Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

Thoracic Radiology

Veterinary Clinical Studies
by

Stephen Joslyn

on 28 January 2015

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Thoracic Radiology

Thoracic Radiology
Thoracic Radiology
Importance?
Many, if not all, pathological processes manifest directly or indirectly, as cardiorespiratory disease. Many of these diseases you, as vets, cannot afford to miss!
Thoracic RadioGRAPHY
time and cost effective
readily available equipment
relatively EASY to perform
usually does not require GA
non-invasive?
nothing else compares!
But.....
Despite all the fact that thoracic radiography is easy, cheap and available, careful technique is imperative. Poor technique is the most common cause for a misdiagnosis. Furthermore, radiographic diagnosis is usually equivocal.... except for a few good diagnoses
Superimposition
What is normal?
Overlap of features
Lack of Confirmation using other tests
Complex Anatomy
Objectives!!!!
Indications
Coughing
Dyspnoea
Cardiovascular Disease
Neoplasia
Trauma
Regurgitation
Bronchitis, Bronchopneumonia, Allergic Lung Disease, Bronchiectasis, Left sided heart failure, Parasitic infection, Inhaled foreign bodies, pressure on airways, pulmonary abscess/granuloma
Pleural Effusion, Pneumothorax, Diaphragmatic Rupture, Mediastinal Mass, pulmonary oedema, pulmonary haemorrhage, bronchopneumonia, feline asthma, pulmonary neoplasia, paraquate toxicity, emphysema, heart worm disease, airway obstruction
Murmurs in young dogs, heart failure, unexplained alteration in heart rate/rhythm.
Pneumothorax, Pneumomediastinum, pulmonary haemorrhage, pulmonary contusions, haemothorax, daiphragmatic rupture, rib fractures
Primary Lung tumor, Multicentric, metastatic spread
Megaoesophagus, oesophageal foreign body, vascular ring anomalies, osophageal stricture, oesophageal diverticuli, oseophageal neoplasia, oesophagitis, hiatal hernias.
and more...
Interstitial Lymphoma
Neurogenic Oedema
Pneumocystis (fungal pneumonia)
Normal
Y U NO GIVE ME
INTERNAL MEDICINE
FNAs, Haematology, Biochemistry, etc.
WHY?
5 opacities in Radiology
METAL
BONE
SOFT TISSUE
FAT
GAS
Microchip, Label, screws, plates, intramedullary pins,
Bone or other mineralised tissue
Organs, Muscle, Fluid (Blood, urine)
Just fat
Gas pockets, lung tissue
opaque
lucent
radio-
Radiography must maximise contrast between all opacities
The radiographic appearance of thoracic structures is
INFLUENCED BY THE POSITION OF THE ANIMAL
and the
CONTRAST
between the various structures. Contrast allows you to distinguish one structure from another. Like bone from soft tissue. When an animal is laterally recumbent (on its sde), the dependent
lung collapses
under weight altering its density which in turn reduces it's distinction with the surrounding structures. For this reason, 2 contra-lateral radiographs are required along with either a dorso-ventral (DV) or a ventro-dorsal (VD) for completeness. By taking at least 3 standard views, you will be able to
maximise detection of small lesions or significant findings
. On the same note, full inspiratory views are the best way to maximise contrast as you have more air surrounding your structures.
VD views are routinely performed over DV views for consistency and due to patient positioning ease. There are still many clinical indications for performing a DV view.
Dorsoventral
Left Lateral
Right Lateral
Summation
ST
ST
Gas
Bone
Quality?
Adequate exposure
Development/Digital Processing
Inspiration
Positioning
Collimation
Labeling
Interpretation
Silhouette
NORMAL ANATOMY
Systematic Approach
Roentgen Signs
Number, Size, Opacity, Position/Location, Displacement, Margin/Contours, Shape
Musculoskeletal
Cardiovascular
Pulmonary
Thoracic Borders
Extrathoracic
Heart, Aorta, Caudal Vena Cava, Lobar veins and arteries.
Trachea, main stem bronchii, lobar bronchii.
Thymus (young),
Ribs, Sternum, Vertebrae, Shoulder, C-C junction
Liver, Stomach
Cranial Vena Cava, brachiocephalic trunk, common carotid, coronary vessels, azygous vein.
Lymphnodes, Oesophagus, Diaphragm (well, kinda)
"veins are central and ventral"
R
L
DV
T1
T2
T3
T4
a
b
a
b
Vertebral Heart Score
a + b = VHS
Dog: 8.7 - 10.7
Cat: 7.5 - 8.5
Always the right lateral projection
Heart Size
Dog: 3-3.5 ICS
Cat: 2-3 ICS
Width: 1/2 - 2/3 of thorax
12
6
3
9
Left atrium
Left Ventricle
Right Ventricle
Right atrium
Great Vessels
LV
RV
RA
AA
PA
LA
DDx
V
I
T
A
M
I
N
D
VASCULAR
INLAMMATORY, INFECTIOUS
TRAUMA, TOXIC
ANOMALOUS (OR CONGENITAL)
METABOLIC, METASTATIC
IATROGENIC, IDIOPATHIC
NEOPLASTIC, NUTRITIONAL
DEGENERATIVE
Abnormalities
Border Abnormalities
Normal
DV
Diaphragmatic Hernia
Rib Tumor
Lung Patterns: Bronchial
Others:
Fractures
(trauma, Asthmatic/Dyspnoeic Cats etc),
Spondylosis
, Calcification of the costal-chondral cartilages
(ageing)
Thickening, Mineralisation of the brochial walls OR peribronchial changes



Produces Doughnuts and Tramlines





Inconsistent in diameter (bronchiectasis).
Normal
DV
End On
Side On
pulmonary artery
pulmonary vein
airway
Allergic Lung Disease
Angiostrongylus (lung worm)
Equine (lateral view)
DDx: Chronic Bronchitis (infectious, allergic, inflammatory), dystrophic mineralisation (ageing), bronchiectsis associated with pulmonary disease, lymphoma, bronchogenic carcinoma, Cushing's (or long term corticosteroid therapy), Idiopathic Pulmonary Fibrosis........
Any change to the pulmonary vascular size, course or opacity.




Most often due to Cardiac disease










Tortuous course seen in heart worm
Normal
DV
Lung Patterns: Vascular
pulmonary artery
pulmonary vein
airway
DDx: Depends on which vessels (pulmonary arteries or veins) are affected. Common conditions causing vascular patterns include acquired heart disease (e.g. CHF), congenital heart defects (e.g PDA), parasitic hypertension (heartworm, lung worm), pulmonary thromboemolism etc
End on
End on
suggests pulmonary congestion
End on
suggests pulmonary hypertension
Lung Patterns: Interstitial
Normal
DV
Increased soft tissue opacity of the lungs
due to fluid, cellular infiltrate, or fibrosis of the interstitial space. But air still remains within the alveoli. For this reason, the
pulmonary vessels can still be seen
(no effacement)!
Mimicked by expiration, poor radiographic technique and obese animals.
Also called unstructured interstitial pattern
normal
interstitial
Pneumocystis Pneumonia
Pulmonary Fibrosis
DIAGNOSIS?!?!
End on
MRI
Lung Patterns: Nodular
Normal
DV
DDx: Primary lung neoplasia, Metastasis, cyst, granuloma, abscess
Well defined soft tissue opacities
> 3mm to be detected
May be completely soft tissue or cavitated
Mimicked by nipples, cutaneous masses, end on pulmonary vessels, etc
Lung Patterns: Alveolar
Normal
DV
Increased soft tissue opacity of the lungs
due to collapse OR fluid, cellular infiltrate, exudate filling the alveolar space. Air is removed. For this reason, the
pulmonary vessels are not seen
(tissue effacement)!
Consolidation or Collapse
Air-bronchograms are a common feature
normal
alveolar (can't see vessels)
soft tissue opacity
a.
v.
soft tissue opacity
soft tissue opacity everywhere
soft tissue opacity everywhere
DDx: Pneumonia, Oedema, Haemorrhage, Atelectasis, Neoplasia, PTE, ARDS etc....
Aspiration Pneumonia
Lobar Pneumonia
Cardiogenic Oedema
Atelectasis VS Consolidation
Normal
DV
Consolidated right middle lobe
Atelectic right middle lobe
mediastinal shift to the right
Air within the right middle lobe is replaced with tissue, fluid, etc. No mediastinal shift.
Pleural Space Pathology
Normal
DV
Normally, the lung margins should extend towards the periphery at the thoracic wall, making them impossible to see.

Any filling of the pleural cavity, will cause retraction of the lobes away from the thoracic wall.
Pneumothorax
will cause retraction of the lung lobes leaving a hyperlucent (dark) space.
Pleural effusion
(transudate, haemorrhage, chyle, pus etc) will cause retraction of the lung lobes leaving a soft tissue opacity filling. This obscurs the heart and diaphragm margins.
Soft tissue (rare) - e.g. mesothelioma, more focal soft tissue filling.
Tracheal Abnormalities
Normal
DV
Variation in Diameter
Change in position
tracheal collapse, chronic dyspnoea, psuedo collapse
oesophageal disease, mediastinal masses, cardiomegaly, lung masses?
Tracheal Hypoplasia
Vascular Ring Anomaly
Tracheal Collapse
The trachea should be
uniform in diameter
and its width is roughly 20% of the thoracic inlet. Some mineralisation of the tracheal cartilages is normal in the ageing animal, but this can be exacerbated by respiratory disease.

The cervical trachea is completely surrounded by soft tissue; therefore, any change in tracheal diameter is "true" and well highlighted. The thoracic trachea is surrounded by aerated tissue, soft tissue and fat; superimposing normal tissue or soft tissue lesions can be confused as tracheal pathology.
Craniodorsal Mediastinal Mass
R
T1
T2
T3
T4
a
b
a
b
12
6
3
9
Left atrium
Left Ventricle
Right Ventricle
Right atrium
Great Vessels
LV
RV
RA
AA
PA
LA
Heart Abnormalities
Normal
Right lateral and DV only
Tetralogy of Fallot
Size
Cardiomegaly or Microcardia?
Margins
Blurred or Sharp?
Location
Displacement by other lesions?
Shape
Chamber enlargement (bulging), Neoplasia
Pericardial Effusion
Endocardiosis
DCM
Mediastinal Abnormalities
Normal
DV
The following structures are not visible wihtin the mediastinum normally: Cranial vena Cava, brachiocephalic trunk, thymus (unless very young), lymphnodes, oesophagus*

Mediastinal massess may be obvious soft tissue lesions, but otherwise are diagnosed based on their mass effect (displacement of surrounding structures) = Focal tracheal deviation, displacement of the cardiac silhouette
DDX:
CHANG:
Cyst, Haematoma, Abscess, Neoplasia, Granuloma

Mediastinal Effusion: Reverse fissure lines radiating out from the mediastinum.
DDx: Hamorrhage, mediastinitis, neoplastic effusion etc....

Pneumomediastinum: More mediastinal structures are visible.
DDx: Trauma, tracheal rupture, oesophageal Rupture
Pneumomediastinum
Tracheobronchial Lymphadenopathy
Cranial Mediastinal Mass
Dilation
- Megaoesophagus, Anaesthetic/sedative induced dilation.
Look for a tracheal stripe sign

FB
- Thoracic inlet, heart base, oesophageal hiatus

Neoplasia (rare)

Contrast study (Barium) helps visulisation -
Don't use if suspected perforation
Always look for concurrent Aspiration Pneumonia
Normal
DV
Oesophageal Disease
Rib Tumor
Pleural Effusion
Pneumothorax
Tension Pneumothorax
Know the importance of taking at least 3 views of the thorax.
Know the normal visible anatomy.
Know the specific signs for cardiac chamber enlargement.
Know lung patterns and how they differ (Alveolar, Interstitial, Bronchial and Vascular)
Use Roentgen terminology

What's your Diagnosis?
http://prezi.com/9iexm6zozly6/thoracic-imaging/
Technique
Metal
Full transcript