Fall 2012 - Radiology - Test 2 - Thorax

Front 1

right lateral

Back 1

What view(s) should be taken to evaluate the neck?

Front 2

If have right breed
- 2-3 mo old bulldog
- Always had prob breathing
- May have pneum

Static dz
- Lumen of trachea doesn’t change much with repeated views (not like trach coll)

Back 2

When would you be suspicious of laryngeal hypoplasia?

Front 3

inspiration (extrathoracic)

expiration (intrathoracic)

Back 3

When during respiration do you expect to see a tracheal collapse?

Front 4

1. Mandible
2. Axis (C2)
3. Bullae
4. Nasopharynx
5. Oropharynx
6. Soft Palate
7. Epiglottis
8. Cricoid Cartilage
9. Hyoid Apparatus
10. Trachea
T. Thyrohyoid Bone
B. Basihyoid Bone
C. Keratohyoid Bone
E. Epihyoid Bone
S. Stylohyoid Bone

Back 4

Front 5

similar to the size of the cricoid cartilage

Back 5

What should the tracheal size be?

Front 6

epiglottic mass

marked dilation/ overinflation of oropharynx and nasoparynx

Back 6

Front 7

neck neoplasia that has invaded trachea

Back 7

Front 8

hypoplastic trachea

decreased generalized lumen of the trachea
- static (no change with repeated images)

bulldog that is 2-3 mo old and has always had difficulty breathing

Back 8

Front 9

tracheal stenosis

hx of trauma
- recent anesth
- FB
- bite wound

Back 9

Front 10

intrathoracic and mainstem bronchi collapse

Back 10

Front 11

mainstem bronchi collapse

Back 11

Front 12

extrathoracic tracheal collapse

Back 12

Front 13

normal mainstem bronchi

Back 13

Front 14

redundant tracheal membrane

Back 14

Front 15

tracheal mass

Looking for:
- Narrowing of tracheal lumen
- Dilation cranial to lesion

Back 15

Front 16

Overinflation of naso/oropharynx

Epiglottis pushed down so really trying to suck in air with all they have (sign of dyspnea)

look for tracheal obstruction caudally (mass/ foreign body/ stenosis)

Back 16

Front 17

tracheal rupture

notice all the air under the skin

Back 17

Front 18

tracheal foreign body (bifurcation of main stem bronchi)

Back 18

Front 19

tracheal foreign body

Back 19

Front 20

high kVp
- thorax has inherent contrast

minimize exposure time
- breathing causes blurring

take at peak inspiration (usually)

use grid if > 10 cm

Back 20

What technique do you want to use for the thorax?

Front 21

Right lateral
- Heart “egg shaped”
- Diaphragmatic crura parallel to each other
- Right crus more cranial (cd vena cava enters right crus)
- gas in fundus of stomach
- Better for assessing changes in the LEFT lung lobes

Back 21

Front 22

Left lateral
- Heart rounded
- Diaphragmatic crura diverge
- Left crus more cranial (cd vena cava enters cd into right crus)
- gas in pylorus
- Better for assessing changes in the RIGHT lung lobes

Back 22

Front 23

DV

diaphragm has one smooth dome

Back 23

Front 24

VD

diaphragm has 3 domes

Back 24

Front 25

right lung

b/c shows up on left lateral and not on the right lateral

Back 25

Front 26

expiratory film

Back 26

Front 27

close to the lung of interest

*there is no dependent lung*

Back 27

For a large animal radiograph being taken with horizontal beam, where do you place the film

Front 28

pectus excavatum

only see clin signs if severe

Back 28

Front 29

pectus carinatum

no clin significance

Back 29

Front 30

rib fractures

they will heal fine with rest

Back 30

Front 31

extrapleural mass

Back 31

Front 32

pulmonary mass

notice acute angle with thoracic wall

Back 32

Front 33

primary rib tumor

ddx
1. OSA
2. OSA
3. OSA
4. CSA
5. fungal/ abscess if hunting dog

Back 33

Front 34

rib met

lysis/ irregular bone formation

Back 34

Front 35

rib mets

Back 35

Front 36

diaphragmatic hernia

Back 36

Front 37

congenital diaphragmatic hernia

incidental finding until proven otherwise

Back 37

Front 38

stomach herniation

Back 38

Front 39

stomach herniation

Back 39

Front 40

celiogram of diaphragmatic hernia

Inject iodinated (NOT barium!) contrast medium into the peritoneal cavity

Lift the hindquarters of the dog to get the contrast to flow cranially

If there is an abnormal hole in the diaphragm, the contrast will show up in the pleural space

Pitfall: Plugging of diaphragmatic rent with organs, fibrin etc.
- If don’t see it leak, doesn’t mean you don’t have it, but if it does leak, into thorax, then you have confirmed hernia

Back 40

Front 41

Hiatal hernia
- Stomach coming through the esophageal hiatus

Transient lesion cd-dorsal on lung lobe that comes and goes, then consist with sliding hiatal hernia
- Usually not a prob (can have vomiting or severe dz if entrapment)

Back 41

Front 42

Peritoneal-pericardial diaphragmatic hernia (PPDH)
- Abdominal contents in the pericardial sac

Back 42

Front 43

Normal Mediastinum

Structures that are normally seen
- Trachea
- Heart
- Aorta
- Caudal vena cava
- Fat

Structures occasionally seen
- Gas in the esophageal lumen
- Thymus (Dogs < 1 yr)

Structures NOT normally seen
Won’t see an outline of these strx physiologically
- Cranial vena cava, brachiocephalic trunk
- Lymph nodes
- Sternal
- Cranial mediastinal
- Tracheobronchial
- Outer surface of trachea and esophagus

Back 43

Front 44

Mediastinal shift due to recumbent atalectasis (pull force)

The mediastinum (with the cardiac silhouette) is shifted to one side on the DV or VD radiograph

Due to:

Pull forces
- Recumbent atelectasis
- They see this multiple times every day
- Dog was laying on right side x few min then do VD = heart on right side
- Previous lung lobectomy
- Bronchial obstruction …
- Decreased volume of lung b/c lung collapses

Push forces
- Intrathoracic masses
- Diaphragmatic hernia
- Chest wall deformities …
- Pectus excavatum

Back 44

Front 45

Mediastinal shift due to diaph hern

The mediastinum (with the cardiac silhouette) is shifted to one side on the DV or VD radiograph

Due to:

Pull forces
- Recumbent atelectasis
- Previous lung lobectomy
- Bronchial obstruction …
- Decreased volume of lung b/c lung collapses

Push forces
- Intrathoracic masses
- Diaphragmatic hernia
- Chest wall deformities …
- Pectus excavatum

Back 45

Front 46

enlarged sternal LN

Neoplastic (less likely inflammatory) process affecting thoracic wall, thymus, cranial mammary complexes, pleura or peritoneum. Make sure to check the abdominal cavity!

Back 46

Front 47

generalized mediastinal lymphdenopathy

lymphoma or fungal dz (blasto)

Back 47

Front 48

generalized mediastinal lymphadenopathy

lymphoma or fungal dz (blasto)

Back 48

Front 49

cranioventral mediastinal mass

most likely lymphoma or thymoma

Back 49

Front 50

cranioventral mediastinal mass

most likely lymphoma or thymoma

Back 50

Front 51

caudodorsal mediastinal mass

most likely paraesophageal mass or hiatal hernia

Back 51

Front 52

caudodorsal mediastinal mass

most likely paraesophageal mass or hiatal hernia

Back 52

Front 53

mediastinal effusion

Recognized by
- Decreased visualization of mediastinal structures
- Diffuse widening of the mediastinum

Back 53

Front 54

mediastinal effusion

Recognized by
- Decreased visualization of mediastinal structures
- Diffuse widening of the mediastinum

Back 54

Front 55

pneumomediastinum

notice that you can see the azygous and aorta

Back 55

Front 56

pleural effusion

notice fissure lines

Back 56

Front 57

pleural effusion

notice fissure lines

Back 57

Front 58

pleural effusion

Back 58

Front 59

pleural effusion

Back 59

Front 60

DV view of pleural effusion

On a DV view, fluid gravitates ventrally and accumulates dorsal to the sternum -> silhouetting of heart and fluid

Back 60

Front 61

VD view of pleural effusion

On a VD view, fluid gravitates dorsally and accumulates around the caudodorsal lung fields -> heart still visible

Back 61

Front 62

pneumothorax

Back 62

Front 63

pneumothorax

Back 63

Front 64

tension pneumo

Back 64