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SESSION SPONSORED BY

SESSION SPONSORED BY. Reading Radiographs… Like a CSI. Dr. LeeAnn Pack Diplomate ACVR. Requirements for becoming a Veterinary Radiographic CSI. Doctor of Veterinary Medicine degree Keen eye for detail No tunnel vision Does not give up the search. Tools of the Trade. Signalment

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SESSION SPONSORED BY

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  1. SESSION SPONSORED BY

  2. Reading Radiographs… Like a CSI Dr. LeeAnn Pack Diplomate ACVR

  3. Requirements for becoming a Veterinary Radiographic CSI • Doctor of Veterinary Medicine degree • Keen eye for detail • No tunnel vision • Does not give up the search

  4. Tools of the Trade • Signalment • Breed specific diseases • Age • Gender and reproductive status • History • Trauma • Past medical history • Physical Examination

  5. Tools of the Trade • The radiograph • Film • Hot light • Digital • Window/levels • Quiet, darkened room • Ambient lighting

  6. Normal Anatomy • You can not recognize abnormal anatomy if you can not recognize normal anatomy • Young animals • Physis – where are they and when do they close • Species differences • MD vs. DVM • An Atlas of Interpretative Radiographic Anatomy – 2nd Ed Arlene Coulson - Blackwell

  7. Cat elbow Look to a book!

  8. Normal Anatomic Variants • Can easily be mistaken for pathology • Sesamoids

  9. Pattern Recognition - Normal • We have an idea of what the film is supposed to look like

  10. Pattern Recognition - Abnormal • Common pathological appearance of disease • The large breed dog – lame – metaphyseal lysis • Wheezing cat with donuts and rail road tracks • A blown cruciate

  11. What is the most likely diagnosis?

  12. It is hard to see what one is not looking for... • 8 month old German Shorthair Pointer • Lame – owner thinks right front limb • Physical Exam – pain on manipulation of the right shoulder • What are things we are thinking about? • What radiographs should be made?

  13. GSP Ante brachial lateral

  14. Complete radiographic study • Minimum 2 views made 90 degrees to each other for most parts • Single films rarely suffice • Pregnancy • Bladder present • Colon size • Number of views needed = number to demonstrate the abnormality • Malpractice

  15. The big picture is important... But so are the details

  16. Did you see the abnormality?

  17. Important points • Be certain to look at the ENTIRE radiograph • Peripherally positioned pathology is more likely to be missed • Sometimes things are unexpected • We tend to look for things in the context of patient presentation • What the owner tells us • What we are suspicious of from our physical exam

  18. Artifacts et al • Artifacts can mimic pathology • Skin folds vs. pneumothorax • Artifacts can obscure pathology • Atelectasis due to prolonged recumbency • If the images are suboptimal • The diagnosis will likely suffer the same fate

  19. What is the diagnosis?

  20. Satisfaction Syndrome • We tend to stop looking when we find a reason for the patient’s clinical signs • We look for what we think it is... • We find it • We are happy with ourselves • We stop and treat

  21. Meet Chester • A 5 year old M/N Scotty • History • Inappropriate urination, hematuria

  22. What is the radiographic diagnosis?

  23. Now what does this add and what does it mean?

  24. Tina • A 10 year old F/S DSH • History of constipation • Owner was a pilot and cat did not want to drink when owner was away • Was given an enema • Esophageal tube placed to give laxative

  25. Tina

  26. Lex • 8 yo Borizoi • Owner noticed swelling along dog’s back and ventral abdomen • Abdominal radiographs were made

  27. Lex

  28. What is the radiographic diagnosis?

  29. What questions do we have?

  30. Does this help us answer them?

  31. Rabbit • Presented to the referring vet for head shaking • During physical exam DVM took rabbit’s temp • Rabbit moved and thermometer cover “sucked” into rectum • Oh no... lets take rads and see where it is

  32. Rabbit

  33. Rabbit

  34. Now you see it - Now you don’t

  35. Let’s work a heart case

  36. Another Diagnostic Test • Sometimes on radiographs we are uncertain of what we see • What can we do? • Ask another in the practice for an opinion • Send to a radiologist for an opinion • Refer • Another diagnostic test

  37. What do we see?

  38. Does this add anything?

  39. Retrograde + contrast urethrogram

  40. Scratches head – then hangs head

  41. Diagnosis?

  42. Diagnosis?

  43. Diagnosis?

  44. Kelbee • 8 yo FS Catahoula • Feb - Owner in Cancun – pet sitter said dog ate part of hand towel • Thought dog vomited it up • Radiographs and US were normal

  45. Kelbee • End March • Owner said dog ate part of hand towel • Owner said dog never did this as puppy • Now on second episode • Back in for more rads

  46. Kelbee March 28th 1pm

  47. Kelbee March 28th 9pm

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