EJCAP Online 22(4), December 2012, English

9 Radiology in Pulmonary Disease

9 Radiology in Pulmonary Disease

A ventrodorsal thoracic radiograph of a dog which was recently hit by a car. There is a mixed unstructured interstitial and alveolar pattern in the peripheral and middle zones of the right caudal lung lobe. This represents a traumatic contusion. The dog also had a concurrent pneumothorax and free pleural air is visible between the left caudal lung lobe and the diaphragm in the left caudal thorax. Although there is significant pulmonary injury, this patient has no rib fractures.

10/10

What is your diagnosis?

Click on the image to see the author’s comments.

Closeup view of a ventrodorsal radiograph of a normal dog thorax. An end on vessel is seen as a welldefined, round, opaque soft tissue structure just lateral to the cardiac silhouette in the center of the image. A side on pulmonary vessel of comparable size is visible in the intercostal space immediately caudal. The opacity of the end on vessel is greater than the side on vessel, indicating that this structure is not spherical but cylindrical and is therefore not a pulmonary nodule.

9/10

Lateral radiograph of a dog with diffuse pulmonary metastases from a splenic haemangiosarcoma. There is increased soft tissue opacity throughout all lung lobes. This is a miliary nodular pattern characterized by numerous small poorly defined soft tissue nodules. The pattern is quite dense which makes it difficult to discern individual nodules.

8/10

Lateral radiograph of a cat with a primary lung tumor. There is a poorly defined soft tissue mass lesion in the middle and peripheral zones of the left caudal lung lobe. This contains multiple, irregularly shaped variably sized hyperlucent foci, consistent with cavitation. This indicates communication of a necrotic part of the mass lesion with the airways. This is a common feature in feline primary lung tumors.

7/10

Lateral thoracic radiograph of a dog with metastatic prostatic carcinoma. There are numerous well-defined soft tissue nodules within the lungs. These are quite variable in size. Individual pulmonary nodules are more difficult to discern in the caudal lung lobes, as a result of superimposition of multiple lesions.

6/10

Closeup of the pulmonary hilar region on a lateral radiograph of a 12-year-old dog. There is diffuse mineralization of the tracheal rings, which appear as ovoid, bright structures along the ventral tracheal border. There is also mineralization of the bronchial walls, which are seen as thin, distinct bright lines radiating from the tracheal bifurcation running parallel to their associated pulmonary vessels. Multiple small, irregularly shaped well-defined mineralized structures are seen within the lung. These are pulmonary osteomas or heterotopic pulmonary ossifications. All of these findings are normal aging changes.

5/10

Right lateral recumbent and ventrodorsal thoracic radiographs of a dog with pneumonia. On the lateral radiograph, there is an alveolar pattern in the periphery of the right cranial lung lobe and throughout the right middle lung lobe. Air bronchograms are seen within the right cranial lung lobe, cranial and ventral to the cranial cardiac border. Multiple air bronchograms are visible within the right middle lung lobe, superimposed on the cardiac silhouette. The ventrodorsal radiographs shows increased soft tissue opacity throughout the right lung. The right cardiac border is completely obscured, an example of a silhouette sign. Air bronchograms are not clearly visible on this projection. Note how the normal vascular structures within the affected part of the right lung are completely obscured. There is also displacement of the heart towards the thoracic wall as a result of partial atelectasis of the right lung. This is termed a mediastinal shift.

4/10

What is your diagnosis?

Click on one of the images to see the

author’s comments.

Lateral thoracic radiograph of an 8-year-old bulldog with chronic cough. The left cranial lung lobe is expanded, rounded and is hyperlucent. A thin soft tissue rim is seen surrounding the lobe. No pulmonary structures are evident within the abnormal segment of lung. This is a lobar bulla and is most likely a congenital anomaly.

3/10

Lateral and dorsoventral thoracic radiographs of a cat with chronic, severe asthma. There is marked overinflation of the lungs, causing caudal displacement and flattening of the diaphragm. On the dorsoventral radiographs, the thorax appears barrel-shaped with the ribs almost perpendicular to the spine. There is a diffuse mixed unstructured interstitial and bronchial pattern, with small focal pulmonary mineralisations.

2/10

What is your diagnosis?

Click on one of the images to see the

author’s comments.

Lateral radiograph of the thorax of a dog with acute enteritis and moderate to severe dehydration. The heart and pulmonary vessels are smaller than normal. The lung appears relatively hyperlucent, darker than normal.

1/10

Pulmonary patterns

Identifying a specific pulmonary pattern is a process of elimination.

Almost all pulmonary disease has a mixed pattern so the objective is

to determine the predominant type if possible.

First author

John Graham

116 Point View Lane,

Longwood,

FL 32779,

USA

E-mail: jgrahamer@gmail.com

John Graham graduated from University College Dublin in 1987. After five years of mixed animal and small animal practice in the UK, he completed specialist training in radiology at the Veterinary Faculty of the Swedish University of Agricultural Sciences in Uppsala. He has held faculty positions at the University of Pretoria and University of Florida and is a Diplomate of the European College of Veterinary Diagnostic Imaging and of the American College of Veterinary Radiology. Currently, he is a consultant radiologist for Idexx Laboratories, working in all areas of small animal diagnostic imaging.

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Lung checklist

When evaluating radiographs, the use of a checklist or series of questions helps ensure that the entire image is evaluated. For pulmonary disease, the checklist could be something as follows:

- Are the lungs normal?

- Are the lungs too dark?

- Are the lungs too light?

- Which type of pattern(s) is present?

- Which lobes are affected?

- Where is the abnormality located within these lobes?

Click to read more about this author

by John Graham

Volume 22(4), December 2012 SPECIAL ISSUE

Pulmonary patterns

Identifying a specific pulmonary pattern is a process of elimination. Almost all pulmonary disease has a mixed pattern so the objective is to determine the predominant type if possible.

What’s your diagnosis?

Look at the images and try to determine species, projection and any abnormality. Then click on the image to read the author’s description of the case.

Commissioned paper

Radiology in Pulmonary Disease

Looking at lungs

Read more...

The thorax is ideally suited to examination by radiography with the air filled lung providing excellent contrast to see the soft tissue structures. The lungs could be considered a window on the body revealing cardiovascular, pulmonary and systemic disease. Thoracic radiographs are also quick, non-invasive and relatively inexpensive. Pulmonary abnormalities are frequently complex and can appear confusing but systematic evaluation will usually yield useful clinical data if not always a definitive diagnosis.

Lung checklist

When evaluating radiographs, the use of a checklist or series of questions helps ensure that the entire image is evaluated.

For pulmonary disease, the checklist could be something as follows:

- Are the lungs normal?

- Are the lungs too dark?

- Are the lungs too light?

- Which type of pattern(s) is present?

- Which lobes are affected?

- Where is the abnormality located within these lobes?