In collaboration with Dr. Adrien-Maxence Hespel from the University of Tennessee, we present the following radiology quiz. The goal of this case is to practice identifying radiographic findings and formulating a radiographic diagnosis based on a brief patient description. The final section provides additional information about the treatment.
2 year old labradoodle. Female Spayed. 2 weeks ago was diagnosed with aspiration pneumonia. Still lethargic.
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Thorax- ventrodorsal and opposite lateral radiographs are available for review.
There is a large volume of gas in the pleural space, bilaterally, with retraction of the pulmonary margins from the body wall. A smaller volume of fluid is also present. In the caudal subsegment of the left cranial lung lobe, there are two well-defined, gas filled structures with a thin, soft tissue opaque rim. The largest measures 2.7cm in diameter, and the smaller, located just cranial to the first measures 0.9cm in diameter. There is an alveolar pulmonary pattern in the ventral aspect of the right cranial lung lobe with an air bronchogram, most prominent on the left lateral projection. Throughout the remainder of the pulmonary parenchyma, there is a mild to moderate, diffuse, unstructured interstitial pulmonary pattern. Dorsal to the second and third sternebrae, there is an ovoid soft tissue structure consistent with an enlarged sternal lymph node (up to 1.6cm in thickness). The stomach contains a moderate volume of heterogenous soft tissue opaque material and gas. The musculoskeletal structures included in collimation are normal.
At least two pulmonary bullae. There is no reported history of trauma, and with the presence of at least two other pulmonary bullae, spontaneous pneumothorax secondary to ruptured bulla is possible.
Alveolar pulmonary pattern in the right cranial lung lobe may represent a focal region of more severe atelectasis (secondary to pneumothorax), however, given the history, underlying pulmonary pathology such as resolving pneumonia is also considered. The pulmonary pattern in the remainder of the lung lobes is consistent with atelectasis.
Mild to moderate sternal lymphadenopathy, likely reactive.
Gastric ingesta may be digestible or indigestible. Evidence of obstruction is not currently identified.
Computed tomography was performed for presurgical planning. Surgery was performed.
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