Test 1: lecture 13 +14 Xray Flashcards
what views are needed for heart Xray
dorsoventral
right and left lateral
why DV vs VD for heart xray
DV: heart closer to detector= less magnification
less distortion
atelectasis of lungs
what view is best for caudal lobar vessels and why
DV
magnified, less distorted, surrounded by aerated lung
what view for a pleual effusion
VD (on back)
how tall is normal heart in dog
<70% of thoracic height
normal angle between trachea and spine in dog
1/3 2/3 rule
how wide should normal dog heart be
deep or barrel chested dog will have a wider cardiac width on lateral
barrel
width of heart on DV for dog
cardiac width on lateral Xray for cat
what happens to older cat heart
lazy heart (lays down)
what happens to cat heart with age on DV
prominent aortic arch
old cats: lazy heart, prominent aortic arch, undulating descending aorta
how to measure vertebral heart score
compare height and width of heart to
number of vertebral bodies starting at T4
then add together
normal VHS in dogs: 8.7-10.7
some breeds have VHS >10.7
normal VHS in dogs
8.7-10.7
normal VHS for cats
6.8-8.1
short cut VHS
in cats only
heart width on VD/DV view
compared to vertebral length on lateral view
what is pericardial fat stripe sign
effusion can hide heart (same density)
fat will cause shadow to be able to see where heart is
where is LA on clock face lateral view
where is LV on clock face lateral view
where is RV on clock face lateral view
where is aorta, Main pulmonary artery, right auricular appendage on lateral clock face
where is aorta on VD clock face
where is the MPA on VD clock face
where is L atrium and L auricle on VD clock face
where is LV on VD clock face
where is RV on VD clock face
5-9
where is right atrium on VD clock face
9-11
what will xray show for left atrial enlargement on lateral view
loss of caudal waist
bulge at 12-2
increased height
dorsal elevation +/- compression of the caudal mainstem bronchi
back pack
enlarged Left atrium has displaced and compressed the mainstem bronchus
trachea has been compressed
what will left atrial enlargement on VD cause
left atrium is in middle of the heart in a dog
double density superimposed
bulge at 2-3
widened angle between the caudal mainstem bronchi (bow legged cowboy sign)
left atrial enlargement
double density superimposed
bulge at 2-3
widened angle between the caudal mainstem bronchi (bow legged cowboy)
left atrium in middle of heart
left atrial enlargement in cat in lateral view
hard to see
widening of the heart base
slight bulging or rounding of caudal contour
left atrial enlargement on VD of cat
left atrial bulge at 2-3 (can extend cranial)
valentine heart
severe left or left and right atrial enlargement
left ventricular enlargement in dogs lateral
tall cardiac silhouette
dorsal tracheal displacement
elevated caudal vena cava
left ventricular enlargement in dog on VD
elongated cardiac silhouette
rounded left heart
right atrial enlargement lateral
bulge 9-11
not common
right atrial enlargement on VD
9-11 rounded contour
right ventricular enlargement on lateral
rounded cranial heart at 5-9
right heart >2/3 of cardiac silhouette (wide heart)
increased cardiosternal contact (may be seen in some normal dogs (barrel chested))
caudodorsal tipping of apex
right ventricular enlargement on VD
rounded right heart 5-9
reverse D
may displace the apex to the left (false impression of left sided cardiomegaly)
microcardia on lateral
narrow, pointed heart
apex may lose contact with sternum
pulmonary arteries and veins may be small
microcardia on VD
narrow, pointed heart
apex may lose contact with sternum
pulmonary arteries and veins may be small
microcardia
right ventricular enlargement
right ventricular enlargement
right atrial enlargement
left ventricular enlargement
Rounded left heart
Elongated cardiac silhouette
left ventricular enlargement
Tall cardiac silhouette
Dorsal tracheal displacement
“Elevated” Caudal Vena Cava
left atrial enlargement in cat
differentials for microcardia
shock: hypovolemia
addisons (low cortisol)
constrictive pericarditis (rare)
where are the pulmonary vein and artery
veins are ventral or central
normal vasculature on lateral should be — the width of the proximal 1/3 of the — rib
less then
4th
artery and vein should be the same diameter
where is aorta and CVC
caudal vena cava should be — the diameter of the aorta and — in length
less then 1.5 x
less then T5
veins and arteries
veins are ventral and central
on VD the width of the — rib should be equal to the diameter of the pulmonary artery and vein
9th
differential for enlarged aorta
Cats: Age-related (aortic arch)
Patent Ductus Arteriosus
Post-stenotic dilatation
§ Subaortic stenosis
Aortic aneurysm (very rare)
enlarged caudal vena cava differential
Right heart failure
Obstruction of caudal vena cava or right atrium
§ Caval syndrome (Dirofilariasis)
§ Blood clot, Mass
Normal Variation
§ Respiration, Cardiac cycle o Evaluate on all views
enlarged MPA differential
Post-stenotic dilatation
§ Pulmonic stenosis
Pulmonary hypertension
Dirofilariasis or Angiostrongylosis
Left to right shunt
§ PDA, ASD, VSD
Fake-Out
§ VD projection
§ Rotated projection
§ Cardiac cycle (systole)
enlarged pulmonary arteries differential
Dirofilariasis
§ Pulmonary arteries often also tortuous and blunted
Pulmonary hypertension
Pulmonary thromboembolism (PTE)
enlarged pulmonary veins differential
Left heart failure
§ May not be enlarged if the patient received diuretics
Fluid/volume overload (relative vs absolute)
Left atrial obstruction
enlarged pulmonary arteries and veins differential
Left to right shunts
Pulmonary congestion
§ Fluid volume overload (relative vs absolute)
§ (Left heart failure - cats)
small pulmonary arteries and vein differential
Pulmonary Hypoperfusion
* Hypovolemia
* Right to left shunts
* Pulmonic stenosis
* Pulmonary thromboembolism
* Decreased cardiac output
§ Pericardial effusion with tamponade
§ Restrictive pericarditis
§ Right heart failure
4 main causes of left heart failure
volume or pressure overload (Mitral valve insufficiency)
myocardial failure
interference with filling
increased requirement for cardiac output
3 major signs of Left heart failure on xray
enlarged left heart (big LA, double density on VD)
pulomonary venous congestion (enlarged veins (cats get enlarged arteries)
pulmonary edema (intersititial to alveolar pulmonary pattern) (caudodorsal)
dogs with pulmonary edema from L CHF will cause
perihilar and caudodorsal interstitial to alveolar pulmonary pattern
can be more severe in right caudal lobe then left
dilated cardiomyopathy: can cause ventral peropheral alveolar pattern
what kind of pulmonary edema will cats with Left CHF have
patchy distribution
can also get pleural effusion
what is most common cause of Left CHF in dogs
mitral valve disease
leads to big LV, enlarged PV and edema in lungs
dog with Left HF, what is wrong
enlarged LA and LV (double density, long and buldge)
enlarged pulmonary vein (ventral)
caudodorsal alveolar pattern worse on the right
pulmonary edema from L HF in dog vs cat
dog: caudodorsal edema (R>L)
cat: diffuse or patchy
what are the arrows
pleural effusion- retraction of lung lobe from the body wall
from left HF in cat
right sided HF
enlarged Right heart (laying down, 1/3 2/3 rule)
enlarged caudal vena cava
hepatomegaly
ascites
pleural effusion
what are some things that cause concentric ventricular hypertrophy
AS
PS
hypertrophic cardiomyopathy
heart would appear normal on XRay
mitral valve disease leads to enlargement of —
left side
tricuspid valve disease leads to enlargement of —
right side
mitral valve disease
left artial enlargement (bulge)
pulmonary veins thicker
caused dorsal displacement of trachea, and tall cardiac silhouette
degenerative mitral valve disease that progressed to HF will show
double density of Left atrium
bulge from big LA and ventricle
enlarged pulmonary veins
caudodorsal alveolar pattern 9R.L)
doberman
dilated cardiomyopathy
left atrial enlargement (buldge and double oppasity on VD)
diffuse interstitital pattern, ventral alveolar regions
hypertrophic cardiomyopathy in cats will cause
LA and LV enlargement (valentine shape on VD)
+/- heart failure
cat cardiomyopathy
LA and LV enlargement (valentine shape)
left heart failure (patchy alveolar pattern)
what will heart worm do to the heart
Pulmonary arteries are enlarged,
tortuous, and blunted
* Right caudal lobar artery affected first
Enlarged main pulmonary artery
Right-sided cardiomegaly
* Cor pulmonale (secondary to pulmonary hypertension)
Enlarged caudal vena cava
* “Caval syndrome”
Right heart failure
Bronchial pulmonary pattern, Multifocal alveolar pulmonary pattern
* Pneumonitis, Thromboembolism
heart worm
enlarged, tortous, blunted pulmonary arteries
enlarged MPA
enlarged RV (reverse D)
diffuse bronchial pattern
what direction shunt for PDA
left to right
patent ductus arteriosis
PDA will cause what on Xray
triad bump: aortic arch, LA/Lauricle, MPA all enlarged
pulmonary arteries and veins also enlarged
PS will cause
enlarged MPA (hat sign)
RV enlargement (reverse D)
sub aortic stenosis
enlarged aortic arch
LV enlarged (tall sihouette, elevated caudal vena cava, dosal tracheal displacement)
+/- enlarged LA if severe (double density)
+/- Left HF
if left to right shunt VSD what happens to pulmonary arteries and veins
enlarged
if right to left shunting from VSD what happens to arteries and veins
small arteries
(skipping lungs)
pericardial effusion on xray
large round (globoid) cardiac silhouette
sharp outline with no motion artifact from heart beating
pericardial effusion can cause — which will cause — pulmonary vasculature
cardiac tamponade
small pulmonary vasculature
right heart failure
what?
Peritoneopericardial Diaphragmatic Hernia (PPDH)
abdominal organs in pericardial sac
will ahve enlarged rounded silhouette
