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DI > Exam 1 material > Flashcards

Exam 1 material Flashcards

1
Q

Positioning for a chest rad

A

Pull legs!

Manubrium to last rib = lateral and VD

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2
Q

Chest rads, when do we want to make the exposure?

A

INSPIRATION

more air in the lungs will make better contrast

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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)

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4
Q

“abnormal” usually means…

A

increased opacity

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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
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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

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7
Q

Checklist for looking over thoracic rads

A

heart

pulmonary vessels

lungs

pleural space

mediastinum

trachea

bones

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8
Q

Label anatomy of the diaphragm

A

A- crus/crura

B- dome

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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

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10
Q

Label the diaphragm anatomy

A

A- aorta

B- esophagus

C- caudal vena cava

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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

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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

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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

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14
Q

Label the lateral views R or L

A
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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
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16
Q

Traumatic Diaphragmatic Hernia

A
  • border effacement of diaphragm = siloutte signs
  • abdominal viscera in pleural space
  • abnormal location of abdominal structures
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17
Q
A

Pylorus displaced to the left and cranially

HBC, cat- Hernia

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18
Q

Anything abnormal?

A
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19
Q

What does this barium study show us?

A
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20
Q

Anything abnormal?

A
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21
Q

What abnormalities are in this rad?

A
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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
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23
Q

What abnormality is seen?

A

PPDH- Peritoneopericardial diaphragmatic hernia

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24
Q

What abnormality is seen?

A

PPDH- Peritoneopericardial diaphragmatic hernia

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25
Q

What does this CT reveal?

A

PPDH

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26
Q

Hiatal hernia

  • What kind is more common?
  • What view is better to see them?
  • How can we confirm?
A
  • 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
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27
Q

What abnormality is seen here?

A

Hiatal Hernia

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28
Q

What lesions are often missed in the thoracic view?

A

RIBS are often ignored

many rib lesions are missed

critical part of thoracic assessment

(fakeouts from superficial nodules)

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29
Q

Costal cartilages on radiographs

A
  • 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
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30
Q

What is detected in this radiograph?

A

Micro-fractures! No pain, no issue!

NORMAL

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31
Q

Skin Nodules

(what priciple is this?)

A
  • Can appear as lung nodules
    • nodules are very distinct
    • may need additoinal views
    • can apply contrast medium to area and retake rad

Superimposition

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32
Q

Rib fractures

A

Rarely clinically significant

can be spontaneous in cats (w/ dyspnea)

healing pattern same as in long bones

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33
Q

Anything abnormal in these rads?

A

fractured ribs

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34
Q

Thoracic wall masses

A
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35
Q

What type of thoracic mass is this?

A
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36
Q

What type of thoracic mass is this?

A
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37
Q

Name the abnormality

A
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38
Q

Name the abnormality

A

Rib tumor

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39
Q

Name the abnormality

A

Rib tumor

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40
Q

Rib tumors

A
  • 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)
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41
Q
A
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42
Q
A
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43
Q

Mediastinum

A
  • 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
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44
Q

What number(s) show the mediastinum?

A

7- cranial mediastinum

8- caudal mediastinum

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45
Q

Name some structures located within the mediastinum

A

Heart

Vena cava

Esophagus

Aorta

Azygos vein

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46
Q

Mediastinal reflections

A

locations where the mediastinum deviates from the midline

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47
Q

Cranioventral mediastinal reflection

A

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

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48
Q

What can be seen in this rad from a young dog?

A
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49
Q

Caudoventral mediastinal reflection

A

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

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50
Q

The thickness of the caudoventral mediastinal reflection depends on…

A

the amount of fat present

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51
Q

Mediastinal shift

A
  • 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
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52
Q

Dz or atelectosis?

A

atelectosis

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53
Q

Common causes of mediastinal masses

A
  • lymph nodes enlargement
  • thymus enlargement
  • esophagus enlargement
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54
Q

Mediastinal Lymph Nodes

  1. Green
  2. Blue
  3. Red
A
  1. Green: Sternal= drain abdomen**
  2. Blue: Cranial Mediastinal
  3. Red: Tracheobronchial= lungs are drained by their (Hilar LNs)
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55
Q

Cranial mediastinal LN

A

thoracic wall, trachea, thyroid

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56
Q

Tracheobronchial LN

A

AKA Hilar LN

Drain Lungs

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57
Q

Sternal LN

A

Drain mammary glands and peritoneum

Peritoneal dz may cause sternal lymphadenopathy

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58
Q

How to Dx the cause of a mediastinal mass?

A

Rule outs can be narrowed based on location

sonography or CT

Usually need cytology

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59
Q

Describe abnormality

A
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60
Q
A

Cyst? Mass? Ultrasound!!!

Cyst is better px than mass

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61
Q

What abnormality is seen here?

A

Moderate Tracheobronchial Lymphomegaly

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62
Q

What abnormality is this?

A

Bow legged cowboy sign

Moderate Tracheobronchial Lymphomegaly

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63
Q

Confounding effect of pleural fluid

A
  • 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!
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64
Q

This radiograph of a cat shows?

A

Pleural fluid

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65
Q

Cat with pleural effusion had US of lungs done. What do we see?

A

soft tissue mass

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66
Q

Pneumomediastinum

What view?

A
  • 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
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67
Q

Causes of pneumomediastinum

A
  • 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”
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68
Q

What is abnormal about this chest rad?

A

Pneumomediastinum

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69
Q

What abnormality is seen in this rad?

A

Mild pneumomediastinum

not normal!

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70
Q

What abnormality is detected?

A

TRICK

its normal! :)

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71
Q

What abnormality is detected?

A

pneumomediastinum

72
Q

Study on pneumomediastinum in cats: 45 cases

A
  • anesthesia with PPV (pos pressure ventilation)
  • trauma
  • tracheal FB

recovery rate is good, but depends on cause

73
Q

Mediastinal Fluid

A

NOT common- no pic for ex

Hemorrhage

Exudate: FIP, Esophageal rupture

74
Q

Espohagus

A
  • 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
Q

What is seen in this radiograph?

A

Stripe sign!

76
Q

Esophagram

A
  • 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
Q

What is seen in this radiograph?

A
78
Q

What is shown in this radiograph?

A
79
Q

Canine Esophagram. Any abnormalities detected?

A

NORMAL

80
Q

Feline Esophagram. Any abnormalities shown?

A

NORMAL

smooth muscle causes striations in caudal feline esophagus

it looks like a feather

81
Q

Any abnormalities detected with the esophagus of this feline?

A

NORMAL

smooth muscles cause striations in caudal feline esophagus

82
Q

Cricopharyngeal dysfunction

A
  • 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
Q

Esophageal dysfunction

common side effect?

A
  • 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
Q

Congenital generalized megaesophagus

A

young dogs

idiopathic neuromuscular dysfunction (common)

85
Q

Acquired generalized megaesophagus

A
  • Idiopathic neuromuscular dysfunction (common)
  • myasthenia gravis (uncommon)
  • endocrinopathy (uncommon)
    • hypothyroidism, addisons
  • distal obstruction (uncommon)
  • anesthesia
86
Q

What abnormality is seen here?

A

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
Q

What abnormality is seen?

A

Megaesophagus

88
Q

What abnormality is seen?

A

megaesphagus

mostly fluid/ingesta in esophagus

89
Q

Segmental Megaesophagus

A
  • 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
Q

Vascular Ring Anomalies

A
  • 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
Q

In PRAA, what is the structure causing the compression on the esophagus and trachea?

A

Ligamentum arteriosum

ductus arteriosis in fetus

92
Q

What abnormality is seen? What test can we perform to get a better look?

A

Megaesophagus from PRAA

barium study

93
Q

What abnormality is seen?

A

Megaesophagus

94
Q

11 yr yorkie

coughing and gagging when eating

A

looks like mass in caudal thorax

scope found a bone chew stuck in esophagus

95
Q

Preferred locations for esophageal foreign bodies

A

thoracic inlet

base of heart

caudal esophagus at hiatus

96
Q

Trachea

A
  • 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
Q

What abnormality is seen?

A

NORMAL

98
Q

What abnormality is seen with regards to the trachea?

A

Normal R tracheal position exaggerated in brachycephalic dogs

mass pushing trachea?

99
Q

When positioning for a radiograph, what is important to remember?

A
  • 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
Q

What abnormality is seen?

A

Tracheal kink due to head position

101
Q

Common lesions of the trachea

A
  • primary
    • tracheal collapse- common
    • foreign body
    • tumor
    • hypoplasia
  • secondary
    • displacement- common
      • esophageal enlargement/mass shows ventral deviation in cranial mediastinum
102
Q

What abnormality is seen here?

A

Tracheal Hypoplasia

small trachea

bulldog

103
Q

Tracheal Collapse

A
  • 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
Q

What abnormality is seen?

A

Intrathoracic collapse of trachea

105
Q

What is the best surgical tx for tracheal collapse?

A

surgical stent

106
Q

Pleural Anatomy

A
  • 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
Q

Interlobular fissures

A
  • 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

it helps to know where to expect to see fissure lines

108
Q

Radiographic anatomy of pleura

A
  • 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
Q

What are the arrows showing? Is this clinically significant?

A

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
Q

Pleural disease

A

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
Q

Pleural Effusion

A
  • 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
Q

Pleural Effusion radiographic signs

A
  • 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
Q

Interlobular fissures: thickness and number depends on…

A

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
Q

What are the arrows pointing to?

A
115
Q

What do the arrows indicate?

A
116
Q

What do the arrows indicate?

A

FISSURES

117
Q

What do the red arrows indicate?

A

Scalloping

118
Q

Fluid detected?

A

Pronounced fluid

lung is retracted badly!!

119
Q

T/F: there always appears to be more fluid than there really is

A

FALSE

there is ALWAYS more fluid than appears to be!!!

120
Q

Fluid detected?

A

Pronounced fluid

121
Q

Dealing with massive fluid

A
  • if large amounts od fluid are present lesions will be obscured
  • ways to obtain more info
    • remove fluid and re-radiagraph
    • ultrasound
122
Q

What does this radiograph show?

A

Massive Fluid

  • cant tell what is going on in thorax
  • could tap and reimage, or use US

removing fluid helps us see!

123
Q

What do we think when we see asymmetric fluid?

A
  • its not common
  • Pyothorax is the most likely cause
124
Q

Chronic pleural fluid, especially exudate, causes ____

A

pleural fibrosis

  • limits ability of lung to expand following fluid removal
125
Q

What is the abnormality in this rad?

A

Retracted lung lobe asymetrically

Asymmetric fluid and pleural fibrosis

126
Q

What is the abnormality seen in this CT?

A

Asymmetric fluid and pleural fibrosis

127
Q

What abnormality?

A

Asymmetric fluid and pleural fibrosis

128
Q

Label the black vs white arrows

A

Black: fissure

White: rib

fissures concave cranially

129
Q

What is the abnormality in this rad?

A

NORMAL in bassest hounds!!!

Chondrodystrophoid morphology

130
Q

What is the arrow indicating?

A

Chondrodystrophoid morphology

basset houds

often mistaken for retraction

131
Q

Pneumothorax

A
  • 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
Q

Radiographic signs of pneumothorax

A
  • 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
Q

What is abnormal with this rad?

A

Mild pneumothorax

white arrows show retraction of lung from thoracic wall

134
Q

What is abnormal in this radiograph?

A

Mild pneumothorax

white arrow pointing at air around ventral heart margin

135
Q

What is abnormal with this rad?

A

Pronounced Pneumothorax

separation of heart from sternum caused by gas

136
Q

Tension Pneumothorax

A
  • 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
Q

Tension pneumothorax on radiograph

A
  • contralateral midline shift
  • flat diaphragm
  • caudal displacement of diaphragm
  • tenting of diaphragm
138
Q

What abnormality is shown in this rad?

A

Tension pneumothorax

diaphragm tenting

139
Q

What is abnormal in this image?

A

tension pneumothorax

140
Q

Pneumothorax fakeouts

A
  • hypovolemia causing cardiac “elevation”
  • thoracic wall conformation causing cardiac “elevation”
  • skin fold creating peripheral radiolucency
141
Q

What does this animal have?

A

Hypovolemia

heart retracts from sternum

can see vessels from lungs

142
Q

What is going on with this animal?

A

narrow thoracic cavity

heart cannot fit

the lines are lung tissue

there is no blackout

143
Q

What is the abnormality?

A

SKIN FOLD

144
Q

When radiographing the thorax we need ___ contrast

A

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
Q

An abnormal lung usually has ____ opacity

A

increased

146
Q

What is the importance of this image?

A

To show that an image caught on expiration can make a healthy dog look like they have lung dz

147
Q

Lungs always look worse in what view?

A

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
Q

Lung Patterns

A
  • 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
Q

Name the lung pattern

A

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
Q

Name the lung pattern

A

NORMAL

151
Q

Name the lung pattern

A

Alveolar pattern

  • air in alveoli is replaced by fluid of some type BUT air remains in bronchi
  • air bronchogram
152
Q

What is found in this rad?

A

Lobar sign

153
Q

What is the abnormality?

A

Air bronchogram

bronchial lumen must contain air and surrounding lung must not

154
Q

What is the abnormality?

A

Lobular sign

created by the junction b/t consolidated lobe (white) and normally aerated lobe (less white)

155
Q

What are the three causes of an alveolar pattern?

A

blood- hemorrhage

pus- exudate

water- edema

156
Q

Rule outs an Alveolar Pattern

A
  • Differentials:
    • pneumonia- almost always ventral- distribution atypical
    • heart failure- distribution atypical
    • hemorrhage- hx of trauma/bleeding?
157
Q

Alveolar Pattern… you think pneumonia. What do we do?

A

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
Q

Findings for this P:

13yr, coughing, lack of stamina, tachypnea, heart murmur III/IV

A

Cardiomegaly

increased pulmonary opacity

lobar sign

intense opacity- white

alveolar pattern

caudodorsal location

159
Q

What is the lung pattern?

A

Alveolar lung pattern may have no air bronchogram or lobar sign

the intensity of the pattern can help

160
Q

Intense lung disease

A
  • only two things create really intesnse lung disease
    • Alveolar disease= INDISTINCT margins
    • Lung mass= DISTINCT margins
161
Q

Back to this patient:

13yr, coughing, lack of stamina, tachypnea, heart murmur III/IV

What are our rule outs/plan?

A

thinking heart failure

so try a heart failure med trial

Dx: mitral insufficiency and left heart failure

162
Q

13 yr old DSH, acute respiratory distress, panting, blue

Findings?

A
  • 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
Q

13 yr old DSH, acute respiratory distress, panting, blue

Rule outs/Plan?

A
  • 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
Q

2yr Corgi, suspect P was kicked by a horse

Findings?

A

Diffuse asymmetric opacity

ventral and dorsal

cranial and caudal

air bronchograms

lobar sign

intense opacity

alveolar

165
Q

2yr Corgi, suspect P was kicked by a horse

Rule outs/plan?

A
  • Hemorrhage- history of trauma! being kicked
  • Plan- support and re-image- cage rest?

Dx: presumptive pulmonary hemorrhage

166
Q

DSH 13yr, chronic coughing, wheezing

Findings?

A

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
Q

What do these three rads show us?

A

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
Q

DSH 13yr, chronic coughing, wheezing

Rule outs for bronchial pattern?

A
  • Allergy
    • exogenous
    • parasitism
      • aelurostrongylus- lung worm
      • heart worm
  • Infection
    • bacterial or protozoal
  • Irritation
    • smoke- 2nd hand smoke
  • Cancer
    • bronchoalveolar-uncommon
  • Pulmonary edema- uncommon
169
Q

DSH 13yr, chronic coughing, wheezing

Plan?

A
  • 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
Q

The second rad was taken after 3 days of pred treatments. What is the thought on this?

A

Pred made it worse!

Heart failure from steroids!!!

171
Q

Bassest hound, 3yr, tachypnea 4 days, LH lameness 4 weeks, lethargy 2 months, anorexia, peripheral LNs enlarged

Findings?

A
  • 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
Q

Bassest hound, 3yr, tachypnea 4 days, LH lameness 4 weeks, lethargy 2 months, anorexia, peripheral LNs enlarged

Rule outs?

A
  • 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
Q

Bassest hound, 3yr, tachypnea 4 days, LH lameness 4 weeks, lethargy 2 months, anorexia, peripheral LNs enlarged

Plan/Dx?

A
  • Clinical fungal antigen testing
  • urine blastomycosis test positive
  • LN aspirate positive for blastomycosis
  • Dx: fungal pneumonia from blastomycosis- miliary, interstitial
174
Q

Basset hound, 6yr, dry cough, lethargy

A
  • 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
Q

Border collie, 13yr, off and on coughing and gagging

FIndings?

A

Intense, fairly well marginated opacity in left caudal lobe

structured interstial mass- 1 mass= primary lung tumor

176
Q

Border collie, 13yr, off and on cough and gagging

Rule out/ Plan?

A
  • most likely primary lung tumor
  • can do a lung aspirate and/or CT to check for others

DI (6 decks)

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