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Introduction to Thoracic Radiology

Introduction to Thoracic Radiology. Dr. LeeAnn Pack Dipl. ACVR. Indications. Coughing Dyspnea/ Tachypnea Heart Murmur, Collapse Primary or Secondary Neoplasia Check for metastasis Thoracic Trauma Chest Wall Mass Exercise Intolerance, Weight Loss. Technical Factors.

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Introduction to Thoracic Radiology

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  1. Introduction to Thoracic Radiology Dr. LeeAnn Pack Dipl. ACVR

  2. Indications • Coughing • Dyspnea/ Tachypnea • Heart Murmur, Collapse • Primary or Secondary Neoplasia • Check for metastasis • Thoracic Trauma • Chest Wall Mass • Exercise Intolerance, Weight Loss

  3. Technical Factors • Potential for Movement • Decrease mAs • High inherent contrast area • High kVp • Collimation • Centering – caudal scapula • Thoracic inlet to diaphragm • Pull forelimbs forward

  4. Determining the Phase of Respiration • Always expose at peak inspiration • Maximizes lung contrast • Inspiratory lateral view • Caudodorsal aspect of lung caudal to T12 • Increased aeration of accessory lung lobe • Separation of heart silhouette and diaphragm • Inspiratory VD/DV view • Diaphragmatic cupola caudal to mid T8 • Lung tips caudal to T10

  5. Inspiratory vs. Expiratory Lateral Note the space inside the triangle

  6. Inspiratory vs. Expiratory VD Easy to see the difference in well visualized lung

  7. DV vs. VD • DV • Less stressful, better for heart • Diaphragm rounded • Caudal pulmonary vessels better visualized • Better to see small amount of pleural air • VD • Better for lungs • Hear appears elongated • Flat diaphragm – Mickey Mouse ears • Better to see small amount of pleural fluid

  8. DV vs. VD

  9. Right vs. Left Lateral etal. • Right Lateral • Better cardiac detail • R crus forward • See Cava go into it • Left Lateral • Heart appears round • L crus forward • See Cava go past • Anesthesia • Breed Differences

  10. The Effects of Lateral Recumbency • Lung lesions (mass, nodule, infiltrate) may only be seen on 1 view!!! • Only the non-dependent (up) lung can be critically evaluated • Dependent lung loses aeration (atelectasis) • Increases in opacity • Silhouettes with lesions

  11. Interpretation of Thoracic Radiographs • Heart • Lungs • Mediastinum • Pleural space • Chest wall • Bones, Abdomen,Neck

  12. Normal Cardiac Silhouette • Subjective • Dog = 2 ½ - 3 ½ intercostal spaces • Cat = 2 – 2 ½ intercostal spaces • 65% or less on VD/DV view • Objective • Buchanan method

  13. Clock Face • 11-1 Aortic Arch • 1-2 Main Pulmonary Trunk • 2-3 Left Auricle • 2-5 Left Ventricle • 5-9 Right Ventricle • 9-11 Right Atrium • Centrally – Left Atrium

  14. Lateral View • Make a Plus sign • Bermuda triangle • Left atrium • Left Ventricle • Right Ventricle

  15. Thoracic and Pulmonary Vessels • Aorta • Caudal Vena Cava • Cranial pulmonary vessels • Proximal third rib • Caudal pulmonary vessels • 9th rib where crosses • Veins are ventral and central

  16. Trachea, Bronchial Tree • Carina – then splits to the main stem bronchi then lobar bronchi • Tracheal rings can mineralize • Decreased tracheal diameter • Tracheal narrowing (stenosis, extramural compression), Tracheal hypoplasia, Tracheal collapse

  17. Lungs • Normal anatomy • Left • Cranial (cranial subsegment) • Cranial (caudal subsegment) • Caudal • Right • Cranial • Middle • Caudal • Accessory

  18. The Mediastinum • Cranial, middle, caudal compartments • Routinely visible structures: • Heart, trachea, cvc, aorta, +/- thymus, +/- esophagus • Cranioventral mediastinal reflection • Caudoventral mediastinal reflection • Aka phrenopericardiac ligament

  19. Mediastinal reflections

  20. Extrathoracic Structures • Sternum • Vertebrae • Ribs • Adjacent soft tissues • Diaphragm

  21. The Diaphragm • Cupola • Cranioventral convex portion • Right and left crura • Attach to cranioventral border of L3 and body of L4 • May cause irregularity on these surfaces • Appearance depends on centering of X-ray beam

  22. The Diaphragm

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