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Pulmonary patterns

Pulmonary patterns. What does it all mean?. Mike Ackerley. Overview. What are they? What do they look like? What are the differentials for each? What can I do to diagnose it further?. What are they?. Interstitial Alveolar Bronchial Mixed. What do they look like?.

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Pulmonary patterns

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  1. Pulmonary patterns What does it all mean? Mike Ackerley

  2. Overview • What are they? • What do they look like? • What are the differentials for each? • What can I do to diagnose it further?

  3. What are they? • Interstitial • Alveolar • Bronchial • Mixed

  4. What do they look like? • Interstitial a.k.a “busy” lungs: smudging or blurring of the outline of structures. Stuff scattered in the outside garbage bag. • Structured • Nodules - < 3 cm (if you can see them they’re at least 4 – 5 mm) • Masses - > 3 cm • Differentiate nodules from end on vessels. • Less numerous • End on vessels more opaque, and smaller in diameter • Adjacent to bronchus & have connected “tail” b/c part of vessel projects laterally • Unstructured • Fluid (non-cardiogenic edema) • Cells (pneumonia – bacterial, fungal, viral) • Scar tissue (contusions) • Age • Artifact?

  5. What are the differentials? • Structured (Nodules/Masses) • Mineralization:osteomas (large breed dog, not significant) • Solitary (can be cavitary or solid): Perihilar region or caudal lung lobes • Tumor • Adenocarcinoma • Bronchogenic carcinoma • SCC • Malignant histiocytosis (Rotties, Goldens, and Bernese) • Abscesses (Can’t tell difference from tumor) • Granuloma • Hematoma • Fulid filled cyst or bullae

  6. What are the differentials? • Structured (Nodules/Masses) • Multiple: • Metastatic tumors • Fungal granulomas • Parasitic granulomas (Aleurosyrongylus – Feline lung worm) • Abscessation • Lymphoma • Malignant hystiocytosis • Lymphoid granulomatosis • Miliary (remember what the seeds look like): • Lymphoma • Fungal pneumonia • Hematogenous bacterial pneumonia • Metastatic thyroid, haemangiosarcoma or mammary carcinoma

  7. What are the differentials? • Unstructured • Artifact (MOST COMMON) • Underexposure/development: film too “light” • Expiratory radiograph • Obese animals • Forelimbs not pulled forward (musculature in way) • Age: lungs less elastic (scarring) • Pneumonia (cells) • Bacterial (MOST COMMON) right middle lung lobe • Fungal: common blasto, crypto, histio, coccidiomycoses • Viral: distemper – caudodorsal distribution

  8. What are the differentials? • Unstructured • Cardiogenic edema (fluid): precedes alveolar pattern • Non-cardiogenic edema: usually caudodorsal • Near drowning • Epilespy, seizure • Electric cord bite • Head trauma • Hemorrhage/contusions: DIC, anticoagulant poisoning • Neoplasia: Lymphoma, metastatic (hemangio/adenocarcinoma) • Allergic • Parasitic: Heartworm or lungworms

  9. What do they look like? • Alveolar pattern: Alveoli are filled with blood, pus, edema, etc. Stuff in the inner garbage bag!!!!! • Air bronchograms – just b/c they’re not there doesn’t mean it’s not alveolar (hard to see in cats) • Lobar sign – alveolar pattern extends to the border of normal lung lobe • Difficult to see heart margins, diaphragm, bronchial walls, or pulmonary vasculature.

  10. What are differentials? • Consolidation (alveoli infiltrated) • Pneumonia • Aspiration usually right middle • Bronchopneumonia usually cranioventral • Edema (Caudal lung lobes in dog, variable in cat) • Cardiogenic – LHF • Non-Cardiogenic – upper airway obstruction (including brachycephalics and lar. Par), electrocution, seizures, allergic, near drowning and blood transfusions. • Hemorrhage – usually asymmetrical • Neoplasia • Atelectasis (alveoli collapsed): look for mediastinal shift towards affected lung, only see bronchograms with moderate to severe collapse • Anesthesia • Pleural effusion • Pneumothorax • Asthma • Lung lobe torsion – usually right middle lung lobe

  11. Remember Dr. Ps ABCs A = Atelectasis, Anesthesia B = Bronchopneumonia, Bacterial pneumonia C = Contusion, Cancer D = Dirofilaria E = Edema (Cardiogenic and Non) F = Bronchial Foreign Body (caudal lobes) G = Granulomatous (Fungal) H = Hemorrhage

  12. What can I do to diagnose it further? • History & PE big help • Signalment, Trauma, anesthesia, previously dx heart dz or murmur ausculted? • Diuretic – If it is edema you will see significant change if you re-radiograph in ~ 12 hours. If it is hemorrhage or bronchopneumonia will see no change • TTW or BAL – determine what type of fluid and culture for possible bronchopneumonia

  13. What do they look like? • Bronchial Pattern: Increased visibility of the bronchial wall due to thickening or mineralization. May see change in size and shape of the lumen. Stuff along the wall of the white balloon. • Donuts (end on) • Railroad tracks (longitudinal)

  14. What are differentials? • Bronchial Mineralization • AGE: Insignificant in older and chondrodystrophic dogs • Calcification of peribronchial mucus glands in cats • Hyperadrenocorticism or long term corticosteroid use • Bronchial Thickening • Chronic bronchitis: older animals • Feline asthma • PIE – Pulmonary Infiltrate with eosinophilia • Parasites (aelurostrongylosis) • Neoplasia: Lymphoma, bronchogenic adenocarcinoma

  15. What can I do to diagnose it further? • TTW or BAL • Cytology to determine what type of cells are present (eosinophils, neoplastic?)

  16. What do they look like? • Mixed: • Variable – depends on what process is dominating • Bronchointerstitial pattern most common • Alveolar and interstitial patterns are sometimes hard to evaluate and often co-exist

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