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DIAGNOSTIC IMAGING > Thorax Radiography > Flashcards

Thorax Radiography Flashcards

1
Q

For VD and DV radiographs, which side of the image is the patients right side?

A

the left side of the image

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2
Q

in VD/DV radiographs, the caudal vena cava is on the left or right side?

A

right side of the patient (left side of image)

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3
Q

what condition would make it so every postion inside the thorax is switched

A

in situs inversus

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4
Q

in VD/DV radiographs, what side should the gastric fundus be?

A

left side

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5
Q

in VD/DV radiographs, what side should the splenic head be

A

left side

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6
Q

What is a cranioventral mediastinal reflection

A

an indicator of laterality in thoracic radiographs
present on the left side - thicker, probably from mediastinal fat

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7
Q

in VD/DV radiographs, what side is the cranioventral mediastinal reflection

A

left side of patient (right side of image)

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8
Q

in VD/DV radiographs, what side is the caudoventral mediastinal reflection?

A

left side of patient (right side of image)

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9
Q

what thoracic view shows the caudodorsal vessels better? *

A

DV

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10
Q

What radiographic view gives you three “bumps” from the diaphragm

A

VD
1) Diaphragm capula
2) Left hemidiaphragm
3) Right hemidiaphragm

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11
Q

What radiographic view gives you on large view of diaphragm

A

DV- cupula

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12
Q

what lateral view has the hemidiaphragms that are close and in line

A

right lateral

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13
Q

what lateral view has the hemidiaphragms separated?

A

left lateral

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14
Q

on lateral radiographs, the caudal vena cava merges with the

A

right hemidiaphragm (best seen on right lateral because the right hemidiaphragm is more cranial)

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15
Q

How do you tell appropriate positioning of a VD/DV thoracic radiograph

A

1) Roughly Equal thorax space each side of spine
2) Sternum is over the spine
3) Spinous-processes straight and have a tear drop shape

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16
Q

How should the sponous processes look in a correctly alighed VD/DV radiograph

A

tear drop shaped

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17
Q

How should the sternum be positioned in a VD/DV radiograph

A

over the spine

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18
Q

In a correctly positioned VD/DV radiograph the thoracic space should be ________ in relation to the spine

A

equal on each side of spine

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19
Q

You see on radiograph that a patient’s sternum is off to the patient’s left side (right side of image). How do you fix the positioning

A

Sternum needs to move a small distance to the patients right side

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20
Q

When taking lateral shots of the thorax, how do you know you have correct positioning

A

1) Rib heads superimposed
2) Rib curvature should match
3) Pull limbs out of image to minimize bone and soft tissue on the top of the lunb

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21
Q

When taking lateral thoracic shots, why do you need to pull the limbs out of the image

A

to minimize bone and soft tissue on the top of the lung that could be hiding a lesion

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22
Q

How many lobes of lung do the dog have

A

Left: 2- Cranial (cranial and caudal part) and Caudal

Right: 4 - cranial, middle, caudal, and accessory

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23
Q

How many lobes does the left canine lung have

A

2- Cranial (cranial and caudal part) and Caudal

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24
Q

How many lobes does the right canine lung have

A

1) Cranial
2) Middle
3) Caudal
4) Accessory

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25
Q

on a right lateral view, mostly the ________ lung is seen

A

left lung

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26
Q

What lung lobe typically shows up on both left and right lateral views

A

accessory lobe (right lung lobe) because it is close to midline

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27
Q

Veins are ________ and ________ to the bronchus

A

ventral and central

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28
Q

normal bornchial walls are invisible when

A

peripheral- becomes very small and invisible

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29
Q

Arteries and veins should be equal in size (or veins slightly larger) and they should be be no larger than the _______________ where they cross

A

9th rib (really subjective)

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30
Q

where do the pulmonary arteries and veins cross

A

at the level of the 9th rib

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31
Q

What might cause an animal to have both big pulmonary arteries and veins on radiograph

A

1) Left to Right Cardiac Shunt (PDA, VSD, ASD)
2) Iatrogenic fluid load

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32
Q

What conditions cause a left to right cardiac shunt and subsequent big arteries and veisn on radiography

A

1) Patent Ductus Arteriosus
2) Ventricular Septal Defect
3) Atrial Septal Defect

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33
Q

What are causes of small pulmonary arteries and veins on radiograph

A

1) Hypovolemia
2) Shock
Uncommon: addisons disease, severe pulmonic stenosis with hypoperfusion to lungs, right to left cardia shunt (tetraology fallot of reversal with high right heart pressure)

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34
Q

With tetralogy of fallot, what will the pulmonary arteries and veins look like

A

small

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35
Q

How might a left to right shunt reverse

A

due to high right sided heart pressure (Eisenmenger syndrome0

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36
Q

What might cause the pulmonary arteries to be big and the veins to be normal

A

1) Pulmonary hypertension
2) Heartworm Disease (huge and weird shaped)
3) Thromboembolism (rare)

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37
Q

With pulmonary hypertension, what appearance will the pulmonary vessels have

A

Big Pulmonary Arteries
normal pulmonary veins

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38
Q

With heartworm disease, what appearance will the pulmonary vessels have

A

Big Pulmonary Arteries
normal pulmonary veins

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39
Q

What causes normal pulmonary arteries and big veins

A

Left sided heart congestion
a) Mitral valve degeneration
b) Cardiomyopathy (dilated, hypertrophic, etc)

rare: mitral valve dysplasia (congential) , left atrial obstruction (mass, thrombosis, cor triatriatum sinister)

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40
Q

In patients with left sided congestion heart failure, what radiographic appearance will you see

A

normal pulmonary arteries and big pulmonary veins

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41
Q

In patients with mitral valve degeneration, what radiographic appearance will you see

A

normal pulmonary arteries and big pulmonary veins

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42
Q

Are lung nodules or masses smaller

A

nodules

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43
Q

How does the appearance of lung nodules differ from lung masses

A

Nodules: soft tissue opaque, usually round

Masses: soft tissue opaque, round or irregularly shaped, can have ill-defined margins, can have air bronchograms

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44
Q

T/F: mineralized nodules are rare, often mixed with soft tissue opacity

A

True

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45
Q

What are your two differentials for multiple nodules/masses in the lung

A

1) Metastatic neoplasia: most common by far
2) Granulomas (fungal if geographical, feline asthma, certain inflammatory diseases)
3) Hematogenous pneumonia (rare)

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46
Q

What might cause multiple granuloma nodules/masses on the lungs

A

1) Fungal disease (if geographical)
2) Feline asthma
3) certain inflammatory diseases

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47
Q

What might cause a solitary nodule/mass in the lungs

A

1) Primary lung tumor (especially if one mass)
2) One small nodule (early metastatic neoplasia)
3) Granuloma (uncommon)

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48
Q

what are miliary nodules

A

nodules that are very tiny
may coexist with larger nodules

can occur in metastatic neoplasia

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49
Q

a pulmonary nodule/ mass that forms spontaneously or from trauma
cavity that contains gas
uncommon

A

Bulla

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50
Q

What is the smallest a nodule cab be visible on pulmonary radiographs

A

as small as 2mm, varies depending on patient size and regional superimposition

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51
Q

What might mimic pulmonary nodules on radiograph?

A

1) pulmonary osteomas
2) End-on vessels
3) Dermal structures: dermal nodules/masses and nipples
4) Costochondral junction remodeling

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52
Q

T/F: pulmonary osteomas is malignant

A

false- it is completely benign and unimportant
just when the lung decides to make bone

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53
Q

How can you tell pulmonary osteomas from pulmonary nodules

A

Pulmonary Osteomas have mineral opaque and often pointy shapes, but can be round

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54
Q

Pulmonary nodules are _____________ opaque while pulmonary osteomas are ________

A

Pulmonary nodules = soft tissue opaque (same as vessels)

Pulmonary Osteomas = mineral opaque (visible at smaller size)

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55
Q

Will Pulmonary osteomas or pulmonary nodules be more visible at a smaller size

A

Pulmonary Osteomas (mineral opaque)

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56
Q

Small pulmonary nodules are ________ shaped while pulmonary osteomas are _____ shaped

A

Small pulmonary nodules: round and smooth

Pulmonary osteomas: visible and weird shape

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57
Q

What are Pulmonary Osteomas

A

also called osseous metaplasia
very common
totally benign and unimportant
mineral opaque
often pointy shape, but can be round
often in lung periphery
may progress throughout the coarse of a dog’s life

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58
Q

End-on vessels will be (more/less) opaque than a same-sized soft tissue nodule

A

more opaque

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59
Q

Why are end-on vessels more opaque than a same size tissue nodule

A

because the opacity is based on the diameter

Nodules are sphere which gives it a soft tissue opacity

End-on vessels are cylinder which gives it a stack of soft tissue opacity = more opaque

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60
Q

How do end-on vessels differ from end-on airways

A

End-on vessels- very opaque, in the path of the vessel

End-on airways- lucent because they contain a stack of gas

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61
Q

What appearance do end-on airways have

A

lucent because they contain a stack of gas

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62
Q

What might cause cutaneous nodules that trick you in thinking pulmonary nodules

A

Nipples

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63
Q

where is costochondral junction

A

between the bone and cartilage within a rib

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64
Q

How can you locate the external location of a nipple when taking radiographs

A

coat the nipples with barium paste

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65
Q

What kind of dogs is costochondral junction remodeling common in

A

old dogs- small mineral nodules around these junctions

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66
Q

What does Costochondral junction remodeling look like

A

1) Mineral opaque
2) Location at the junction between the bone and cartilage
3) Usually irregular, can be smooth/round

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67
Q

How to you double check you are seeing nodules correctly

A

take other views
-DV to see caudodorsal lungs
-oblique views?
-retake the same view to see if it moves relative to the lung
-external structures coated with barium paste or tape on BBs
-humanoid projection
-recheck in 1-2 months

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68
Q

What is a humanoid projection

A

a VD where the thoracic limbs are pulled caudall.
move scapulae and soft tissues away from the cranial lung lobes
can help distinguish if you worried about pulmonary nodules

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69
Q

gas filled round structure with a very thin soft tissue opaque rim

A

bulla

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70
Q

what causes bulla

A

unknown cause or from trauma

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71
Q

what could rarely occur with bullas

A

could rarely rupture causing a pneumothorax - be careful with the degree of lung inflation under anesthesia

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72
Q

show up in typical locations between lobes
when normal, can see thin margins of visceral pleura that surrounds the lung lobes

A

pleural fissure lines

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73
Q

What appearance does pleural effusion have?

A

it widens the pleural fissure lines, especially wider peripherally (triangle-shaped)

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74
Q

What are the radiographic signs of pleural effusion

A

1) Widened pleural fissure lines
2) Larger volumes- thorax more opaque and soft tissue opacity around the lungs (border effacement of cardiac silhouette and diaphragm)
3) Lungs retracted and rounded

VD/DV: apparent widening of the cranial mediastinum (border effaced)

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75
Q

On VD/DV, what does pleural effusion look like?

A

apparent widening of. the cranial mediastinum (border effaced)

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76
Q

When you see widened pleural fissure lines, what do you think?

A

pleural effusion

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77
Q

Lungs may have interstitial pattern with pleural effusion due to

A

1) Underexpansion
2) Superimposed soft tissue opaque

may have an alveolar pattern if atelectasis

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78
Q

Lungs may have an alveolar pattern with pleural effusion due to

A

atelectasis

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79
Q

On a DV radiograph, where is pleural effusion pulled

A

gravity pulls fluid into the ventral thorax
-ventral thorax is narrower
-fluid stacks higher
-more opaque
heart is ventral and more border effaced by fluid on this view

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80
Q

On a VD radiograph, where is pleural effusion pulled

A

fluid goes into the dorsal thorax
-wider and able to spread out
more easily see pleural fissure lines

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81
Q

Are pleural fissure lines better seen on DV or VD

A

VD

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82
Q

With pleural effusion, is the heart more easily border effaced on a DV or VD view

A

DV

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83
Q

How will pleural effusion change the cranial mediastiium

A

it will make it look wider

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84
Q

free gas around retracted lung margins
-lack of vessels in gas-filled pleural space
atelectasis

A

pneumothroax

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85
Q

what does pneumothorax look like on lateral view

A

1) heart is dorsally displaced due to gas between the heart and sternum
2) Diaphragm is flattened

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86
Q

what does pneumothorax look like

A

1) free gas around retracted lung margins
-lack of vessels in gas-filled pleural space
2) atelectasis

Lateral:
1) heart is dorsally displaced due to gas between the heart and sternum
2) Diaphragm is flattened

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87
Q

what are the three pulmonary pattern types

A

-Bronchial
-Alveolar
-Interstitial

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88
Q

the region where blood vessels and other structures (like bronchi) enter an organ

A

Hilus

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89
Q

What does a bronchial pattern look like

A

End-on: thick rings, lucent in center (onion rings)
Long-axis: Paired thick lines, seen more peripherally, thinner than vessels

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90
Q

What is the mechanism of developing a bronchial pattern

A

*Thickening of airways
1) usually chronic inflammation (hypertrophy and fibrosis)
2) sometimes acute( edema)
3) Rarely neoplasitc

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91
Q

What diseases cause a bronchial pattern?

A

a) Feline asthma
b) Eosinophilic bronchopneumopathy
c) Chronic/previous inflammation (older patients, previous disease, inhaled irritants)
d) infection (usually other patterns are present)

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92
Q

What is your first differential for a purely bornchial pattern in cats

A

Feline asthma

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93
Q

what is the radiographic appearance of alveolar pattern

A

-Soft tissue opaque lung region

-At least one of the following:
1) Air bronchogram
AND/OR
2) Lobar signs
AND/OR
3) Border effacement with soft tissues

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94
Q

An alveolar pattern is soft tissue opaque with one of what three criteria?

A

1) Air bronchogram
AND/OR
2) Lobar signs
AND/OR
3) Border effacement with soft tissues

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95
Q

What is an air bronchogram seen with the alveolar pattern

A

lucent airways with surrounding soft tissue opacity

all regional vessels are border effaced (because they are also soft tissue opaque)

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96
Q

What is the lobar sign seen with alveolar pattern

A

distinct smooth soft tissue opaque margin at the edge of a lobe, adjacent to normal lung

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97
Q

What is border effacement with nearby soft tissues seen in alveolar pattern

A

lose visibility of margins of cardiac silhouette, diaphragm, etc

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98
Q

What causes alveolar pattern

A

1) Edema (noncardiogenic or cardiogenic pulmonary edema)
2) Blood (trauma or coagulopathy)
3) Pus (Pneumonia- aspiration) or inflammatory (eosinophilic bronchopneumopathy)
4) Neoplasia (primary or metastatic)

*stuff in alveoli or atelectasis

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99
Q

What are the radiographic features of an interstitial pattern

A

1) Increased background opacity of the lung: opacified interstitial space is usually textured appearance between the gas-filled alveoli

2) Large pulmonary vessels visible but fuzzy (small peripheral vessels are not visible)

*Not as severe as alveolar- not meeting any of the 3 criteria

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100
Q

T/F: intersitial is not as severe as alveolar

A

true

101
Q

What causes an interstitial pattern

A

1) Edema (noncardiogenic or cardiogenic pulmonary edema)
2) Blood (trauma or coagulopathy or LEPTOSPIROSIS)
3) Pus (Pneumonia- aspiration) or inflammatory (eosinophilic bronchopneumopathy)
4) Neoplasia (primary or metastatic LYMPHOMA)
5) Fibrosis *

6) Underexpansion (lack of air in alveoli)

102
Q

Underexpansion (lack of air in alveoli) would lead to what pattern

A

Interstitial

103
Q

Leptospirosis causes what pattern

A

Interstitial

104
Q

Fibrosis causes what pattern

A

Interstitial

105
Q

Lymphoma causes what pattern

A

Interstitial

106
Q

Feline asthma causes what pattern

A

Bronchial

107
Q

Eosinophilic bronchopathy causes what pattern

A

Bronchial

108
Q

What pattern is seen with decreased lung volume

A

Interstitial or Alveolar
-can be one lobe, one region, or entirety of lungs

109
Q

What causes atelectasis on radiography

A

1) Image taken at expiratory phase of breathing (not at peak inspiration)
2) Hypo inflated- dog not taking deep breathes (body shape, mass, disease preventing lung expansion)
3) Sedation
4) Anesthesia - pure O2 increases atelectasis
5) Prolonged recumbency in one position
6) Pleural space contents: Pneumothorax- gas; Pleural effusion- fluid
7) Bronchial obstruction: mucus plug, mass, foreign body

110
Q

How could anesthesia cause atelectasis

A

1) Pure O2
2) Prolonged recumbency in one position
3) Sedation

111
Q

What pleural contents could cause atelectasis

A

1) Gas- pneumothorax
2) Pleural effusion- fluid

112
Q

What pattern is seen with atelectasis

A

Interstitial or alveolar from decreased lung volume

113
Q

It is best to take thoracic radiographs at

A

peak inspiration

114
Q

Taking radiographs at expiratory phase could result in

A

marked caudodorsal interstitial pattern
-should go away with inspiratory phase

115
Q

What radiographic finding tells you the dgeree of lung inflation

A

the size of the triangle between the cardiac silhouette, caudal vena cava, and diaphragm

-indicates the degree of lung inflation

116
Q

What lung shows lesions better

A

the up lung

Right lateral shows left lung better

DV shows dorsal lung better than VD

117
Q

Is the down or up lung more likely to have atelectasis

A

down lung
-soft tissue opaque lesions will be invisible or less visible
Mineral lesions might still show up

*some important lesions might still show up (can miss lesions or fail to localize without both laterals)

118
Q

What is the horizontal beam VD

A

a view to demonstrate atelctasis

Dog laying on left side (like left lateral view)
X-ray tube moved to make radiograph parallel with the tube
Partial atelectasis of the down lung happens with all lateral thoracic views

119
Q

Partial atelectasis of the down lung happens with all

A

lateral thoracic views

120
Q

Why is a right and left lateral recommended in al thoracic study

A

because Partial atelectasis of the down lung happens with all lateral thoracic views

121
Q

DV shows ________ lung better than VD

A

dorsal lung

122
Q

What should be included in a thoracic study

A

right AND left lateral is recommended
Typically VD or DV (can do both)

123
Q

When do we use DV views

A

1) Dyspneic animals
2) Better view of dorsal lungs and pulmonary vessels
3) Cardiac studies (depends on familiarity)

124
Q

When do we use VD views

A

1) Usually better patient compliance
2) Spread out pleural fluid

125
Q

Is DV or VD better for dorsal lungs and pulmonary vessels

A

DV

126
Q

Is DV or VD better for dyspneic animals

A

DV

127
Q

What radiograph view spread out pleural fluid

A

VD

128
Q

Can you rule out minimal pleural effusion if you see thin pleural fissure lines?

A

NO

129
Q

show up in typical locations between lobes

A

pleural fissure lines

130
Q

What widens pleural fissure lines

A

pleural effusion

131
Q

What are the radiographic findings of pleural effusion

A

1) Widened pleural fissure lines
2) Larger volumes
-Thorax is more opaque than usually (soft tissue opacity around lungs)
-Border effacement of cardiac silhouette and diaphragm
-Lungs retracted and rounded
-VD/DV: apparent widening of cranial mediastinum (border effaced)

132
Q

With pleural effusion, how are the lungs shaped *

A

retracted and rounded

133
Q

what sign of VD/DV will you see with pleural effusion

A

apparent widening of the cranial mediastinum (Border effaced)

134
Q

Lungs may have _______ pattern with pleural effusions by may have ___________ if atelectasis

A

Pleural effusion: interstitial

Atelectasis: Alveolar

135
Q

Why do lungs have intersitital pattern with pleural effusion

A

-Underexpansion
-Superimposed soft tissue opaque fluid

136
Q

On DV, where does pleural effusion go

A

gravity pulls fluid to the ventral thorax
-Fluid stacks higher
-More opaque

Heart is ventral (more likely border effaced by fluid on this view

137
Q

With pleural effusion, what view is most likely to result in the heart being border effaced

A

DV- heart is ventral

138
Q

Does pleural fluid stack higher on DV or VD

A

DV- fluid stacks higher and more opaque

139
Q

On VD, where does pleural effusion go

A

dorsal thorax- wider and more spread out
more easily see pleural fissure lines

140
Q

Is pleural effusion lines more likely to be seen on DV or VD

A

VD- fluid is in dorsal thorax and more widely spread out

141
Q

free gas around retracted lung margins

A

pneumothorax
-lack of vessels in gas-filled pleural space *

142
Q

What are the radiographic appearances of pneumothorax

A

1) Free gas around retracted lung margins
2) Lack of vessels in gas filled pleural space
3) Atelectasis
4) Heart is dorsally displaced (gas between heart and sternum)
5) Flattened diaphragm

143
Q

What might you be suspicious of if you see the heart being dorsally displaced from the sternum on lateral view

A

Pneumothorax

144
Q

all the “middle” tissues between the lungs (including the heart)

A

mediastinum

145
Q

what does the normal thymus look like

A

“sail sign”
-triangular soft tissue opacity in cranial mediastinum
-visible in left cranial thorax

146
Q

Where is the normal thymus visible

A

left cranial thorax

147
Q

When should the thymus be gone by

A

1 year of age
(often a small amount of remnant)

148
Q

What is a mediastinal shift

A

rightward or leftward displacement of the mediastinum (including cardiac silhouette) on DV/VD

149
Q

What might cause a mediastinal shift

A

volume loss of increase

150
Q

What might cause a leftward mediastinal shift

A

1) Volume increase on right due to lung mass

2) Volume decrease due to left cranial lung lobectomy or atelectasis

3) Obliquity

151
Q

left cranial lung lobectomy would result in a

A

leftward mediastinal shift

152
Q

right lung mass would result in

A

leftward mediastinal shift

153
Q

in an anesthetized dog you see a left sided mediastinal shift due to volume decrease from atelectasis, what would bring it back to normal

A

positive pressure ventilation

154
Q

What is the normal cranial mediastinum size on VD view *

A

Dog: <2x the width of the thoracic vertebrae

Cat: Same size as thoracic vertebrae

155
Q

What are causes of cranial mediastinum widening on VD view

A

1) Fat (especially brachycephalic breeds) *
2) Masses *
3) Pleural or mediastinal fluid
4) Esophageal dilation (esp w fluid)

156
Q

What breed is likely to have cranial mediastinal widening due to fat

A

brachycephalic breeds

157
Q

What are your differentials for a cranioventral mediastinal mass

A

1) Lymph node enlargement
-Neoplasia- lymphoma, histiocytic sarcoma, metastatic neoplasia)
-Fungal disease
-Reactive lymphoid hyperplasia (node draining inflamed region)

2) Thymoma- or normal thymus in a very young patient

3) Brachial / Mediastinal cyst (benign) -especially in cats, can be large

4) Ectopic thyroid tumor (rare)

158
Q

What might cause mediastinal masses (not in the cranioventral area)

A

-Enlarged esophagus (dilation, foreign body, tumor, abscess)

-Abscesses, mediastinitis (rare)

-Hiatial hernia

159
Q

What are the radiographic signs of cranioventral mediastinal masses

A

VD/VD: usually midline mass- widened cranial mediastinum and rounded margin

All views (sometimes)
-Trachea displaced/compressed
-Heart displaced
-Less cranial lung inflation

160
Q

T/F: Pneumomediastinum can lead to pneumothorax

A

true

161
Q

T/F: Pneumothorax can lead to pneumomediastinum

A

false

162
Q

What are the radiographic findings of Pneumomediastinum

A

1) Small volume (bubbles)
2) Large volume = increased visibility of mediastinal structures
-Trachea (inner and outer margins)
-Esophagus
-Major vessels
3) +/- Gas in neck or retroperitoneal space
-Areas connected with mediastinum
4) Normal lung expansion unless also pneumothorax

163
Q

With Pneumomediastinum large volume of gas there is an increased visibility of mediastinal structures. Which structures?

A

-Trachea (inner and outer margins)
-Esophagus
-Major vessels

164
Q

With pneumomediastinum there is normal lung expansion unless there is

A

pneumothorax

165
Q

What are the causes of pneumomediastinum

A

1) Tracheal tear/ rupture
-HBC
-Bite wound
-overinflation of endotracheal tube (in cats often days after anesthetic event)

2) Esophageal perforation

166
Q

Overinflation of the endotracheal tube can lead to

A

pneumomediastinum

overinflation of endotracheal tube (in cats often days after anesthetic event)

167
Q

What are the 3 different intrathoracic lymph nodes

A

Sternal
Cranial Mediastinal
Tracheobronchial

168
Q

Where are the sternal lymph nodes

A

just dorsal to the 1st to 3rd sternebrae on midline

usually seen on lateral view (if very large, cranial mediastinum widened on VD/DV)

169
Q

What view can you see sternal lymph nodes

A

usually seen on lateral view

(if very large, cranial mediastinum widened on VD/DV)

170
Q

If there is very large sternal lymphadenopathy, where might you see the sternal lymph nodes

A

(if very large, cranial mediastinum widened on VD/DV)

171
Q

Where are the cranial mediastinal lymph nodes

A

dorsal to the region of the sternal lymph nodes

cranial to cardiac silhouette, ventral to trachea

172
Q

just dorsal to the 1st to 3rd sternebrae on midline

A

sternal lymph nodes

173
Q

How many tracheobronchial lymph nodes are there

A

3
Right
Left
MIddle

Any may be enlarged

174
Q

What are the radiographic signs of tracheobronchial lymphadenopathy

A

VD/DV: enlarged middle node = mass between the mainstem bronchi
(mainstem bronchi pushed laterally)

Lateral view: carina may be angled ventrally

175
Q

On lateral view, what sign will show you there is tracheobronchial lymphadenoapthy

A

carina may be angled ventrally

176
Q

On VD/DV, what sign shows you there is tracheobronchial lymphadenopathy

A

enlarged middle node = mass between the mainstem bronchi
(mainstem bronchi pushed laterally)

177
Q

What are your differentials for tracheobronchial lymphadenopathy

A

-Histiocytic sarcoma or lymphoma
-Fungal disease
-Sometimes inflammatory lung diseases (e.g eosinophiic bronchopneumopathy0

178
Q

How do you tell tracheobronchial lymph node vs left atrial enlargement

A

Both will have a perihilar mass that spreads the mainstem bronchi on VD image
HOWEVER

tracheobronchial LN enlargement is separated from the cardiac silhouette, sometimes ventral angle of carina

LA enlargement merges with the cardiac silhouette
-No ventral angle of carina

179
Q

Does tracheobronchial LN enlargement or LA enlargement more likely to have ventral angle of carina

A

Tracheobronchial LN enlargement

180
Q

What are reasons to image the trachea

A

-“honking cough”
-dyspnea
-cough elicited easily on tracheal palpation

181
Q

What might cause narrowing of the trachea

A

tracheal collapse due to chondromalacia (common)

182
Q

tracheal collapse due to chondromalacia is common in what breeds

A

small/toy breed dogs

183
Q

What is dynamic tracheal collapse

A

narrowing of the trachea that is sometimes seen different between views in a radiographic study

184
Q

What is static tracheal collapse

A

narrowing of the trachea that is consistent throughout respiratory cycle

185
Q

What is a fakeout for tracheal collapse

A

soft tissue is often superimposed with the dorsal trachea
-called redundant dorsal tracheal membrane or esophageal draping

interpretation should be informed by dog breed (some small breeds and most larger dog breeds shouldnt get chondromalacia)

186
Q

redundant dorsal tracheal membrane

A

also called esophageal drapping
soft tissue is often superimposed with the dorsal trachea

interpretation should be informed by dog breed (some small breeds and most larger dog breeds shouldnt get chondromalacia)

187
Q

What are the radiographic findings of traumatic diaphragmatic hernia

A

1) Cant see part of the diaphragm
2) Abdominal organs in the thorax
-Soft tissue opaque and/or gas containing
-Abdominal organs absent from abdomen
3) Mediastinal shift due to herniated structures
4) Pleural effusion

188
Q

What diaphragmatic hernia is typically congenital

A

Peritoneo-pericardial diaphragmatic hernia (PPDH)

usually doesnt cause problems

189
Q

T/F: Peritoneo-pericardial diaphragmatic hernia (PPDH) usually doesnt cause a problem

A

true

190
Q

What are the two different types of hiatal hernias

A

1) Sliding hiatal hernia (common)
-Brachycephalics
-Stomach slides cranial through hiatus

2) Paraesophageal hernia (uncommon)
-Fundus herniates to side of esophagus

191
Q

What is the most common hiatal hernias

A

Sliding hiatal hernia (common)
-Brachycephalics
-Stomach slides cranial through hiatus

192
Q

a hernia where the stomach slides cranial through the hiatus

A

Sliding hiatal hernia

193
Q

Sliding hiatal hernia is commonly seen in what breeds

A

Brachycephalics

194
Q

a hernia where the fundus herniates to the side of the esophagus

A

paraesophageal hernia

195
Q

where a portion of stomach herniates into thorax in expected region of esophagus
with or without gas
often intermittent/dynamic

A

hiatal hernia

196
Q

How many ribs are there normally

A

13 paired ribs
evenly spaced

197
Q

Rib tumors

A

may be expansile, lytic, and/or osteoproductive (produce bone)
-Primary bone tumor most common
-Metastasis also common

Look for rib lysis if there is an extrapleural mass
Can be complete lysis of rib

198
Q

Rib tumors may be:
1)
2)
3)

A

Expansile
Lytic- extrapleural
Osteoproductive

199
Q

Are rib tumors likely to be

A

primary bone tumor

200
Q

How do you distinguish extrapleural vs pulmonary masses

A

Extrapleural: obtuse angle of surrounding lung
broad margin in the chest wall

Pulmonary: acute angle of surrounding lung, narrow interface with chest wall (if any)

only works if you are tangential to the interface

201
Q

What does an acute rib fracture look like

A

displaced sharp margins
may have soft tissue swelling or emphysema (trapped gas)

202
Q

What does a chronic rib fracture look like

A

smooth oval of bony callus when healed
some may never heal, resorption causes smooth edges

203
Q

T/F: with rib fractures, often multiple ribs are affected in a row and at similar level

A

true

204
Q

T/F: degenerative changes in the sternum are common and unimportant

A

True unless there is ill-defined lysis, irregular periosteal proliferation (neoplasia or osteomyelitis)

205
Q

When might sternal abnormalities be important

A

ill-defined lysis, irregular periosteal proliferation (neoplasia or osteomyelitis)

206
Q

What are the general regions of lung distribution on lateral radiographs

A

Cranioventral
Caudodorsal
Ventral
Perihilar
Peripheral

207
Q

Cardiogenic pulmonary edema in dogs is from

A

left sided congestive heart failure

208
Q

What lung pattern is typically seen with cardiogenic pulmonary edema

A

interstitial and/or alveolar pattern
-generally caudodorsal region or perihilar

209
Q

T/F: Perihilar intersitital and/or alveolar pattern is less common but more specific for cardiogenic pulmonary edema

A

True

210
Q

Where is the interstitial and/or alveolar pattern typically seen with cardiogenic pulmonary edema

A

perihilar or caudodorsal region

211
Q

What are the radiographic findings of cardiogenic pulmonary edema in dogs

A

1) Intersitial and/or alveolar pattern (generally caudodorsal or perihilar)
2) Left Atrial enlergement +/- left ventricle enlargement (tall silhouette), may be obscured by the alveolar pattern
3) +/- visible pulmonary vein dilation (very specific)

asymmetric or symmetry

212
Q

What are radiographic signs of cardiogenic pulmonary edema in cats

A

1) Cardiomegaly (less than dogs)
2) No typical pattern of cardiogenic edema in cats
-sometimes similar to dogs
-often more random patchy, multifocal
3) Can have pleural effusion with L sided congested heart failure

213
Q

Cats can have what with L sided congested heart failure

A

pleural effusion

214
Q

Does Cardiogenic or Noncardiogenic pulmonary edema have:
left atrial enlargement

A

Cardiogenic

215
Q

Does Cardiogenic or Noncardiogenic pulmonary edema have:
Perihilar pattern

A

Cardiogenic

216
Q

Does Cardiogenic or Noncardiogenic pulmonary edema have:
Peripheral pattern

A

Noncardiogenic

217
Q

Does Cardiogenic or Noncardiogenic pulmonary edema have:
normal pulmonary vessels

A

Noncardiogenic

218
Q

Does Cardiogenic or Noncardiogenic pulmonary edema typically occur in older animals

A

cardiogenic - except in congenital heart disease

219
Q

Does Cardiogenic or Noncardiogenic pulmonary edema have systemic problems

A

noncardiogenic

220
Q

What are the clinical signs of non-cardiogenic pulmonary edema

A

1) Intersitial and/or alveolar pattern (mainly caudodorsal) but peripheral distribution is more specific for non-cardiogenic
2) Heart often normal (unless coincidence)

asymmetric or symmetric

221
Q

What should you do if you are unsure there is cardiogenic or noncardiogenic pulmonary edema

A

Echocardiogram or try furosemide to see if pattern improves in 24 hours

222
Q

Peripheral distribution is more specific in pulmonary edema that is

A

non-cardiogenic

223
Q

What are the important causes of non-caridogenic pulmonary edema

A

1) Seizures (if severe)
2) Electric shock (chewing on chord)
3) Hypoxemia
4) Near drowning
5) Choking or other upper respiratory obstruction
6) Acute Respiratory Distress Syndrome (ARDS)

224
Q

you should suspect aspiration pneumona is what is in the history

A

vomiting, regurgitation, or anesthesia
-especially if severe vomiting or dysfunction of larynx (ie laryngeal paralysis)

225
Q

What are the different kinds of pneumonia

A

1) Aspiration: vomiting, regurg, anesthesia, laryngeal dysfunction
2) Infectious (Bronchopneumonia)
Bacteria, viruses, some parasites
Fungal infection (Histo, Blasto, Valley fvr)
3) Hematogenous

226
Q

What pattern is typically seen with aspiration pneumonia

A

alveolar pattern
+/- interstitial and/or bronchial

almost always ventral distribution (especially craniovental)
one or multiple lung lobes

227
Q

Aspiration pneumonia is almost always what distribution

A

almost always ventral distribution (especially craniovental)
one or multiple lung lobes

228
Q

What does aspiration pneumonia look like on radiographs

A

1) Alveolar patterns (+/- interstitial and/or bronchial) - often hide the cardiac silhouette
2) Ventral distribution (esp cranioventral), one or multiple lung lobes

229
Q

Bacterial/Parasitic pneumonia may be identical to aspiration pneumonia or

A

random patchy bronchial/interstitial/alveolar pattern

230
Q

What does viral pneumonia look like

A

diffuse or regional interstitial pattern

if secondary bacterial infection: ventral alveolar pattern

231
Q

What can fungal pneumonia look like

A

any pulmonary pattern or combination
can have miliary pattern, nodules, or masses

often thoracic lymph node enlargement

Systemic illness and travel hx is very important

232
Q

What is often enlarged in fungal pneumonia

A

thoracic lymph nodes

233
Q

what does metastatic pulmonary neoplasia look like

A

multiple nodules/masses
miliary pattern (numerous tiny nodules)
solitary site of metastatic neoplasia is less common

234
Q

What does primary pulmonary neoplasia look like

A

usually one mass
can have lung metastasis late in dises (one buig mass and multiple smaller nodules - size disparity)

can be cavitary (esp in cats)

rarely have regional bronchial thickening from infiltration

235
Q

What does lymphoma look like of radiographs

A

Diffuse interstitial pattern or nodules
+/- thoracic LN enlargement

rarely bronchial thickening

236
Q

What does histocytic sarcoma look like on radiographs

A

one or multiple pulmonary masses
+/- thoracic lymph node enlargement
Predisposed to peripheral locations

237
Q

What are other differentials for neoplastic processes in the thorax

A

fungal disease (geographic)
abscess (single mass, rare)
granulomas (feline asthma)

238
Q

In cats, primary pulmonary masses can

A

spread to the digits

can be one digit or multiple digits on multiple limbs

239
Q

In lung-digit syndrome, what phalanx is most commonly affected by lysis

A

distal 3rd phalanx

240
Q

T/F: in lung digit syndrome in cats, lameness is often detected before the pulmonary mass

A

true

241
Q

What should you do if you see lysis of the digits upon radiography

A

take thoracic radiographs

242
Q

Lower airway diseases, commonly caused by allergic, infectious/inflammatory etiologies is what pattern

A

Bronchial pattern * +/- other patterns

243
Q

What are the radiographic consequences of bronchial disease

A

1) Lung lobe collapse
-Bronchial obstruction from mucus plugs
-Cranial and middle lung lobes most common
-Marked volume loss, alveolar pattern

2) Pulmonary hypertension
-Lucent expanded lungs
-Flattened diaphragm
-Tenting of diaphragm

3) Spontaneous rib fractures from respiratory effort- especially caudal ribs

4) Bronchiectasis

244
Q

With bronchial disease, what causes lung lobe collapse

A

bronchial obstruction from mucus plugs

245
Q

With bronchial disease, what lobes are most commonly affected

A

cranial and middle lung lobes

246
Q

weakened bronchial wall due to chronic inflammation, seen in lower airway disease

A

Bronchiectasis

247
Q

What are the radiographic features of Bronchiectasis

A

1) persistently increased bronchial diameter
2) Bronchus doesn’t taper well peripherally
3) Thickened bronchial wall if bronchitis

248
Q

What does pulmonary hyperinflation seen with lower airway disease look like

A

1) lucent expanded lungs
2) flattened diaphragm
3) Tenting of diaphragm

249
Q

What does a pulmonary contusion look like on radiograph

A

patchy interstitial to alveolar pattern, can be anywhere
often asymmetric
history of trauma
can have other findings of trauma and shock

DIAGNOSTIC IMAGING (7 decks)

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