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Pulmonary Patterns

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sihirlifil's version from 2017-10-12 13:14

Section

Question Answer
List the 4 pulmonary patternsBronchial
Intersitial
Vascular
Alveolar
What happens in nature with pulmonary patternsOften mixed depending on stage of disease process
3 things to look at when evaluating pulmonary patternsDistribution
Symmetry
Extent (perihilar, middle, or peripheral lung fields)
How are vessels supposed to look in normal longitudinal?Artery, bronchus, and vein should be around the same size (blood vessels carry the same amount)
What is the normal lung pattern like in cross section?Blood vessels bright circular soft tissue opacities, wall of bronchus so thin it can't be ID
How are the arteries, bronchi, and veins always arranged on lateral?Artery dorsal to vein and bronchus in middle
How are the arteries, bronchi, and veins always arranged on VD?Artery most lateral vein most medial
What happens to bronchioles as they get closer to the periphery?Lumen gets narrower
Hallmark of bronchial patternPeribronchial cuffs
Radiographic signs of a bronchial patternAir-filled, white-walled tramline effect of bronchial walls (longitudinal)
Thicker bronchial walls on cross-section aka peribronchial cuffs (actually visible on xray)
Bronchial pattern: bronchitis = Inflammation of the bronchial walls (peribronchial cuffs/tram lines)
Bronchial pattern: bronchiectasis =Abnormal distention of the bronchial lumen with undulating bronchial walls
Thick bronchial cuffs suggest?Acute condition
Thinner bronchial cuffs suggest?Chronicity (e.g. bronchiectasis)
Circle =
Peribronchial cuff
Which pattern is this?
Bronchial
Bronchiectasis
The main background opacity in lung radiographs =Interstitium
(made of alveoli, alveolar ducts, interlobular CT septae, blood capillaries, CT supporting lymphatics, bronchioles, pulmonary vasculature)
Radiographic signs of an interstitial patternIncrease in opacity (loss of contrast in lung fields)
Outlines of pulmonary vessels less sharp
Hallmark of interstitial patternNon-linear markings = nonvascular, short, don't follow course of blood vessels
Interstitial pattern common in who?Older animals (fibrosis)
Causes of interstitial pattern?Interstitial disease (e.g. canine distemper)
Interstitial edema
Allergic disease- Pulmonary infiltration with eosinophils (PIE)
Neoplastic infiltration (e.g. lymphoma)
Appearance of unstructured interstitial pattern?Honeycomb/fishnet with lack of full radiolucency
The 2 types of interstitial patterns:Unstructured & structured
Unstructured interstitial pattern =General loss of contrast, blurring of pulmonary vasculature
Structured interstitial pattern =Linear markings & nodular opacities
Which pattern is this?
Interstitial pattern
Vascular pattern: cause for enlarged pulmonary arteries?Dirofilaria immitis & angiostrongylosis vasorum infestation
Vascular pattern: cause for enlarged pulmonary veins?Venous congestion e.g. left-sided heart failure, pericardial effusion, pulmonary thromboembolism, iatrogenic overhydration
Vascular pattern: cause for enlarged pulmonary arteries AND veins?Pulmonary overcirculation (PDA)
Vascular pattern: causes for small pulmonary vessels?Shock
Severe dehydration
Addison's disease
RHF (pulmonic stenosis) (blood from body not getting back into heart to go back into lungs)
Right-left shunts (Tetralogy of Fallot, reverse PDA)
Pulmonary overinflation
Radiographic signs of a vascular pattern?Increase/decrease in visibility or size of the arteries/veins (hyper-/hypovascularization)
Vascular pattern: radiographic signs of venous congestion?Vein much more prominent (greater diameter than artery)
Venous congestion (vascular pattern)
Arterial enlargement- Dirofilaria immitis (top arrow: pulmonary artery comes to sudden stop, parasite sitting in vessel occluding it. Purple: lobar a. becomes tortuous)
Vascular pattern: radiographic signs of decreased vascular pattern?Hyperlucent lungs (look overexposed), generalized decreased vascularity. Arteries and veins are tiny, bronchiole normal
Hypovascularization (vascular pattern)
(can see aorta really well, no whiskers of vessels at periphery)
What does an alveolar pattern do to all other patterns that might be present?Obscures them!
Hallmark of an alveolar patternAir bronchograms or 'cotton wool' appearance
How does an alveolar pattern happen?Alveoli become filled with fluid, cell debris, neoplastic infiltration; alveolar collapse
Alveolar pattern: a ___ view is best as a scout radiograph (what else do you need?)DV
Need 2 opposing recumbent laterals to fully evaluate lung fields!
What is the distribution & pattern of this alveolar pattern?
Lobar distribution, asymmetric (R middle & caudal lobe affected)
Arrows pointing to?
Air bronchograms (linear aerated tubes = bronchi)
What does pulmonary hemorrhage look like?Alveolar infiltration & air bronchograms
Usually asymmetrical
Often patchy, localized, or lobar
Thoracic wall disruption possible (fracture, swelling, skin wounds)
Pulmonary hemorrhage
Mixed pattern Nodular interstitial & alveolar; asymmetric (worse in caudal lung lobes) (cat w/ rat poison)
What does pneumonia look like?Alveolar infiltration & air bronchograms
Usually asymmetrical
Often localized or lobar
May have bronchial and interstitial component
Causes of pneumoniaAspiration, bacterial, viral
Pneumonia
Long arrow = widened bronchus of cranial lung lobe; short arrow = air bronchograms
(Classic alveolar pattern, R mid lobe more inflated)
What's going on here?
(Pneumonia) Tracheal bifurcation is widened/diverging, suggests hilar lymphadenopathy or left atrial enlargement (long arrow) (small arrow = air bronchogram)
Pulmonary edema: what's the distribution in DOGS?Symmetrical (cardiogenic)
Pulmonary edema: what's the distribution in CATS?Asymmetrical! (& dogs with dilated cardiomyopathy)
What does pulmonary edema look like?Alveolar infiltration & air bronchograms
Perihilar and spreads peripherally
Pulmonary edema (arrows = air bronchograms)
Symmetrical
Border effacement of cardiac shadow
What are bullae? associated with what?Completely/partially air-filled, thin-walled structure(s) within lung parenchyma
May be associated with trauma or chronic lung disease
If you see a thick-walled cavitary mass, think...Cavitated neoplasm or abscess (not bulla)
Spontaneous pneumothorax may be a result of what?Ruptured bulla(e)
Pulmonary bulla
Pulmonary neoplasia: primary looks like?Usually single and lobar
Pulmonary neoplasia: metastatic looks like?Multiple widely disseminated nodules
Lymphoma/cellular infiltrates have what kind of distribution?Interstitial
Metastatic neoplastic nodules (osteosarcoma)
Miliary metastatic nodules (mammary/prostatic carcinoma)
Nodular, interstitial
Primary lung tumor (1 large mass caudodorsal region)
Bronchogenic carcinomas
Pulmonary osteomata =Focal, mineralized pleural plaques scattered throughout parenchyma (incidental findings, not clinically significant)
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