Radiology

Elizabeth Baines

doi:10.22233/9781905319534.6

Radiology

British Small Animal Veterinary Association , 33 (2010); https://doi.org/10.22233/9781905319534.6

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Radiology

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Author: Elizabeth Baines
From: BSAVA Manual of Canine and Feline Cardiorespiratory Medicine
Item: Chapter 6, pp 33 - 52
DOI: 10.22233/9781905319534.6
Copyright: © 2010 British Small Animal Veterinary Association
Publication Date: March 2010

Abstract

The hyoid apparatus and soft tissues of the larynx are visible on a well exposed radiograph, and the tubular air lucency of the trachea can be seen coursing craniocaudally in the ventral part of the neck towards the thoracic inlet. Mineralization of the laryngeal cartilages and tracheal rings may occur as a normal aging change. The epiglottis may be seen contacting the caudal border of the soft palate, but commonly, following extubation, it will remain in close contact with the base of the tongue and not be visible radiographically. The air-filled nasopharynx, oropharynx and laryngopharynx are usually visible, although less so in brachycephalic breeds. The trachea should be very slightly narrower than the larynx cranially, and at the thoracic inlet, the width of the trachea should be 20% the height of the thoracic inlet in non-brachycephalic breeds. The larynx and trachea and thorax are addressed in this chapter.

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Figures

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6.1

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6.1 Lateral thoracic radiograph of a 7-year-old Jack Russell Terrier with tracheal collapse.

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6.2

Standing lateral thoracic radiograph of a 5-year-old Great Dane with suspected megaoesophagus and aspiration pneumonia. A dilated partially fluid-filled oesophagus can be seen dorsally, causing ventral deviation of the trachea. There is an alveolar pattern in the ventral part of the cranial and middle lung lobes. The brachial musculature can be appreciated overlying the cranioventral part of the thorax. © 2010 British Small Animal Veterinary Association

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6.2 Standing lateral thoracic radiograph of a 5-year-old Great Dane with suspected megaoesophagus and aspiration pneumonia. A dilated partially fluid-filled oesophagus can be seen dorsally, causing ventral deviation of the trachea. There is an alveolar pattern in the ventral part of the cranial and middle lung lobes. The brachial musculature can be appreciated overlying the cranioventral part of the thorax.

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6.3

(a) Lateral and (b) DV thoracic radiographs of a 7-year-old Labrador with a thoracic wall chondrosarcoma. A large mixed opacity mass is visible on the right 7th rib, causing medial deviation of the right caudal lobe. © 2010 British Small Animal Veterinary Association

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6.3 (a) Lateral and (b) DV thoracic radiographs of a 7-year-old Labrador with a thoracic wall chondrosarcoma. A large mixed opacity mass is visible on the right 7th rib, causing medial deviation of the right caudal lobe.

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6.4

(a) Lateral and (b) DV thoracic radiographs of a 9-year-old Staffordshire Bull Terrier with a malignant thoracic wall mass. There is a poorly defined increase in soft tissue opacity over the caudal part of the left hemithorax, with destruction of the distal part of the 8th rib. Pleural fissures can be seen on the right side at the sixth and ninth intercostal spaces. © 2010 British Small Animal Veterinary Association

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6.4 (a) Lateral and (b) DV thoracic radiographs of a 9-year-old Staffordshire Bull Terrier with a malignant thoracic wall mass. There is a poorly defined increase in soft tissue opacity over the caudal part of the left hemithorax, with destruction of the distal part of the 8th rib. Pleural fissures can be seen on the right side at the sixth and ninth intercostal spaces.

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6.5

Lateral thoracic radiograph of a 2-year-old Domestic Shorthaired cat with a PPDH. The cardiac silhouette is enlarged and is confluent with the ventral half of the diaphragm. Within the abdomen, the stomach and transverse colon are displaced cranially. © 2010 British Small Animal Veterinary Association

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6.5 Lateral thoracic radiograph of a 2-year-old Domestic Shorthaired cat with a PPDH. The cardiac silhouette is enlarged and is confluent with the ventral half of the diaphragm. Within the abdomen, the stomach and transverse colon are displaced cranially.

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6.6

(a) Lateral and (b) DV thoracic radiographs of a 2-year-old Domestic Shorthaired cat with diaphragmatic rupture. The outline of the left side of the diaphragm has been lost and the left hemithorax contains mixed opacities, consistent with abdominal contents. The transverse colon is displaced cranially within the abdomen. © 2010 British Small Animal Veterinary Association

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6.6 (a) Lateral and (b) DV thoracic radiographs of a 2-year-old Domestic Shorthaired cat with diaphragmatic rupture. The outline of the left side of the diaphragm has been lost and the left hemithorax contains mixed opacities, consistent with abdominal contents. The transverse colon is displaced cranially within the abdomen.

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6.7

(a) Lateral and (b) DV thoracic radiographs of a 6-year-old Domestic Longhaired cat with lymphoma. There is increased soft tissue opacity within the cranial mediastinum, with border effacement of the cranial cardiac silhouette. © 2010 British Small Animal Veterinary Association

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6.7 (a) Lateral and (b) DV thoracic radiographs of a 6-year-old Domestic Longhaired cat with lymphoma. There is increased soft tissue opacity within the cranial mediastinum, with border effacement of the cranial cardiac silhouette.

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6.8

DV thoracic radiograph of a 1-year-old Golden Retriever with a history of trauma. There is a massive increase in homogenous soft tissue opacity in the cranial mediastinum due to mediastinal fluid. © 2010 British Small Animal Veterinary Association

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6.8 DV thoracic radiograph of a 1-year-old Golden Retriever with a history of trauma. There is a massive increase in homogenous soft tissue opacity in the cranial mediastinum due to mediastinal fluid.

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6.9

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6.9 Position of reverse fissures in patients with a small volume of mediastinal fluid.

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6.10

(a) DV and (b) lateral thoracic radiographs of a 7-year-old Ragdoll with chylothorax. The lungs are retracted from the periphery of the thorax and there is an overall increase in opacity. The cardiac silhouette and ventral part of the diaphragm are obscured due to the pleural effusion. © 2010 British Small Animal Veterinary Association

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6.10 (a) DV and (b) lateral thoracic radiographs of a 7-year-old Ragdoll with chylothorax. The lungs are retracted from the periphery of the thorax and there is an overall increase in opacity. The cardiac silhouette and ventral part of the diaphragm are obscured due to the pleural effusion.

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6.11

(a) DV, (b) right lateral recumbent (c) left lateral recumbent thoracic radiographs of a 10-month-old Rottweiler with bilateral pneumothorax. There is also a small pneumomediastinum. The thymic sail can be seen in the DV view as a triangular soft tissue opacity extending from the midline into the left hemithorax. © 2010 British Small Animal Veterinary Association

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6.11 (a) DV, (b) right lateral recumbent (c) left lateral recumbent thoracic radiographs of a 10-month-old Rottweiler with bilateral pneumothorax. There is also a small pneumomediastinum. The thymic sail can be seen in the DV view as a triangular soft tissue opacity extending from the midline into the left hemithorax.

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6.12

Position of the lobar divisions. Ac = Accessory lobe; LCa = Left caudal lobe; LCr = Left cranial lobe; RCa = Right caudal lobe; RCr = Right cranial lobe; RM = Right middle lobe. © 2010 British Small Animal Veterinary Association

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6.12 Position of the lobar divisions. Ac = Accessory lobe; LCa = Left caudal lobe; LCr = Left cranial lobe; RCa = Right caudal lobe; RCr = Right cranial lobe; RM = Right middle lobe.

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6.13

(a) Lateral and (b) DV thoracic radiographs demonstrating the normal pulmonary vessels. The veins (blue arrows) are ventral and medial, and the arteries (red arrows) are dorsal and lateral to the corresponding lobar bronchus. © 2010 British Small Animal Veterinary Association

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6.13 (a) Lateral and (b) DV thoracic radiographs demonstrating the normal pulmonary vessels. The veins (blue arrows) are ventral and medial, and the arteries (red arrows) are dorsal and lateral to the corresponding lobar bronchus.

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6.14

Lateral thoracic radiograph of a 2-year-old Boxer with a pulmonary infiltrate with eosinophils. There is a marked alveolar pattern, particularly in the perihilar region and the caudal lobes with a lobar sign between the middle and caudal lobes, overlying the cardiac silhouette. There are also bronchial infiltrates and a craniodorsal soft tissue opacity, which most likely represents lymphadenomegaly in the mediastinum. © 2010 British Small Animal Veterinary Association

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6.14 Lateral thoracic radiograph of a 2-year-old Boxer with a pulmonary infiltrate with eosinophils. There is a marked alveolar pattern, particularly in the perihilar region and the caudal lobes with a lobar sign between the middle and caudal lobes, overlying the cardiac silhouette. There are also bronchial infiltrates and a craniodorsal soft tissue opacity, which most likely represents lymphadenomegaly in the mediastinum.

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6.15

Alveolar patterns. (a) Lateral thoracic radiograph of a 9-year-old Labrador following a road traffic accident. There is a widespread alveolar pattern in the cranial and middle lobes, with air bronchograms clearly visible over the cardiac silhouette. A lobar sign can be appreciated between the middle and caudal lobes. The alveolar pattern is likely to be due to haemorrhage. (b) DV thoracic radiograph of a 3-year-old Mastiff with angiostrongylosis. There is a widespread alveolar pattern throughout the lobes with air bronchograms visible. The cardiac silhouette is partially obscured and there is a lobar sign between the cranial and caudal parts of the left cranial lobe. The alveolar pattern is likely to be due to haemorrhage. (ci) Lateral and (cii) DV thoracic radiographs of an 11-year-old Cavalier King Charles Spaniel with acute CHF. There is a widespread alveolar pattern, particularly in the right caudal lobe with a lobar sign between the middle and caudal lobes. The cardiac silhouette is partially obscured but there is some elevation of the carina. The alveolar pattern is likely due to pulmonary oedema. (di) Lateral and (dii) DV thoracic radiographs of a 4-year-old Whippet with lung lobe torsion. There is a homogenous increase in soft tissue opacity in the position of the caudal part of the left cranial lobe, with some localized pleural fluid. On the lateral view, the left bronchus cannot be seen over the heart and the lobar shape is abnormally triangular and displaced dorsally. The left crus of the diaphragm is displaced cranially, suggesting some decrease in volume of the left hemithorax. © 2010 British Small Animal Veterinary Association

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6.15 Alveolar patterns. (a) Lateral thoracic radiograph of a 9-year-old Labrador following a road traffic accident. There is a widespread alveolar pattern in the cranial and middle lobes, with air bronchograms clearly visible over the cardiac silhouette. A lobar sign can be appreciated between the middle and caudal lobes. The alveolar pattern is likely to be due to haemorrhage. (b) DV thoracic radiograph of a 3-year-old Mastiff with angiostrongylosis. There is a widespread alveolar pattern throughout the lobes with air bronchograms visible. The cardiac silhouette is partially obscured and there is a lobar sign between the cranial and caudal parts of the left cranial lobe. The alveolar pattern is likely to be due to haemorrhage. (ci) Lateral and (cii) DV thoracic radiographs of an 11-year-old Cavalier King Charles Spaniel with acute CHF. There is a widespread alveolar pattern, particularly in the right caudal lobe with a lobar sign between the middle and caudal lobes. The cardiac silhouette is partially obscured but there is some elevation of the carina. The alveolar pattern is likely due to pulmonary oedema. (di) Lateral and (dii) DV thoracic radiographs of a 4-year-old Whippet with lung lobe torsion. There is a homogenous increase in soft tissue opacity in the position of the caudal part of the left cranial lobe, with some localized pleural fluid. On the lateral view, the left bronchus cannot be seen over the heart and the lobar shape is abnormally triangular and displaced dorsally. The left crus of the diaphragm is displaced cranially, suggesting some decrease in volume of the left hemithorax.

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6.17

Bronchial patterns. (a) Close up of a lateral thoracic radiograph of a 10-year-old Poodle with a pulmonary infiltrate with eosinophils. There is enhancement and thickening of the bronchial walls. Lateral (bi) survey radiograph and (bii) bronchogram of a mature Cocker Spaniel with chronic bronchial disease and bronchiectasis. There is marked dilatation and sacculation of the bronchi in all lobes, especially the cranial and middle lobes. Some of the bronchi appear truncated, possibly secondary to mucus plugging. (c) Lateral thoracic radiograph of an 8-year-old Domestic Longhaired cat with chronic bronchial disease. There are multiple small, coalescing mineral foci throughout the lungs, consistent with mineralization of the peribronchial mucus glands. © 2010 British Small Animal Veterinary Association

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6.17 Bronchial patterns. (a) Close up of a lateral thoracic radiograph of a 10-year-old Poodle with a pulmonary infiltrate with eosinophils. There is enhancement and thickening of the bronchial walls. Lateral (bi) survey radiograph and (bii) bronchogram of a mature Cocker Spaniel with chronic bronchial disease and bronchiectasis. There is marked dilatation and sacculation of the bronchi in all lobes, especially the cranial and middle lobes. Some of the bronchi appear truncated, possibly secondary to mucus plugging. (c) Lateral thoracic radiograph of an 8-year-old Domestic Longhaired cat with chronic bronchial disease. There are multiple small, coalescing mineral foci throughout the lungs, consistent with mineralization of the peribronchial mucus glands.

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6.19

Unstructured interstitial patterns. (a) Lateral thoracic radiograph of a 9-year-old Labrador with lymphosarcoma. There is a diffuse unstructured, honeycomb interstitial pattern throughout the lobes. Fine-needle aspiration confirmed the diagnosis. (b) Lateral thoracic radiograph of a 2-year-old Cavalier King Charles Spaniel with Pneumocystis carinii infection. There is a marked hazy, unstructured interstitial pattern throughout the lungs. This appearance may be confused with an alveolar pattern as it may be thought that air bronchograms are visible, but the abaxial margins of the lobar vessels are still visible, indicating that the alveoli remain aerated. © 2010 British Small Animal Veterinary Association

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6.19 Unstructured interstitial patterns. (a) Lateral thoracic radiograph of a 9-year-old Labrador with lymphosarcoma. There is a diffuse unstructured, honeycomb interstitial pattern throughout the lobes. Fine-needle aspiration confirmed the diagnosis. (b) Lateral thoracic radiograph of a 2-year-old Cavalier King Charles Spaniel with Pneumocystis carinii infection. There is a marked hazy, unstructured interstitial pattern throughout the lungs. This appearance may be confused with an alveolar pattern as it may be thought that air bronchograms are visible, but the abaxial margins of the lobar vessels are still visible, indicating that the alveoli remain aerated.

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6.20

Nodular interstitial patterns. (a) Lateral thoracic radiograph of a 12-year-old Rough Collie bitch with nasal adenocarcinoma. There are multiple, poorly defined soft tissue nodules throughout the lungs, consistent with pulmonary metastases. (b) Lateral thoracic radiograph of an 8-year-old Rottweiler with a primary malignant bone tumour. There are multiple, large, soft tissue opacity nodules which summate with one another. In the cranial lobe there is also an alveolar pattern; this may be due to accumulation of secretions, secondary to bronchial obstruction by a perihilar nodule. (c) Lateral thoracic radiograph of a 9-year-old Border Terrier with prostatic carcinoma. There are multiple nodules of various sizes and mixed opacities throughout the lung fields, consistent with pulmonary metastases. Some nodules appear solid and others have radiolucent centres. © 2010 British Small Animal Veterinary Association

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6.20 Nodular interstitial patterns. (a) Lateral thoracic radiograph of a 12-year-old Rough Collie bitch with nasal adenocarcinoma. There are multiple, poorly defined soft tissue nodules throughout the lungs, consistent with pulmonary metastases. (b) Lateral thoracic radiograph of an 8-year-old Rottweiler with a primary malignant bone tumour. There are multiple, large, soft tissue opacity nodules which summate with one another. In the cranial lobe there is also an alveolar pattern; this may be due to accumulation of secretions, secondary to bronchial obstruction by a perihilar nodule. (c) Lateral thoracic radiograph of a 9-year-old Border Terrier with prostatic carcinoma. There are multiple nodules of various sizes and mixed opacities throughout the lung fields, consistent with pulmonary metastases. Some nodules appear solid and others have radiolucent centres.

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6.23

Lateral thoracic radiograph of a 3-year-old Standard Poodle with PDA. All lobar vessels are enlarged (arrowed) due to over-circulation of the lungs. There is an enlarged LA. © 2010 British Small Animal Veterinary Association

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6.23 Lateral thoracic radiograph of a 3-year-old Standard Poodle with PDA. All lobar vessels are enlarged (arrowed) due to over-circulation of the lungs. There is an enlarged LA.

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6.24

DV thoracic radiograph of a 6-year-old Shar Pei with pulmonary thromboembolism secondary to renal disease. The right caudal lung lobe is hyperlucent with only thready vessels visible within it. © 2010 British Small Animal Veterinary Association

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6.24 DV thoracic radiograph of a 6-year-old Shar Pei with pulmonary thromboembolism secondary to renal disease. The right caudal lung lobe is hyperlucent with only thready vessels visible within it.

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6.25

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6.25 Principles of interpretation of pulmonary parenchymal changes.

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6.26

Clock face analogy of the cardiac silhouette on a DV or VD view. The location of dilatation of the left auricular appendage (LAu), main pulmonary artery (MPA), aorta (AO) and right atrium (RA) are shown. © 2010 British Small Animal Veterinary Association

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6.26 Clock face analogy of the cardiac silhouette on a DV or VD view. The location of dilatation of the left auricular appendage (LAu), main pulmonary artery (MPA), aorta (AO) and right atrium (RA) are shown.

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6.27

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6.27 Vertebral heart scale. (a) Canine. (b) Feline.

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6.28

(a) Lateral (b) DV thoracic radiographs of a 19-week-old Bulldog with mitral dysplasia. There is marked elevation of the carina, straightening of the caudal cardiac border and tenting of the LA. On the DV view there is a bulge at the 2–3 o’clock position in the location of the LAu, and splitting of the mainstem bronchi. There is an increased opacity overlying the cupula of the diaphragm, consistent with a massively enlarged LA. © 2010 British Small Animal Veterinary Association

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6.28 (a) Lateral (b) DV thoracic radiographs of a 19-week-old Bulldog with mitral dysplasia. There is marked elevation of the carina, straightening of the caudal cardiac border and tenting of the LA. On the DV view there is a bulge at the 2–3 o’clock position in the location of the LAu, and splitting of the mainstem bronchi. There is an increased opacity overlying the cupula of the diaphragm, consistent with a massively enlarged LA.

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6.29

(ai) Lateral and (aii) DV thoracic radiographs of a 3-year-old Standard Poodle with PDA. There is an increase in height of the cardiac silhouette with elevation of the caudal trachea and carina, increased sternal contact, straightening of the caudal cardiac border and some tenting of the LA. The apex is displaced markedly to the right on the DV view and there is a bulge at the 2–3 o’clock position, consistent with an enlarged LAu. The lungs have a hypervascular pattern. (bi) Lateral and (bii) DV thoracic radiographs of a 17-year-old Domestic Shorthaired cat with HCM. The cardiac silhouette is more rectangular and less egg-shaped than normal. On the DV view, the heart is wider than normal and has bulges on its cranial border consistent with atrial enlargement. There is a diffuse unstructured interstitial pattern, which could be consistent with mild pulmonary oedema. © 2010 British Small Animal Veterinary Association

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6.29 (ai) Lateral and (aii) DV thoracic radiographs of a 3-year-old Standard Poodle with PDA. There is an increase in height of the cardiac silhouette with elevation of the caudal trachea and carina, increased sternal contact, straightening of the caudal cardiac border and some tenting of the LA. The apex is displaced markedly to the right on the DV view and there is a bulge at the 2–3 o’clock position, consistent with an enlarged LAu. The lungs have a hypervascular pattern. (bi) Lateral and (bii) DV thoracic radiographs of a 17-year-old Domestic Shorthaired cat with HCM. The cardiac silhouette is more rectangular and less egg-shaped than normal. On the DV view, the heart is wider than normal and has bulges on its cranial border consistent with atrial enlargement. There is a diffuse unstructured interstitial pattern, which could be consistent with mild pulmonary oedema.

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6.30

(a) Lateral and (b) DV thoracic radiographs of a 1-year-old Golden Retriever with tricuspid dysplasia and atrial septal defect. The cardiac silhouette is enlarged with markedly increased sternal contact, rounding of the cranial cardiac border and elevation of the trachea cranial to the carina. The craniocaudal width of the heart is five intercostal spaces. On the DV view, the apex of the heart is displaced to the left and the heart has a reverse ‘D’ shaped appearance. The caudal vena cava is widened and tapers towards the cardiac silhouette, suggesting increased systemic venous pressures. © 2010 British Small Animal Veterinary Association

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6.30 (a) Lateral and (b) DV thoracic radiographs of a 1-year-old Golden Retriever with tricuspid dysplasia and atrial septal defect. The cardiac silhouette is enlarged with markedly increased sternal contact, rounding of the cranial cardiac border and elevation of the trachea cranial to the carina. The craniocaudal width of the heart is five intercostal spaces. On the DV view, the apex of the heart is displaced to the left and the heart has a reverse ‘D’ shaped appearance. The caudal vena cava is widened and tapers towards the cardiac silhouette, suggesting increased systemic venous pressures.

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6.31

(a) Lateral and (b) DV thoracic radiographs of a 3-year-old German Shepherd Dog with DCM. The cardiac silhouette is of increased height and width, with elevation of the trachea and carina, straightening of the caudal and rounding of the cranial cardiac borders. On the DV view, the right lateral border is rounded and there is a bulge at the 2–3 o’clock position, consistent with enlargement of the LAu. © 2010 British Small Animal Veterinary Association

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6.31 (a) Lateral and (b) DV thoracic radiographs of a 3-year-old German Shepherd Dog with DCM. The cardiac silhouette is of increased height and width, with elevation of the trachea and carina, straightening of the caudal and rounding of the cranial cardiac borders. On the DV view, the right lateral border is rounded and there is a bulge at the 2–3 o’clock position, consistent with enlargement of the LAu.

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6.32

(a) Lateral and (b) DV radiographs of a 10-year-old Rottweiler with a haemorrhagic pericardial effusion secondary to a right atrial mass. The cardiac silhouette is enlarged with a globoid appearance. There is rounding of all borders with no discrete bulges. The caudal vena cava is enlarged and ascites is present. A splenic mass was detected on abdominal ultrasonography and a presumptive diagnosis of haemangiosarcoma was made. (Courtesy of S. Dennis.) © 2010 British Small Animal Veterinary Association

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6.32 (a) Lateral and (b) DV radiographs of a 10-year-old Rottweiler with a haemorrhagic pericardial effusion secondary to a right atrial mass. The cardiac silhouette is enlarged with a globoid appearance. There is rounding of all borders with no discrete bulges. The caudal vena cava is enlarged and ascites is present. A splenic mass was detected on abdominal ultrasonography and a presumptive diagnosis of haemangiosarcoma was made. (Courtesy of S. Dennis.)

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6.33

(a) Lateral and (b) DV thoracic radiographs of an 11-year-old Jack Russell Terrier with mitral insufficiency in CHF. There is gross generalized cardiomegaly with an ill defined fluffy increase in opacity in the perihilar region. The pulmonary veins are enlarged relative to the arteries; this is particularly visible in the right caudal lobe. © 2010 British Small Animal Veterinary Association

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6.33 (a) Lateral and (b) DV thoracic radiographs of an 11-year-old Jack Russell Terrier with mitral insufficiency in CHF. There is gross generalized cardiomegaly with an ill defined fluffy increase in opacity in the perihilar region. The pulmonary veins are enlarged relative to the arteries; this is particularly visible in the right caudal lobe.

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6.34

(a) Lateral and (b) DV thoracic radiographs of a 6-year-old German Shepherd Dog with hypoadrenocorticism. The cardiac silhouette is greatly reduced in size with the apex just contacting the sternum, and has an abnormal pointed shape. The lung fields appear relatively hyperlucent and the pulmonary vessels are thready. © 2010 British Small Animal Veterinary Association

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6.34 (a) Lateral and (b) DV thoracic radiographs of a 6-year-old German Shepherd Dog with hypoadrenocorticism. The cardiac silhouette is greatly reduced in size with the apex just contacting the sternum, and has an abnormal pointed shape. The lung fields appear relatively hyperlucent and the pulmonary vessels are thready.

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6.35

Transverse plane ultrasonogram of the thorax in a 12-year-old Domestic Shorthaired cat with pleural effusion secondary to neoplasia. The effusion is anechoic and loculated. The hyperechoic interfaces indicate the pleural surfaces of the collapsed lung. © 2010 British Small Animal Veterinary Association

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6.35 Transverse plane ultrasonogram of the thorax in a 12-year-old Domestic Shorthaired cat with pleural effusion secondary to neoplasia. The effusion is anechoic and loculated. The hyperechoic interfaces indicate the pleural surfaces of the collapsed lung.