Lecture Thorax 2 Flashcards
Questions when evaluating pulmonary parenchyma
- Inc/dec opacity?
- anatomic position (peripheral, mid-zone, hilar)(generalized)?
- Mediastinal shift?
- Pulmonary patterns?
- Severity pulmonary change?
- Prioritized differentials based on
- anatomic position
- severity
- pulmonary pattern
Decreased opacity
- Focal (shape, lobar)
- Multifocal
- Generalized (hypovolemia most common)
Increased opacity
- Focal, multifocal, or Generalized
- Anatomic location
- Mediastinal shift present
- Pulmonary pattern
Generalized decreased opacity
- overexposure
- hypovolemia
- addisons dz
- hyperinflation
- air trapping (asthma)
- Emphysema
Lobar Decreased Opacity
- PTE (Pulmonary thrombo-embolism)
- Congenital bronchial cyst
- Pneumatocoele
- Bulla
- Hematocoele
- Cavitated mass
Bronchiectasis
A condition in which the lungs’ airways become damaged, making it hard to clear mucus.
Mass:
Nodule:
Greater than or equal to 3cm
Less than 3cm
Mass characteristics
- > 3cm
- Rounded margins
- Lobar sign
- Border effacement
- Can be interstitial, bronchial or alveolar in origin
Alveolar pulmonary patterns: 5 features
- Uniform soft tissue gray
- Presence of air bronchograms
- Border effacement of cardiac silhouette or diaphragm
- Border effacement of cardiac silhouette or diaphragm
- ‘Lobar sign’ - normal lung lobe adjacent to lobe with pathology
Bronchial pulmonary pattern
- Presence of rings and lines
- Generalized
- Thickened airway walls create the ‘rings and lines’
- Can get thickening with age and ares of discrete dystrophic mineralization within the central airways
- Evaluate in the periphery of the lung fields on both the lateral and VD projections
Vascular pulmonary pattern
- Small arteries and veins
- hypovolemia
- Addison’s disease - Enlarged pulmonary veins
- LHF - Enlarged Pulmonary Arteries
- heartworm disease - Enlarged PA/PV (over circulation)
- left to right PDA, VSD
- Fluid overload
- AV fistulas (peripheral or central)
- Cats-LHF
Pulmonary patterns, decreased vessel size
Results in overall decreased opacity
Pulmonary pattern: Structured Interstitial Pattern
- Miliary
- LSA
- Metastasis
- Fungal
- Pulmonary nodules
- Prior granulomatous pneumonia
- Osteomas: osseous metaplasia of sub pleural surface of lung lobes
Pulmonary Nodule fake-outs
- Nipple
- End-on vessel
- Cutaneous nodule
- Ectoparasite
- HW disease (vessels)
- Osteomas
Structured interstitial pattern: osteomas roentgen signs
- Focal pinpoint areas of dystrophic mineralization
- Gravity dependent (ventral and cranial distribution)
- Collies and Shelties predisposed
- Smaller than a met or true soft tissue nodule
- Can be very impressive when numerous
Pulmonary pattern: interstitial
- increased opacity to lung lobe or overall lung field
- ‘hazy’ appearance to pulmonary vessels
- lack of distinct visualization of caudal vena cava and descending thoracic aorta
- structured (nodular or miliary) or unstructured
- Usually generalized and moderate to severe
Pulmonary pattern caveats
- Mass lesion doesn’t fit into definitions, except alveolar. Don’t know where mass orginated (bronchus, interstitium, alveoli)
- Doesn’t equate with histology or pathology
- Anatomic localization almost more important for helping to formulate differentials
- Often a continuum and disease can go thorugh interstitial to alveolar states and back again once treated (dz is in transition between patterns)
- Avoid Jargon: Broncho-interstial (combo terms not useful); Consolidation (happens on wall street); Infiltrate (cellular term not histo)
Cranioventral Distribution
- Aspiration pneumonia
- Bronchopneumonia
- Hemorrhage
- Lobar collapse or atelectasis
- Lobar torsion (right middle)
- Compression from cranial mediastinal mass
- Primary lung tumor (less common location)
Caudodorsal distribution
- Neurogenic edema
- Hemorrhage
- Primary lung tumor (most common site)
- Heartworms
- Pulmonary thrombo-emboli
- Septic emboli
- Expiration (fat dog or cat)
Hilar distribution
- Left heart failure (dog)
- Fungal
- Hemorrhage
- Lobar mass
- Ddx
- TB LN
- esophageal abnormality
- left atrium
Generalized distribution
- PIE/Asthma/Allergic lung disease
- Fungal
- Hemorrhage
- Miliary (LSA, Fungal, Mets)
- Severe edema
- Near drowning
- Smoke inhalation
- Artifact
- Fibrosis
- Lymphoma
- Pneumonitis (viral, uremia, pancreatitis, septicemia)
Pulmonary Thrombo-embolism
Necrotic mass in Caudal lung lobe
Cavitated
Air bronchograms
Implies an alveolar pattern
Lobar sign / alveolar pattern
- Contralateral shift
- Border effacement of heart
- Lobar signs
Lobar sign in the lateral view…caudal border of opacity
Bronchial pulmonary Pattern
- Characterized by rings and lines
Generalized increase in opacity
To label Bronchial Patterns:
- Must evaluate periphery of lung fields on lateral and VD projections
Structured interstitial pattern
Indicative of metastatic dz
This picture could be a bronchial pattern also
Osteomas
Structured interstitial pattern
Caudodorsal unstructured interstitial pattern
