Teaching and learning about veterinary diagnostic imaging.
This week’s case is a 13-year-old female neutered Siamese cat with weight loss and tachypnea. Try to characterize the pulmonary pattern in this case. It’s quite challenging, but it gives you some clue to the disease processes.
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On radigoraphs of the thorax, there is dilation of the trachea with undulation in the thorax on the right lateral projection. There is a diffuse bronchial pattern with multiple regions of rounded radiolucency, especially in the cranioventral thorax. The lungs appear hyperinflated. The cardiovascular structures appear normal. There is poor detail in the peritoneal space and the animal is in thin body condition.
Hyperinflation and bronchointerstitial pattern with pulmonary emphysema may be secondary to chronic lower airway disease with inflammation. The tracheal dilation is likely secondary to the increased respiratory effort and/or tracheomalacial.
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Feline Pulmonary Langerhans Cell Histiocytosis with Multiorgan Involvement. Busch MDM, Reilly CM, Luff JA, Moore PF. Vet Pathol (2008) 45: 816.
Please tell me how you distinguish a hyperinflated lung?
I think the diaphragm is round, rather than flat. And triangular lung region does not increase in size.
So, I want to know other findings correlated with lung hyperinflation.
Here are some indications this thorax is hyperinflated. The thorax has an increased volume, and the tips of the lung lobes are situated caudally to normal position with increased distance between the heart and diaphragm. The cranial lung lobes are rounded and extend past the first ribs.
I’ll give this a try before looking at the answers!
A mixed bronchial/interstitial pattern is present involving all lung lobes. There is marked generalised bronchiectasis, and a tortuous trachea, suggestive of chronic pulmonary disease (likely airway disease). Border effacement of the ventral cardiac silhouette with the pleura suggestive of small volume pleural effusion.
Poor abdominal serosal detail suggestive of either poor body condition or potentially abdominal fluid. A mild cranial deviation of the gastric axis may represent microhepatica.
Assessment: Chronic pulmonary disease with likelihood being airway disease.
differentials include allergic bronchitis, infectious (pneumonia, fungal), parasitic (eg lungworm), neoplastic (diffuse neoplasms being more rare than other differentials)
Poor serosal detail likely due to malaise from chronic process.
Recommend sonography to evaluate for any pleural or abdominal fluid + fluid analysis if possible.
Great job! Good to commit before looking at the answers.