Thoracic Radiography Quiz

Question 1

• 4 year old, medium crossbreed, ME dog
• Presented with difficulty breathing after being missing for 6 hours
• Indistinct chest sounds on auscultation

Discuss the radiographs and the diagnosis

Answer 1

Key points:

• Overall radiolucent appearance to images
• Radiolucent space between cardiac silhouette and sternum, in caudal and dorsal thorax and lateral to lung lobes
• Collapsed lung lobes seen centrally with increased radiopacity and some air bronchograms

Final diagnosis

•Pneumothorax

Question 2

• 10 year old, DSH, FN cat
• Presented with coughing and “wheezing” for several weeks
• NAD on examination

Discuss the radiographs and a diagnosis

Answer 2

Key points:

• Increased lung opacity with bronchial markings thickened, increased in number and extending to the periphery of the lung lobes (= bronchial pattern)
• Diaphragm caudal displaced and flattened (= lung hyperinflation)

Diagnosis

• Feline asthma – most likely (final diagnosis)
• Aelurostongylus could produce bronchial pattern but unlikely to lead to hyperinflation

Question 3

• 12 year old, DSH, MN cat
• Presented with mild difficulty in breathing for 3 months with sudden worsening previous 18 hours
• Semi-collapsed, mildly cyanotic, muffled chest sounds on auscultation, esp. RHS

Discuss the radiographs and a diagnosis

Answer 3

Key points:

• Overall increase in radiopacity throughout the thorax in both views.
• Lateral view - normal soft tissue structures obscured
• DV view – homogeneous soft tissue/fluid opacity in right hemithorax. Collapsed lung visible on LHS.
• Mineralised mass visible on ventral portion of 2nd right rib

Final diagnosis

• Rib mass with neoplastic pleural effusion
• (Histopath = osteosarcoma)

Question 4

• 11 year old, ME, Chihuahua
• Coughing “on and off” for 4 months. Marked cough and mild lethargy for 10 days.
• NAD on examination, no response to empirical treatment (antibiotics and bronchodilators)

Discuss the radiographs and diagnosis

Answer 4

Key points:

•Irregular, but well defined soft tissue opacity in right caudal lung lobe

Diagnosis

• Right caudal lung lobe mass
• Histopathology = lung carcinoma
• N.B. As the mass is not in contact with the heart, caudal vena cava or diaphragm, the borders of these can be seen superimposed on the mass (giving the unusual appearance of a rim of increased radiopacity)

Question 5

• 3 year old, DLH, FN cat
• Presented with “heavy breathing” for 4 weeks. Started at about time cat returned with scuffed claws and few minor grazes.
• Muffled chest sounds on auscultation.

Discuss the radiographs and diagnosis

Answer 5

Key points:

• Increased radiopacity ventral and mid thorax
• Markedly reduced abdominal contents
• Thoracic soft tissue structures and diaphragm obscured
• Colon courses cranioventrally across the abdomen and into ventral thorax

Diagnosis

•Ruptured diaphragm

Question 6

• 6 year old, FE, Cavalier King Charles Spaniel
• Presented with coughing for 4-6 months
• Grade 4 heart murmur, loudest over left heart apex

Discuss the radiographs and diagnosis

Answer 6

Key points:

• Signs of marked right- and left-sided heart enlargement
• Pulmonary blood vessels normal size
• No increase in lung opacity

Diagnosis

• Generalised cardiomegaly but no signs of congestive heart failure
• Ultrasonography detected chronic degenerative valve disease (mitral valve)

Question 7

• 2 year old, MN, Staffordshire Bull Terrier
• Regularly vomiting/regurgitating for several months. Recently started coughing
• Harsh lung rales on auscultation (particularly LHS), HR 110bpm, RR 38bpm, T 39.8C

Discuss the radiographs and diagnosis

Answer 7

Key points:

• Alveolar lung pattern L middle/ventral lung field
• Interstitial lung pattern L cranial, R cranial and middle lung lobes
• Marked generalised thoracic megaoesophagus

Final diagnosis

• Bronchopneumonia following aspiration
• Myaesthenia gravis was diagnosed as cause of megaoesophagus

Question 8

• 3 year old, ME, Springer Spaniel
• Presented 2 weeks ago for a soft cough and mildly increased respiratory effort. Now lethargic, off food and vomiting several times daily
• Increased lung sounds on auscultation, particularly caudally. HR 120 bpm, respiratory sinus arrhythmia. Good colour and CRT. Urea 60mmol/l; creatinine 800µmol/l.

Discuss the radiograph and diagnosis

Answer 8

Key points:

• Alveolar lung pattern R caudal/accessory lobe dorsally
• Interstitial lung pattern R cranial/middle lung lobes

Final diagnosis

• Non-cardiogenic pulmonary oedema due to severe azotaemia
• Kidneys appeared dysplastic on ultrasonography