Thoracic Radiology of the Dog

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Transcript Thoracic Radiology of the Dog

Thoracic Radiology of the Dog Dr. LeeAnn Pack Dipl. ACVR http://people.upei.ca/lpack/vetrad/

Thoracic Radiology of the Dog • Indications • Technical factors • Normal radiographic anatomy • Pulmonary vasculature • Alveolar lung pattern • ABC’s • Bronchial Lung Ds • Cardiology – PDA – Pulmonic stenosis – Aortic stenosis – Mitral insufficiency – DCM – Heartworm Disease • Pleural Effusion • Primary Lung Tumors • Pulmonary Nodules • Megaesophagus http://people.upei.ca/lpack/vetrad/

Indications • Coughing • Dyspnea • Cardiovascular disease • Thoracic trauma • Assessment of primary or secondary neoplasia • Regurgitation of food • Other abnormalities detected on PE http://people.upei.ca/lpack/vetrad/

Technical Factors • Potential for movement – Low mAs • High inherent contrast – Low kVp • INSPIRATION • Collimation/centering http://people.upei.ca/lpack/vetrad/

Inspiration vs. Expiration http://people.upei.ca/lpack/vetrad/

Normal Radiographic Anatomy • Heart – 2 ½ to 3 ½ intercostal spaces wide on lateral view – < 65% of the width of the thorax on the VD view – “clock face” – Lung lobes http://people.upei.ca/lpack/vetrad/

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Chamber Location http://people.upei.ca/lpack/vetrad/

Pulmonary Vasculature • Cranial pulmonary vessels – Lateral view – Artery = dorsal, vein = ventral – Diameter of vessels at the 4th ICS should not exceed the diameter of the proximal portion of the 3 rd rib http://people.upei.ca/lpack/vetrad/

Cranial Pulmonary Vessels http://people.upei.ca/lpack/vetrad/

Pulmonary Vasculature • Caudal pulmonary vessels • DV view • Artery = lateral, Vein = medial • Vessels should not exceed the diameter of the 9 th rib where they cross it http://people.upei.ca/lpack/vetrad/

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Alveolar Lung Pattern • Hallmark = air bronchograms – Consolidation = alveoli filled with fluid/cells • Retains shape – Atelectasis = collapse of alveolar lung space • Lobe size decreased, mediastinal shift possible http://people.upei.ca/lpack/vetrad/

Air Bronchogram http://people.upei.ca/lpack/vetrad/

Alveolar Lung Pattern • Lobar sign • Summation – superimposed over cardiac silhouette • May not see pulmonary vessels in area of pattern due to soft tissue opacity http://people.upei.ca/lpack/vetrad/

Nice Air Bronchograms  http://people.upei.ca/lpack/vetrad/

The ABC’s http://people.upei.ca/lpack/vetrad/

• Atelectasis – General anx – Recumbent animals – Dependent lung lobes affected • Aspiration pneumonia – Cranial,cranioventral lung lobes affected – Megaesophagus – Post anesthesia A http://people.upei.ca/lpack/vetrad/

• Bronchopneumonia – Cranioventral, ventral • Bacterial pneumonia – Cranioventral, ventral B http://people.upei.ca/lpack/vetrad/

• Contusion – History of trauma – Rib fractures – Distribution varies C http://people.upei.ca/lpack/vetrad/

• Dirofilariasis – Most common cause of thromboembolic disease – Increased lung opacity – Mixed interstitial – alveolar – Caudodorsal distribution http://people.upei.ca/lpack/vetrad/ D

• Edema • CARDIOGENIC – Left heart failure – Perihilar, symmetrical • NON-CARDIOGENIC – Electrocution – Salt water drowning – Seizures – caudodorsal http://people.upei.ca/lpack/vetrad/ E

Cardiogenic Edema http://people.upei.ca/lpack/vetrad/

Non Cardiogenic Edema Lateral http://people.upei.ca/lpack/vetrad/

Non Cardiogenic Edema VD’s http://people.upei.ca/lpack/vetrad/

• Foreign Body – Located in bronchus – Affected area depends on affected bronchus F http://people.upei.ca/lpack/vetrad/

• Granulomatous • Fungal – Eosinophilic • Variable distribution G http://people.upei.ca/lpack/vetrad/

• Hemorrhage – Distribution variable depending on the cause – Trauma • Rib fractures – Coagulopathy • Patchy, generalized H http://people.upei.ca/lpack/vetrad/

Bronchial Lung Disease http://people.upei.ca/lpack/vetrad/

Bronchial – RR Tracks http://people.upei.ca/lpack/vetrad/

http://people.upei.ca/lpack/vetrad/ Bronchial

http://people.upei.ca/lpack/vetrad/ Donuts

Bronchial Lung Disease http://people.upei.ca/lpack/vetrad/

Bronchial Lung Disease http://people.upei.ca/lpack/vetrad/

Feline Asthma http://people.upei.ca/lpack/vetrad/

Feline Asthma http://people.upei.ca/lpack/vetrad/

Cardiology • Congenital • Acquired • Small breeds • Large breeds • Younger • Older http://people.upei.ca/lpack/vetrad/

Patent Ductus Arteriosis • Enlargement of the descending aorta • Enlargement also of the: – Main pulmonary artery – Left atrium – Left auricle • Vessels enlarged, lungs over-circulated • Poodle, pom, collie, GSD, sheltie http://people.upei.ca/lpack/vetrad/

http://people.upei.ca/lpack/vetrad/ PDA

http://people.upei.ca/lpack/vetrad/ PDA

Pulmonic Stenosis • Malformation of the pulmonic valve • Enlargement of the main pulmonic aa • Right ventricular enlargement • Vessels normal to small • Beagle, English Bulldog, Samoyed, mastiff, boxer http://people.upei.ca/lpack/vetrad/

http://people.upei.ca/lpack/vetrad/ PS

Aortic Stenosis • Narrowing of the subvalvular region of the left ventricle • Aortic arch enlarged • Left ventricle enlarged • Vessels normal • GSD, Newfoundland, Boxer, golden retriever, rott http://people.upei.ca/lpack/vetrad/

http://people.upei.ca/lpack/vetrad/ AS

Mitral Insufficiency • Primary degeneration of the mitral valve leaflets • Regurg through the valve  left atrial enlargement • Pulmonary veins enlarged • Pulmonary edema due to left heart failure http://people.upei.ca/lpack/vetrad/

Mitral Insufficiency http://people.upei.ca/lpack/vetrad/

Severe Left Atrial Enlargement http://people.upei.ca/lpack/vetrad/

Splitting of the MSB http://people.upei.ca/lpack/vetrad/

Compression at Carina http://people.upei.ca/lpack/vetrad/

Dilated Cardiomyopathy • Cardiac chamber enlargement + systolic ventricular dysfunction ~ impaired cardiac contractility • Generalized cardiomegaly • Vessels may be enlarged • Pleural effusion due to right heart failure • Dobe, Great Dane, Newfoundland, Irish Wolfhound http://people.upei.ca/lpack/vetrad/

http://people.upei.ca/lpack/vetrad/ DCM

http://people.upei.ca/lpack/vetrad/ DCM

Pericardial Effusion http://people.upei.ca/lpack/vetrad/

Heartworm Disease • Dilated, tortuous pulmonary arteries • Right sided heart enlargement • Reverse D shape • DV radiograph to see caudal vessels http://people.upei.ca/lpack/vetrad/

Pleural Effusion • Fluid in the pleural space • Exudate, transudate or modified transudate • Appearance is sam regardless of the type • Usually bilateral • Fissure lines, retraction of lungs, silhouetting of heart and diaphragm http://people.upei.ca/lpack/vetrad/

Pleural Effusion – VD vs. DV http://people.upei.ca/lpack/vetrad/

Where Is the Heart?

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Pleural Effusion – CMM Present?

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Primary Lung Tumors • Usually large solitary • Caudal lung lobes usually • Adenocarcinoma • Bronchogenic carcinoma • Squamous cell carcinoma • Malignant histiocytosis http://people.upei.ca/lpack/vetrad/

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Pulmonary Nodules http://people.upei.ca/lpack/vetrad/

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Megaesophagus • Congenital • Acquired • Segmental • Generalized • Radiographic signs • Aspiration pneumonia http://people.upei.ca/lpack/vetrad/

Generalized Megaesophagus http://people.upei.ca/lpack/vetrad/

Segmental ME - Surveys http://people.upei.ca/lpack/vetrad/

Segmental ME - Contrast http://people.upei.ca/lpack/vetrad/

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What Do You See?

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Chest Rads – Same Dog http://people.upei.ca/lpack/vetrad/

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Thoracic Radiology in the Dog Questions????

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