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Thoracic Radiology

Thoracic Radiology. Wendy Blount, DVM Lufkin TX. Thoracic Rads - Normal. Review of thoracic radiographs – 8 Steps Skeletal - Spine , front limbs, ribs, sternum Cranial abdomen Airways, Lung fields Mediastinum Great vessels - Aorta , pulmonary arteries, cranial & caudal vena cava

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Thoracic Radiology

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  1. Thoracic Radiology Wendy Blount, DVM Lufkin TX

  2. Thoracic Rads - Normal Review of thoracic radiographs – 8 Steps • Skeletal - Spine, front limbs, ribs, sternum • Cranial abdomen • Airways, Lung fields • Mediastinum • Great vessels - Aorta, pulmonary arteries, cranial & caudal vena cava • Smaller vessels - Internal thoracic arteries, pulmonary lobar a & v, brachiocephalic trunk, left subclavian artery • Cardiac silhouette -Vertebral heart score, bulges • Left Heart Failure? Right Heart Failure?

  3. American Pit Bull Terrier

  4. Afghan

  5. Bassett Hound

  6. Chow Chow

  7. Dachshund

  8. French Bulldog

  9. English Bulldog

  10. German Shepard

  11. Newfoundland

  12. Yorkshire Terrier

  13. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Comparing heart size to lung field size doesn’t work • Dogs of different conformation have different ratios of heart size to lung size

  14. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Comparing heart size to lung field size doesn’t work • Dogs of different conformation have different ratios of heart size to lung size

  15. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Comparing heart size to lung field size doesn’t work • Dogs of different conformation have different ratios of heart size to lung size

  16. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Comparing heart size to lung field size doesn’t work • Dogs of different conformation have different ratios of heart size to lung size • Lung field size changes with the breathing cycle • Abdominal fat pushes the diaphragm cranially • Thoracic fat makes lung fields appear smaller • Comparing heart size to vertebral size works better • Vertebral heart score

  17. Thoracic Rads - Normal Positioning Tips • Lateral Views • Center on the caudal edge of the scapula • Include thoracic inlet to the caudodorsal tips of the lungs

  18. Thoracic Rads - Normal Positioning Tips • Lateral Views • Center on the caudal edge of the scapula • Include thoracic inlet to the caudodorsal tips of the lungs • Pull front legs forward to evaluate cranial lung lobes • Try to superimpose the paired ribs, by symmetrical alignment of the front limbs • Try to click on peak inspiration

  19. Thoracic Rads - Normal Positioning Tips • Lateral Views • Center on the caudal edge of the scapula • Include thoracic inlet to the caudodorsal tips of the lungs • Pull front legs forward to evaluate cranial lung lobes • Try to superimpose the paired ribs, by symmetrical alignment of the front limbs • Try to click on peak inspiration

  20. Thoracic Rads - Normal Positioning Tips • VD or DV Views • Legs usually pulled over the head for VD, and always pulled forward for DV • Can pull legs back for “humanoid view” to better see the cranial mediastinum and lung lobes

  21. Thoracic Rads - Normal Positioning Tips • VD or DV Views • Legs usually pulled over the head for VD, and always pulled forward for DV • Can pull legs back for “humanoid view” to better see the cranial mediastinum and lung lobes • Include thoracic inlet to the caudal tips of the lungs • Spine superimposed on the sternum • Tear drop shaped dorsal spinous processes

  22. Thoracic Rads - Normal Positioning Tips • VD or DV Views • Legs usually pulled over the head for VD, and always pulled forward for DV • Can pull legs back for “humanoid view” to better see the cranial mediastinum and lung lobes • Include thoracic inlet to the caudal tips of the lungs • Spine superimposed on the sternum • Tear drop shaped dorsal spinous processes

  23. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Things can make the heart look bigger

  24. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Things can make the heart look bigger

  25. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Things can make the heart look bigger

  26. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Things can make the heart look bigger • Pericardial fat • Pericardial effusion • Peritoneopericardial diaphragmatic hernia

  27. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Things can make the heart look bigger • Pericardial fat • Pericardial effusion • Peritoneopericardial diaphragmatic hernia

  28. Thoracic Rads - Normal Why is it so difficult to evaluate cardiac and chamber size on radiographs? • Things can make the heart look bigger • Pericardial fat • Pericardial effusion • Peritoneopericardial diaphragmatic hernia • Oblique positioning on VD/DV can make right heart look bigger • MYTH - “increased sternal contact” means right heart enlargement

  29. Thoracic Rads - Normal

  30. Thoracic Rads - Normal

  31. Thoracic Rads - Normal Normal cats change with age • Long axis of the heart is more horizontal in old cats (40%) • Aortic bulge develops (30%) • Not due to hypertension or hyperthyroidism • At the aortic isthmus • Cardiac echo measurements in young & old cats are the same, despite these conformational changes in the thorax

  32. Thoracic Rads - Normal Vertebral Heart Score 5.0 + 4.8 = 9.8

  33. Thoracic Rads - Normal Vertebral Heart Score • Measure heart long axis • carina to the apex • Measure heart short axis • Widest point perpendicular to length • Count vertebrae from cranial aspect T4 • Add together • Dogs – normal 8.5-10.5 (breed variation) • Cats – normal 7-8

  34. Thoracic Rads - Normal Vertebral Heart Score • Measure heart long axis • carina to the apex • Measure heart short axis • Widest point perpendicular to length • Count vertebrae from cranial aspect T4 • Add together • Dogs – normal 8.5-10.5 (breed variation) • Cats – normal 7-8

  35. Thoracic Rads - Normal Heart Chambers – VD/DV - Left LV - Left Ventricle AV - Aortic Valve (AoV) AA - Ascending Aorta DA - Descending Aorta

  36. Thoracic Rads - Normal Heart Chambers – VD/DV - Left LV - Left Ventricle AV - Aortic Valve (AoV) AA - Ascending Aorta DA - Descending Aorta LA – Left Atrium

  37. Thoracic Rads - Normal Heart Chambers – VD/DV - Left

  38. Thoracic Rads - Normal Heart Chambers – VD/DV - Right PV RV - Right Ventricle PV - Pulmonic Valve MPA - Main Pulmonary Artery RPA - Right Pulmonary Artery LPA - Left Pulmonary Artery

  39. Thoracic Rads - Normal Heart Chambers – VD/DV - Right

  40. Thoracic Rads - Normal Heart Chambers – VD/DV – Clock Face • Aorta 12-1 o’clock • LV 3-6 o’clock

  41. Thoracic Rads - Normal Heart Chambers – VD/DV – Clock Face • Aorta 12-1 o’clock • MPA 1-2 o’clock • LV 3-6 o’clock • RV 7-9 o’clock

  42. Thoracic Rads - Normal Heart Chambers – VD/DV – Clock Face • Aorta 12-1 o’clock • MPA 1-2 o’clock • LV 3-6 o’clock • RV 7-9 o’clock • LA has to be really big to see on K9 VD

  43. Thoracic Rads - Normal Heart Chambers – VD/DV – Clock Face • Aorta 12-1 o’clock • MPA 1-2 o’clock • LV 3-6 o’clock • RV 7-9 o’clock • LA has to be really big to see on K9 VD • RA 9-12 o’clock

  44. Thoracic Rads - Normal Heart Chambers – Lateral – Left • LA – Left Atrium • MV – Mitral Valve • LV – Left Ventricle • AV – Aortic Valve (AoV) • SV – Sinus of Valsalva • AAo – Ascending Aorta • BCT – Brachiocephalic Trunk • LS – Left Subclavian a.

  45. Thoracic Rads - Normal Heart Chambers – Lateral – Right • RA – Right Atrium • RAu – R Auricle • RV – Right Ventricle • MPA – Pulmonary a.

  46. Thoracic Rads - Normal Heart Chambers – Lateral – Right • RA – Right Atrium • RAu – R Auricle • RV – Right Ventricle • MPA – Pulmonary a. • RVOT – RV Outflow • PV – Pulmonic Valve • RPA – R Pulmonary a. • LPA – L Pulmonary a.

  47. Thoracic Rads - Normal Dog

  48. Thoracic Rads - Normal Cat

  49. Thoracic Rads - Normal Heart Chambers – Lateral – Clock Face • LA (caudal waist) – • 12-3 o’clock • LV - 2-6 o’clock

  50. Thoracic Rads - Normal Heart Chambers – Lateral – Clock Face • LA (caudal waist) – • 12-3 o’clock • LV - 2-6 o’clock • RV - 6-9 o’clock • MPA – 10-11 o’clock – bulge at 1-2 o’clock

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