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Small Animal Cardiology > Imaging > Flashcards

Imaging Flashcards

1
Q

What diseases don’t show many changes on a thoracic radiograph?

A 
Pulmonary thromboembolism
Acute viral pneumonia
Acute & chronic tracheobronchitis
Lungworm
Upper airway disease
Tracheal stenosis 
Bronchial foreign bodies 
Osteosarcoma mets
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2
Q

What false pathologies can GA create on radiographs?

A

Anaesthetic induced megaoesophagus

Atelectasis in lateral recumbency

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3
Q

What view should you always take first?

A

DV

Lateral will create artefact due to GA induced atelectasis

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4
Q

How can you assess rotation on a DV?

A

Position of the sternum relative to the dorsal spinous processes

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5
Q

How can you increase the diagnostic quality of a thoracic radiograph?

A

Inspiratory view

High KV/ low mAs technique - short exposure time reduces movement blur

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6
Q

What anatomical spaces are there in the thorax?

A

Pleural space
Thoracic wall
Mediastinum
Lungs

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7
Q

Name some focal lung pathologies. These will either have a craniodorsal or cranioventral distribution that needs to be described.

A

Pneumonia
Atelectasis
Haemorrhage

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8
Q

Name some generalised lung changes seen on radiography.

A 
Fibrosis
Bronchitis
Pneumonia
Oedema 
Haemorrhage 
Metastatic neoplasia
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9
Q

What pathologies cause mediastinal shift?

A

Pneumothorax

Masses

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10
Q

Describe the systematic approach you should take to interpreting a thoracic radiograph.

A
  1. Assess radiopacity
  2. Determine the anatomical compartment involved
  3. Assess thoracic boundaries - spine, sternum, ribs, diaphragm
  4. Consider the aetiology of the pathology
  5. Assess the lungs - opacity, volume, distribution of lesion
  6. Assess mediastinal shift
  7. Assess lung patterns
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11
Q

How does a bronchial pattern appear on a radiograph?

A

Increased radiopacity of the bronchial walls

= donuts and tramlines

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12
Q

What differential diagnosis would you consider with a bronchial pattern?

A

Calcification of the bronchi
Bronchitis - allergic, irritant, parasitic, idiopathic
Peribronchial cuffing - oedema, eosinophillic, neoplasia, pneumonia
Bronchiectasis
= widened bronchitis seen in chronic, severe disease

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13
Q

What is an alveolar pattern?

A

Increased cells or fluid (radiopacity) in the alveolar space
- border effacement
- lobar sign
- air bronchograms
= air in the bronchi stands out from the parenchyma as radiolucent

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14
Q

What does a generalised alveolar lung pattern suggest?

A

Haemorrhage
Pneumonia
Oedema

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15
Q

What does a focal alveolar lung pattern suggest?

A 
Pneumonia
Haemorrhage
Oedema
Primary or secondary lung tumour 
Infarction
Lung lobe torsion
Atelectasis
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16
Q

How does an interstitial pattern appear?

A

Increased fluid or cells in the interstitial space
Not as severe and not as well defined as an alveolar pattern
Usually occurs before the pathology spills over into the alveolar space

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17
Q

What differentials would you consider with an interstitial lung pattern?

A

Artefact - fat, expiration, underexposure
Ageing - pulmonary osteomata
Lymphoma
Metastatic neoplasia - diffuse or nodular
Pneumonitis - viral, parasitic, toxic or metabolic
Disease in transition

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18
Q

What size must a pulmonary nodule be to be picked up on radiography?

A

4-5mm

and surrounded by air

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19
Q

What pathologies can cause a diffuse decrease in radiopacity?

A 
Artefact
Hypovolaemia
Hyperinflation 
Pneumothorax 
Pneumomediastinum
Subcutaneous emphysema
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20
Q

What can cause a focal decrease in radiopacity in the lung?

A 
Cavitatory lung lesion
Emphysema
Pulmonary thromboembolism
Focal pneumothorax 
Focal pneumomediastinum
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21
Q

What radiographic changes will you see with a pleural effusion?

A

Border effacement of the heart and diaphragm
Pleural fissures
Retraction of the lung lobes from the margins of the chest wall

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22
Q

What radiographic changes will you see on a radiograph with pneumothorax?

A

Increased radiolucency in the pleural space (air)
Retraction of the lungs from the thoracic margins
Lungs appear more radiopaque
Elevation of the cardiac silhouette from the sternum
Mediastinal shift - opposite to the side with pneumothorax

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23
Q

What structures are contained in the mediastinum?

A 
Heart and great vessels
Oesophagus
Trachea
Sternal lymph nodes
Thymus
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24
Q

What is the most common location of a mediastinal mass and how will this be seen on a radiograph?

A

Cranioventral mass

Widened mediastinum
Dorsal deviation of the trachea
Mild pleural effusion

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25
Q

How does pulmonary oedema appear on a radiograph?

A

Perihilar location

Initially interstitial pattern -> alveolar pattern when it spills over into the alveolar space

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26
Q

What is the typical distribution of aspiration pneumonia?

A

Cranioventral

Alveolar pattern

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27
Q

Radiographic signs does right sided CHF?

A

Hepatic congestion
Vena caval distension
Pleural effusion
Ascites

28
Q

What radiographic signs does left sided CHF show?

A

Pulmonary oedema
Pouching of the left atrium
Pulmonary venous congestion

29
Q

How can you do a vertebral heart score?

A

Measure the long axis of the heart
Measure the short axis of the heart
Compare to T4 - count the number of vertebrae that lie within length

30
Q

What is the normal vertebral heart scores?

A 
Dogs = 9.7 +/- 0.51
Cats = 7.5 +/- 0.32
31
Q

What are the radiographic signs of left sided cardiac disease?

A

Dorsal deviation of the trachea
Tenting of the left atrium
Straightening of the caudal border of the heart
Compression of the bronchus caudal to the corina
Cowboy sign - divergence of the bronchi on DV
Perihilar alveolar pattern in the lungs (interstitial in early/mild)
Dilation of the lobar vessels

32
Q

What are the radiographic signs of Right sided cardiac disease?

A 
Increased cardiac width
Rounding of the right side of the heart 
Reserve D shape on DV
Increased right to left ratio
Increased sternal contact (care in obese patients)
33
Q

How can you assess the lobar vessels and what does their enlargement suggest?

A

Cranial lobar vessels - should be no bigger than the width of the proximal 1/3 of the 4th rib

Caudal lobar vessels - should be no bigger than the 9th rib where they cross

Venous congestion indicates left sided CHF
Congestion of the lobar arteries suggests pulmonary hypertension

34
Q

How is the radiographic appearance of pulmonary oedema different in cats?

A

Patchy interstitial / alveolar pattern with a more variable distribution
May develop a pleural effusion in left sided CHF
(Unlike dogs that develop this in right sided CHF)
- border effacement, lobar sign, lung lobes retracted from wall

35
Q

How does dilated cardiomyopathy appear on radiographs?

A

Massively enlarged cardiac silhouette (ddx pericardial effusion)
Signs of right and left atrial enlargement
Eg : left atrial - cowboy sign
Right atrial - increased sternal contact

36
Q

What is the difference between the radiographic appearance of chamber enlargement in the cat?

A

Chamber enlargement is less specific in cats

= generalised cardiomegaly

37
Q

How does a pericardial effusion appear on a radiograph?

A

Round, well defined enlargement of the cardiac silhouette

No specific chamber enlargement

38
Q

What radiographic changes will you see in Pulmonic stenosis?

A

Post stenotic bulge over the pulmonary artery on DV
Small lobar vessels
Concurrent right sided enlargement with volume overload

39
Q

What radiographic changes will you see with a PDA?

A

Decreased radiopacity of the lungs - increased pulmonary flow
Thick lobar vessels - increased pulmonary flow
Enlargement of the left side of the heart
Aortic enlargement

40
Q

What radiographic signs will you see with a reverse PDA? (Hypertension with consequent right sided enlargement - cor pulmonae)

A

Right sided enlargement

41
Q

What are the radiographic signs of a persistent right aortic arch?

A

Left deviation of the trachea
Ventral deviation of the trachea (megaoesophagus)
Focal megaoesophagus

42
Q

What are the radiographic finding in a peritoneal pericardial diaphragmatic hernia?

A

Enlarged cardiac sillouhette
- due to gut contents in the pericardium
Looks like the diaphragm and pericardium communicate
- dorsomesothelial remnant

43
Q

What would you suspect if you saw microcardia and radiopaque (hypo vascular) lungs?

A

Hypovolaemia

44
Q

What does the right parasternal 4 chamber view tell us on echo?

A

Left ventricular and atrial shape
Contractility of the heart
Mitral valve
Atrial septum

Calculation of
End diastolic volume
End systolic volume
Ejection fraction

45
Q

What are the normal dimensions on the right parasternal 4 chamber view?

A

Right heart is no more than 1/3 of the size of the left heart
Left ventricular walls are no more than 1/3 of the chamber diameter

46
Q

What is the right parasternal 5 chamber view used for?

A

Assessing abnormalities of the aortic valve and left ventricular outflow tract

Doppler can be used to assess

  • aortic stenosis
  • aortic regurgitation
  • ventricular septal defects
47
Q

What are the 5 levels that you can look at on the right parasternal short axis view?

A
  1. Left ventricular apex
  2. Papillary muscle level
  3. Chordae tendinae level
  4. Mitral valve level
  5. Aortic level
48
Q

What is the right parasternal short axis view used for at the level of the papillary muscles?

A

Positioning the cursors for M mode

At the tips of the papillary muscles

49
Q

What is the right parasternal short axis view at the level of the mitral valve used for?

A

Mitral valve disease - irregular valve leaflets
Mitral valve stenosis - inadequate opening

Used to create the peaks on M mode
E peak - closure of mitral valve
A peak - opening of mitral valve

The space between the peaks indicates the length of diastolic filling
The greater the distance between the two indicates:
- Dilation
- Rounding of the left ventricle
- Poor stroke volume

50
Q

What is the right parasternal short axis view used for at the level of the aorta?

A

Assessing the aortic valve leaflets

51
Q

What is the left apical and parasternal views used for?

A

Imaging the long axis of the heart in the vertical plain
Can perform Doppler during this view - in line with the flow of the heart
*mist be parallel with flow to calculate the blood velocity

52
Q

What is the subcostal view used for?

A

Measuring aortic outflow tract velocity in aortic stenosis

53
Q

When do the smallest ventricular dimensions occur?

A

End systole

54
Q

How can you measure fractional shortening and what value is normal?

A

Use M mode
Measure the distance between the left ventricular walls in diastole and in systole

FS = (distance in diastole - distance in systole) / disc in diastole
X100

Should be more that 25%

55
Q

What does a fractional shortening of less than 25% indicate?

A

Poor heart contractility

56
Q

What can make fractional shortening an unreliable measure of systolic function?

A

Significant mitral valve regurgitation
Wall motion abnormalities
Right sided heart disease associated with pressure overload

57
Q

What is the pressure gradient across a heart valve?

A

4 x velocity^2

58
Q

What is the normal e point septal separation of a dog? And what does this suggest?

A

<7mm

An increased E point septal separation indicates myocardial failure and is seen in DCM

59
Q

What is the ejection fraction? And what is normal?

A

EF = (EDV - ESV) / EDV x 100
Normal >50%
A reduced ejection fraction indicates poor contractility and reduced volume of blood pumped out of the heart
= SV

60
Q

What does a normal pulse wave spectral Doppler trace look like?

A

Peak above the line - flow towards the transducer
Peak below the line - flow away from the transducer

Pulse wave - peak velocity and depth limited

Continuous - peak velocity and depth not limited

Turbulent flow - filled in peak

61
Q

What can colour flow Doppler show you?

A

Red - flow towards transducer
Blue - flow away from transducer
Green - turbulent blow flow

62
Q

What view should you use to assess the diameter of the aorta and what is normal?

A

Right parasternal short axis view at the level of the aorta

Left atrium to aorta ratio should be less than 1.5

63
Q

What echo abnormalities will you see with subaortic stenosis?

A

Increase aortic outflow tract velocity

Left ventricular septum and wall are thickened

64
Q

What is normal aortic velocity? And what grades of aortic stenosis are seen?

A

Normal aortic velocity - <1.7m/s

Calculate the pressure gradient using the aortic velocity
PG = 4x velocity^2

0-40mmHg - mild
40-80mmHg - moderate
>80mmHg - severe

65
Q

What abnormalities will you see with pulmonic stenosis?

A

Thickened right ventricular wall and septum

Increased pulmonic velocity

Small Animal Cardiology (9 decks)

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