RUSVM DI Midterm 1
GSD GD Irish Setter
Breeds predisposed to PRAA
Usually a sign of disorder elsewhere Always important! REQUIRES WORKUP!
Clinical significance of pleural effusion?
Enlarged LN, Thymus, Esophagus On midline or in a reflection Displace another mediastinal organ
Common causes of mediastinal masses
Aspiration pneumonia
Complication that can be seen with any type of ME?
Abdominal viscera protrude through the diaphragm. Due to trauma (acquired)
Describe a diaphragmatic hernia Whats most common cause (and what type is it)
A = Extrapleural -grows in from outside lung -has rounded (curved) attachment B = Intrapulmonary -grows from inside lung -has sharp (angular) attachment to thoracic wall
Describe the 2 types of thoracic wall lesions A? B?
Caudal Rib mass on left side!
Don't forget to check entire thoracic cage! What can you see in this image?
Border effacement of diaphragm Abdominal viscera in pleural space Displacement of abd. structures
Helpful radiographic signs of traumatic DH
Lung opacity, no heart shift = disease Lung opacity, heart shift = atelectasis
How can a mediastinal shift help differentiate lung disease vs ateletasis
Mediastinal structures become more conspicuous (see things you don't normally see)
How can you tell if pneumomediastinum present?
Cranioventral Caudoventral Caval; can't see
What are the 3 mediastinal reflections? Which one cant be seen?
Normal deviation at thoracic inlet Normal deviation over dorsum of trachea
What are the normal deviations detected in this image?
Diaphragm not complete ventrally
What can be seen easily on this CT scan about the PPDH?
Pneumothorax No only pneumomediastinum → pneumothorax NOT other way around! Lateral view
What can pneumomediastinum progress to? Vice versa? Which view is best?
Mild pleural effusion interlobar fissures
What do red arrows indicate?
mediastinal lymph nodes Red = tracheobronchial Blue = cranial mediastinal Green = sternal
What do the red ovals indicate? Blue oval? Green oval?
Mammary glands Peritoneum Peritoneal dz may cause sternal lymphaenopathy
What do the sternal LN drain?
Lungs
What do the tracheobronchial LN drain?
Pleural air (pneumothorax)
What does NOT accumulate in fissures?
Caudal Vena Cava Right Crus Left Crus Gas in fundus of stomach (right to) Left lateral
What is Red arrow pointing to? What is Green arrow pointing to? What is Blue arrow pointing to? What is Yellow circle indicating? What lateral view is this?
Caudal Vena Cava Right Crus Left Crus (left to) Right lateral
What is Red arrow pointing to? What is Green arrow pointing to? What is Blue arrow pointing to? What lateral view is this?
T13 has characteristics of L1 or vice versa
What is T-L transitional anomaly?
Portion of fundus herniated through esophageal hiatus 2 types = sliding & paraesophageal Sliding
What is a hiatal hernia? How many types are there? Which type more common in animals?
Endoscopy exam
What is better diagnostic test for esophagitis?
Border between accessory lobe (R lung) & left caudal lobe (L lung) The left aspect of accessory lobe crosses midline pushing mediastinal pleura to left
What is caudoventral mediastinal reflection? How is it formed?
Prevents id of mediastinal mass Drain fluid & reimage or ultrasound!
What is confounding effect of pleural fluid? What is best method to confirm?
Not sternal LN! too far caudal & touching heart ddx: ectopic thyroid tissue, thymic mass, mediastinal cyst Turns out u/s revealed it was mediastinal cyst!
What is detected in these images?
Sternal LN enlargement
What is detected in these images?
bowlegged cowboy sign tracheobroncheal LN megaly
What is detected in this image
Gas and fluid in esophagus
What is detected in this image?
Megaesophagus
What is detected in this image?
Megaesophagus Funnel sign
What is detected in this image?
Moderate tracheobronchial lymphomegaly
What is detected in this image?
Pneumomediastinum
What is detected in this image?
Pneumomediastinum with air in retroperitoneal space and in neck
What is detected in this image?
Segmental ME due to PRAA
What is detected in this image?
Tracheoesophageal stripe sign
What is detected in this image?
fluid/ingesta in esophagus
What is detected in this image?
mild pneumomediastinum
What is detected in this image?
Normal feline esophagram smooth muscle is causing striations in caudal esophagus
What is detected in this image? What is causing pattern
Normal canine esophagram cricopharyngeal sphincter
What is detected in this image? What is the area without barium visible
Mild pleural effusion interlobar fissure (on lat view seen as straight line)
What is indcated by red arrow?
mediastinal space
What is indicated by #2
100 mL
What is minimum amount of fluid needed for detection of wide interlobar fissures?
Space between lung lobes & body wall -individual lung lobes Normally a potential space -contains some fluid that lubricates lung & thoracic wall
What is pleural space? What is it normally?
Acute rib fractures Healing rib fractures Healed rib fractures
What is seen in these radiographs from left to right?
T-L transitional anomaly
What is seen in this radiograph?
Pylorus displaced to left and cranially
What is seen in this view of a HBC cat
Border effacement of diaphragm Normal axis of stomach Cranially displaced stomach (pylorus in thoracic cavity)
What is seen within blue circle? What does orange triangle represent? What does yellow line represent?
Everything between R & L pleural sacs Bounded by mediastinal pleura Extends from thoracic inlet to diaphragm
What is the Mediastinum?
Border between R cranial lung lobe & cranial part of left cranial lobe Cranially the left lung extends to right Caudally the right lung extends to left
What is the cranioventral mediastinal reflection? How is it formed?
Cranialventral mediastinal reflection
What is the reflection seen here in both views?
PPDH
What is this?
Peritoneopericardial DH
What is this?
Pleural effusion Caudal ribs Iceberg effect
What is usually present with rib tumors? Which ribs usually affected? What effect is seen?
Esophagus
What may cause a dorsal mediastinal mass?
Mediastinal LN Thymus Sternal LN Cyst
What may cause cranioventral mediastinal masses
Tracheobronchial LN L Atrium Heart base tumor (HSA)
What may cause hilar mediastinal masses
Heart Trachea Thymus (young animals) Caudal Vena Cava Esophagus (sometimes L Lat) Aorta
What organs are normally seen in the mediastinum?
Normal thymus in young dogs (not always visible) gone by 1 yr of age Not usually seen in cats
What resides in the cranial mediastinum and has a characteristic "sail sign"? When does it disappear Is it usually seen in cats?
Rotate pt 45 ° to either side to move cardiac silhouette out of way
What technique can help to visualize esophagus on VD view
Congenital Sometimes associated w/ fewer than normal sternebrae (8) Usually an incidental finding
What type of hernia is a Peritoneopericardial DH (PPDH)? What is it sometimes associated with? What kind of finding is it usually?
Extrapleural
What type of mass is this?
Intrapulmonary
What type of mass is this?
Lipoma
What type of mass is this?
Cranioventral Hilar Dorsal
Where are the 3 areas mediastinal masses are seen?
Extrapleural lytic sternebra
Where is this lesion? What is the bonus seen?
Right
Which recumbency was this dog in when radiographed?
DV
Which thoracic view is this?
VD
Which thoracic view is this?
Most common to see in L lateral view but NOT in R lateral or VD Due to position of stomach axis.
Which view is it most common to see a hiatal hernia in? Why?
Left is DV Right is VD Heart disappears on DV *note fissure lines
Which view is which? Why?
Stomach displaced ventral to heart
In this ultrasound image what is in red circle
L lateral
In which image can you occasionally see sm. amt. of gas or fluid in esophagus?
No -thin & doesn't absorb enough xrays to be detected
Is normal pleura visible?
Yes! Retraction of lung (scalloping) Fissure lines Disappearing heart in DV
Is pleural effusion detected or not? What radiographic signs can be seen in these views
No, it communicates with neck & retroperitoneal space
Is the mediastinum a closed cavity?
Yes, to left side Pt laying in L lateral Pt was rolled to dorsal or sternal giving left a chance to reinflate & reimaged
Is there a mediastinal shift in the left picture? If yes to which side? Possible cause? Why is right different?
Atelectasis
Most common cause of mediastinal shift?
RCHF Malignancy Trauma Chylothorax
Most common causes of pleural effusion
Commonly mineralize Can be confused w/ tumors, infection or lung nodules
What are some common issues with costal cartilages?
Bilateral
Pleural dx is usually....?
Thoracic inlet Hilar region esophageal foramen
Preferred locations for esophageal foreign bodies?
Round, enlarged cardiac silhouette Heterogeneous opacity if gas or lg. amt. of fat present confluent silhouette between heart & diaphragm
Radiographic signs of PPDH
Tubular structure in lateral view, dorsal to trachea & CVC -usually gas filled but may contain fluid/ingesta Trachea displaced ventrally Converging "funnel" opacity in caudal thorax on VD
Radiographic signs of generalized megaesophagus
Widened interlobar fissures (soft tissue opacity) - VD Retraction of pleural surface of lung away from thoracic wall w/ interposed soft tissue opacity - VD ↑ soft tissue opacity w/ scalloping - Lateral ↓ cardiac silhouette visualization - DV Obscured diaphragmatic outline - all views
Radiographic signs of pleural effusion - which view seen?
Volume of fluid Pt. positioning Free fluid or trapped Free fluid
Radiographic signs of pleural effusion depends on...? Which type of fluid most common?
Thin pleural lines can be noted between lobes -soft tissue opacity No clinical significance
Regarding pleura, what may be detected? Clinical significance?
Acquired Congenital
What are the 2 types of diaphragmatic hernias
Can appear as lung nodules Can apply contrast medium to area & reimage Need more than ONE VIEW!
The problem with skin nodules.... How to solve?
Amount of fat present in mediastinum
The thickness of mediastinal reflection depends on what?
Congenital (young) -Idiopathic Acquired (adult) -Idiopathic -Anesthesia -Myasthenia Gravis -Gastroesophageal obstruction -Endocrinopathy --Hypothyroidism --Addison's
What are 2 forms of generalized megaesoophagus and common causes
Congenital -Vascular ring anomaly (uncommon) --PRAA Acquired -FB -Stricture (rare)
What are 2 types of segmental megaesophagus and common causes?
Pleural effusion -fluid in pleura space Pneumothorax -gas in pleural space -enters from outside, mediastinum or lung
What are 2 very common categories of pleural dz?
Shift Mass Gas
What are 3 common mediastinal abnormalities?
Regurgitation Dysphagia Survey radiographic findings
What are indications for esophagram
The divisiona between lobes Pleural fluid (pleural effusion) "Fissure lines"
What are interlobar fissures If present, what can accumulate here and is visible? What is they called?
Focal mass effect or gas accumulation Trachea usually displaced ventrally if abnorm. cranial to heart base. Midline opacity on VD
What are radiographic signs of Segmental M.E.?
Because it is fenestrated
Why does or doesn't the mediastinum contain unilateral dz?
Can't tell what's going on -Remove fluid & reimage -Ultrasound
With massive fluid in thorax what can you see? What to do?