Exam 1 material Flashcards
(176 cards)
1
Q
Positioning for a chest rad
A
Pull legs!
Manubrium to last rib = lateral and VD
2
Q
Chest rads, when do we want to make the exposure?
A
INSPIRATION
more air in the lungs will make better contrast
3
Q
For chest rads we need ____ contrast image.
This means ___mAs and ____kVp for film
A
LOW contrast
low mAs, high kVp
(motion is an issue so low time)
4
Q
“abnormal” usually means…
A
increased opacity
5
Q
Non-pathological things that lead to increased lung opacity
A
- radiographic technique: underexposed/low contrast
- Aeration: Atelectasis is bad
- lungs always look worse in lateral views
- sedation leads to atelectasis
- Habitus: overlying tissue increases opacity in image
6
Q
Issue with lateral rads and lungs
A
the increased opacity in the “down” lung reduces lesion conspicuity in the dependent hemithorax (silhoutte sign)
Recumbent atelectasis occurs quickly, increases with chemical restraint. PPV when anesthetized. ALWAYS make R and L lat rads. Both VD and DV good too
7
Q
Checklist for looking over thoracic rads
A
heart
pulmonary vessels
lungs
pleural space
mediastinum
trachea
bones
8
Q
Label anatomy of the diaphragm
A
A- crus/crura
B- dome
9
Q
Crura attach to the ventral aspect of ____ and cause confusion why?
A
L3 and L4
create an indistict cortex that is sometimes confused with an aggressive lesion
10
Q
Label the diaphragm anatomy
A
A- aorta
B- esophagus
C- caudal vena cava
11
Q
What helps us determine L or R lateral view?
A
The most dependent (down) crus is USUALLY more cranial
does not work in all dogs, not in cats
12
Q
What side is this dog laying on?
A
Right lateral
R crus is more cranial
CVC attaches to R crus
therefore CVC blends with most cranial crus
13
Q
What side is this dog laying on?
A
Left Lateral
L crus more cranial
CVC by passes the most cranial crus and attaches to more caudal crus
R and L crus are more divergent
Fundus of stomach caudal to L crus
14
Q
Label the lateral views R or L
A
15
Q
Acquired Diaphragmatic Hernias
A
- abdominal viscera protrudes thru the diaphragm (compress lungs)
- most common cause: trauma
- may or may not result in CS
- may have concurrent pleural fluid
- not easy to dx
- US-experts, Barium study*
- remove pleural fluid if present by thoracocentesis and repeat rads
16
Q
Traumatic Diaphragmatic Hernia
A
- border effacement of diaphragm = siloutte signs
- abdominal viscera in pleural space
- abnormal location of abdominal structures
17
Q
A
Pylorus displaced to the left and cranially
HBC, cat- Hernia
18
Q
Anything abnormal?
A
19
Q
What does this barium study show us?
A
20
Q
Anything abnormal?
A
21
Q
What abnormalities are in this rad?
A
22
Q
Peritoneopericardial Diaphragmatic Hernia (PPDH)
A
- Abdominal viscera herniates into pericardial sac through a congential defect b/t ventral thorax and abdomen
- Sometimes associated with fewer than normal sternebrae
- Usually an incidental finding, rarely need to be corrected
- occasionally produces CS
- Round, enlarged, cardiac silhouette
- Heterogenous opacity if gas or large amount of fat present (fat=radiolucent)
- Confluent silhouette between heart and diaphragm
23
Q
What abnormality is seen?
A
PPDH- Peritoneopericardial diaphragmatic hernia
24
Q
What abnormality is seen?
A
PPDH- Peritoneopericardial diaphragmatic hernia
25
What does this CT reveal?
PPDH
26
Hiatal hernia
* What kind is more common?
* What view is better to see them?
* How can we confirm?
* Portion of fundus herniated through esophageal hiatus
* two types:
* **sliding** (more common in animals)
* paraesophageal
* Often manifests in patients with partial upper airway obstruction= brachycephalics
* Most common to see in **L lat view** but not in R lat or VD
* May have to give barium to confirm
27
What abnormality is seen here?
Hiatal Hernia
28
What lesions are often missed in the thoracic view?
RIBS are often ignored
many rib lesions are missed
critical part of thoracic assessment
(fakeouts from superficial nodules)
29
Costal cartilages on radiographs
* Commonly mineralize
* even in young dogs
* Once mineralized (stiff) exuberant calcifications can form around the costochondral junction
* commonly confused with tumors, infection or lung nodules
30
What is detected in this radiograph?
Micro-fractures! No pain, no issue!
## Footnote
**NORMAL**
31
Skin Nodules
| (what priciple is this?)
* Can appear as lung nodules
* nodules are very distinct
* may need additoinal views
* can apply contrast medium to area and retake rad
## Footnote
**Superimposition**
32
Rib fractures
Rarely clinically significant
_can be spontaneous in cats (w/ dyspnea)_
healing pattern same as in long bones
33
Anything abnormal in these rads?
fractured ribs
34
Thoracic wall masses
35
What type of thoracic mass is this?
36
What type of thoracic mass is this?
37
Name the abnormality
38
Name the abnormality
Rib tumor
39
Name the abnormality
Rib tumor
40
Rib tumors
* usually late by the time the O brings P in
* Pleural effusion typically present
* Usually mesenchymal
* OSA vs CSA
* Caudal ribs
* Iceburg effect (see pic)
41
42
43
Mediastinum
* The space b/t right and left pleural sacs; bounded by mediastinal pleura
* Extends from thoracic inlet to diaphragm
* **NOT** a closed cavity
* communicates with neck and retroperitoneal space
* **_Fenestrated_**: usually does NOT contain unilateral dz
44
What number(s) show the mediastinum?
7- cranial mediastinum
8- caudal mediastinum
45
Name some structures located within the mediastinum
Heart
Vena cava
Esophagus
Aorta
Azygos vein
46
Mediastinal reflections
locations where the mediastinum deviates from the midline
47
Cranioventral mediastinal reflection
Border b/t right cranial lung lobe and the cranial part of the left cranial lobe
Cranially, the left lung extends to the right
Caudally, the right lung extends to left
48
What can be seen in this rad from a young dog?
49
Caudoventral mediastinal reflection
Border b/t the accessory lobe (R Lung) and the left caudal lobe (L lung)
the left aspect of the accessory lobe crosses midline pushing mediastinal pleura to the left
50
The thickness of the caudoventral mediastinal reflection depends on...
the amount of fat present
51
Mediastinal shift
* Atelectasis is the most common cause
* Displacement of heart is the most reliable sign
* Helps differentiate lung dz from atelectasis
* lung opacity, no heart shift = dz
* lung opacity, heart shift = atelectasis
52
Dz or atelectosis?
atelectosis
53
Common causes of mediastinal masses
* lymph nodes enlargement
* thymus enlargement
* esophagus enlargement
54
Mediastinal Lymph Nodes
1. Green
2. Blue
3. Red
1. Green: **Sternal**= drain abdomen\*\*
2. Blue: **Cranial Mediastinal**
3. Red: **Tracheobronchial**= lungs are drained by their (**Hilar** LNs)
55
Cranial mediastinal LN
thoracic wall, trachea, thyroid
56
Tracheobronchial LN
AKA Hilar LN
Drain Lungs
57
Sternal LN
Drain mammary glands and peritoneum
Peritoneal dz may cause sternal lymphadenopathy
58
How to Dx the cause of a mediastinal mass?
Rule outs can be narrowed based on location
sonography or CT
Usually need **cytology**
59
Describe abnormality
60
Cyst? Mass? Ultrasound!!!
Cyst is better px than mass
61
What abnormality is seen here?
Moderate Tracheobronchial Lymphomegaly
62
What abnormality is this?
Bow legged cowboy sign
Moderate Tracheobronchial Lymphomegaly
63
Confounding effect of pleural fluid
* prevents identification of mediastinal mass
* need to take additional steps
* drain fluid and re-radiograph bc fluid hides things
* US- fluid is our friend w/ US!
64
This radiograph of a cat shows?
Pleural fluid
65
Cat with pleural effusion had US of lungs done. What do we see?
soft tissue mass
66
Pneumomediastinum
What view?
* means air in the mediastinum
* mediastinal structures become more conspicuous due to contrast provided by mediastinal gas
* Structures not normally visible are seen
* Pneumomediastinum can progress to pneumothorax if distension is severe
* Pneumothorax will _not_ progress to pneumomediastinum
* **_LATERAL_** **_VIEW_** is the $$$ shot
67
Causes of pneumomediastinum
* Neck wound- dog fights
* Hole in trachea
* bite wound
* jugular vein puncture miss
* endotracheal tube cuff overinflation
* Retrograde flow along airways from intrapulmonary rupture= "_Macklin effect_"
68
What is abnormal about this chest rad?
Pneumomediastinum
69
What abnormality is seen in this rad?
Mild pneumomediastinum
not normal!
70
What abnormality is detected?
TRICK
its normal! :)
71
What abnormality is detected?
pneumomediastinum
72
Study on pneumomediastinum in cats: 45 cases
* anesthesia with PPV (pos pressure ventilation)
* trauma
* tracheal FB
recovery rate is good, but depends on cause
73
Mediastinal Fluid
NOT common- no pic for ex
Hemorrhage
Exudate: FIP, Esophageal rupture
74
Espohagus
* Is a conduit (tube) for ingesta
* Functional sphincter at both ends
* cranial- cricopharyngeal
* caudal- gastroesophageal
* Dorsal to trachea
* thus, enlargement causes **_ventral displacement of trachea_**
* _Normally not visible_ on survey radiographs
* Occasionally a small amount of gas or fluid
* usually not significant
75
What is seen in this radiograph?
Stripe sign!
76
Esophagram
* Valuble for assessing esophageal function and structure
* assessing function requires dynamic evaluation- fluoroscopy= looks at continuous motion!
* easy to assess structure
* Indications
* regurge
* dysphagia
* survey radiographic findings
* When to give what:
* esophagitis: scoping is better than esophagram
* location: barium paste
* stricture: barium + food
77
What is seen in this radiograph?
78
What is shown in this radiograph?
79
Canine Esophagram. Any abnormalities detected?
NORMAL
80
Feline Esophagram. Any abnormalities shown?
NORMAL
smooth muscle causes striations in caudal feline esophagus
it looks like a feather
81
Any abnormalities detected with the esophagus of this feline?
NORMAL
smooth muscles cause striations in caudal feline esophagus
82
Cricopharyngeal dysfunction
* swallowing disorder
* failure of the sphincter to relax
* asynchrony of pharynx contraction and sphincter relaxation
* unable to propel food from pharynx into esophagus
* need dynamic study to dx
* can lead to tracheal aspiration→ trachitis
83
Esophageal dysfunction
common side effect?
* Primary or secondary
* Usually leads to dilation (megaesophagus)
* segmental- congenital or acquired
* generalized- congenital or acquired
* **_Secondary aspiration pneumonia is common._..** always check for this
84
Congenital generalized megaesophagus
young dogs
idiopathic neuromuscular dysfunction (common)
85
Acquired generalized megaesophagus
* Idiopathic neuromuscular dysfunction (common)
* myasthenia gravis (uncommon)
* endocrinopathy (uncommon)
* hypothyroidism, addisons
* distal obstruction (uncommon)
* anesthesia
86
What abnormality is seen here?
Generalized megaesophagus
* tubular structure in lateral view
* dorsal to trachea and caudal vena cava
* trachea displaced ventrally
* usually gas filled but may contain fluid/ingesta
* converging "funnel" opacity in caudal thorax in VD
87
What abnormality is seen?
Megaesophagus
88
What abnormality is seen?
megaesphagus
mostly fluid/ingesta in esophagus
89
Segmental Megaesophagus
* Congenital -vascular ring anomaly (uncommon)
* Acquired
* foreign body (common)
* stricture (rare)
* Focal mass effect or gas accumulation
* Trachea usually displaced ventrally if abnormality is cranial to heart base
* Midline opacity on VD
90
Vascular Ring Anomalies
* more common in **dogs**
* arise from aortic arch or subclavian artery abnormalities
* most patients also have generalized esophageal neruomuscular dysfunction- affects px
* _assess the location of the compression relative to the heart base_
* always attempt to assess esophageal motility caudal to the compression
* Breeds predisposed to PRAA: german shepard, great dane, irish setter
91
In PRAA, what is the structure causing the compression on the esophagus and trachea?
Ligamentum arteriosum
ductus arteriosis in fetus
92
What abnormality is seen? What test can we perform to get a better look?
Megaesophagus from PRAA
barium study
93
What abnormality is seen?
Megaesophagus
94
11 yr yorkie
coughing and gagging when eating
looks like mass in caudal thorax
scope found a bone chew stuck in esophagus
95
Preferred locations for esophageal foreign bodies
thoracic inlet
base of heart
caudal esophagus at hiatus
96
Trachea
* attached at larynx and carina
* surrounded by cartilaginous rings (not complete)
* easiest to evaluate on lateral view
* thoracic trachea normally slightly to right of mediastinum in VD
* exaggerated in obese and brachycephalic breeds
* can mistake for mediastinal mass
* trachea may angle slightly ventral at carina
* in normal animals the diameter does not vary significantly during respiration
97
What abnormality is seen?
NORMAL
98
What abnormality is seen with regards to the trachea?
Normal R tracheal position exaggerated in brachycephalic dogs
mass pushing trachea?
99
When positioning for a radiograph, what is important to remember?
* in lateral view, neck must remain **neutral**
* extension results in compression and narrowing at thoracic inlet
* flexion results in a bend in cranial mediastinum
* false dx of cranial mediastinal mass
100
What abnormality is seen?
Tracheal kink due to head position
101
Common lesions of the trachea
* primary
* tracheal collapse- common
* foreign body
* tumor
* hypoplasia
* secondary
* displacement- common
* esophageal enlargement/mass shows ventral deviation in cranial mediastinum
102
What abnormality is seen here?
Tracheal Hypoplasia
small trachea
bulldog
103
Tracheal Collapse
* dynamic airway collapse
* diameter vaires with respiratory cycle
* **cervical** narrowing= **inspiration**
* **thoracic** narrowing= **expiration**
* need rads at both phases
* toy breeds predisposed; weakening in tracheal rings
* chondromalasia- weak cartilage
104
What abnormality is seen?
Intrathoracic collapse of trachea
105
What is the best surgical tx for tracheal collapse?
surgical stent
106
Pleural Anatomy
* mediastinum is the space b/t pleural sacs
* parietal pleura lines thoracic cavity
* visceral pleura covers the lung
* pleural dz can spread throughout via fenestrations
* pleural space is b/t parietal and visceral layers and b/t lung lobes
107
Interlobular fissures
* the divisions b/t lung lobes
* pleural fluid (pleural effusion) typically accumulates here and is visible
* called a "fissure line" when seen
* pleural air (pneumothorax) does not accumulate in fissures
## Footnote
*it helps to know where to expect to see fissure lines*
108
Radiographic anatomy of pleura
* normal pleura is not visible
* thin and does not absorb enough x rays to be detected
* thin pleural lines can sometimes be seen- soft tissue opacity
* pleura may line up exactly with beam and absorb enough xrays
* pleura may be slightly thick
* usually of no clinical significance
109
What are the arrows showing? Is this clinically significant?
Thin pleural fissure lines
b/t cranial and caudal parts of left cranial lobe
pleural fibrosis or small amount of fluid BUT it is NOT significant unless it gets larger
110
Pleural disease
VERY COMMON
* CS are none to various degrees of dyspnea
* Pleural dz
* pleural effusion= fluid in pleural space (hydrothorax)
* pneumothorax= gas in pleural space
* enters from outside, mediastinum or lung
* pleural mass
* tumor- uncommmon
* hernia
111
Pleural Effusion
* ALWAYS IMPORTANT clinically
* never ignore, should be investigated
* remove fluid- helps P breath, test fluid
* Causes:
* trauma- common
* right heart failure- common
* pyothorax
* cancer- common
* chylothorax
* hypoproteinemia
112
Pleural Effusion radiographic signs
* signs depend on
* volume of fluid
* patient positioning
* fluid type has NO effect on appearance
* **_Wide interlobular fissures♦_**
* soft tissue opacity
* seen first in **VD** view
* **_Lung retraction from thoracic wall♦_**
* seen first in **VD** view
* Scalloping of ventral lung margins
* later view
* Silhouetting of heart
* DV view
* Silhouetting of diaphragm
* all views
113
Interlobular fissures: thickness and number depends on...
the amount of fluid present and position of patient
minimum of 100ml of fluid needed for detection of wide fissures in 40# dog
x-ray must strike the fissure tangentially
114
What are the arrows pointing to?
115
What do the arrows indicate?
116
What do the arrows indicate?
FISSURES
117
What do the red arrows indicate?
Scalloping
118
Fluid detected?
Pronounced fluid
lung is retracted badly!!
119
T/F: there always appears to be more fluid than there really is
FALSE
there is ALWAYS more fluid than appears to be!!!
120
Fluid detected?
Pronounced fluid
121
Dealing with massive fluid
* if large amounts od fluid are present lesions will be obscured
* ways to obtain more info
* remove fluid and re-radiagraph
* ultrasound
122
What does this radiograph show?
Massive Fluid
* cant tell what is going on in thorax
* could tap and reimage, or use US
removing fluid helps us see!
123
What do we think when we see asymmetric fluid?
* its not common
* Pyothorax is the most likely cause
124
Chronic pleural fluid, especially exudate, causes \_\_\_\_
pleural fibrosis
* limits ability of lung to expand following fluid removal
125
What is the abnormality in this rad?
Retracted lung lobe asymetrically
## Footnote
**Asymmetric fluid and pleural fibrosis**
126
What is the abnormality seen in this CT?
Asymmetric fluid and pleural fibrosis
127
What abnormality?
Asymmetric fluid and pleural fibrosis
128
Label the black vs white arrows
Black: fissure
White: rib
**fissures concave cranially**
129
What is the abnormality in this rad?
NORMAL in bassest hounds!!!
Chondrodystrophoid morphology
130
What is the arrow indicating?
Chondrodystrophoid morphology
basset houds
often mistaken for retraction
131
Pneumothorax
* Gas in pleural space
* tear in lung involving visceral pleura
* hole in thoracic wall
* extension of pneumomediastinum
* iatrogenic
* rupture of cavity lung lesion
* congenital or traumatic bulla
* tumor
* abscess
* ususally bilateral
* small pneumothorax without CS will not likely require tx
* persistent pneumothorax will likely require tx
132
Radiographic signs of pneumothorax
* retraction of lung margin from thoracic wall
* seen first in **lateral view**
* radiolucent b/t lung and thoracic wall
* lung markings do not extend to edge of thorax
* air around ventral heart margin
* seen first in lateral
* separation of heart from sternum
* seen in lateral view
* interlobular fissures **NOT** seen
133
What is abnormal with this rad?
Mild pneumothorax
white arrows show retraction of lung from thoracic wall
134
What is abnormal in this radiograph?
Mild pneumothorax
white arrow pointing at air around ventral heart margin
135
What is abnormal with this rad?
Pronounced Pneumothorax
separation of heart from sternum caused by gas
136
Tension Pneumothorax
* Hole in lung or thoracic wall
* functions as ball valve
* air enters pleural cavity on inspiration but cant escape on expiration
* pleural pressure \> atmospheric pressure
* causes marked atelectasis
* medical emergency!!
137
Tension pneumothorax on radiograph
* contralateral midline shift
* flat diaphragm
* caudal displacement of diaphragm
* tenting of diaphragm
138
What abnormality is shown in this rad?
Tension pneumothorax
diaphragm tenting
139
What is abnormal in this image?
tension pneumothorax
140
Pneumothorax fakeouts
* hypovolemia causing cardiac "elevation"
* thoracic wall conformation causing cardiac "elevation"
* skin fold creating peripheral radiolucency
141
What does this animal have?
Hypovolemia
heart retracts from sternum
can see vessels from lungs
142
What is going on with this animal?
narrow thoracic cavity
heart cannot fit
the lines are lung tissue
there is no blackout
143
What is the abnormality?
SKIN FOLD
144
When radiographing the thorax we need ___ contrast
low contrast needed to avoid overexposing lung and lesions
lots of greys, few blacks, few white
LOW mAs, HIGH kVp for film
LOW contrast algorithm for digital
145
An abnormal lung usually has ____ opacity
increased
146
What is the importance of this image?
To show that an image caught on expiration can make a healthy dog look like they have lung dz
147
Lungs always look worse in what view?
this is why _3 views are critical_
* **down lung collapses quickly and has increased opacity**
* increased opacity in down lung reduces lesion conspicuity in that lung (silhouette sign)
* most significant in lateral recumbency but also occurs in VD. minimal in DV
**ATELECTASIS**
148
Lung Patterns
* increased lung opacity can fall into a particular pattern
* certain patterns are associated with certain diseases
* the distribution of the pattern is important
* patterns:
* Alveolar
* Bronchial
* Interstitial
149
Name the lung pattern
NORMAL
* normal is the MOST difficult pattern to dx
* the ability to see vessels, bronchi, and some interstitial markings is normal
* a normal lung pattern does NOT mean the absence of disease
150
Name the lung pattern
NORMAL
151
Name the lung pattern
Alveolar pattern
* air in alveoli is replaced by fluid of some type BUT air remains in bronchi
* air bronchogram
152
What is found in this rad?
Lobar sign
153
What is the abnormality?
Air bronchogram
bronchial lumen must contain air and surrounding lung must not
154
What is the abnormality?
Lobular sign
created by the junction b/t consolidated lobe (white) and normally aerated lobe (less white)
155
What are the three causes of an alveolar pattern?
blood- hemorrhage
pus- exudate
water- edema
156
Rule outs an Alveolar Pattern
* Differentials:
* pneumonia- almost always ventral- distribution atypical
* heart failure- distribution atypical
* hemorrhage- hx of trauma/bleeding?
157
Alveolar Pattern... you think pneumonia. What do we do?
If you are thinking pneumonia do a tracheal wash! Can show you bacteria if pneumonia. Run a culture and sensitivity so you know what antibiotic to prescribe
bacterial pneumonia should improve radiographically in 5-7 days if the correct antibiotic is used
bact pneumonia is more common in dogs
158
Findings for this P:
13yr, coughing, lack of stamina, tachypnea, heart murmur III/IV
Cardiomegaly
increased pulmonary opacity
lobar sign
intense opacity- white
alveolar pattern
caudodorsal location
159
What is the lung pattern?
Alveolar lung pattern may have no air bronchogram or lobar sign
the _intensity_ of the pattern can help
160
Intense lung disease
* only two things create really intesnse lung disease
* Alveolar disease= INDISTINCT margins
* Lung mass= DISTINCT margins
161
Back to this patient:
13yr, coughing, lack of stamina, tachypnea, heart murmur III/IV
What are our rule outs/plan?
thinking heart failure
so try a heart failure med trial
Dx: mitral insufficiency and left heart failure
162
13 yr old DSH, acute respiratory distress, panting, blue
Findings?
* Heart difficult to assess
* Caudal lobe arteries enlarged in DV
* Asymmetric patchy dorsal and ventral opacity
* minimal air bronchograms
* intense opacity
* alveolar
* Pleural effusion
163
13 yr old DSH, acute respiratory distress, panting, blue
Rule outs/Plan?
* Patchy dorsal and ventral alveolar pattern
* pneumonia is rare in cats: so no
* heart failure? dorsal caudal in dogs, anywhere in cats
* Pleural fluid
* heart failure
* cancer- not typical
* pyothorax- not typical
* Plan
* Empiric therapy
* lasix trial
* echo
* Dx: HCM and left heart failure (pleural effusion)
164
2yr Corgi, suspect P was kicked by a horse
Findings?
Diffuse asymmetric opacity
ventral and dorsal
cranial and caudal
air bronchograms
lobar sign
intense opacity
alveolar
165
2yr Corgi, suspect P was kicked by a horse
Rule outs/plan?
* Hemorrhage- history of trauma! being kicked
* Plan- support and re-image- cage rest?
Dx: presumptive pulmonary hemorrhage
166
DSH 13yr, chronic coughing, wheezing
Findings?
_rings_, increase opacity, red arrows show lung collapse
* **Bronchial pattern!**
* fluids or cells in or around brnchial wall
* Generalized increased opacity
* not intense
* many rings and some trams
* Increased opacity in right middle lobe= collapse!
167
What do these three rads show us?
**Right Middle Lobe Collapse**
Due to bronchial plugging- occluded with mucus, lobe retracts
the right middle lobe is most common to collapse with bronchial dz
Not dangerous!! don't tx
168
DSH 13yr, chronic coughing, wheezing
Rule outs for bronchial pattern?
* Allergy
* exogenous
* parasitism
* aelurostrongylus- lung worm
* heart worm
* Infection
* bacterial or protozoal
* Irritation
* smoke- 2nd hand smoke
* Cancer
* bronchoalveolar-uncommon
* Pulmonary edema- uncommon
169
DSH 13yr, chronic coughing, wheezing
Plan?
* Empiric therapy
* steroids- CAUTION- any degree of heart dz underlying, giving steroids can induce heart failure
* Fecal
* floatation
* sediment- aelurostrongylus don't float
* Transtracheal aspirate
* some risk in cats
* rule out heart worm
Took a **BAL sample (bronchoalveolar lavage**): it showed _allergic lower airway dz_ to be to issue AKA asthma
saw eosinophilic infiltrate
170
The second rad was taken after 3 days of pred treatments. What is the thought on this?
Pred made it worse!
Heart failure from steroids!!!
171
Bassest hound, 3yr, tachypnea 4 days, LH lameness 4 weeks, lethargy 2 months, anorexia, peripheral LNs enlarged
Findings?
* Generalized increased opacity
* not intense
* multiple tiny nodules (miliary)
* rings
* Structured (nodular) interstitial
* miliary
* The interstitium- supporting tissue of the lung
* the space b/t alveoli, vessels, airways
172
Bassest hound, 3yr, tachypnea 4 days, LH lameness 4 weeks, lethargy 2 months, anorexia, peripheral LNs enlarged
Rule outs?
* Metastasis
* usually no LN enlargement
* usually no alveolar component
* Multifocal primary tumor
* usually no LN enlargement unless lymphoma
* usually no alveolar component
* Infection
* _fungal_? causes enlarged lymph nodes
* bacterial doesn't cause enlarged LN
173
Bassest hound, 3yr, tachypnea 4 days, LH lameness 4 weeks, lethargy 2 months, anorexia, peripheral LNs enlarged
Plan/Dx?
* Clinical fungal antigen testing
* urine blastomycosis test positive
* LN aspirate positive for blastomycosis
* Dx: fungal pneumonia from blastomycosis- miliary, interstitial
174
Basset hound, 6yr, dry cough, lethargy
* Multiple well defined nodular opacities
* One large cavitary nodule
* Classic structured interstitial pattern
* Cardia silhouette enlarged
* Metastasis- common
* Lung aspirate- lung cancer, epithelial neoplasia
175
Border collie, 13yr, off and on coughing and gagging
FIndings?
Intense, fairly well marginated opacity in left caudal lobe
structured interstial mass- 1 mass= primary lung tumor
176
Border collie, 13yr, off and on cough and gagging
Rule out/ Plan?
* most likely primary lung tumor
* can do a lung aspirate and/or CT to check for others
