Thoracic Radiology

1. Thoracic Radiology Wendy Blount, DVM Nacogdoches TX

2. Thoracic Rads - Normal Review of thoracic radiographs - Steps • Skeletal • Spine, front limbs, ribs, sternum • Cranial abdomen • Airways, Lung fields • Great vessels • Aorta, pulmonary arteries, cranial & caudal vena cava • Smaller vessels • Internal thoracic arteries, pulmonary lobar a & v, brachiocephalic trunk, left subclavian artery • Cardiac silhouette • Vertebral heart score, bulge • Left Heart Failure? Right Heart Failure?

9. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Comparing heart size to lung field size doesn’t work • Dogs of different conformation have different ratios of heart size to lung size

10. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Comparing heart size to lung field size doesn’t work • Dogs of different conformation have different ratios of heart size to lung size

11. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Comparing heart size to lung field size doesn’t work • Dogs of different conformation have different ratios of heart size to lung size

12. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Comparing heart size to lung field size doesn’t work • Dogs of different conformation have different ratios of heart size to lung size • Lung field size changes with the breathing cycle • Abdominal fat pushes the diaphragm cranially • Thoracic fat makes lung fields appear smaller • Comparing heart size to vertebral size works better • Vertebral heart score

13. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Things can make the heart look bigger

14. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Things can make the heart look bigger

15. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Things can make the heart look bigger

16. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Things can make the heart look bigger • Pericardial fat • Pericardial effusion • Peritoneopericardial diaphragmatic hernia

17. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Things can make the heart look bigger • Pericardial fat • Pericardial effusion • Peritoneopericardial diaphragmatic hernia

18. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Things can make the heart look bigger • Pericardial fat • Pericardial effusion • Peritoneopericardial diaphragmatic hernia • Oblique positioning on VD/DV can make right heart look bigger • MYTH - “increased sternal contact” means right heart enlargement

19. Thoracic Rads - Normal

20. Thoracic Rads - Normal

21. Thoracic Rads - Normal Normal cats change with age • Long axis of the heart is more horizontal in old cats (40%) • Aortic bulge develops (30%) • Not due to hypertension or hyperthyroidism • At the aortic isthmus • Cardiac measurements in young & old cats are the same, despite these conformational changes in the thorax

22. Thoracic Rads - Normal Vertebral Heart Score 5.0 + 4.8 = 9.8

23. Thoracic Rads - Normal Vertebral Heart Score • Measure heart long axis • carina to the apex • Measure heart short axis • Widest perpendicular to length • Count vertebrae from cranial aspect T4 • Add together • Dogs – normal 8.5-10.5 • Cats – normal 7-8

24. Thoracic Rads - Normal Heart Chambers – VD/DV - Left LV - Left Ventricle AV - Aortic Valve AA - Ascending Aorta DA - Descending Aorta

25. Thoracic Rads - Normal Heart Chambers – VD/DV - Left LV - Left Ventricle AV - Aortic Valve AA - Ascending Aorta DA - Descending Aorta LA – Left Atrium

26. Thoracic Rads - Normal Heart Chambers – VD/DV - Left

27. Thoracic Rads - Normal Heart Chambers – VD/DV - Right PV Right Ventricle Pulmonic Valve Main Pulmonary Artery Right Pulmonary Artery Left Pulmonary Artery

28. Thoracic Rads - Normal Heart Chambers – VD/DV - Right

29. Thoracic Rads - Normal Heart Chambers – VD/DV – Clock Face • Aorta 12-1 o’clock • LV 3-6 o’clock

30. Thoracic Rads - Normal Heart Chambers – VD/DV – Clock Face • Aorta 12-1 o’clock • MPA 1-2 o’clock • LV 3-6 o’clock • RV 7-9 o’clock

31. Thoracic Rads - Normal Heart Chambers – VD/DV – Clock Face • Aorta 12-1 o’clock • MPA 1-2 o’clock • LV 3-6 o’clock • RV 7-9 o’clock • LA has to be really big to see on VD

32. Thoracic Rads - Normal Heart Chambers – VD/DV – Clock Face • Aorta 12-1 o’clock • MPA 1-2 o’clock • LV 3-6 o’clock • RV 7-9 o’clock • LA has to be really big to see on VD • RA 9-12 o’clock

33. Thoracic Rads - Normal Heart Chambers – Lateral – Left • LA – Left Atrium • MV – Mitral Valve • LV – Left Ventricle • AV – Aortic Valve • SV – Sinus of Valsalva • AAo – Ascending Aorta • BCT – Brachiocephalic Trunk • LS – Left Subclavian a.

34. Thoracic Rads - Normal Heart Chambers – Lateral – Right • RA – Right Atrium • Raur – R Auricle • RV – Right Ventricle • MPA – Pulmonary a.

35. Thoracic Rads - Normal Heart Chambers – Lateral – Right • RA – Right Atrium • Raur – R Auricle • RV – Right Ventricle • MPA – Pulmonary a. • RVOT – RV Outflow • PV – Pulmonic Valve • RPA – R Pulmonary a. • LPA – L Pulmonary a.

36. Thoracic Rads - Normal Heart Chambers – Lateral – Clock Face • LA (caudal waist) – • 12-3 o’clock • LV - 2-6 o’clock

37. Thoracic Rads - Normal Heart Chambers – Lateral – Clock Face • LA (caudal waist) – • 12-3 o’clock • LV - 2-6 o’clock • RV - 6-9 o’clock • MPA – 10-11 o’clock – bulge at 1-2 o’clock

38. Thoracic Rads - Normal Heart Chambers – Lateral – Clock Face • LA (caudal waist) – • 12-3 o’clock • CdVC – 2 o’clock • LV - 2-6 o’clock • RV - 6-9 o’clock • Raur – 9 o‘clock • RA not easily seen • on the lateral view • CrVC – 10 o’clock • MPA – 10-11 o’clock – bulge at 1-2 o’clock

39. Thoracic Rads - Abnormal Case #1 – 8 year old neutered male cocker spaniel – coughing

40. Thoracic Rads - Abnormal 6.2+ 5.9 = 12.1 • Case #1 – 8 year old neutered male cocker spaniel – coughing

41. Thoracic Rads - Abnormal Case #1 – 8 year old neutered male cocker spaniel - coughing • Skeletal, Cranial abdomen • No abnormalities noted • Airways, Lung fields • Mild perihilar edema • Great vessels • enlarged caudal vena cava • Smaller vessels • enlarged pulmonary lobar veins • Cardiac silhouette • Generalized cardiomegaly, enlarged LA

42. Thoracic Rads - Abnormal Case #1 – 8 year old neutered male cocker spaniel - coughing • Skeletal, Cranial abdomen • No abnormalities noted • Airways, Lung fields • Mild perihilar edema • Great vessels • enlarged caudal vena cava • Smaller vessels • enlarged pulmonary lobar veins • Cardiac silhouette • Generalized cardiomegaly, enlarged LA

43. Thoracic Rads - Abnormal Case #1 – 8 year old neutered male cocker spaniel – coughing

44. Thoracic Rads - Abnormal Case #1 – 8 year old neutered male cocker spaniel – coughing

45. Thoracic Rads - Abnormal Case #1 – 8 year old neutered male cocker spaniel – coughing

46. Thoracic Rads - Abnormal Case #1 – 8 year old neutered male cocker spaniel - coughing • Left Congestive Heart Failure • Mild perihilar edema • enlarged pulmonary lobar veins • enlarged LA (generalized cardiomegaly) • Enlarged LV (elevated trachea) • Right Congestive Heart Failure • enlarged caudal vena cava • Generalized cardiomegaly (RV enlargement) • (ascites, pleural effusion)

47. Thoracic Rads - Abnormal Case #1 – 8 year old neutered male cocker spaniel - coughing • Diagnosis by echo - DCM

48. Thoracic Rads - Abnormal Are rads or echo better for detecting congestive heart failure? • radiographs Are rads or echo better for detecting enlarged heart chambers? • echo

49. Thoracic Rads - Abnormal Generalized cardiomegaly (all 4 heart chambers enlarged) Dogs • Dilated Cardiomyopathy • Mitral regurgitation • Tricuspid regurgitation Cats • Dilated cardiomyopathy • anemia

50. Thoracic Rads - Abnormal