Thorax & Heart Pt 2 Radiology

Front 1

What are 2 causes of canine dilated cardiomyopathy?

Back 1

1) Generalized cardiomegaly
-Typically left side predominant
-Left atrial enlargement & left auricular enlargement
2) Left, right or biventricular heart failure

Front 2

What breed of dogs usually get dilated cardiomyopathy? What breed typically has a normal sized heart with dilated cardiomyopathy?

Back 2

Dobermans

Front 3

What type of lung pattern is seen with dilated cardiomyopathy?

Back 3

Interstitial to alveolar
Often severe, diffuse

Front 4

What is an important differential for dilated cardiomyopathy?

Back 4

Mitral endocardiosis, but this is more common in small breeds

Front 5

Feline cardiomyopathy=______.

Back 5

Hypertrophic cardiomyopathy

Front 6

What shape is the heart in a cat with hypertrophic cardiomyopathy?

Back 6

bean shaped

Front 7

How does a heart appear with left atrial enlargement? What shape?

Back 7

Valentine heart (not biatrial enlargement)
Can get so long get an apex shift
Can look like left atrium is ice cream on a cone

Front 8

How do you only put contrast medium in the left atrium?

Back 8

=Selective
-place catheter into heart and inject contrast into where you want it
in this case went into left ventricle and injected contrast so can see the slim lumen in left ventricle, thickening of left ventricle wall, gigantic LA and aorta outflow tract

Front 9

What is the sequel to an inflow obstruction at the left ventricle?

Back 9

Left atrium enlarges as reservoir and buffer

Front 10

How come left atrial enlargement can result from left ventricular obstruction and not result in pulmonary edema?

Back 10

If increase in volume back up occurred slowly the heart has time to compensate

Front 11

The left atrium enlarges with chronic left ventricular disease to accommodate what 3 conditions?

Back 11

1) In mitral regurgitation, regurgitant volume
2) In DCM, with LV, to maintain stroke volume
3) In HCM, inflow from lungs

Front 12

What is the buffer b/w the left ventricle and the lung?

Back 12

Left atrium

Front 13

What happens to pressure if the heart has time to accommodate and enlarges?

Back 13

pressure remains normal (indicates pulmonary veins might distend but still no cardiogenic failure)

Front 14

True or false. Pressures rises with a chronic mitral regurgitation.

Back 14

False, the left atrium is very compliant so pressures does not rise in chronic MR

Front 15

True or false. Pressure rises with an acute mitral regurgitation.

Back 15

True, heart doesn't have time to compensate and enlarge the LA

Front 16

The left ventricle remains compliant in mitral regurgitation but not in _____.

Back 16

Dilated cardiomyopathy
-Have thinning of ventricle so it can't maintain function, but it can with MR

Front 17

What develops as a sequel to acute left ventricular failure?

Back 17

Heart can't compensate==> edema

Front 18

What is the sequence of edema patterns with acute left ventricular failure? (5)

Back 18

1) Interstitium
2) Alveoli
3) Peribronchial
4) Subpleural
5) Pleural cavity

Front 19

What is the definition of left sided heart failure?

Back 19

Inability of the heart to adequately handle volume of blood returning from pulmonary circulation.

Front 20

What are 3 sequelae to left sided heart failure?

Back 20

1) Pulmonary venous congestion
-May not see changes in animals on diuretics
2) Pulmonary edema
-Caudodorsal/perihilar pulmonary infiltrate
-Interstitial>>> alveolar
3) Left-sided or generalized cardiomegaly

Front 21

Are the pulmonary veins or arteries larger with pulmonary venous congestion from left sided heart failure?

Back 21

Pulmonary veins

Front 22

What does it mean if the caudal vena cava is elevated dorsally?

Back 22

Sign of left atrial enlargement

Front 23

What is sometimes the only sign of heart failure in cats?

Back 23

Bronchial thickening (can look like donuts)
Pleural effusion

Front 24

What is sometimes the only sign of heart failure in cats?

Back 24

Bronchial thickening (can look like donuts)
Pleural effusion

Front 25

Explain how interstitial edema develops.

Back 25

Have loose CT surrounding bronchioles, artery and venule-all run together
lymphatics drain from CT connecting space, separated from tight interstitial space on other side of capillary..
When increase in fluid get more lymph and at first drainage can support increase in fluid but over time too much fluid in drainage and can't be supported so over time get an increase in fluid in interstitial space surrounding bronchi (stage 2) so see increase in interstitial space, potential thickening around bronchioles and lose ability to see vessels in lung

Front 26

How does interstitial edema develop into alveolar edema?

Back 26

Over time the tight junction b/w alveoli and capillary isn't tight anymore from fluid distention so get leakage of fluid towards alveolar space and in severe stage end up with interstitial to alveolar lung pattern adn only see air filling in bronchi

Front 27

What are 3 right sided heart diseases that result in "right heart" enlargement?

Back 27

1) Pulmonic stenosis
2) Tricuspid regurgitation
-Congenital
-Acquired w/ mitral endocardiosus
3) Heartworm (severe cor pulmonale-Cor pulmonale is failure of the right side of the heart brought on by long-term high blood pressure in the pulmonary arteries and right ventricle of the heart.)

Front 28

What are 2 signs of right atrial enlargement on a lateral view?

Back 28

1) Dorsal bowing of trachea cranial to carina
2) Loss of cranial waist of heart

Front 29

What is a sign of right atrial enlargement on a VD/DV view?

Back 29

Increased prominence in 9-11 region

Front 30

What are 3 radiographic signs of right ventricular enlargement on a lateral view?

Back 30

1) Increased width of the cardiac silhouette
2) Increased convexity of cranial margin
3) Dorsal bowing of trachea cranial to carina (like w/ RAE)

Front 31

What do are 2 signs of right ventricular enlargement on a VD/DV view?

Back 31

1) Increased prominence in 5-9 region
2) Reverse D shape

Front 32

What does it mean if it looks like the heart has 2 apexes?

Back 32

RV enlargement

Front 33

What are 3 examples of chronic airway and lung disease that results in cor pulmonale?

Back 33

1) Thick soft palate
2) Collapsed trachea
3) Fibrosis of lung
-If lungs not air filled enough--> increased density--> icnreased pressure--> right side of heart has to work against pressure in pulmonary artery--> muscle gets larger

Front 34

How does the heart appear when an animal has a chronic airway and lung disease that results in cor pulmonale?

Back 34

Enlargement of pulmonary outflow tract
Rounding of RV

Front 35

Lung fibrosis is rare except in what specie?

Back 35

Westies

Front 36

What is the worst case scenario for a dog with cor pulmonale from for example a thick soft palate?

Back 36

Rarely develops to RH failure

Front 37

Where are the worms mostly located in cases of heartowrm (dirofilariasis)?

Back 37

Mostly in pulmonary arteries and obstruct them

Front 38

What is the cause of clinical signs related to heartworms?

Back 38

Worms cause severe lung reaction that causes the clinical signs

Front 39

What causes the changes in the heart in a dog with dirofilariasis?

Back 39

Cor pulmonale causes heart changes

Front 40

What are 4 radiographic signs of heartworm disease?

Back 40

1) Pulmonary arteries dilated and larger than veins
2) Right ventricular enlargement
3) Right atrial enlargement
4) Enlarged main pulmonary artery

Front 41

What kind of pulmonary infiltrates are seen with heartworm disease?

Back 41

Pulmonary interstitial edema
Pulmonary thromboembolic disease

Front 42

How does heartworm disease cause right heart failure?

Back 42

Due to massive inflammation get the thrombi spread and get thromboembolic disease--> right sided heart failure

Front 43

What will you see when there's a severe lung reaction to heartworms?

Back 43

massive increased density can see in both cranial ventral and caudodorsal lung field, only see bronchiole trees

Front 44

What is the definition of right sided heart failure?

Back 44

Inability of the heart to adequately handle volume of blood returning from systemic circulation

Front 45

What are 3 sequelae to right sided heart failure?

Back 45

1) Systemic venous congestion
-Enlargement of caudal vena cava
2) Visceral congestion
-Generalized hepatosplenomegaly
3) 3rd space fluid transudation
Canine-ascites predominates
Feline-pleural effusion predominates

Front 46

What are 4 radiographic signs of right sided heart failure?

Back 46

1) CVC enlargement
2) Pleural effusion
3) Hepatomegaly w/or w/o splenomegaly
4) Ascites

Front 47

What is the normal ratio b/w the size of the aorta and caudal vena cava?

Back 47

1:1 ratio

Front 48

How does pleural effusion appear on a radiograph?

Back 48

Can see the lung retracting from the thoracic wall due to the fluid in the pleural space

Front 49

What are 6 differential diagnoses for a small dog that's coughing other than mitral regurgitation and congestive heart failure?

Back 49

1) Collapsed trachea
2) Chronic bronchitis
3) Idiopathic pulmonary fibrosis
4) Heartworms
5) Collapsed main bronchus
6) Compressed L main bronchus

Front 50

Will you see a collapsed main bronchus on a radiograph taken upon inspiration or expiration?

Back 50

Expiration

Front 51

What dogs tend to get tracheal collapse?

Back 51

Small dogs & chondrodystrophic breeds

Front 52

What are 3 differentials for an enlarged heart without signs of primary heart disease?

Back 52

1) Pericardial effusion
2) Pericardio-diaphragmatic hernia
3) Cor pulmonale

Front 53

What are your next 2 steps when evaluating an enlarged heart that doesn't have signs of primary heart disease?

Back 53

1) Identify the apex
2) Rule out Left atrial enlargement in large dogs (to rule out DCM)

Front 54

If a heart is enlarged, but there's no apex or left atrial enlargement, what should you suspect?

Back 54

Pericardial disease

Front 55

In animals with a pericardial effusion, will the heart shift left or right on a VD/DV?

Back 55

Can shift left

Front 56

What are 2 signs of pericardial effusion?

Back 56

1) Spherically enlarged, globoid cardiac silhouette
-Very sharp curved caudo-dorsal border on left lateral
2) Lack of discrete chamber definition
-Differentiate from generalized cardiomegaly

Front 57

What type of additional imaging should be used for pericardial effusion?

Back 57

Ultrasound

Front 58

What happens when there's pericardial tamponade in a heart with constrictive pericarditis?

Back 58

Get severe increase in pressure because pericardium can't expand so get a drastic increase in pressure

Front 59

True or false. Pericardial effusion results in an increase in pressure with a relatively small amount of fluid increase.

Back 59

False, Pericardial effusion that is long standing can increase the fluid pretty drastically and not get increased pressure for quite a while

Front 60

The degree of cardiomegaly present with pericardial effusion depends upon _____.

Back 60

Volume

Front 61

True or false. Pericardial effusion results in cardiogenic edema.

Back 61

False

Front 62

What are 5 signs of congenital peritoneopericardial diaphragmatic hernia?

Back 62

1) Irregular shape of enlarged heart shadow (giant heart)
2) Faint lucencies in heart (omental fat)
3) Gas shadows (bowel gas)
4) Effacement of diaphragm border near heart
5) Cranially displaced stomach

Front 63

Congenital PPDH can be seen together with _______.

Back 63

Sternal deformity

Front 64

What are 2 diagnostic aids for diagnosing a PPDH?

Back 64

1) Contrast passage
2) Ultrasound

Front 65

What is the prognosis like if a young animal has an enlarged heart?

Back 65

Very bad

Front 66

Why is it so important to catch a congenital heart disease early on?

Back 66

Because heart is plastic when younger so surgical intervention can be done

Front 67

What are the heredity/breeding concerns related to congenital heart diseases?

Back 67

Need to have a conversation with the owner and tell them not to breed the animal

Front 68

What are the 3 most common congenital cardiac diseases?

Back 68

1) Pulmonic stenosis
2) Aortic stenosis
3) Patent ductus arteriosus

Front 69

What are 3 treatments for congenital cardiac diseases?

Back 69

1) Surgical treatment
2) Catheter-placed coils
3) Ballon dilation of valve
-PDA< aortic stenosis, pulmonic stenosis

Front 70

Place supravalvular, valvular and subvalvular in order of occurence with pulmonic valvular stenosis.

Back 70

Valvular> subvalvular>> supravalvular

Front 71

What are 4 sequelae to pulmonic valvular stenosis?

Back 71

1) Right heart enlargement
RVE +/- RAE
2) Main pulmonary artery segment enlargement (usually a post stenotic dilation)
3) Normal to small pulmonary vessels
4) Right heart failure

Front 72

Whate are 2 signs of a subvalvular aortic stenosis?

Back 72

1) LVE +/- LAE
-Elongation of cardiac silhouette
2) Increased prominence of aortic arch

Front 73

What is a sign of increased prominence of aortic arch (such as seen with a subvalvular aortic stenosis on a lateral and on a VD/DV?

Back 73

1) Bulge in cranial waste (lateral)
2) Widening of 11-1 area (DV/VD)

Front 74

True or false. Radiographs may be normal in a heart with aortic valvular stenosis.

Back 74

True

Front 75

What is a patent ductus arteriosus?

Back 75

Shunt from aorta to pulmonary artery

Front 76

What are 4 sequelae to pulmonic valvular stenosis?

Back 76

1) Right heart enlargement
RVE +/- RAE
2) Main pulmonary artery segment enlargement (usually a post stenotic dilation)
3) Normal to small pulmonary vessels
4) Right heart failure

Front 77

Whate are 2 signs of a subvalvular aortic stenosis?

Back 77

1) LVE +/- LAE
-Elongation of cardiac silhouette
2) Increased prominence of aortic arch

Front 78

What is a sign of increased prominence of aortic arch (such as seen with a subvalvular aortic stenosis on a lateral and on a VD/DV?

Back 78

1) Bulge in cranial waste (lateral)
2) Widening of 11-1 area (DV/VD)

Front 79

True or false. Radiographs may be normal in a heart with aortic valvular stenosis.

Back 79

True

Front 80

What is a patent ductus arteriosus?

Back 80

Shunt from aorta to pulmonary artery

Front 81

What are 5 sequelae of a patent ductus arteriosus?

Back 81

1) LVE, LAE, Left auricular enlargement
2) Aneurysmal dilatation of proximal descending aorta
3) Pulmonary artery segment enlargement
4) Normal to large pulmonary vessels (get large pulmonary vessels if a lot of blood is shunted)
5) Left heart failure

Front 82

Why can a PDA result in mitral problems?

Back 82

if go out through aorta and shunt to pulmonary arteries blood has to come back to left atrium--> volume overload of left atrium--> mitral problems

Front 83

What direction do most PDA's shunt blood? Why?

Back 83

Left to right bc the left is the high pressure side

Front 84

If you see the 3 knuckles on the left side of the heart, what's on your differentials?

Back 84

Patent ductus arteriosus

Front 85

What are 3 diseases (excluding congenital disease) that can still have a normal sized heart?

Back 85

1) Hypertrophic cardiomyopathy (cats)
2) Dilated cardiomyopathy (large dog)
3) Mitral insufficiency/ tricuspid insufficiency (subclinical)

Front 86

What are 3 differentials for generalized cardiomegaly in a small dog?

Back 86

1) MI/ TI
2) Pericardial effusion
3) PPDH

Front 87

What are 3 differentials for generalized cardiomegaly in a large dog?

Back 87

1) DCM
2) Pericardial effusion
3) PPDH

Front 88

What are 3 differentials for generalized cardiomegaly in a cat?

Back 88

1) HCM
2) DCM (Rare!)
3) PPDH

Front 89

What is a differential for left sided heart enlargement in a small dog?

Back 89

Mitral insufficiency

Front 90

What is a differential for left sided enlargement in a large dog?

Back 90

DCM

Front 91

What is a differential for left sided heart enlargement in a cat?

Back 91

Hypertrophic cardiomyopathy

Front 92

What are 2 differentials for right sided heart enlargement in a small dog?

Back 92

Tricuspid insufficiency
HWD

Front 93

What is a differential for right sided heart enlargement in a large dog?

Back 93

HWD

Front 94

What are 2 differentials for a small heart?

Back 94

Hypovolemia
Addison's disease

Front 95

Wgat are 2 signs of left sided heart failure?

Back 95

1) Pulmonary edema
2) Veins> artery, not always

Front 96

What are 4 signs of right sided heart failure?

Back 96

1) Enlarged CVC
2) Pleural effusion
3) Hepato/splenomegaly
4) Ascites

Front 97

What are 6 possible signs of biventricular heart failure?

Back 97

1) Pulmonary edema
2) Veins> artery
3) Enlarged CVC
4) Pleural effusion
5) Hepatosplenomegaly
6) Ascites
*Combo of right and left sided heart failure