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Cardiology and Respiratory SA Med > Thoracic radiograph interpretation > Flashcards

Thoracic radiograph interpretation Flashcards

1
Q

What does good thoracic radiograph interpretation do for you?

A
  • Localize a problem to an organ system in patients with respiratory symptoms, e.g. cardiac, pulmonary airway, pleural space, or mediastinal disease
  • Assess changes in heart shape and size AND assess the presence or absence of heart failure (fluid)
  • Evaluate intrathoracic blood vessels
  • Chest conformation
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2
Q

What type of cardiac disease (pressure vs volume overload) are thoacic radiographs good for discerning?

A
  • Volume overload

- Most diseases in dogs are volume overload (e.g. mitral valve regurgiation or endocardiosis)

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3
Q

What three things can often lead to diagnosis for cardiac disease?

A
  1. Solid radiographic interpretation
  2. Good cardiac examination
  3. Knowledge of common diseases
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4
Q

What are three common radiography pitfalls?

A
  • Position
  • Technique
  • Anatomical variation
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5
Q

Advantages of DV

A
  • Pulmonary vessels
  • Cardiac silhouette is not as elongated
  • Better to see the heart with pleural effusion
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6
Q

Advantages of VD

A
  • Can see the vena cava very well
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7
Q

Normal cardiac size: dog heart lateral

A
  • Height: Cardiac base < 2/3 chest cavity height (apex to spine)
  • Width: <2.5-3.5 intercostal spaces
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8
Q

Normal cardiac size: dog heart dorsoventral projection

A
  • Length: <5 intercostal spaces (<6 on VD)

- Width: Maximal width <2/3 width of chest cavity at same level

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9
Q

Normal cardiac size: cat heart lateral

A
  • Height: <2/3 chest cavity height
  • Width: less than 2.5-3.5 intercostal spaces
  • Cardiac apex SHOULD NOT OVERLAP with diaphragm
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10
Q

Normal cardiac size: cat heart dorsoventral view

A
  • Length: similar to dog (<5 intercostal spaces on DV or <6 on VD)
  • Width: maximal width <1/2 width of chest cavity at same level
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11
Q

Which chamber tends to be enlarged if heart is taller than normal on a lateral view (for dogs)?

A

Left heart enlargement

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12
Q

Which chamber tends to be enlarged if heart is wider than normal on a lateral view (for dogs)?

A
  • Right heart enlargement
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13
Q

Which chamber tends to be enlarged if heart is taller than normal on a DV/VD view (for dogs)?

A
  • Usually left sided enlargement
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14
Q

Which chamber tends to be enlarged if heart is wider than normal on a DV/VD view (for dogs)?

A
  • Left or right heart
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15
Q

Chamber at 1-2 o’clock on lateral view?

A
  • Left atrium
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16
Q

Chamber at 4-6 o’clock on lateral view?

A
  • Left ventricle
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17
Q

Chamber at 7-8 o’clock on lateral view?

A

Right ventricle

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18
Q

Chamber at 9-10 o’clock on lateral view?

A

Right atrium

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19
Q

Chamber at 10-11 o’clock on lateral view?

A
  • Aorta and main pulmonary artery
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20
Q

Chamber at 1-2 o’clock on DV view?

A
  • Main pulmonary artery
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21
Q

Chamber at 2-3 o’clock on DV view?

A

Left auricle

22
Q

Chamber at 4-6 o’clock on DV view?

A

Left ventricle

23
Q

Chamber at 7-8 o’clock on DV view?

A
  • Right ventricle
24
Q

Chamber at 9-11 o’clock on DV view?

A

Right atrium

25
Q

LOOK AT A RADIOGRAPH FOR EXAMPLE OF WHERE AORTA AND LEFT ATRIUM ARE

A
  • Just do it
26
Q

What is normal ratio of aorta and caudal vena cava?

A

1:1 on lateral view

27
Q

Location of pulmonary artery and pulmonary vein relative to each other on lateral projection?

A
  • Artery is dorsal

- Vein is ventral

28
Q

Location of pulmonary artery and pulmonary vein relative to each other on DV projection?

A
  • Artery is outside

- Pulmonary vein is more medial

29
Q

Normal size of pulmonary vasculature

A
  • 7th-9th rib, the vessel as it crosses the rib should not be wider than the 7th, 8th, or 9th rib
30
Q

Causes of pulmonary vessel overcirculation

A
  • Ventricular septal defect

- Patent ductus arteriosus

31
Q

Causes of pulmonary vessel undercirculation

A
  • Severe pulmonic stenosis
32
Q

Causes of pulmonary artery enlargement

A
  • Pulmonary arterial hypertension
  • Sometimes terminal portions will be attenuated, while proximal portions are very large in chronic PAH
  • In heart worm disease, pulmonary arteries may become markedly tortuous
33
Q

Pulmonary venous hypertension

A
  • Usually occurs prior to left heart failure and may manifest as engorged pulmonary veins relative to arteries
34
Q

Caudal vena cava enlargement

A
  • May be enlarged in cases of systemic venous congestion as may occur with elevations in right heart filling pressure
  • Compare to aorta on lateral film (1:1 is normal)
35
Q

Ductus bump

A
  • PDA causes a dilation of the descending portion of the aorta (turbulence of the ductus) noted on DV or VD view
36
Q

Post-stenotic dilation of PS

A
  • Dilation of main pulmonary artery caused by pulmonic stenosis often times seen on the DV radiograph in the 1:00-2:00 position
  • This helps create the reverse D pattern noted radiographically with right ventricular pressure overload
37
Q

Post-stenotic dilation of SAS

A
  • Subaortic stenosis can cause a post-stenotic dilation of ascending aorta typically noted as a bulge in the cranial heart base region on a lateral radiograph
38
Q

Bronchial pattern appearance

A
  • Doughnuts and train tracks

- overall increased opacity of airways

39
Q

Interstitial pattern appearance

A
  • Cloudy parenchyma
  • Obscures edges and vessels
  • Can be patchy or focal
40
Q

Alveolar pattern appearance

A
  • Very progressed interstitial (flooded alveoli)
  • Bronchi are visible (air bronchogram)
  • Parenchyma dense to consolidated
41
Q

Consolidated lungs

A
  • Dense alveolar pattern without an air bronchogram
42
Q

Vascular pattern of lungs

A
  • Generalized enlarged pulmonary vessels (arteries and veins)
43
Q

Do normal thoracic radiographs rule out airway disease or inflammation?

A
  • NOPE

- Especially in cats

44
Q

What can lead to an interstitial pattern?

A

Generally caused by infiltration of inflammatory fluid, hemorrhage, or neoplasia into tiny alveolar spaces

  • Not diffuse
45
Q

What can lead to an alveolar pattern?

A
  • When tiny alveolar spaces are infiltrated with inflammatory fluid, hemorrhage, or neoplasia
  • Soft tissue opacity highlights the larger airways, creating a hallmark dark “air bronchograms”
46
Q

What pattern is often seen with pneumonia

A
  • Alveolar pattern

- If aspiration, often cranial ventral opacity in the lung

47
Q

What are the three classic findings of radiographic left heart failure?

A
  1. Left heart enlargement (especially left atrium)
  2. Pulmonary venous enlargement
  3. Interstitial opacity, especially around vessels (pulmonary edema secondary to increased hydrostatic pressure secondary to venous congestion)
48
Q

What are the 3 hallmarks of the reverse D on a dorsoventral view secondary to right heart pressure load?

A
  1. Right ventricle enlargement
  2. Right atrial enlargement
  3. Main pulmonary trunk bulge (also enlarged right PA)
49
Q

What disease process should come to mind when you see a reverse D on dorsoventral view?

A
  • Right heart pressure overload (e.g. pulmonary arterial hypertension or pulmonic stenosis)
50
Q

What two things can occur with feline left sided congestive heart failure?

A
  • Pleural effusion or interstitial pattern (pulmonary edema)

Cardiology and Respiratory SA Med (15 decks)

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