Radiology Packet 9

1. Radiology Packet 9 Alveolar Pulmonary Pattern

2. 6-week old mixed breed puppy“Rascal” • Hx: Presented with severe respiratory distress. He chewed through an electrical cord and has burns on his tongue and lips.

4. 6-week old mixed breed puppy“Rascal” • RF • Severe, generalized opacification of all the lungs is identified. • There are areas of alveolar infiltrates, with the presence of air bronchograms. Best seen caudally. • Other areas have heavy to mild interstitial infiltrates. • RD • Noncardiogenic pulmonary edema • Next • Diuretic therapy to reduce the pulmonary edema and take follow-up radiographs.

5. 6-week old mixed breed puppy“Rascal” • Follow-up films The lungs, while not normal, show tremendous improvement over the last 24hrs

6. 6-year old MN Siamese cat“Sammy” • Hx: Presented for thoracic radiographs prior to anesthesia for a radiographic series of the skull. L

7. R

9. 6-year old MN Siamese cat“Sammy” • RF • The triangular area of soft tissue opacity that silhouettes with the right cardiac margin is a consolidated right middle lung lobe. • In the left lateral radiographic projection there is a sharp demarcation between the consolidated right middle lobe and the normal air-filled accessory lobe seen over the heart. • Hyper-expansion of the thorax. • RD • Mild diffuse interstitial lung pattern with areas of peribronchial infiltrate • Consolidated right middle lung lobe • R/O • Feline asthma • Secondary pneumonia and/or atelectasis

10. 12-year old Schipperke“Robbie” • Hx: Presented with a systolic heart murmur. On PE crackles are heard over all of the lung fields.

12. 12-year old Schipperke“Robbie” • RF • In the lateral view the caudal border of the heart is elongated, there is loss of the caudal cardiac waist and elevation of the mainstem bronchi. • The heart appears widened and there is increased sternal contact. • In the DV view the cardiac silhouette occupies more than 65% the thoracic width. • There is rounding of the left heart border, a small bulge in the left auricle area and spreading of the caudal mainstem bronchi (“bowlegged cowboy”) • The cranial and caudal pulmonary vessels are visible and the vein is larger than the artery. • In the lateral view there is increased opacity in the hilar region and air bronchograms are seen in the region of the accessory lung lobe. • In the DV view air bronchograms are seen in the hilar region and extending into the caudal lung lobes. • RD • Moderate to sever generalized cardiomegaly • Pulmonary venous congestion • Pulmonary edema • R/O • Left-sided congestive heart failure • Mitral valve insufficiency secondary to valvular endocardiosis • Tricuspid insufficiency secondary to valvular endocardiosis • Next • Echocardiography

13. 11-year old MN Collie“Kerry” • Hx: Had surgery for removal of a splenic mass 2 days ago. He is now febrile and has a productive cough.

15. 11-year old MN Collie“Kerry” • RF • There is a mild diffuse broncho-interstitial lung pattern present that is consistent with normal aging changes. • Air bronchograms are visible overlying the heart in the lateral view and in the VD view the triangular area of soft tissue opacity silhouetting with the right cardiac margin is evidence of alveolar opacification of the right middle lung lobe. • Incidental finding of several sites of spondylosis in the thoracic spine. • In the VD view the diaphragm is visible as a thin, linear soft tissue structure. This is due to the presence of free abdominal gas between the liver and the diaphragm. • RD • A ventrally distributed alveolar lung pattern consistent with aspiration pneumonia

16. 8-year old Rottweiller“Heidi” • Hx: Presented for evaluation of a chronic cough. Pneumonia is suspected. She is also noted to be losing weight.

19. 8-year old Rottweiller“Heidi” • RF • The left cranial lung lobe is consolidated and silhouettes with the heart. • In the R lateral view the sharp margin seen overlying the heart is the edge of the consolidated lung lobe. • In the left lateral view there is an area of increased opacity with air bronchograms cranial to the heart and overlying the heart. • In the caudal lung fields there are patchy areas of heavy interstitial to alveolar pattern. • In the left lateral view there is a focal area of opacity dorsal to the mainstem bronchi that has caused depression of the bronchi. • The trachea is elevated of the trachea over the heart base. • RD • Diffuse patchy heavy interstitial to alveolar lung pattern • Consolidation of the left cranial lung lobe • Hilar lymphandenopathy • R/O • Eosinophilic granulomatosis • Fungal lung disease • Other granulomatous lung disease • Next • US-guided lung fine needle aspirate or biopsy • Trans-tracheal aspirate