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108 Cards in this Set
- Front
- Back
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What are the lobes of the left lung?
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Cranial
-Cranial subsegment -Caudal subsegment -Caudal lung lobe |
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What are the lobes of the right lung?
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Cranial
Middle Caudal Accessory |
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Which lung lobe has a very small volume and surface area and easy collapses?
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Right middle lung lobe
-Followed by cranial right lung lobe |
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Where is the caudal boundary of the cranial lung lobes on a VD? What fissures do you see in this area?
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4th to 5th intercostal space
-Fissures b/w left cranial lung subsegments & right cranial and middle lung lobes |
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Where is the lung boundary b/w the right middle lung lobe and right caudal lung lobe on a VD? What fissures do you see in this area?
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B/w 6th to 7th intercostal spaces Fissures between:
-Left cranial and caudal lung lobes -Right cranial and middle |
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What are the 3 regions of a specific lung lobe?
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1) Perihilar
-Segment closest to hilus, where mainstem bronchi divide 2) Midzone (middle of lobe) 3) Periphery -Aspect furthest from hilus *Opposite directions in cranial VS caudal lung lobes |
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What are the 4 pulmonary patterns?
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1) Interstitial
-Structured or unstructured 2) Alveolar 3) Bronchial 4) Mixed |
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What is the interstitium of the lungs? What are the 3 components of the interstitium?
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Non-air containing element of lung, excluding macroscopic blood vessels
1) Alveolar septum 2) Interlobular septum 3) Microscopic blood vessels |
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What are the 2 types of interstitial patterns?
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1) Unstructured
2) Structured -Nodular -Reticular |
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What is an unstructured interstitial pulmonary pattern?
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Grey haze over lungs and lose borders of vasculature
-Increase lung opacity -Obscured, but not obliterated vascular margins |
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What kind of pulmonary pattern would you say if you see a salt and pepper pattern in the lung field?
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Structured interstitial pattern-reticular pattern
e.g. blastomycosis |
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What kind of pulmonary pattern would you say if you see a salt and pepper pattern in the lung field?
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Structured interstitial pattern-reticular pattern
e.g. blastomycosis |
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How are unstructured interstitial patterns characterized? (2)
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By distribution:
-Focal -Multifocal -Diffuse -Patchy Characterized by location -Perihilar (hilar), midzone, periphery |
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**When is an overall increased opacity of the lungs normal?
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In older animals or in very young animals
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What are 6 causes of an overall increase in the opacity of the lungs, aside from in an older animal?
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1) Fat
2) Expiration, anesthesia 3) Underexposure 4) Distended abdomen 5) Overlying muscle of front leg 6) Pleural fluid |
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Interstitial edema _________ alveolar edema.
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Precedes
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What are 2 broad types of edema?
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Cardiogenic
Non-cardiogenic |
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Explain how cardiogenic edema advances in dogs (pattern wise..).
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Starts perihilar and spreads to periphery
-Affects caudal lung lobes first *Except in dobermans |
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Explain how cardiogenic edema advances in cats (pattern..).
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Variable, patchy, more ventral
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What are 4 examples of non-cardiogenic edema?
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1) Near drowning
2) Epilepsy 3) Electric shock 4) Head trauma |
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What part of the lung is usually affected first by non-cardiogenic edema?
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Caudal lungs, does not start perihilar like cardiogenic edema in dogs
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If you are examining a thoracic radiograph of a non-doberman breed and see it affects the caudal lung lobes, but not the hilar region, what type of edema do you think this is?
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Non-cardiogenic edema
-Near drowning -Epilepsy -Electric shock -Head trauma |
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A disseminated distribution throughout the lungs is an ___________ interstitial pattern.
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Unstructured
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What is the most common cause of pneumonia?
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Bacterial
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What are 3 types of pneumonia/ portals of entry?
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1) Bronchopneumonia
2) Aspiration pneumonia 3) Hematogenous |
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How does aspiration pneumonia present on a thoracic radiograph?
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Ventral distribution is typical
-Right middle and cranial lung lobes |
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What are 2 examples of agents that can cause pneumonia hematogenously?
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1) Fungal (blasto, crypto, histo, coccid)
2) Viral (distemper) - caudo-dorsal distribution |
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What is characteristic of an unstructured interstitial pattern from allergies?
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Pulmonary infiltrates with eosinophils (PIE)
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What are 4 causes of hemorrhage in the lungs?
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1) Trauma
2) DIC 3) Anticoagulant poisoning *Rat poisoning 4) Immune mediated diseases |
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What are 2 causes of lung granulomas?
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1) FIP
2) Parasitic -Lungworms or heartworms |
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What dog breed is predisposed to fibrosis of the lungs?
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West highland white terriers
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What kind of lung pattern does an acute respiratory distress syndrome and overcirculation result in?
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Unstructured interstitial pattern-disseminated distribution through lungs
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How does hemorrhage in the lungs from trauma appear on a radiograph?
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Trauma can be located anywhere
-Patchy -If patient had trauma-most likely hemorrhage in lungs |
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How does hemorrhage from Warfarin appear on a radiograph compared to trauma?
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More uniform in distribution than trauma
-Lose definition of cardiac silhouette |
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When do you consider something on a thoracic radiograph a nodule instead of a mass? When can they be seen?
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Nodule <3cm
Masses> 3cm -Can't be seen until > 2-3 mm |
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Compare a soft tissue nodule to an end-on vessel? How do you tell the difference?
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Soft tissue nodule:
-Not associated w/ vessels -Similar opacity to longitudinal vessels -May be larger than adjacent vessel End -on vessel: -Close in size and location to side on vessels ****More opaque than side on vessel **End-on vessels is more opaque than a small nodule of same size |
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What is more opaque, a soft tissue nodular or a end-on vessel of the same size?
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****End- on vessel!!!!
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What are 3 ways to characterize pulmonary nodules/masses?
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1) Soft tissue or mineral
2) Solitary or multiple 3) Solid or cavitary |
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**Always do _______ if you suspect neoplasia or infiltrative disease!!!!
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3 views!!! if position a patient on lateral view upper lung is better airated and allows visualization of masses, bottom is compressed w/ increased soft tissue density
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What are 4 differentials for a solitary mass in the lungs?
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1) Neoplasia
2) Hematoma -History of trauma 3) Granuloma 4) Fluid filled bulla or cyst -Abscess |
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What are the 4 primary lung tumors that form solitary masses?
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1) Adenocarcinoma
2) Bronchogenic carcinoma 3) Squamous cell carcinoma 4) Malignant histiocytosis -can have solitary lung metastasis |
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If you're not sure if a solitary mass in the lungs is neoplasia or a granuloma, what can you do?
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Wait and reshoot the film in a week, neoplasia will progress granulomas won't
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What are 3 differentials for multiple mass lesions in the lungs?
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1) Neoplastic
2) Fluid filled bullae or cysts 3) Granulomas |
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What are 4 types of neoplasia that can cause multiple mass lesions in the lungs?
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1) Metastasis
2) Lymphoma 3) Malignant histiocytosis 4) Lymphoid granulomatosis |
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What are 2 differentials for solitary granulomas in the lungs?
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Parasitic or fungal
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What are 4 differentials for multiple granulomas in the lungs?
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1) Fungal
2) Parasitic 3) Viral -FIP in cats 4) Inflammatory -Allergic in cats -Abscessation |
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What are 2 parasites that can cause multiple granulomas in the lungs?
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1) Lung fluke (paragonimus kellicotti)
2) Feline lung worms (Aelurostrongylus) |
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If you have a radiograph with a mass in the right middle lung lobe and some small nodular lesions, what is high on your differentials?
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Malignant histiocytosis
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If you see small nodular lesions in the lungs of a cat with a bronchial pattern, what is high on your differentials?
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Allergies
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Mineralized nodules in the lungs= ____________.
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Pulmonary osteomas
-Heterotopic bone formation |
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What animals tend to get pulmonary osteomas?
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Older dogs
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How do pulmonary osteomas appear on a thoracic radiograph? How do you distinguish them from end on vessels or soft tissue nodules?
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small, but very opaque
-More irregularly shaped or marginated compared to end on vessels or soft tissue nodules |
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What type of lung pattern do you see with pulmonary osteomas?
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Nodular (structured) interstitial pattern
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If you suspect you have a cat with feline asthma bronchiectasis (plugged bronchi) what should be your next diagnostic step?
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Bronchoalveolar lavage-less invasive than a fine needle aspiration, if it is feline asthma then will see eosinophils, then treat and reshoot film to look for improvement
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How does feline asthma with inflammatory nodules appear on a thoracic radiograph?
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See a lot of thickened bronchi with train tracts and round nodular lesions
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A miliary interstitial pattern is a subcategory of ________.
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Structured or nodular pattern
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What is a miliary interstitial pattern?
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<3mm punctate nodules that coalesce
-Salt and pepper -Ill defined border of heart, lose ability to see vessels, Ill- defined border of CVC, looks fuzzy |
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What are 4 differentials for a miliary interstitial pattern?
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1) Lymphoma
2) Fungal pneumonia 3) Hematogenous bacterial pneumonia 4) Metastatic mammary or thyroid carcinoma |
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How can you distinguish b/w neoplastic nodules and asthma in a cat?
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W/ neoplasia don't see massive thickening of bronchiolar walls like w/ asthma
-Look in periphery and if see small nodular lesions its more likely they aren't vessels bc vessels should be smaller in periphery, so if see nodules out farther=true nodular lesions |
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What is a mixed lung pattern?
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Alveolar + interstitial pattern
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What causes an alveolar lung pattern?
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Alveoli become filled w/ fluid or cells (consolidation) or collapse (atelectasis)
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How do alveolar lung patterns appear on a radiograph?
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-Often spreads to limits of lobe
-Homogenous increase in soft tissue opacity -Obscures underlying structures -Often coalesces **Silhouetting of adjacent structures +/- air bronchograms |
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What is the most consistent finding of alveolar lung patterns?
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***Silhouetting of adjacent structures
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What are 5 requirements for an air bronchogram?
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1) Alveoli filled or collapsed
2) Vessels obscured 3) Walls of bronchus obscured 4) Air opacity-branching tree 5) Not in hilus |
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What type of pulmonary pattern do you have without an air bronchogram? With an air bronchogram?
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Without=interstitial
With=alveolar (signifies lung disease) |
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What is the most common reason you can't see the diaphragm?
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Increased density of lungs --> silhouettes w/ diaphragm
-Silhouette sign |
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What is a silhouette sign?
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Where lung opacity is soft tissue like and obliterates margins (border effacement) of adjacent structures
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What are 4 structures that an increased lung opacity can obliterate the margins of (what's affected by the silhouette sign)?
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1) Pulmonary vessels
2) heart/great vessels 3) Walls of bronchus obscured 4) Diaphragm |
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What is the most likely cause of an apparent air bronchogram in the hilus?
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Not lung infiltrate, but lymph node tissue
e.g. Mediastinal lymph node enlargement w/ blastomycosis- lnn sit dorsal and ventral of the bronchial bifurcation *Not a true air bronchogram if at hilus |
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*True or false. An air bronchogram is a disease.
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FALSE!!!!!!!! many diseases may or may not have an air bronchogram, depends on the severity
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What are 3 causes of an air bronchogram (alveolar pattern)?
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1) Flooded alveoli
2) Collapsed alveoli-compression 3) Thick alveolar walls and interstitium |
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What are 4 differentials for flooded alveoli?
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1) Edema
2) Inflammation 3) Hemorrhage 4) Neoplasia |
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What are 2 differentials for collapsed alveoli?
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1) Pneumothorax
2) Pleural effusion |
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What are 2 differentials for thick alveolar walls and interstitium?
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1) Chronic pneumonia
2) Neoplasia |
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What are 3 things to look for to differentiate canine lymphoma and fungal from edema and other lung infiltrates?
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1) Look for mediastinal lymph node enlargement
2) Rule out heart failure-large heart? 3) Rule out pulmonary infiltrates with eosinophils by history, hematology etc |
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Lots of diseases have air bronchograms, so how do you determine the cause of the diffuse infiltrates?
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The location of the diffuse infiltrates is the guide to the case
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If you have a diffuse infiltrate in the cranio-ventral lung lobe, what is the most likely diagnosis?
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Pneumonia
|
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If you have a diffuse infiltrate in the periphery, what is the most likely diagnosis?
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Pneumonia
|
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If you have a diffuse infiltrate that is located peribronchial, what are 3 differentials?
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1) Pneumonia
2) Pulmonary infiltrates with eosinophils 3) Asthma |
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If you have a diffuse infiltrate that is lobar what is the most likely diagnosis?
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Pneumonia
|
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If you just have a general diffuse infiltrate what are the 2 most likely differentials?
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1) Hematogenous spread of disease
2) Edema in cats |
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What is the most likely differential if there's a diffuse infiltrate that is dorsal, especially caudo-dorsal?
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Edema
|
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What is the most likely 2 differentials if there's a diffuse infiltrate that is patchy?
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1) Hematogenous spread disease
2) Edema in cats |
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What is atelectasis?
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Reduced aeration of lung lobe w/ collapse of alveoli
|
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What are 7 common causes of atelectasis?
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1) Anesthesia or prolonged recumbency
2) Pleural effusion 3) Pneumothorax 4) Cats w/ asthma (right middle lobe) 5) Bronchial foreign body 6) Surfactant deficiency in new borns 7) Lung lobe torsion |
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What should you do if you have a dog in lateral recumbency and you suspect atelectasis?
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Put upright for a little bit then Take the other lateral view, because if due to recumbency atelectasis should disappear
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Which lung lobe most commonly collapses, for example in a cat with asthma?
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Right middle lobe
-Fairly large surface area but fairly little volume |
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What will you see with lung lobe torsion other than atelectasis?
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Torsion of bronchus
|
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What is a primary distinguishing factor b/w atelectasis and consolidation (alveoli filled w/ cells)?
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Atelectasis causes a mediastinal shift and consolidation does NOT, because consolidation retains shape and size of lungs and atelectasis loses volume of lung lobe-> loss of pillow for mediastinum
|
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What are the 3 characteristics of atelectasis?
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Atelectasis:
-Volume loss of lung lobe ~Considerable loss needed to create alveolar pattern ~ Lung retracted from body wall -Mediastinal shift -Presence of pleural fluid, pneumothorax |
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What are the 2 characteristics of consolidation?
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Lungs retain shape and size
-Not the case in atelectasis, why get mediastinal shift-loss of pillow No mediastinal shift |
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What is a bronchial pattern?
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Increased visualization of the bronchial walls
-Thickening or mineralization of the wall -Soft tissue adjacent to the wall (Peribronchial infiltate) |
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What are 4 sings on a radiograph that's consistent with a bronchial pattern?
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1) "tramtracks"- longitudinal thickened bronchi
2) "doughnuts"- end of thickened bronchi 3) Focus more on midzone and periphery 4) Brochiecstasis -Lumen widens (irregular, lare rings or lines of bronchi) -Loss of normal tapering of bronchi -+/- thickening of wall |
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What are 2 causes of bronchiectasis? What's the prognosis?
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1) Congenital
2) Acquired -E.g. Irritation of bronchial wall -Not good prognosis |
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Bronchial markigns are normally visible only in _____ zone of large dogs.
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Hilar
|
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What are 6 differentials for a bronchial pattern?
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1) Chronic bronchitis (acute may be normal)
2) Feline asthma 3) Normal aging change 4) Pulmonary infiltrates w/ eosinophils 5) Parasites 6) Neoplasia |
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How does bronchial mineralization appear on a radiograph?
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Mineralization of wall w/o increase in thickness
|
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Bronchial mineralization is insignificant in ______.
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Older dogs
|
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Where does bronchial mineralization originate in cats?
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Peribronchial mucous glands
|
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What are 2 congenital predispositions to bronchiectasis?
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1) Primary ciliary dyskinesia
2) Kartagener's syndrome -Ciliary dyskinesia + situs inversus (mirror image transposition of heart & abdominal orgas) |
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What are 3 sequelae to primary ciliary dyskinesia?
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1) Chronic rhinitis
2) Pneumonia/bronchitis 3) +/- bronchiectasis |
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What are 2 examples of acquired bronchiectasis?
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1) Middle aged to older patients
2) Chronic bronchitis leading to bronchiectasis *Tend to get reoccurring pneumonia bc mucous gets retained and creates good environment for infection |
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In general, what causes a diffuse hyperlucency of the lungs?
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Air trapping due to expiratory obstruction
|
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What are 5 differentials for diffuse hyperlucency of the lungs?
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1) Feline asthma
2) Chronic bronchitis 3) Congenital lobar emphysema -Shih Tzu & jack russels 4) Overinflation 5) Underperfusion |
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What are 3 differentials for focal hyperlucency of the lungs?
|
1) Cysts in young animals
-Rare 2) Lung flukes in dogs -Paragonimus kellicotti 3) Bulla (pneumoatocele) |
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What is different about the appearance of canine and feline lungs w/ lung worms?
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Canines=focal hyperlucency
Cats= usually solid and nodular pattern |
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What are 2 differentials for thin walled bulla (focal hyperlucency) in the lungs?
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1) Cavitated tumors
2) Bleb -Subpleural bulla-rare seen, sometimes w/ pneumothorax |
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What are 2 differentials for thick walled bulla (focal hyperlucency) in the lungs?
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1) Abscess
2) Tumor |
