Diagnostic Imaging Final

True or False:

Degenerative joint disease and osteoarthritis are interchangable.

True

Who and where do we often see DJD?

Medium/large breed dogs

hip, shoulder and stifle

______________ occurs when abnormal biomechanical stresses applied to a joint. Primarily aging change. Can be acquired secondary to developmental disease/trauma.

DJD/ osteoarthritis

Label the image

1. intra-capsular soft tissue swelling

2. osteophytes

3. enthesophytes

4. subchondral erosions

5. intra-articular calcified bodies

6. subchondral sclerosis

7. subchondral cysts

8. joint space narrowing

__________________

increased soft tissue opacity within the joint space. A result of joint effusion or soft tissue proliferation.

Intra-capsular swelling

What is the arrow pointing to?

intra-capsular swelling

________________

peri/intra articular new bone formation in areas of non-weight bearing in order to try and stabilize the joint,

Osteophytes

What is the image pointing to?

osteophytes

_____________

periosteal response at the site of attachment of soft tissue to bone (tendon, ligament, muscle).

Enthesophyte

What is the arrow pointing to?

Enthesophyte

__________________

pieces of articular cartilage or peri-articular bone that have become detached.

Intra-articular calcified bodies

aka joint mice

What is the arrow pointing to?

Intra-articular calcified bodies aka joint mouse

_________________

subchondral bone becomes more opaque. Secondary to increased biomechanical forces/stress remodelling

Subchondral sclerosis

What is the arrow pointing to?

subchondral sclerosis

__________________

decreased size of joint due to destruction of articular cartilage. Rarely diagnosed radiographically because the patient is usually non-weight bearing.

Joint space alteration.

Four common locations for DJD/OA

shoulders

hips

stifle

elbow

Wha condition is this image depicting? What is the red label showing?

Shoulder DJD

Osteophytes present on the caudal glenoid cavity and caudal humeral head

What is the general condition depicted?

What are the numbers labelling?

Hip DJD

1. acetabular rim osteophytes

2. femoral head osteophytes

3. morgan line (poor example)

4. subchondral sclerosis of acetabular rim

What condition? What main feature does the image show?

Stifle DJD (likely from a cruciate ligament rupture)

intracapsular swelling (cranial displacement of infra patellar fat pad and caudal displacement of fascial stripe)

What are 4 common osteophyte locations for stifle DJD?

1. apex of the patella

2. trochlear groove

3. medial and lateral aspects of the distal femur and proximal tibia

4. fabellae

Condition?

Stifle DJD

What is this image showing?

patellar luxation

What animals are patellar luxations most common in (breed/age)? Medial or lateral luxation more common?

young toy breeds

medial (but lateral can be seen in large dogs)

What is the arrow pointing to?

large osteophyte on the anconeal process (earliest change seen in DJD)

What is the arrow pointing to?

osteophyte on the medial coronoid process in elbow DJD

list the lobes of the lungs

What regions of the lung lobes are the colours representing?

Black: perihilar

orange: midzone

blue: periphery

When trying to see the thoracic inlet to diaphragm, what is one thing you can do to better visualize it?

pull forelimbs forward

When doing thoracic rads, when should you always take the image?

Peak inspiration to maximize lung contrast

_______________ view of thorax:

elongated cardiac silhouette, convex right and left crura, arotic and great vessel changes more noticeable.

ventrodorsal

______________ view of thorax:

round/oval cardiac silhouette, domed diaphragmatic cupula, caudal pulmonary vessels better visualized.

Dorsoventral

What rib generally shows the tip of the lung field?

T12

How do you tell what side the lateral is taken on when viewing the thorax?

What ever side is layed down on comes more cranial and the caudal vena cava enters through the right crura.

Why should you always take 3 views of the thorax when looking for pulmonary lesions?

Only the non-dependent (up) lung can be evaluated. The down lung will not be fully aerated (atelectic) which increases in soft tissue opacity.

What are the 4 pulmonary patterns?

bronchial

interstitial

alveolar

mixed

___________ lung pattern:

increased visualization of the bronchial wall from bronchial wall thickening/mineralization. Lumen remains normal diameter. Will see peri-bronchial cells/fluid.

Bronchial

What are the two main radiographic findings in the bronchial lung pattern?

• rings (doughnuts) which are end on bronchi

• lines (tram tracks) which are longitudinal bronchi

What lung pattern?

Bronchial pattern (see doughnuts)

What lung pattern? What are the arrows pointing to?

Bronchial pattern

tram tracks

Lung pattern?

diffuse severe bronchial pattern

What are a few ddx for bronchial lung patterns?

Allergic: canine bronchitis, feline asthma

mineralization: age related (dogs)

infectious: parasitic (lungworm), fundal, bacterial (bordetella)

Cat. Likely condition? How do you know?

Feline asthma

flat diaphragm, donuts (bronchial pattern), huge lungs

_____________:

permanent widening of bronchial lumen. Differs from straight forward bronchial pattern because lumen is affected. Will see very large donuts. Can be acquired or congenital.

Bronchiectasis

Condition?

bronchiectasis

What are the three main radiographical findings in the alveolar lung pattern?

border effacement of other soft tissue structures

air bronchograms

lobar sign (normal lung abutting consolidated/atelectic lung)

Compare and contrast consolidation vs atelectasis when referring to alveolar pattern?

Consolidation: filling of alveoli with higher density substance, lungs retain shape and size, no mediastinal shoft

Atelectasis: air loss from lung lobe/alveoli, lungs retracted from body wall, mediastinal shift to side with more room.

_____________: replacing air of alveoli with higher density substance. Commonly caused by inflammation, hemmorhage, edema.

Consolidation

____________: reduced aeration of a lung lobe with collapse of alveoli. Commonly caused by prolonged recumbancy, pleural effusions, pneumothorax, etc

Atelectasis

What lung pattern? How do you know?

alveolar pattern

border effacement/silhouetting

What alveolar pattern? How do you know?

Alveolar pattern

air bronchograms where the bronchi are the only remaining air-filled structure

___________: contrast between lung lobes. Soft tissue opacity of lung lobe (consolidated/atelectic) abuts a normal air filled lung lobe.

Lobar sign

What lung pattern? What is the arrow pointing to?

Alveolar pattern

lobar sign

If the alveolar pattern is in the right middle lobe, what is your main differential? Cranioventral? Perihilar?

RM: aspiration pneumonia

CV: pneumonia, hemorrhage

cardiogenic edema

What is the likely condition? What are the arrows pointing to?

Aspiration pneumonia (bc right middle)

red: air bronchogram

blue: border effacement

yellow: lobar sign

What condition is this showing in a dog? How would it differ in a cat?

Cardiogenic edema (perihilar distribution)

Cat: would look patchy and mulitfocal anywhere (see image)

General condition?

Atelectasis

note the mediastinal/cardiac shift to the right and the soft tissue opacity of right middle lung lobe

What condition?

Atelectasis secondary to pneumothorax

note: retraction of lung lobes from thoracic wall and soft tissue opacity of left and right middle lung lobe

Radiographic findings of __________ pattern:

• increase in pulmonary opacity

• loss of contrast between vessels and pulmonary parenchyma

• can have hazy or busy appearance

• does NOT border efface soft tissue structures in thorax

Unstructured interstitial pattern

What is the most commonly misdiagnosed pulmonary pattern?

unstructured interstitial pattern

bc external factors can cause the pulmonary parenchyma to appear falsely opaque/hazy (like obese patients, technique, etc)

What lung pattern?

interstitial

____________________ pattern:

aggregates of cells within the interstitium including nodules and masses >5mm. Used to see neoplasia, granulomas, cysts, abscesses and bullae

Lung pattern?

Structured interstitial pattern (metastatic disease)

________________: neoplastic sydrome of unknown etiology affecting middle-older dogs. Will see periosteal reaction of digits/long bones associated with neoplastic or infectious lung disease. Distal limbs.

Hypertrophic osteopathy (Maries disease)

What are the arrows pointing to?

end on vessels which attenuate more of the X ray beam than a small nodule so they appear more opaque. Look for rail to connect to vessel to help differentiate.

Lesion? Who is predisposed?

Pulmonary osteomas (small mineralized nodules <3mm).

More irregularly shaped, mineral opacity, too small to be seen if soft tissue, no tail.

Collies and older large breed dogs

What are two common mixed lung patterns?

broncho-interstitial

interstitial coalescing to alveolar

Pattern?

mixed interstitial to alveolar pattern

______________ pattern

increased or decreased visualization of pulmonary vessels. Altered course of vessels.

Vascular

What lung pattern?

vascular

What lung pattern?

Vascular pattern

Is this a VD or DV projection based on the appearance of the diaphragm?

VD

Harry is a 7yo Boxer who underwent surgery for a gastric foreign body. He had a difficult anesthetic recovery and his ET tube contained fluid when he was extubated. The following day he  he is febrile, depressed, tachypnea and dyspnea.

What lung pattern?

ddx?

Alveolar Pattern (note air bronchograms and border effacement of the silhouette)

ddx: bronchopneumonia secondary to aspiration post surgically

Lucy is a 9yo Fs DSH that the owner says seems to be trying to cough up hairballs lately.  He owner books her a veterinary appointment today because she notices that she is breathing faster lately.

Lung pattern?

ddx?

Diffuse bronchial pulmonary pattern (donuts and tram tracks)

ddx: feline asthma

“Ziggy” is a 3 mth old pup that choked on a Greenie earlier in the day. The owner was able to pull it out of his mouth. Now he presents at clinic with dyspnea.

Pattern?

ddx?

Alveolar pulmonary pattern of the right middle lobe

ddx: aspiration pneumonia

Pattern?

ddx?

severe diffuse bronchial pulmonary pattern

ddx: infectious etiologies like lungworm, Bordetella etc.

Pattern?

ddx?

diffuse structured interstitial pulmonary pattern

ddx: metastatic neoplasia

Ted is a 4 mth old Lab Retriever who ran away for 3 hours - he came home panting but not dyspneic. Later in the evening owners notice he is still panting and seems to be struggling for breath 

Pattern?

ddx?

 Marked interstitial coalescing to alveolar pulmonary pattern of the caudal dorsal lung parenchyma

ddx: non-cardiogenic pulmonary edema, hemorrhage

What are the arrows pointing to? Pattern?

Lobar signs

alveolar pattern

Pattern?

Structured interstitial pattern

Which view shows aortic/great vessel changes more noticeable?

Caudal pulmonary vessels?

VD

DV

How many intercostal spaces should a dogs heart be? A cats?

Dog: 2.5-2.5 ICS

Cats: 2-2.5ICS

When doing a vertebral heart score, both long and short axis lines transposed on the vertebral column begin at ___ vertebrae

cranial T4

What is the average vertebral heart score for cats? Dogs?

Cats: 7.5 ±0.3

dogs: 9.7± 0.5

What heart condition?

4 ddx?

globoid cardiomegaly

1. pericardial effusion

2. dilated cardiomyopathy

3. peritoneal pericardial diaphragmatic hernia

4. severe tricuspid valve disease

What are two ddx for microcardia?

hypovolemia

artifact (deep chested dogs, pulmonary overinflation, etc)

Condition?

Microcardia

aka small cardiac silhouette

What are seen in each quadrant?

Label

Where is the left atrium seen on vd?

What is the arrow pointing to?

Left atrial enlargement (increase opacity)

What is this image showing?

Left atrial enlargement

What is the arrow pointing to?

left ventricular enlargement

on a lateral view, how tall should the heart be? What do you expect if it is taller?

2/3 of thoracic height

LV enlargement

What is the arrow pointing to?

Right atrial enlargement

What is the arrowing pointing to?

Right ventricular enlargement

note the reverse “D” shape

What is the arrow pointing to?

aortic enlargement

What are the arrows pointing to?

Aortic enlargement

Note: hat on top of the heart

What is the anomaly and who is it seen in?

Tortuous aorta

brachycephalics, older cats

What is the arrow pointing to?

Pulmonary trunk enlargement

note: knuckle pointing to animals armpit

2 ddx for caudal vena cava enlargement?

right heart failure

heartworm disease