Radiology Board Review Session. Nancy E. Love DVM, Dip ACVR

Transcription

1 Radiology Board Review Session Nancy E. Love DVM, Dip ACVR

2 Introduction Review of COMMON radiographic abnormalities Test will probably have common easy to identify abnormalities seen on a single view Gravid uterus & megaesophagus on sample questions Can t learn everything in 90 minutes!

3 Introduction Small Animal Thorax Abdomen Musculoskeletal Equine Musculoskeletal

4 Small Animal - Thorax Pleural Space Pleural effusion Pneumothorax Mediastinum Cranial Mediastinal Mass Pneumomediastinum Megaesophagus Lungs Alveolar pattern Structured interstitial pattern Heart Left Atrial Enlargement Patent Ductus Arteriosus Heartworm Disease Hypertrophic Cardiomyopathy

5 Small Animal -Thorax Pleural Effusion Radiographic Findings Increased soft tissue opacity in pleural space Scalloping and apparent elevation of the lung lobe margins Pleural fissure lines, +/- visualization of individual lung lobes Blunting of the costophrenic angles Decreased visualization of the cardiac silhouette &/or diaphragm Often associated with: Rib tumors Lung lobe torsion

6 Pleural Effusion Severe - Inability to see heart & diaphragm - Increased pleural ST opacity - Retraction of lungs from wall Mild - Pleural fissure lines - Increased ST opacity

7 Pleural Effusion - Inability to see heart & diaphragm - Pleural fissure lines - Scalloped lung lobes

8 Small Animal - Thorax Pneumothorax Radiographic Findings Elevation of the cardiac silhouette from the sternum with a gas opacity ventral to the heart Tenting of diaphragm Retraction of the lung lobes from the body wall No lung markings in the gas opacity/lucency surrounding the retracted lung lobe margins Possible increased pulmonary pattern unstructured interstitial alveolar Collapsed lung lobes Mediastinal shift

9 Pneumothorax - Elevation of heart from sternum - Collapsed lung lobes - No lung markings

10 Pneumothorax - Collapsed lung lobes - No lung markings - Mediastinal shift - Tenting of diaphragm

11 Small Animal - Thorax Cranial Mediastinal Mass Radiographic Findings Widening of the cranial mediastinum Caudal displacement of the cardiac silhouette Tracheal elevation Possible visualization of a circumscribed structure Caudal &/or lateral displacement of the cranial lung lobes

12 Cranial Mediastinal Mass - Widening of cranial mediastinum - Circumscribed structure in cranial mediastinum - Lateral displacement of cranial lung lobes

13 Small Animal - Thorax Pneumomediastinum Radiographic Findings Increased visualization of cranial mediastinal structures

14 Pneumomediastinum

15 Small Animal - Thorax Megaesophagus Radiographic Findings Tubular structure dorsal to the trachea Some portions may be ventral ( draping ) Ventral (& rightward) displacement of the trachea May be fluid, gas or food filled Always check for associated aspiration pneumonia Tracheal stripe sign Often Associated with: Aspiration pneumonia R middle lobe most commonly affected

16 Megaesophagus Tracheal stripe -Tubular gas structure dorsal to trachea - Ventral displacement of trachea - Tracheal stripe sign

17 Megaesophagus Alveolar pattern

18 Small Animal - Thorax Alveolar Pattern Radiographic Findings Lack of visualization of the pulmonary vasculature in the region of the alveolar pattern (due to silhouette effect). Increased soft tissue opacity may be mild, moderate, severe. May be patchy to homogeneous. May have summation effect if alveolar pattern is superimposed over the cardiac silhouette. May have a lobar sign if the disease is along the periphery of a lung lobe. May have an air bronchogram

19 Small Animal - Thorax Alveolar Pattern Differential Diagnosis Bacterial pneumonia Aspiration pneumonia Pulmonary edema Cardiogenic Non-cardiogenic Pulmonary hemorrhage Collapse Lung lobe torsion Inflammatory Neoplasia

20 - Air bronchograms Alveolar pattern

21 Alveolar Pattern

22 Small Animal - Thorax Structured Interstitial Pattern Radiographic Findings Non-cavitary Circumscribed soft tissue, mineral or mixed nodule /mass in the interstitium of the lung May be single or multiple Cavitary Circumscribed nodule /mass containing a gas opacity in the interstitium of the lung May be single or multiple

23 Small Animal - Thorax Structured Interstitial Pattern Differential Diagnosis Neoplasia Fungal mycosis Abscess Eosinophilic granuloma Parasitic pneumonia

24 Non-cavitary Structured Interstitial Pattern Cavitary

25 Small Animal - Thorax L Atrial Enlargement Radiographic Findings Elevation of the caudal lobar bronchi Caudodorsal bulge of the L atrium Increased soft tissue opacity in the region of the L atrium (DV/VD) summation effect Bowlegged cowboy sign separation of the caudal lobar bronchi Important Need to determine if heart failure is present

26 Left Atrial Enlargement - Elevation of bronchi - Increased ST opacity in region of L atrium - Large L auricle

27 Small Animal - Thorax Hypertropic Cardiomyopathy Radiographic Findings May see bulge in the region of the L atrium Possible valentine shaped heart Important Need to determine if heart failure is present

28 Hypertropic Cardiomyopathy - Valentine shaped heart - Caudodorsal bulge in region of L atrium - L heart failure in this example - unstructured interstitial & alveolar lung patterns

29 Small Animal - Thorax Patent Ductus Arteriosus Radiographic Findings 3 bumps Main pulmonary artery enlargement Aortic knob L auricular enlargement Overcirculation L sided heart enlargement

30 Patent Ductus Arteriosus MPA Aortic knob L Auricle L Atrium Overcirculation

31 Patent Ductus Arteriosus

32 Small Animal - Thorax Heartworm Disease Radiographic findings Right heart enlargement Main pulmonary artery enlargement Large, tortuous, blunted arteries Possible pulmonary infiltrates

33 Heartworm Disease R heart enlarge MPA - R sided heart enlargement - Lg, tortuous pulmonary arteries - MPA enlargement

34 Heartworm Disease