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Interactive lower respiratory radiography

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Abstract

Radiology is the most widely-available imaging modality used to assess the lower respiratory tract in veterinary practice, although CT (if available) will generally give the optimal visualisation of the pulmonary structures. Interpretation of pulmonary disease on radiographs can be challenging, and obtaining images of good diagnostic quality is critical (some apparent pulmonary pathology can easily be mimicked by underexposed radiographs) – a complete radiographic examination is also important as unilateral lesions can be missed if only one radiograph is obtained. When assessing pulmonary pathology, important factors to consider are the lung pattern(s) present and their distribution – these will significantly affect the priority given to the potential differential diagnoses. The most common lung changes seen are bronchial, alveolar and nodular patterns – genuine unstructured interstitial and abnormal vascular patterns are less frequently identified. For a bronchial pattern, the most common causes are incidental age-related mineralisation and chronic bronchitis. Alveolar change (classically seen as air bronchograms) can be due to pulmonary collapse or consolidation – when consolidation is distributed ventrally (and often asymmetrically), this is more suggestive of aspiration pneumonia or haemorrhage, while bilaterally symmetric peri-hilar and caudodorsal change would be more typical of pulmonary oedema. In the UK, nodular lesions are most commonly seen with neoplastic disease.

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