introduction to thoracic radiology dr. leeann pack dipl. acvr
TRANSCRIPT
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Introduction to Thoracic Radiology
Dr. LeeAnn Pack
Dipl. ACVR
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Indications
• Coughing• Dyspnea/ Tachypnea• Heart Murmur, Collapse• Primary or Secondary Neoplasia
– Check for metastasis
• Thoracic Trauma• Chest Wall Mass• Exercise Intolerance, Weight Loss
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Technical Factors
• Potential for Movement– Decrease mAs
• High inherent contrast area– High kVp
• Collimation• Centering – caudal
scapula– Thoracic inlet to
diaphragm– Pull forelimbs forward
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Determining the Phase of Respiration
• Always expose at peak inspiration– Maximizes lung contrast– Inspiratory lateral view
• Caudodorsal aspect of lung caudal to T12• Increased aeration of accessory lung lobe• Separation of heart silhouette and diaphragm
– Inspiratory VD/DV view• Diaphragmatic cupola caudal to mid T8• Lung tips caudal to T10
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Inspiratory vs. Expiratory Lateral
Note the space inside the triangle
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Inspiratory vs. Expiratory VD
Easy to see the difference in well visualized lung
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DV vs. VD
• DV– Less stressful, better for heart– Diaphragm rounded– Caudal pulmonary vessels better visualized– Better to see small amount of pleural air
• VD – Better for lungs– Hear appears elongated– Flat diaphragm – Mickey Mouse ears– Better to see small amount of pleural fluid
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DV vs. VD
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Right vs. Left Lateral etal.
• Right Lateral– Better cardiac detail– R crus forward– See Cava go into it
• Left Lateral– Heart appears round– L crus forward– See Cava go past
• Anesthesia• Breed Differences
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The Effects of Lateral Recumbency
• Lung lesions (mass, nodule, infiltrate) may only be seen on 1 view!!!
• Only the non-dependent (up) lung can be critically evaluated– Dependent lung loses aeration
(atelectasis)• Increases in opacity• Silhouettes with lesions
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Interpretation of Thoracic Radiographs
• Heart
• Lungs
• Mediastinum
• Pleural space
• Chest wall
• Bones, Abdomen,Neck
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Normal Cardiac Silhouette• Subjective
– Dog = 2 ½ - 3 ½ intercostal spaces– Cat = 2 – 2 ½ intercostal spaces
• 65% or less on VD/DV view
• Objective– Buchanan method
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Clock Face
• 11-1 Aortic Arch
• 1-2 Main Pulmonary Trunk
• 2-3 Left Auricle
• 2-5 Left Ventricle
• 5-9 Right Ventricle
• 9-11 Right Atrium
• Centrally – Left Atrium
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Lateral View
• Make a Plus sign
• Bermuda triangle
• Left atrium
• Left Ventricle
• Right Ventricle
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Thoracic and Pulmonary Vessels
• Aorta• Caudal Vena Cava• Cranial pulmonary
vessels– Proximal third rib
• Caudal pulmonary vessels– 9th rib where crosses
• Veins are ventral and central
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Trachea, Bronchial Tree
• Carina – then splits to the main stem bronchi then lobar bronchi
• Tracheal rings can mineralize
• Decreased tracheal diameter– Tracheal narrowing (stenosis, extramural
compression), Tracheal hypoplasia, Tracheal collapse
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Lungs
• Normal anatomy– Left
• Cranial (cranial subsegment)
• Cranial (caudal subsegment)
• Caudal
– Right• Cranial
• Middle
• Caudal
• Accessory
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The Mediastinum
• Cranial, middle, caudal compartments
• Routinely visible structures:– Heart, trachea, cvc, aorta, +/- thymus, +/-
esophagus– Cranioventral mediastinal reflection– Caudoventral mediastinal reflection
• Aka phrenopericardiac ligament
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Mediastinal reflections
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Extrathoracic Structures
• Sternum• Vertebrae• Ribs• Adjacent soft
tissues• Diaphragm
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The Diaphragm• Cupola
– Cranioventral convex portion
• Right and left crura– Attach to cranioventral
border of L3 and body of L4
– May cause irregularity on these surfaces
• Appearance depends on centering of X-ray beam
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The Diaphragm