Ch 4 Thorax Flashcards
Which normal artifacts does lung provide on US?
reverberation
dirty shadowing
Which large mediastinal vessels are visible using a right intercostal approach?
brachiocephalic veins (L and R)
cranial vena cava
brachiocephalic trunk
7y elkhound with previous thymoma surgery in cranial mediastinum.
What is the ‘sign’ of the mass, and the diagnosis?
extrapleural sign (convex, broad-based mass displacing the normal lung)
This was a metastasis of the previous thymoma.
What is an extrapleural sign?
Displacement of the lung by a broad-based extrapleural mass with an obtuse angle with the thoracic wall
Which ‘sign’ would not be present with pneumothorax on US, but present with normal lung air?
glide sign
DDx for cranial mediastinal masses
Branchial cyst
Hematoma
Abscess
Neoplasia (lymphoma, thymoma)
Granuloma
Lymphadenomegaly
Fat
9y cat
cyst, incidental
A-B: 4y cat
C-D: 7y dog
cranial mediastinal lymphoma
12y cat
thymoma
Name an infectious cause of this appearance in a cat
Cryptococcosis
Ddx for this tracheal appearance in a 4y cat
Tracheal wall thickening caused by eosinophilic airway disease
chronic pleuritis with pleural fluid and atelectasis
- Hyperechoic linear strands (thin arrows) are visible within the fluid, consistent with pleural adhesions or fibrin strands and indicative of chronicity. The visceral pleura is also thickened (arrowheads). The superficial parietal pleura (arrows) is irregularly thickened, irregular, and hypoechoic. The vis- ceral pleura of the left caudal lung lobe is also markedly thickened (arrowheads).
Differential diagnoses for
cranial mediastinal masses:
- branchial cysts,
- lymphadenomegaly,
- neoplasms (e.g., lymphoma or thymoma),
- inflammatory/infectious lesions (abscesses or
- granulomas e.g. cryptococcosis),
- hematomas.
Fat accumulation may be confused with an infiltrative tumor; however, it usually does not distort the mediastinal vessels or lymph nodes.
Cranial mediastinal cysts are an occasional incidental finding in cats - true or false?
true (Zekas and Adams 2002)
9y cat
cranial mediastinal cyst, often well circumscribed, thin-walled, and filled with anechoic fluid
Which cranial mediastinal neoplasia more commonly has a cystic component?
Cranial mediastinal lymphomas tend to appear as solid masses, while thymomas more commonly have a cystic component (Tidwell 1998). However, cranial mediastinal masses cannot be dif- ferentiated based solely on their ultrasonographic appearance, and histopathology or cytology is needed to assess the nature of the lesion.
heart base mass in small breed dog - cytology suggestive of neuroendocrine
A: Consolidation.he affected portion (arrows) is hypoechoic when compared with the normally aerated, hyperechoic lung portion (L). The lung lobe retains its normal size, shape, and contour.
B: Atelectasis. The lung is collapsed because of pleural effusion (PE). The affected lung lobe is significantly reduced in volume (arrows). Occasional hyperechoic foci within the collapsed lung lobe are consistent with a small amount of residual air. The reverberating interface of the contralateral air-filled lung is seen in the far field
The peripheral portion of the lung lobe is hypoechoic, and dispersed hyperechoic foci in the central portion are associated with reverberation artifacts, consistent with gas (G). This pattern is commonly encountered with lung-lobe torsion. A fluid-filled bronchus (fluid bronchogram) appears in the apex of this lobe (B)
Lung-lobe torsion in a small-breed dog. A, B: Ultrasonographic images of different portions of the right cranial lung lobe, which appears “hepatized” and enlarged (arrows). The lobe is diffusely and mildly echogenic and presents dispersed hyperechoic foci that were consistent with gas. When color Doppler is used (B), there is no evidence of any vascular flow. A small volume of hypoechoic pleural effusion (PE) is also apparent around the lobe.
Lung masses or nodules are easily identified as pulmonary in origin when they move with the rest of the lung during res- piration. However, this feature is not observed in cases of _________________.
pleural adhesions
Pulmonary metastases may be recognized as____________ distributed, round, _____echoic nodules moving with the aerated lung.
peripherally
hypo
what echogenicity would you expecty for this metastatic nodule (sarcoma)?
hypoechoic
before (a) and 6 days after (b/c) BAL
hematoma
