DI Quiz 2 Flashcards
What tissue opacity is labeled “1”?
Fat -in the pericardial sac
Label image
Label the image
What is the diagnostic imaging modality of choice to look for signs of left-sided heart failure (cardiogenic pulmonary edema) in the dog?
thoracic rads (always take rads 1st)
This image is showing what?
pericardial fat
This CT image is pointing to
pericardial fat
Conspicuity of cranial lobe vessels is better in ____ lateral
left
name the vessels
left and right side vessels seen distinctly in L lateral
they are superimposed in R lateral
Dilation is more _____ than hypertrophy.
conspicuous (visible)
hypertrophy occurs at expense of lumen volume
Ventricular hypertrophy can be seen sometimes, but it depends on
the degree. Appearance is nonspecific- more specific than for dilation
need echocardiogram for characterization
Ventricular Hypertrophy: right versus left
- Left
- rads of little value
- Right
- increased sternal contact
- elevation of apex from sternum
- backward “D”
- causes:
- pulmonic stenosis- congenital
- heartworm dz
These rads are an example of
ventricular hypertrophy
Ventricular dilation can be seen sometimes, but depends on the
degree.
appearance is nonspecfic
need echocardiogram for characterization
The Vertebral Heart Score (VHS
Changes due to dilation in VD/DV
- Right ventricle
- Left ventricle
- Left auricle
- MPA
Right atrial dilation
- very rare as an isloated abnormality
- tricuspid dysplasia
- common in combo with other abnormalities
- appearance is nonspecific
- need echo for characterization
Left atrial dilation
- Common
- mitral valve disease
- most common heart dz you will see
- Fairly specific
- we are going to cover in detail
- Echocardiogram still better for complete characterization- can confirm and grade it
What does this image show?
What does this image show?
What does this image show?
What does this image show?
double wall sign
Left Atrium dilation
Large ____ causes splaying of main stem bronchi
Left atrium
What does this image show?
enlarged left atrium
Caudal vena cava changes normally with _____
respiration
very rarely is an important structure
Aortic arch
enlarges in congenital aortic stenosis
not a common problem
geriatric changes in cats very common
mineralization of aortic bulb in dogs
Main pulmonary artery
enlarges commonly in heartworm disease
also pulmonic stenosis- not that common
What is the arrow pointing at?
kink- incidental
tortuous aorta: geriatric cat
NOT significant
What is the arrow pointing to?
Aortic bulb mineralization
What is the arrow pointing to?
main pulmonary artery
MPA
If radiographs are characterized by low sensitivity and specifity, why bother?
a global view is obtained
pulmonary vessels can be assessed
What clinical sign does heart failure present with?
coughing
Pulmonary vessels in lateral view
veins are ventral to arteries
Pulmonary vessels in VD/DV view
veins are medial to the arteries
Rule of thumb: in DV view, vessels should be be _____ compared to the 9th rib at their point of intersection
the same size
Pumonary Vein > artery
venous hypertension
mitral valve
Pulmonary Artery > vein
pulmonary hypertension
heartworms, pulmonary fibrosis
Pulmonary Artery & vein increased
shunt: L to R
fluid overload
fluid retention
Pulmonary Artery & vein decreased
dehydration
decreased right ventricle output
Does this show vessel enlargement?
Does this show vessel enlargement?
Does this show vessel enlargement?
Which sided heart failure is more common?
left sided
mitral valve degeneration
cardiomyopathy
Pulmonary edema with left heart failure
- patterns depends on stage & tx
- interstitial
- difficulat to dx
- bronchial
- con confuse with inflammatory dz
- alveolar
- expected pattern
- interstitial
Lungs always look more opaque in what view?
lateral rads
Veins may not be enlarged with left heart failure because of
prior diuretic therapy
This patient has?
What do these rads show?
What is seen in the rad?
A diffuse bronchial pattern often seen in cats
donuts- asthma
What does this rad show?
cat with pleural effusion
What does this rad show?
dilated cardiomyopathy
In dilated cardiomyopathy, cardiogenic pulmonary edema has an airway pattern that can easily be confused with _______
inflammatory lung disease
In dilated cardiomyopathy, enlarged arteries AND veins are common due to
fluid retention
What is wrong with this heart?
enlarged- pericardial effusion
T/F: radiographic findings are sensitive and specific with regard to cardiac evaluation
FALSE: NOT sensitive or specific
(except for LA dilation)
Pericardial effusion
cardiac silhouette eventually becomes round
will be a phase where it is not round in all views
Underlying causes of pericardial effusion
- metabolic
- uremia
- neoplastic
- pericardial
- cardiac
- inflammatory
- trauma
- blunt trauma
- LA split
- idiopathic- most common but we need to rule out everything else
Whats abnormal with this rad?
rounded heart from pericardial effusion
trachea is pushed dorsal
What is abnormal with this rad?
rounded heart from pericardial effusion
What does X show in this ultrasound?
pericardial effusion
PPDH- peritoneal pericardial diaphragmatic hernia
- anatomic defect b/t peritoneal and pericardial cavities allowing migration of organs
- many animals free of associated signs
- radiographic signs
- enlarged and globular cardiac silhouettes with diaphragm
- opacity of cardiac silhouette often heterogeneous
- anomalous number of sternebrae
What is the abnormality seen in this rad?
PPDH
What is the abnormality seen in this rad?
PPDH
B. Right Pulmonary Artery
D. 2-3 o clock
Osteoblasts are responsible for
bone development and synthesis of osteoid
Osteoclasts are responsible for
bone resorption
break down bone
Approx ___ days b/t osteoid formation and mineralization
12-15
As an osteoblast expends capability for osteoid, it is renamed _____
osteocytes
Main functions of skeletal system
support
protection
movement facilitation
mineral storage
storage of hematopoietic tissue
lipid storage- for energy
Label bone terminology
Articular cartilage is the growth center for _____
epiphysis
Physis (epiphyseal plate) is the growth center for ______
diaphysis
______: secondary center of bone formation that provides a point for muscle attachement
Apophysis
Examples of predilection sites
Osteoprogenitor cells also found in endosteum and periosteum, What do they do?
- responsible for remodeling and growth of bone cortex
- remain active through life
- responsible for osteogenesis during fracture repair
Mesenchymal progenitors differentiate into _____
fibrous tissue
undergoes further differentiation into osteoblasts
occurs in flat bones of skull
Metatarsal sequestrum: caused by disruption of periosteal blood supply (eg. wire cut) with subsequent necrosis due to poor communication with endosteal blood supply
bone blood supply
major artery enters through nutrient foramen
can be confused with a fracture
Wolffs law
bone will respond to the stresses or strains placed (or not placed) on it
Osteochondritis Dissecans (OCD) results from
failure of endochondral ossification
-common in young, rapidly growing large breed dogs
Dog predilection sites for OCD:
Caudal humeral head
medial humeral condyle
lateral and medial femoral condyle
lateral and medial trochlea of talus -medial much more common
Does osteochondrosis (OC) happen in cats?
not common
Radiographic signs of OC/OCD
flattening or concavity of subchondral bone
adjacent sclerosis
+/- mineralized flap
What is the abnormality?
bilateral OCD
(image of shoulder joint w/ flattening of caudal humeral head)
Any abnormalities?
What are joint mice?
necrotic cartilage breaks free
can attach to synovium and become vascularized
watch out for caudal circumflex humeral vessels
What do we have to be careful about with joint mice?
make sure its not blood vessels! this is a blood vessel head on
What abnormality is detected?
joint mice
What is the arrow pointing out?
distal femoral osteochondrosis
What is the arrow pointing out?
distal humeral osteochondrosis
Dysplasia= the failure to
develop properly
Elbow dysplasia
- triad of developmental lesions
- ununited anconeal process (ulna)
- fragmented medial coronoid process (ulna)
- osteochondrosis of humeral condyle
- current theory: related to joint incongruity
Ununited anconeal process
- probably due to incongruity and not a failure to unite
- really a fracture
What abnormality is pointed at?
ununited anconeal process
What abnormality is seen?
ununited anconeal process
large peice separated
Treatment of ununited anconeal process (UAP)
- medical management
- not as effective
- removal
- fixation & ulnar osteotomy* best choice
Fragmented medial coronoid process
very common
meduim/large breed dogs
signs as early as 4-6 months
coronoid fragment difficult to detect radiographically
CT is needed to Dx
Fragmented medial coronoid process radiographic signs
- new bone formation on proximal aspect of anconeal process
What do the arrows indicate?
new bone formation
fractured medial coronoid process
(joint incongruity)
Abnormality seen?
What lesion is seen?
fragmented medial coronoid process that caused “kissing” lesion on medial aspect of humeral condyle secondary to FCP
What lesion is seen?
Panosteitis
- self limiting dz of large breed dogs
- 5-12months
- CS- weeks to months
- shifting leg lameness
- etiology unknown
Panosteitis radiographic signs
- increased medullary opacity
- begining as nodular then becoming diffuse
- lesion often begins at nutrient foramen
- smooth, continuous periosteal new bone occur in a minority of patients
- cortical thickening can persist - remodeling
What abnormality is seen?
smooth periosteal reaction
(can do spontaneous resolution)
Who does Hypertrophic Osteodystrophy effect?
- not common, developmental systemic dz of rapidly growing young dogs
- 7 weeks- 8 months
- large/giant breed dogs: great danes, boxer, german shepard, irish setter, weimaraner (inherited?)
- weimaraner- only breed where entire litter affected
Hypertrophic Osteodystrophy Clinical Signs
mild self-limiting disease to servere multisystemic, life-threatening illness
pyrexia
malaise
pain + swelling over metaphyseal region
lameness
Hypertrophic Osteodystrophy Radiographic signs
- begins in metaphysis of tubular bones
- “double physis” sign
- radiolucent line in metaphysis adjacent and parallel to physis
- radiographs may go from normal to abnormal in 48hrs
- advanced stages
- irregular periosteal new bone formation along metaphysis
- physeal closure or retarded growth
What abnormality is seen here?
development of “double physis” sign
Hypertrophic Osteodystrophy
What is the abnormality?
Hypertrophic Osteodystrophy
“double physis”
Treatment of Hypertrophic Osteodystrophy
since the cause is unknown, tx is supportive
corticosteroids are more effective than NSAIDs
-suggests immune suppression may be important
Fragmented medial coronoid process
Aseptic Necrosis of Femoral head
- adolescent toy and small breed dogs
- compromised blood supply to femoral head causes bone necrosis while overlying cartilage continues to grow
- revascularization will occur
- phagocytosis of necrotic bone during healing results in decreased opacity
- incomplete removal of necrotic bone and invasion of granulation tissue interferes with healing
- bone is weak and subject to microfracture
Aseptic Necrosis of Femoral head Radiographic signs
- varies with stage and duration
- lysis of femoral head/neck
- widening of joint space due to hyperplastic cartilage
- microfracture and deformation of femoral head
- secondary DJD and muscle atrophy
Whats the abnormality?
Aseptic necrosis of the femoral head
Cat that jumped off the bed. What is this called?
Spontaneous capital physis fracture in cats
Tibial Crest Avulsion
- the normal tibial crest appearance in young dogs is commonly misinterpreted as an avulsion
- important to be familiar with normal appearance and abnormal to distinguish
Tibial crest. Avulsion present?
NORMAL
Tibial crest. Avulsion present?
Avulsion present
Incomplete Humeral Condyle Ossification is common in what breed? what are they at risk for?
spaniels
at risk for fractures in both condyles******
with this condition, the humeral condyle fails to fuse and thus can lead to intracondylar fractures of the humerus (splitting in the middle aka Salter Harris type IV fracture through metaphysis, physis & epiphysis) you would also want to x ray both limbs bc it occurs bilaterally
Causes of aggressive bone lesion
Neoplasia and infection most common
- cant tell apart on images
- using signalment, hx, CS, and lesion distribution, one can be given preference, but not definitively
Aggressive Vs Non-aggressive lesion
Aggressive: cortical destruction, periosteal reaction (irregular), no distinct border/transition. Aspirate or biopsy, thoracic rads
Non-aggressive: distinct transition/border, none or smooth periosteal reaction, no cortical destruction. Wait? can be risky
NOTE: only ONE feature of aggressiveness needed
Cortex Destruction present?
YES
Cortex Destruction present?
No, cortex is affected but is still there
How many views are needed to assess the cortex?
2
What is this an example of?
Periosteal Reaction
Irregular = Active
What is this an example of?
Periosteal reaction
Smooth = Inactive
Transition Zone/Border present?
Indistinct
Transition Zone/ Border present?
Distinct
NO
cortex is moved, smooth, see transition zone
Yes
irregular, no border
Yes
no border
Yes
no cortex edge
Lesion present?
Yes, aggressive
Lesion present?
Yes, aggressive- irregular
Most common primary bone tumor
osteosarcoma
monostatic & metaphyseal
large & giant breeds
favorite sites: toward stifle, away from elbow
Radiographic features of primary bone tumor
aggressive bone lesion
can be lytic, blastic, or mixed
Blastic
more bone
more opaque… radiopaque = whiteness
osteoblastic, sclerotic
Lytic
less bone
less opaque… radiolucent = blackness
osteolytic, dectructive
Types of primary bone tumors. Label them
Fungal Osteomyelitis
can mimic primary bone tumor, but often polystotic
Is this lesion aggressive? What is our next step?
aggressive, send out for testing
came back as apergillosis
Humerus and femur both have lesions. What is our next step?
sample/test
Coccidoidomycosis
Hematogenous bacterial osteomyelitis is ____ in dogs in cants
VERY rare
Nail Bed Lesions
- Subungual tumor
- squamous cell carcinoma
- large breed dogs with black coats
- standard poodle, labrador retriever
- may be multiple
- large breed dogs with black coats
- malignant melanoma
- squamous cell carcinoma
- Pododermatitis
need to sample/test!! to differentiate
Hematogenous Metastasis
not common
distrubution in skeleton variable- axial involvement common
usually an epitheial primary
osteosarcoma least likely- because 2 lesions
Why is digital adjustment important?
can reveal fractures/ things not seen otherwise
Name 3 things confused with fractures
nutrient foramen
normal physis
sesamoid bones
What type of fracture is this?
transverse
What type of fracture is this?
oblique
What type of fracture is this?
comminnuted
What kind of fracture is this?
incomplete
What kind of fracture is this?
spiral
Salter Harris
- Physeal fracture classification system
- applies only to skeletally immature patients
- as grade increases, chance of physeal growth perturbation increases
- chance of secondary growth anomaly much higher with type V than with any other type
Grade the fractures
LOW
almost zero
Pathologic fractures are seen in weakened bone from diseases like…
hypoparathyroidism- demineralization
cancer
fractures occur secondary to an event that would not normally lead to fracture; jumping off bed
Luxation vs Subluxation
Luxation: dislocation of an anatomic part
Subluxation: partial dislocation of an anatomic part- may require stress views to demonstrate full extent of instability
What is this an example of?
luxation
What is this an example of?
subluxation
What does this stress view indicate?
Gap in tarsal joint- needs sx
Bone healing stages
Primary Fracture Healing
rigid fixation
direct bone contact- minimal fracture gap
Secondary Fracture Healing
- motion or distraction of fragments
- callus formation
- fibrocartilage stabilizes the fracture
- ossification of callus then bony union
- callus will diminish as stability returns
30-45 days to see callus on rads
Normal callus appearance
should be smooth and nonaggressive (inactive)
Factors that influence fracture healing
vascular integrity
fracture location
extent of fracture
apposition
degree of motion
Vascular integrity
perfusion not evaluated radiographically
perfusion diminishes as soft tissue injury increases
nutrients going into the bones/tissues to heal
tiny fragments/shot gun pellets prolong healing because of increased tissue/vascular damage
Distal antebrachium fractures in toy breeds…
heal slowly and have a high complication rate
(chihuahuas are disasters waiting to happen)
Degree of motion
callus does not bridge
may result in a delayed or non union
-no healing if too much motion
just fine
Malunion
the bone healed in an abnormal position
this is a problem in humans, in animals we are happy it healed
Delayed union
fracture has not healed in the time expected
Nonunion
all fracture healing has stopped and fragments have not united
What is this an example of?
malunion
femur is crooked
can predispose to DJD******
What is this an example of?
taken 3 months later
delayed union
dont give up, damage causes slow healing
What is this an example of?
nonunion
fracture ends are round and sclerotic
this wont heal
Osteomyelitis
infection of the bone
- hematogenous bacterial osteomyelitis very rare in dogs and cats
- usually the result of a wound or fracture (open fractures)
- an aggressive bone… not normal callus
- irregular periosteal reaction is a key finding
- sometimes lysis around implants
Fracture complications
Physeal growth abnormalities
young animals prior to physeal closure
usually result of type V injury
most common in antebrachium- distal radial and/or ulnar physes
Insufficient Ulnar Growth
Distal ulnar physis susceptible to type V
conical shape
ulnar retardation leads to radius being “trapped”
What is the abnormality?
Insufficient Ulnar Growth
Valgus deformity
bows and twists away from midline
Insufficient Ulnar Growth results in one or more of which
humeroulnar subluxation
bowed radius
valgus of manus
What can correct early humeroulnar subluxation?
Ulnar osteoctomy
Radial closure
not as common as ulnar closure
humeroradial subluxation
-ulna pushes humerus away from radius
+/- varus manus
Tx: more complicated, effective if caught early
Degenerative joint disease (DJD) aka Osteoarthritis (OA)
radiographic signs
What are the signs of joint effusion show in the second rad?
_fluid in the joint pushes the infrapatellar fat pad cranially and caudally displaces the fascial stripe******_
What is this rad showing?
periarticular cyst like lesions
advanced DJD begins to look aggressive… may be confused with tumor or infection
usually are co-existing signs of DJD
femoral head looks like a mushroom
Is hip dysplasia present?
yes
T/F: A tear of the cranial cruciate ligament can be dx using rads
false
can only see secondary signs
Erosive Arthropathy
hyperplastic synovium from immune-mediated cause results in subchondral cysts
-rheumatoid arthropathy
usually small breeds
usually distal joints
Thoughts?
tap and culture joint
may be septic arthritis
Meniscal ossicles in cats
small mineralized opacities in feline stifle joints
found to be mineralization in meniscus
- usually medial
- leads to cartilage erosion on medical condyle of femur due to mechanical interference
Rads of a cat. What is circled?
meniscal ossicles
What is abnormal in these cat rads?
meniscal ossicles
Canine hip dysplasia
inherited debilitating coxofemoral dysplasia
primarily large dogs
inherited but phenotypic changes not present at birth
- subluxation early
- osteoarthritis later
Problems with selective breeding for dogs without hip dysplasia
Normal hip Vs one with hip dysplasia on rads
What is the earliest radiographic sign of canine hip dysplasia?
joint laxity
Hip dysplasia detected?
No, normal
What abnormality?
very lax joint
source of pain, limits function
laxity leads to osteoarthritis
Signs of severe OA
OFA method
- extended leg VD view of pelvis
- good for detecting secondary OA, not good for joint laxity
- twisting of joint capsule tends to force femoral head into acetabulum- may cause us to underestimate joint laxity
- rads scored by 3 board certified radiologists
- grading system: excellent, good, fair, borderline, mild, moderate, severe
- dogs cannot be certified until they are 24 months/2yrs
- any vet can submit rads to OFA
PennHIP method
- position unique to PennHip
- does not place torque on joint capsule
- a fulcrum b/t the thighs allows operator to apply lateral force to the hip
- images are interpreted by AIS
- can be done early as 4 months
- technique allows quantification of joint instability, not OA
- Distraction index is calculated
- radiographer must be certified by AIS- online training
DI > 0.3 is associated with
significant incidence of DJD
higher the DI, the higher chance of developing osteoarthritis
What method is more reliable? OFA or PennHip
PennHip
genetic testing would be even more reliable
excellent
no subluxation
mild, moderate, severe
less than half head under dorsal rim
joint is lax
osteoarthritis subluxation
see morgan line
mild, moderate, severe
too young to certify
subluxation, morgan hair, mushroom cap
What do we need to do in order to get good spinal rads?
deep sedation or anesthesia, except in HBC
To compensate for beam divergence, what can we do to get good spinal rads?
make multiple exposures (5-6)
Algorithm for pain/neuropathy
___ is the most common cause of spinal pain/neuropathy you will see in practice
Disc Disease
prompt recognition of problem and appropriate action are keys to success
What are the arrows showing?
mineralized discs
degenerate discs
subject to herniation
Type I disc disease
-
acute herniation of degenerate nuclear material into vertebral canal with spinal cord compression & possible spinal cord injury
- usually mineralized
- typical chonrodystrophic dogs
- dachshund is poster child
- acute pain, paresis, paralysis
- survey radiographs not sensitive or specific
- rare between T2-T9 because of intercapital ligament, but it does occur (german shepards still get it)
Type II Disc Disease
-
chronic annulus/nucleus protrusion into vertebral canal with spinal cord compression
- disc is degenerate
- typically large dogs
- chronic progressive neuropathy
- survey rads not sensitive or specific
T/F: radiographs are valuable when diagnosing Type I or II disc disease
FALSe: of little value
findings are non-specific
should be done for screening
Non specific radiographic signs of disc disease
- vertebrae move closer together
- narrowed disc space
- narrow foramen
- narrow dorsal joint space
- material in vertebral canal
- can only see if mineralized
This dog has T3-L3 myelopathy and disc-related changes. Are these findings in the rad helpful?
these non-specific findings are not helpful
Whats the issue with using ribs are a landmark for vertebrae?
How to diagnose disc herniation
- Myelography
- injection of positive contrast medium into subarachnoid space
- useful but tedious
- being replaced by CT and MRI
- CT/MRI
- myelographic principles of value in interpreting CT and MRI studies
Where do we insert the myelogram contrast medium?
subarachnoid space
Classic lesion locations for disc disease
normal
extradural
intradural-extramedullary (subarachnoid space)
intramedullary
Extradural rule outs Vs location
disc
tumor
stenosis
abscess
hemorrhage
Intramedullary rule outs Vs location
edema- inflam
tumor
myelitis
Intradural-extramedullary rule outs Vs location
tumor (nerve root)
Lesion location?
extradural- collapsed disc space
(central deviation of contrast medium)
Lesion?
Osteophytic articular processes causing extradural spinal cord compression
Lesion?
Intradural-extramedullary
lesion is in subarachnoid space, creating filling
Problems with myelography
CT detection of disc herniation
fast and non-invasive
specific
disc material must be mineralized
cannot assess spinal cord injury
slices acquired throughout region of potential herniation, ex: T2-L3
**** if lesion suspected in T2-L3 you need to image T2-L3 ****
MRI Detection of Disc Herniation
quick, longer than CT
more sensitive than CT since detection not based on mineralization
able to assess integrity of spinal cord
the best test
cost vs value
(MRI looks for increased water lesions)
T2 image
water and fat have high signal
ANNPE- Acute Non-compressive nucleus pulposus extrusion
AKA missile disc
disc explodes out, normally hydrated
acute herniation of hydrated nucleus
no mass in vertebrae canal
spinal cord swelling
spinal cord “bruise”- hemorrhage/inflam: visible with MRI
rads, myelography or CT will NOT be helpful here
Spondylosis
very common, acquired
new bone proliferation originating from ventral aspect of vertebral body, near endplate
associated with annular degeneration and tearing
usually not important clinically, except at L7-S1
5 year old poodle that is an indoor-outdoor dog. Over 10 days the dog developed lameness. What is the most likely dx?
infection
(periosteal rxn in picture)
A 10 year old poodle, which the owner has had its entire life, is presented with lameness after jumping off the bed. What dx is most likely?
pathological fracture- radiograph of the coxofemoral joints; you could presume this bc of history- should fracture from jumping off bed
A cat presented with spontaneous femoral capital physis fracture. What are the risk factors?
overweight, neurtered male, delayed physeal closure
(NOT from an all meat diet)
11 month old German shepard presented with lameness and pain. Increase opacity of medullary cavity in most of the ulna and diaphysis of radius. What disease is likely?
panosteitis
Image with bilateral necrotic femoral heads
avascular necrosis of the femoral head
Which of the following is NOT true about determining if a lesion is aggressive or not?
cortical destruction
indistinct transitional zone
irregular periosteal rxn
radiopaque and radiolucent
radiopaque and radiolucent- lysis and sclerosis dont tell you aggressiveness
If a 1.5 year old dog has OFA done and looks bad, do we have to wait until 2 yrs to officially say he has canine hip dysplasia?
this dog most likely has canine hip dysplasia and will have it for life
dont have to wait to dx
What is the cause?
extradural
(central deviation of contrast medium)
Will spondylosis cause severe pain?
no, further evaluate because there must be another cause
T/F: you can dx cranial cruciate teaers with radiographs
FALSE