veterinary radiology - radiographic lung patterns · abrupt demarcation between diseased and normal...
TRANSCRIPT
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Radiographic Lung Patterns
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Systematic approachheart
mediastinum
vessels
lungs
pleural space
thoracic wall
diaphragm/abdomen
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Lung pathologyMost cause INCREASED OPACITY
patterns
INTERSTITIAL
ALVEOLAR
BRONCHIAL
VASCULAR
NODULAR
Some cause DECREASED OPACITY
emphysema, air trapping
hypoperfusion
PTE
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Approach
Is there increased opacity?
What is the pattern(s)?
What is the distribution?
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FOCAL/MULTIFOCAL
DIFFUSE
PATTERNNODULAR
BRONCHIAL
ALVEOLAR
VASCULAR
INTERSTITIAL
DISTRIBUTION
INTERSTITIAL
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VASCULAR
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Vascular pattern
What you will see...
DIFFUSE increased opacity
Due to:
Multiple enlarged pulmonary vessels
Veins
Arteries
BOTH
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Vascular pattern
Remember compare:
cranial vessels to:
caudal vessels to:
Artery and vein should be:
same size or smaller than rib
similar size to each other
4th rib9th rib
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Vascular
BIG VEINSBIG ARTERIES
BIG VEINSnormal ARTERIES
BIG ARTERIES normal VEINS
OvercirculationPulmonary hypertension
Left heart failure
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BRONCHIAL
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What you will see...
DIFFUSE increased opacity
Due to...
Prominent bronchial walls
“RAILROAD TRACKS”
“DONUTS”
out to PERIPHERY
Bronchial pattern
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Bronchial pattern
Chronic bronchitis
allergic, irritant
Feline asthma
Infectious bronchitis
Lungworms
Heartworm disease
DIFFERENTIALS
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INTERSTITIAL
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Interstitial patternWhat you will see...
DIFFUSE or FOCAL
UNSTRUCTURED haziness
BLURRING of vessel margins
Due to:
interstitial fluid or cells
ARTIFACT
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Interstitial pattern
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Interstitial DifferentialsArtifact - expiratory, obesity
“old-dog” lungs
Pneumonitis
viral, parasitic, metabolic, toxic
Alveolar disease in transition
Pulmonary fibrosis
ARDS
Neoplasia - RARE (LSA, mets)
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Bronchial vs. Interstitial
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Bronchial vs. Interstitial
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DIFFUSE increased opacity
NOhazy
blurred vessels
YES
INTERSTITIALBRONCHIAL
vessels donutsRR tracks
VASCULAR
Is opacity made up of STRUCTURES or
MARKINGS?
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ALVEOLAR
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Alveolar pattern
What you will see...
FOCAL or MULTIFOCAL distribution
Uniform fluid opacity - fluffy to solid
Due to:
cells/fluid filling alveoli
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Alveolar patterncontinuum with INTERSTITIAL
AIR BRONCHOGRAMS
LOBAR SIGN
SILHOUETTE SIGN
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Air Bronchogram
Branching BLACK airway
WHITE background
CAN’T see vessels
yesyes
nono
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Lobar signPeriphery of lobe affected
Abrupt demarcation between diseased and normal lung
DON’T confuse with PLEURAL FISSURES
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Silhouette signAdjacent to ST structure
Effacement of margins
cardiac silhouette
pulmonary vessels
diaphragm
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Alveolar pattern
BLOOD
PUS
WATER
BIG 3 Differentials:
hemorrhage, contusions
edema
pneumonia
Other Differentials:
Atelectasis
Neoplasia
Lung lobe torsion
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Cardiogenicpulmonary
edema
Alveolar
CAUDODORSALHILARCRANIOVENTRAL
Non-cardiogenicpulmonary
edema
Pneumonia
Location?
Hemorrhage HemorrhageHemorrhage
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NODULAR
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Nodular PatternAKA = structured interstitial
What you will see...
FOCAL or MULTIFOCAL opacities
Due to:
nodules or masses
MUST define characteristics of nodule(s)!!
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Differentials for nodules
ematoma - trauma
bscess - foreign body
eoplasia - primary and metastatic
ranuloma - fungal, parasitic
ulla - air or fluid filled
H
A
N
G
B
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Nodule characteristics
NUMBER - Single vs. Multiple
SIZE - overall and relative
nodule vs. mass (>3 cm)
similar vs. variable
MARGINATION
well defined vs. ill defined
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Single Nodule/Mass
WELL-DEFINED margins
NEOPLASIA!!
Primary vs. single metastatic nodule
> 3 cm more likely PRIMARY tumor
BULLA, HEMATOMA
ABSCESS
GRANULOMA
ILL-DEFINED margins
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Multiple Nodules/Masses
WELL-DEFINEDMARGINSILL-DEFINED
SIZE VARIABLYSIMILARLYsmall, miliary
OTHERLYMPHADENOPATHYSYMPTOMATIC
Fungal Pneumonia Metastatic Neoplasia
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Margination
If you see both ILL and WELL DEFINED?
ILL DEFINED won’t look WELL DEFINED
WELL DEFINED can look ILL DEFINED
Due to:
respiratory motion
silhouetting
associated hemorrhage or inflammation
BUT..
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Cavitated Nodules
Soft tissue and AIR
WALL THICKNESS!!
Differentials
H A N G with necrosis
thick irregular wall
Bulla
thin wall
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Nodular patternBEWARE OF IMPOSTORS...
End on vessels
Surface structures
Pulmonary osteomas
REMEMBER REAL NODULES!
size > 5mm on BOTH views ST opacity
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SUMMARY
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NODULAR
BRONCHIAL
ALVEOLAR
VASCULAR
INTERSTITIAL
PATTERN
blurring of vessels
air bronchogramsilhouette sign
lobar sign
railroad tracks, donuts
enlarged pulm vessels
focal/multifocal nodules
SIGNS
diffuse
focal