Pulmonary Patterns Flashcards
Alveolar pattern
Diseases in the alveoli (air spaces)
What are alveolar patterns caused by?
Atelectasis/ collapse
Fluid accumulation
Cellular infiltrates
Pulmonary infarct
Extension of interstitial dz (edema, smoke, pneumonia)
Pathology of alveolar patterns
Alveoli filled with fluid, cells/ cellular debris (most opaque)
Alveoli collapsed
Lung collapse/ atelectasis causes
Airway obstruction (FB, mass)
Compression by adjacent lesion (lung mass)
Secondary to pleural effusion
Cranio-ventral/ gravity dependent part of lungs differentials
Bronchopneumonia and aspiration pneumonia (secondary to esophageal issue)
Caudo-dorsal part of caudal lobes distribution
Non-cardiogenic pulmonary edena (neurogenic)- peripheral part of the lung
Caudo-hilar (dorsal) distribution
Cardiogenic pulmonary edema secondary to left sided heart failure- central
(except in cats and dobermans)
Descriptions of distribution for alveolar patterns
Patchy, focal, multifocal, diffuse, consolidated*, asymmetrical
Bacterial pneumonia (bronchopneumonia)
Ventral portion: cr. and right middle lobes
Starts peripherally then spreads inward
Patterns associated with bronchopneumonia and aspiration pneumonia
Interstitial pulmonary pattern
Alveolar pattern (air bronchogram)
Diagnostics of bronchopneumonia (basic)
Rads
CBC: inflamm leukogram (left shift)
Neutropenia
Tx of bronchopneumonia
Supplemental O2
Antimicrobials
Bronchodilators
IV fluids
Saline nebulization and coupage
Aspiration pneumonia position
Ventral portion: right middle, cr., accessory and cd. lobes
What other signs come with aspiration pneumonia?
Esophageal dz:
Enlarged/ distended esoph.
Ventral deviation of trachea
Dorsal stripe sign
What is aspiration pneumonia secondary to?
Regrug, vomiting
Laryngeal dz (Paralysis/ neoplasia)
Iatrogenic aspiration from force feeds, anesthesia or meds
Weakness/ debilitating
Cleft palate
Tracheo-esophageal or broncho-esophageal fistula
Cardiogenic pulmonary edema is secondary to
Left sided heart dz from:
Mitral regurg in small breed dogs with Myxomatous mitral valve degeneration (MMVD)
DCM in large breeds
Hypertrophy cardiomyopathy (HCM) in cats
History of a patient with cardiogenic pulmonary edema
Coughing, resp. distress
Syncope
Exercise intolerance and heart murmur
Tx for cardiogenic pulmonary edema
Supplemental O2
Diuretics (furosemides)
Cardiovascular drugs
DV view preferred
T/F: IV fluids are contraindicated in animals with cardiogenic pulmonary edema
TRUE
could cause fluid overload
Non-cardiogenic pulmonary edema
Fluid accumulation secondary to direct or indirect lung injury and not due to cardiac coagulation
Results in hypoxemia
Fluid edema protein rich
3 mechanisms of Non-cardiogenic pulmonary edema
↑ endothelial permeability
↓ plasma oncotic pressure (pleural effusion)
Impaired lymphatic drainage
Differentials of Non-cardiogenic pulmonary edema
Neurogenic pulmonary edema (from electrocution, seizures, and cerebral injury)
Near drowning
Acute upper airway obstruction
Toxins/ inhaled irritants (smoke)
Drug reactions/ overdose
CS of Non-cardiogenic pulmonary edema
Coughing, resp. distress
Consolidation
Lung filled with fluid, pus or other material (norm. volume)
Soft tissue lung opacity
Stops @ lung limit
What is consolidation secondary to?
Bronchopneumonia
Atelectasis
Volume loss (airless)
Soft tissue lung opacity
Seen as mediastinal shift on VD/DV
What is atelectasis secondary to?
External compression by severe pneumothorax, pleural effusion, large pleura or thoracic wall mass, prolonged recumbency, general anesthesia, airway obstruction
Lung lobe torsions
In cats, deep chested dogs and small breeds
Associated with right middle lobe
What’s seen on the radiograph with lung lobe torsions?
Concurrent pleural effusion
Change in opacity, size, shape and position of lobe
Abrupt stop to bronchus/ abnormally angled bronchus near hilus
Trapped pockets of gas scattered throughout opaque lobe
Interstitial lung pattern
Disease within the interstitium (CT) of the lungs between airways
Unstructured interstitial lung pattern
Hazy interstitium or parenchyma from pulmonary opacity that obscures the margins of the pulmonary vasculature (still visible, margins blurred)
Structured interstitial lung pattern
Nodular interstitial lesions visualized greater than 4-5cm in diameter
Localized/ focal differentials for unstructured interstitial pattern
Atelectasis
Contusion
Hemorrhage
Pulm. edema
Airway obstruction
Interstitial pneumonia, parasitic migration
Diffuse differentials for unstructured interstitial pattern
Pneumonitis
Viral- distemper
Parasitic
Metabolic (uremia, pancreatitis, septicemia)
Inhalation (allergy/ smoke)
Toxic, edema, interstitial pneumonia, hemorrhage
Structured interstitial patterns
Pulmonary masses > 2 cm
Nodules < 2cm
Nodules visualized greater than 5 mm in diameter
Differentials for solitary/ pulmonary masses
CHANG
Cyst
Hematoma
Abscess
Neoplasia
Granuloma
Primary pulmonary neoplasia
Solitary masses that can metastasize to other lung lobes (causing smaller nodules)
Metastatic neoplasia
Smaller nodules, well-defined
Presents with history or suspicion of malignant neoplasms (spread to the lung)
Bronchioloar carcinoma (primary neoplasia)
75% of cases
Orginiates from smaller airways and lcoated at periphery of th elung
Bronchogenic carcinomas (primary neoplasia)
Originated from large bronchi in the hilar region (adenocarcinoma, SCC, anaplastic carcinoma)
Nodular and miliary interstitial
Small nodules or very small (mille seeds) pulmonary opacities
Differentials for Nodular and miliary interstitial
Metastatic dz
Fungal dz (thoracic lymphandenopathy- hilar or tracheobronchal LNs affected)
Fungal pneumonias
Histoplasmosis, blastomycosis, coccidiomycosis
Radiographic findings of fungal pneumonias
Miliary to nodular interstitial pattern
Thoracic lymphadenopathy
CS of fungal pneumonias
Coughing, ↑ resp. effort
Known history of travel to endemic area
Tx of fungal pneumonias
Itra-, fluco, ketoconazole
Amphotericin B
O2 therapy and supportive care
Visualization of bronchial walls from:
Thickening
Calcification of bronchial cartilage
Cellular infiltrates around bronchi and bronchioles (peri-bronchial cuffing)
Bronchial pattern
Dz involving the airway
Thickened walls of bronchi and bronchioles
Radiographic findings of bronchial patterns
End-on/ cross sectional view of airways (donuts)
Longitudinal view of airways (tramlines, train racks and monorails)
Bronchiectasis (dilated bronchi)
Differentials for bronchial patterns
Infectious bronchitis (bacterial or viral)
Non-infectious (Chr. or allergic bronchitis)
Eosinophilic bronchopneumopathy
Feline asthma
Bronchial calcification
CS of bronchitis
Coughing, resp. distress, exercise intolerance
What’s seen on thoracic radiographs with bronchitis?
↑ bronchial markings
Interstitial pattern (peri-bronchial cuffing)
Secondary pneumonia
Bronchiectasis
Disease where there’s permanent enlargement of parts of the airways of the lung
Types of Bronchiectasis
Cystic/ Saccular: dilated bronchus forms clusters of cyst
Varicose: irreg areas of constriction and dilation
Cylindrical: enlarged and cylindrical
Feline Asthma
Bronchospasm and thicken airway by mucus and debris causes narrowing/ occlusion (airway obstruction)
Whats seen on the rads of a cat with feline asthma?
Lobar sign on right middle lobe
Hyperinflated lungs from air-trapping causing flattening of the diaphragm
CS of feline asthma
Coughing, wheezing and resp. distress
Functional vascular system
Pulm. a. carry O2 deprived blood away from right ventricle to the lung
Pulm. v. carry oxygenated blood to left atrium
Lobar artery, bronchus and vein to the left and right CRANIAL lung lobes
Assessed on lateral view
Compared to diameter of proximal 1/3 of 4th rib
Lobar artery, bronchus and vein to the left and right CAUDAL lung lobes
Assessed on DV view
Measured by assessing area of summation of vessels over 9th rib
Different lobar artery, bronchus and vein size
Good: make a square
Enlarged vessel: wide rectangle
Small vessel: Upright/ narrow rectangle
Hyper-vascular
Enlarged pulm arteries: heartworm dz or pulm hypertension
Enlarged pulm veins: left sided heart failure
Both: left to right shunts or iatrogenic overhydration
Hypo-vascular
Small pulm. arteries and veins
Microcardia, small caudal vena cava and hyperlucent lung capacity
Differentials of hypovascular
Pulmonary hypotension (shock, blood loss, severe dehydration, hypoadrenocorticism and addisons dz)
