Small Animals Fracture Repair

Radiographic Interpretation of the thorax

Figures 21, 22:

Signalment:

2 year old mixed breed dog

History:

Presented on emergency for acute collapse following gunshot wound. A small wound can be seen over the right flank.

Radiographs made:

Abdominal, thoracic and horizontal beam radiographs of the abdomen were obtained.

Findings:

Within the midventral abdomen there is a loss of serosal margin detail consistent with free peritonial fluid. A large gas pocket can be identified adjacent to the diaphragm on both lateral and V/D projections. The gas outlines the serosal margin of the stomach, liver and kidneys. Horizontal beam radiographs were obtained with the patient in dorsal recumbency (beam centered at the xyphoid) and in right lateral recumbency (beam centered at the last few ribs). Both views demonstrate the free air between the abdominal organs, body wall and diaphragm. A lateral view of the thorax was obtained. The bullet is seen in the ventral thorax. Pleural fissure lines and alveolar lung disease (hemorrhage) can be identified.

Radiographic opinion:

Gunshot wound to the abdomen and thorax with free abdominal air, and pleural fluid.

Figures 23, 24:

Signalment:

12 year old female spayed Collie

History:

Chronic history of coughing and back pain

Radiographs made:

Right lateral and ventrodorsal views of the thorax.

Findings:

A large air bronchogram is seen in the left cranial lung lobe. This lung lobe silhouettes with the cranial margin of the heart. The heart and pulmonary vasculature are small suggesting hypovolemia. The intervertebral disc spaces at T5-6 and 6-7 are collapsed and indistinct. There is irregular lysis of these endplates.

Radiographic opinion:

Bronchopneumonia left cranial lung lobe. Hypovolemia. Discospondylitis T5-6 and T6-7.

Figures 25, 26:

Signalment:

1 year old male Doberman.

History:

Chronic coughing and fever

Radiographs made:

Right lateral and ventrodorsal views of the thorax.

Findings:

Air bronchograms are identified within the right cranial and middle lung lobes over the plane of the heart on the lateral view. There is increased soft tissue opacity on the ventrodorsal view which silhouettes with the heart. There is a mediastinal shift to the right. This indicates a decrease in lung volume of the right lung.

Radiographic opinion:

Alveolar lung disease. Based on location and history, the most likely etiology is bacterial pneumonia. A transtracheal wash may be of benefit.

Figures 27, 28:

Signalment:

7 year old male mixed breed dog

History:

There are two sets of radiographs with this dog.  Radiographs were made 1 day following the dog being hit by a car.

Findings:

There is a unilateral pneumothorax on the left side. On the lateral view the pleural margin can be identified in the dorsocaudal lung field and free pleural air is seen above it. On the dorsoventral view, there is atelectasis of the left lung lobes and increased opacity (and an air bronchogram) within them which may represent focal alveolar lung disease (hemorrhage). Note the normal appearance of the right lung and the lack of a mediastinal shift which indicates an equality of pressure between the right and left sides of the thorax. There is fracture of the fourth, fifth, and sixth ribs.
8/15/94: Resolution of the pneumothorax. Identify pulmonary markings to the edges of the pleural margin. The rib fractures are as previously noted.

Radiographic opinion:

Thorax trauma with pneumothorax, pulmonary atelectasis and possible contusions. Rib fractures.

Figures 29, 30:

Signalment:

2 year old male castrated mixed breed dog.

History:

Palpable mass on the right side of ribs noted for the last few weeks which is slowly increasing in size.

Radiographs made:

Right lateral and ventrodorsal views of the thorax.

Findings:

There is an extensive lysis with irregular periosteal reaction of the fourth rib on the right side. There is an associated large soft tissue mass which extended both laterally and medially into the chest. This mass displaces third and fourth ribs away from it. Irregular periosteal new bone can be seen on these ribs. Faint pleural fissure lines are present.

Radiographic opinion:

Aggressive bony lesion of the fourth right rib. The most likely rule out is a primary neoplasm with chondrosarcoma most likely and osteosarcoma also possible.

Figures 31, 32:

Signalment:

4 year old female spayed Lab

History:

Chronic coughing.

Radiographs made:

Right lateral and ventrodorsal views of the thorax.

Findings:

There is severe enlargement of the tracheobronchial lymph nodes. The carina of the trachea is displaced abruptly ventrally. On the ventrodorsal view there is severe narrowing of the caudal lobar bronchi in a "cowboy leg" appearance. The cardiac silhouette is mildly enlarged. Faint pleural fissure lines can be seen. The remainder of the thorax has a moderate to severe bronchointerstitial lung opacity with the bronchial component predominating. Multiple "doughnuts" can be seen on both radiographs toward the periphery of the lung.

Radiographic opinion:

Severe tracheobronchial lymphadenopathy or lymph node enlargement. Rule outs include neoplasia such as lymphosarcoma or fungal disease such as histoplasmosis. Moderate to severe bronchointerstitial lung opacity. A transtracheal wash may be of benefit. Mild cardiomegaly.

Figure 33:

Signalment:

2 year old spayed female Chow

History:

Radiographs made:

2 sets of radiographs: The radiographs are of the thorax: right lateral and ventrodorsal views.

Findings:

There is a moderate amount of pleural effusion noted with multiple pleural fissure lines being identified. The lung lobes are partially retracted from the chest wall, particularly seen on the ventrodorsal view in the caudal lung lobes. On the lateral view the lung lobes are slightly rounded and retracted. The cardiac silhouette margins are difficult to identify but overall cardiac size appears to be within normal limits.

Radiographic opinion:

Pleural effusion.

Figures 34, 35:

Signalment:

8 month old mixed breed dog.

History:

Hit by car 24 hours previously.

Radiographs made:

Lateral and ventrodorsal views of the thorax.

Findings:

The left seventh, eighth, and ninth ribs are fractured. There is a moderate increase in bronchointerstitial lung opacity throughout the thorax. On the lateral view "railroad tracks" can be identified over the plane of the heart. "Doughnuts" are identified throughout the thorax. There is a focal increased interstitial opacity in the left caudal lung lobe on the ventrodorsal view which most likely represents interstitial hemorrhage due to trauma. (Not severe enough to be alveolar lung disease, no air bronchograms.)

Radiographic opinion:

Thoracic trauma with rib fractures and contusions. Small volume of free air (pneumothorax) ventral to the heart on the lateral view. Moderate bronchointerstitial lung disease. Considering the youth of this patient heartworm evaluation and/or a transtracheal wash should be considered.

Figure 36, 37:

Signalment:

10 year old male Poodle

History:

Coughing and syncopal episodes beginning approximately 3 days ago. On auscultation, a grade 3 out of 6 systolic murmur is identified.

Radiographs made:

Right lateral and ventrodorsal views of the thorax.

Findings:

There is cardiomegaly. On the lateral view there is straightening of the caudal border of the heart and dorsal deviation of the trachea indicating left atrial enlargement. On the ventrodorsal view the cardiac silhouette appears slightly rounded, particularly along the left side at approximately the 3 o'clock position, which is enlargement of the left auricle. The right side of the heart is also slightly rounded. There is mild to moderate bronchointerstitial lung opacity consistent with the age of the patient.

Radiographic opinion:

Cardiomegaly with right and left atrial enlargement. These findings are most consistent with mitral and tricuspid insufficiency. A cardiac ultrasound exam may be of further benefit in this case.

Figure 38, 39:

Signalment:

9 year old female spayed DSH

History:

The cat has had intermittent exercise intolerance and rear leg weakness for several months.

Radiographs made:

Right lateral and ventrodorsal views of the thorax.

Findings:

There is cardiomegaly with biatrial enlargement seen best on the ventrodorsal view. The cardiac silhouette is nearly as wide as the entire thorax. On the lateral view, there is slight straightening of the caudal border of the heart indicating left atrial enlargement. Overall, the cardiac silhouette is greater than 3 intercostal spaces in lenght. Tha pulmonary vasculature is prominent. A mild interstitial infiltrate is noted.

Radiographic opinion:

Cardiomegaly consistent with cardiomyopathy. An ultrasound exam may be of benefit to determine if the cardiomyopathy is hypertrophic or congestive. The cat is not yet in heart failure.

  Figure 40,

Signalment:

10 year old female German Shepard

History:

Chronic coughing and recent abdominal distension.

Radiographs made:

Right lateral and ventrodorsal views of the thorax.

Findings:

There is severe cardiomegaly which is predominantly right-sided. The main pulmonary artery segment is enlarged on the ventrodorsal view. Pulmonary vessels are enlarged (greater than the width of the fourth rib on the lateral view and ninth rib on the ventrodorsal view) and tortuous. The abdomen is markedly distended with homogeneous soft tissue opacity indicating ascites.

Radiographic opinion:

Right heart failure due to heartworm disease as characterized by a reverse "D" appearance of the heart and significant pulmonary artery enlargement.