This case is of a 9 year old, male castrated, DSH outdoor cat that was presented with bloody discharge from the left ear and anisochoria (the left pupil was constricted).
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A 1.5 years old female spayed Labradoodle was presented due to an acute onset of melena and coughing blood.
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Here is a good example of a common orthopedic condition that we see quite often. This radiograph is from a 3 years old female dog with an acute right hind leg lameness.
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The radiograph below is from a 12 years old German shepherd. There are multiple small interstitial miliary nodules (some are marked with arrows) which are incidental benign pulmonary osteomas.
This is a common incidental benign finding in older dog's chest x rays.
Differentials for small circumscribed densities in the lungs include end on blood vessels and neoplasia. End on vessels get smaller towards the lung periphery and always lie along blood vessels. The peripheral nodules visible on this radiograph are too large to be an end on vessel and too small to be a neoplasia since neoplasia should only be detectable by radiographs if the mass is greater than 5mm. Pulmonary osteomas are idiopathic mineralizations which have no physiological significance. It is however important to differentiate them from neoplasia.
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Many times we see patients with an existing heart murmur that present with respiratory signs.
Many geriatric patients have acquired valvular diseases and when they are presented with a cough it is tempting to attribute the signs to heart failure, especially if there is cardiomegaly on the radiographs.
In both pulmonary edema and small airway disease there are peribronchial changes and interstitial to alveolar infiltrates.
If these changes result from cardiogenic pulmonary edema there should be a left atrial enlargement (usually a profound one) and pulmonary venous congestion. If those are not visible than the changes probably indicate an airway disease.
The example below is a 10 year old male castrated Tibetan terrier which was presented with acute lethargy, and cough. A 2/6 systolic heart murmur was auscultated.
Do the clinical signs result from a deterioration of the preexisting cardiac disease or do they result from an airway disease?
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Thoracic radiology: pulmonary patterns
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This is a short review of pulmonary patterns.
Interstitial pattern:
can be structured versus non structured.
The structured pattern is further divided to milliary (distinct structures which are smaller than 5mm) and nodular (the structures are larger than 5 mm). Pulmonary masses are interstitial. Click here to view an example of milliary pattern.
Non structured interstitial pattern is characterized by increased lung opacity and a decrease in the visualization of the pulmonary vessels.
Obesity, expiration films and under exposure will also result in increased lung opacity.
Non structured interstitial pattern results from the presence of cellular infiltrates (neoplastic, inflammatory, hemorrhagic), fibrosis or fluids within the lung parenchyma. When becomes severe, it develops into alveolar pattern.
When the pattern observed is mainly interstitial a lung aspiration or biopsy is required in order to characterize the pathology.
Bonchial pattern
This pattern results from accumulation of fluid or cells around the bronchial walls. It is characterized by thickening of the bronchial walls which appears like tram lines (longitudinal view) or donuts (end-on). Donuts are easier to recognize.
Bronchoalveolar lavage and trans tracheal wash can aid in the diagnosis.
An example of a bronchial pattern:
An 11 year old cat with chronic asthma.
Note the diffuse broncho-interstitial pattern
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Alveolar pattern
This pattern is characterized by air bronchogram and when severe enough a lobar sign will be seen as well.
When the amount of the fluid/cellular infiltrates in the interstitium is overzealous and the interstitium is full, there is air left only in the bronchi. In this case we will see air bronchograms which are a complete silhouette sign of the airway's wall.
A lobar sign is a sharp line of demarcation between an opaque (consolidated) lung lobe and adjacent aerated lung lobe.
Bobcho-alveolar lavage and transtracheal wash can be used to characterize the fluid.
In the example below there are airbronchograms and a lobar sign associated with the left cranial lung lobe. Those are visible over the cardiac silhouette.
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