Small Animals Fracture Repair

Radiographic Interpretation of the thorax

Figure  41:

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.

Figures 42, 43:

Signalment:

10 month old female spayed Sheltie

History:

Detectable heart murmur since birth. Currently the heart murmur is 5 out of 6, best heard on the right side. The dog is exercise intolerant and coughs occasionally.

Radiographs made:

Right lateral and ventrodorsal views of the thorax.

Findings:

There is generalized cardiomegaly with marked enlargement of the left atrium as evidenced by straightening of the caudal border of the heart and dorsal deviation of the trachea. The cardiac silhouette extends from nearly the spine to the sternum. On the ventrodorsal view there is a large bulge at approximately 3 o'clock which represents an enlarged auricle. A faint "double bubble" appearance can be seen on the ventrodorsal view which is the shadow of the left atrium over the shadow of the ventricles. The pulmonary veins are mildly enlarged. There is an interstitial lung opacity predominantly over the hilar region but also extending caudodorsally.

Radiographic opinion:

Severe cardiomegaly with particular enlargement of the left atrium. Early left heart failure is suspected. This dog had congenital mitral and tricuspid valve insufficiency and left heart failure.

Figure 44:

Signalment:

6 month old male German Shepard.

History:

Exercise intolerance and palpable heart murmur (grade 5 out of 6 on the left side).

Radiographs made:

Right lateral and ventrodorsal views of the thorax.

Findings:

A bulge is seen at the 12 o'clock position on the ventrodorsal view indicating enlargement of the aortic arch. This bulge is also seen on the lateral view in the region of the ascending aorta just ventral to the trachea. Overall, the cardiac silhouette appears elongated and slightly rounded particularly along the left ventricle. There is slight enlargement in the left atrial region. Incidently, the thymus can still be identified on the ventrodorsal view.

Radiographic opinion:

Cardiac changes consistent with aortic stenosis and post-stenotic dilation of the ascending aorta. Left ventricular hypertrophy and mild enlargement of the left atrium is also present. For confirmation, echocardiography or selective angiography could be performed.

Figures 45, 46:

Signalment:

8 year old female Doberman

History:

Exercise intolerant for several weeks. The last few days the dog has been weak and unable to walk. On physical exam the heart rate and rhythm are chaotic.

Radiographs made:

Right lateral and ventrodorsal views of the thorax.

Findings:

There is mild to moderate cardiomegaly with straightening of the caudal border of the heart. On the ventrodorsal view the cardiac silhouette appears rounded. Part of this appearance is due to the orientation of the heart within the chest; however, it is enlarged even in light of that normal finding.Pleural fissure lines are identified on the ventrodorsal view. There is increased interstitial, which may be coalescing to alveolar, lung disease particularly around the hilar region which is best seen in the ventrodorsal view between the heart and the diaphragm. Pulmonary veins are enlarged, particularly well seen on the lateral view over the plane of the heart, involving the cranial lobar vessels.

Radiographic opinion:

Cardiomegaly with left and right sided heart failure. The left side predominates. Considering the breed, canine cardiomyopathy is most likely.

Figures 47, 48:

Signalment:

4 year old Golden Retriver

History:

Sudden lethargy and collapse 3 days previously.

Radiographs made:

Right lateral and dorsoventral views of the thorax.

Findings:

The cardiac silhouette is greatly enlarged and globoid in shape. The diaphragm is not well identified at its ventral margin. There is a slight sternal deformity at the eighth sternebra. There is a mild increased interstitial lung opacity located throughout the lung which is most likely due to partial atelectasis of the lung due to great enlargement of the cardiac silhouette.

Radiographic opinion:

Globoid enlargement of the cardiac silhouette. The most likely rule out is pericardial effusion. Dilated cardiomyopathy can not be ruled out. Further evaluation such as ultrasound or pericardiocentesis would confirm the diagnosis.

Figures 49, 50, 51:

Signalment:

6 week old mixed breed dog

History:

Decreased rate of growth and a systolic murmur grade 5 out of 6 auscultated on the right side.

Radiographs made:

Right lateral and ventrodorsal views of the thorax and a right lateral view following placement of a catheter into the right ventricle.

Findings:

Survey radiographs: The cardiac silhouette is greatly enlarged. The enlargement is entirely right-sided with shifting of the apex to the left. A bulge is seen at approximately 1 to 2 o'clock on the ventrodorsal view in the region of the main pulmonary artery segment. There is severe rounding of the right heart an a "reverse D" position. The caudal vena cava appears distended. Radiographs made following a severe angiocardiogram show focal constriction of the pulmonary outflow track at the pulmonic valves. There is a large post-stenotic dilation of the pulmonary outflow track.

Radiographic opinion:

Pulmonic stenosis located at the pulmonic valve with severe right-sided cardiomegaly.

Figures 52, 53:

Signalment:

1 year old female spayed DSH cat

History:

Lethargy, depression and abdominal distension, cardiac murmur.

Radiographs made:

Right lateral and ventrodorsal views of the thorax .

Findings:

There is severe cardiomegaly which is predominantly right-sided. The cardiac silhouette appears round on the lateral and ventrodorsal views. The caudal vena cava is distended. The portion of the abdomen that can be seen has a homogenous soft tissue opacity suggesting abdominal fluid.

Radiographic opinion:

Marked right-sided cardiomegaly with right heart failure.

Figures 54, 55, 56:

Signalment:

5 year old male German Shepard

History:

Being presented for routine castration. The dog had never been on heartworm preventative. He had a positive Knott's test.

Radiographs made:

Right lateral and ventrodorsal views of the thorax.

Findings:

On the ventrodorsal view there is bulge in the region of the main pulmonary artery at approximately 1 to 2 o'clock. The right caudal lobar pulmonary artery is enlarged, being greater than the ninth rib as it crosses it. There is moderate to severe bronchointerstitial lung opacity with "doughnuts" being identified.

Radiographic opinion:

Cardiopulmonary changes consistent with heartworm disease. Bronchointerstitial pulmonary infiltrate most likely due to PIE (Pulmonary Infiltrative Eosinophilia). A transtracheal wash may be of benefit.

Figure 57:

Signalment:

10 year old female spayed DSH

History:

2 day Hx of hindlimb paresis and paralysis. The hind legs are cold and cyanotic with no deep pain or femoral pulses palpable. The cat has a grade 3 out of 6 systolic murmur.

Radiographs made:

Right lateral and ventrodorsal views of the thorax .

Findings:

There is cardiomegaly with bilateral enlargement seen best on the ventrodorsal view. The cardiac silhouette is greater than half the width of the thorax at its widest point. On the lateral view the cardiac silhouette appears tall. Also on the lateral view, the caudal vena cava is distended and a dense pleural fissure line can be identified in the dorsal lung field between the cranial and caudal lungs. Pleural fissure lines are faintly identified on the ventrodorsal view. The pulmonary veins are distended and there is a mild interstitial infiltrate in the hilar region.

Radiographic opinion:

Cardiomegaly most likely due to cardiomyopathy. Early left and right heart failure. The hindlimb clinical signs aremost likely due to thrombosis of the aorta at the bifurcation of the external iliacs.

Figures 58, 59:

Signalment:

7 year old male castrated DSH

History:

Intermittent coughing and vomiting

Radiographs made:

Right lateral and ventrodorsal views of the thorax .

Findings:

There is a mild generalized cardiomegaly with a cardiac silhouette appearing to be approximately 3 intercostal spaces on the lateral view. On the ventrodorsal view the pulmonary arteries are enlarged, particularly the right caudal lobar artery. On the left lateral view in the caudodorsal lung. A "cigar" shaped dilation of the pulmonary vasculature can be seen. There is mild bronchointerstitial lung disease. The liver is slightly enlarged.

Radiographic opinion:

Cardiovasculature changes consistent with feline heartworm disease. Usually in cats the peripheral pulmonary arteries become enlarged before the heart does. Often a bronchointerstitial lung opacity similar to feline asthma is present. An antigen test may be of benefit to diagnose heartworm disease.

Figure 60:

Signalment:

8 month old female Chihuahua

History:

Poor doing, coughing for 2 months and a continuous murmur that can be ausculatedon the left side of the chest.

Radiographs made:

Right lateral and ventrodorsal views of the thorax.

Findings:

The cardiac silhouette is markedly enlarged. On the lateral view the left atrium is greatly enlarged with straightening of the caudal border of the heart and deviation of the trachea dorsally. The trachea appears to be narrowed at the carina due to the great cardiac enlargement. Pulmonary vasculature is prominent suggesting over-circulation such as that seen with a left to right shunt. On the ventrodorsal view, a bulge is seen at approximately at the 12:30 to 1:00 o'clock position and also at approximately at 2'oclock. These bulges most likely are due to aneurysmal dilation of the descending aorta and main pulmonary artery segment such as that seen with patent ductus arteriosus.

Radiographic opinion: