and angiocardiography in dogs with acquired CV disease. Vet Rad 6.1
Depends.. do you suspect right to left or left to right?
Left to right (acyanotic dogs) - place in the left chamber at level of which you think the shunt is occurring
right to left (cyanotic dogs) - place in the right chamber
Congenital: What diseases are you looking for with a right atrial injection in a young patient?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
Atrial septal defect with right to left shunting
What normally occurs with an ASD? What is normal blood flow? where is optimal place to perform angiography?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
Left –> right
Best to place catheter within the left atrium
Will inject contrast and see the right atrium opacify before/same timeas the ventricle
When will an ASD reverse?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
When there is confounding changes. Also has pulmonic stenosis, tricuspid dysplasia.
Congenital: what diseases are being examined when injection is made into right ventricle?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
VSD (R–>L)
PS
What will you see with PS on angiography?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
Thickened right ventricle
Narrowed pulmonic valve area.
With an uncomplicated VSD - what would you expect to see? where would you inject contrast?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
Left –> right
Inject into left ventricle or PA
When/why would you see reversal of flow through a VSD?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
Development of pulmonary hypertension due to increased pulmonary vascular resistance (overload resulting in thickening of pulmonary arteries) with secondary right sided heart changes and increased pressures.
What are characteristics of tetralogy of fallot?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
pulmonic stenosis
PLUS 3 features of eisenmengers - right ventricular hypertrophy, vsd, over-riding aorta
What is hemodynamics of tetralogy?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
Increased pulmonary vascular resistance due to the PS resulting in thickened right sided changes
Right sided thickening results in increased pressure and right to left shunting.
Congenital:
What diseases are being evaluated when injection is made into PA?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
Pulmonic insufficiency
ASD/VSD - left to right shunt
Evaluate PA
What would you see with pulmonic insufficiency?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
Marked dilation of PA
regurgitant flow into the right ventricle
Congenital: what disease is being evaluated when injection is made into LA?
What will you see?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
ASD
Injection into LA –> RA at the same time as left atrium and ventricle
Congenital: what diseases are being evaluated when injection is made into the left ventricle?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
Mitral insufficiency
subaortic stenosis
VSD
What is seen with mitral insufficiency?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
contrast medium injected into left ventricle regurgitates into left atrium during ventricular systole
What is seen with subaortic stenosis on angiography?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
Left sided thickening
Post-stenotic dilation of the aorta
narrowed outflow tract, just below the leaflets
What are the anatomy and hemodynamics in an uncomplicated VSD?
complicated?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
Usually the defect is in the membranous portion of the septum (very dorsal in septal wall)
Bloods hunts from left ventricle into right ventricular outflow tract and MPA - get minimal changes to right heart
Complicated - with time, the increased bloodflow into the PA will result in thickening and increased vascular resistance leading to RV thickening and equilibrium of pressures and eventual reversal.
Congenital:
What diseases are being evaluated when contrast is injected into the aorta?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
Aortic insufficiency
PDA
What is seen on angiography with a PDA?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
Contrast injected into aorta will flow through the ductus into the MPA continuously
May not see the shunt, but will frequently see the dilation of the aorta
What are hemodynamics of a reverse PDA?
Selective angiography and angiocardiography in dogs with congenital CV disease Vet Rad 6.1
Normally - blood is shunted from aorta into MPA continuously (during both systole and diastole). Eventually this increased volume of fluid within the lungs will lead to an increase in pulmonary resistance as well as in MPA and right ventricle.
Eventually, this will lead to a reversal of flow through the shunt with blood going from MPA –> Aorta
What are radiographic changes seen with aelurostrongylus infection in cats?
CT, radiography, and echo findings in cats naturally infected with Aelurostrongylus abstrusus. JFMS Pre-published (2016)
Generalized structured, nodular interstitial pattern that blurred margins between lungs and airways
mixed bronchial lung pattern - multifocal thickening of bronchi
vascular inflammation and thrombosis
Criteria for pulmonary hypertension diagnosed by echocardiogram?
CT, radiography, and echo findings in cats naturally infected with Aelurostrongylus abstrusus. JFMS Pre-published (2016)
Right sided enlargement
Pulmonic insufficiency >2.2m/s
Tricuspid regurgitation velocity > 2.8m/s
What were common radiographic changes in cats with natural infections with Aelurostrongylus abstrusus?
CT, radiography, and echo findings in cats naturally infected with Aelurostrongylus abstrusus. JFMS Pre-published (2016)
Generalized unstrucutred interstitial pattern
bronchointerstitioalveolar infiltrate
bronchointerstitial pattern with thickened bronchial walls
Sternal lymphadenopathy in 6/14
What were CT findings inc ats with naturally infected Aelurostrongylus abstrusus?
CT, radiography, and echo findings in cats naturally infected with Aelurostrongylus abstrusus. JFMS Pre-published (2016)
bronchointerstitioalveolar infiltrates with ground glass
interstitioalveolar with multiple pulmonary nodules
interstitial ground glass
Thoracic lymph node enlargement in 11/14 (more than what was seen on radiographs)
subpleural thickening in 4/14 (not seen on any cat on rads)
No evidence of vascular thrombosis
How many cats had evidence of pulmonary hypertension on echocardiography?
CT, radiography, and echo findings in cats naturally infected with Aelurostrongylus abstrusus. JFMS Pre-published (2016)
None
Other differentials for changes in a cat with aelurostrongylus?
CT, radiography, and echo findings in cats naturally infected with Aelurostrongylus abstrusus. JFMS Pre-published (2016)
pulmonary fibrosis, pulmonary edema, fungal disease, asthma, neoplasms, other parasitic disease (heartworm, toxocara)
What is cutoff for inflammatory vs neoplastic lymph node changes on CT?
What other criteria may make you think metastatic disease over inflammatory?
CT, radiography, and echo findings in cats naturally infected with Aelurostrongylus abstrusus. JFMS Pre-published (2016)
> 12mm - 86% sensitive and 95% specific for metastatic disease
rim enhancement
What are the two most common causes of congenital lobar emphysema most commonly secondary to?
ID: congenital lobar emphysema in an English Sheepdog puppy. VRU
Idiopathic
Hypoplasia of bronchial cartilage during development
What is the pathophysiology behind congenital lobar emphysema?
ID: congenital lobar emphysema in an English Sheepdog puppy. VRU
Cartilage defects that result in air trapping from dynamic bronchial collapse during expiration
Differentials for underlying causes for congenital lobar emphysema?
ID: congenital lobar emphysema in an English Sheepdog puppy. VRU 52.1
idiopathic, bronchial cartilage hypoplasia, intraluminal bronchial obstruction, extraluminal bronchial compression
What lung lobes are most commonly affected with congenital lobar emphysema?
ID: congenital lobar emphysema in an English Sheepdog puppy. VRU 52.1
Right middle
Left cranial
Differentials for an enlarged, hyperlucent lung?
Imaging diagnosis – congenital lobar emphysema in a dog VRU 52.1.
Congenital lobar emphysema, bullae emphysema, bronchial obstruction due to intraluminal foreign material, extraluminal compression or lung lobe torsion
What does a ground glass opacity look like on CT?
Imaging diagnosis – congenital lobar emphysema in a dog VRU 52.1
Hazy, increased parenchyma attenuation with preservation of bronchial and vascular markings.
DDx for ground glass opacity on CT?
Imaging diagnosis – congenital lobar emphysema in a dog VRU 52.1
fibrosis, interstitial pneumonia, interstitial inflammation, pulmonary edema (cardiogenic or non-cardiogenic), hemorrhage
Causes of spontaneous pneumothorax
Pulmonary abscess, neoplasia, HW, bacterial pneumonia, bullae or blebs, trauma
