Introduction to Thoracic Radiology

Dr. LeeAnn Pack Dipl. ACVR

Indications
Coughing Dyspnea/ Tachypnea Heart Murmur, Collapse Primary or Secondary Neoplasia
Check for metastasis

Thoracic Trauma Chest Wall Mass Exercise Intolerance, Weight Loss

Technical Factors
Potential for Movement
Decrease mAs

High inherent contrast area

High kVp

Collimation Centering caudal scapula

Thoracic inlet to diaphragm Pull forelimbs forward

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

Inspiratory vs. Expiratory Lateral

Note the space inside the triangle

Inspiratory vs. Expiratory VD

Easy to see the difference in well visualized lung

DV vs. VD
DV

Less stressful, better for heart Diaphragm rounded Caudal pulmonary vessels better visualized Better to see small amount of pleural air
Better for lungs Hear appears elongated Flat diaphragm Mickey Mouse ears Better to see small amount of pleural fluid

VD

DV vs. VD

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

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

Interpretation of Thoracic Radiographs

Heart Lungs Mediastinum Pleural space Chest wall Bones, Abdomen,Neck

Normal Cardiac Silhouette

Subjective
Dog = 2 - 3 intercostal spaces Cat = 2 2 intercostal spaces

65% or less on VD/DV view Objective

Buchanan method

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

Lateral View
Make a Plus sign Bermuda triangle Left atrium Left Ventricle Right Ventricle

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

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

Lungs
Normal anatomy
Left
Cranial (cranial subsegment) Cranial (caudal subsegment) Caudal

Right
Cranial Middle Caudal Accessory

The Mediastinum
Cranial, middle, caudal compartments Routinely visible structures:
Heart, trachea, cvc, aorta, +/- thymus, +/esophagus Cranioventral mediastinal reflection Caudoventral mediastinal reflection
Aka phrenopericardiac ligament

Mediastinal reflections

Extrathoracic Structures
Sternum Vertebrae Ribs Adjacent soft tissues Diaphragm

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

The Diaphragm