This episode of KCC had some unusual appearing lesions that made a logical approach to the radiographs all the more important. See if you can come up with some differential diagnoses from the description, before you look at the answers!
12 year old female neutered West Highland White Terrier with difficulty breathing.
On thoracic radiographs, there is increased soft tissue opacity in the cranial mediastinum and superimposed over the left cranial heart on the d/v projection. The right heart is enlarged and the pulmonary vessels appear small. There is a diffuse interstitial pulmonary pattern and the thorax appears hypoinflated. The soft tissue opacity associated with the cardiac silhouette is most likely the main pulmonary artery. Differential diagnoses include breed-associated pulmonary fibrosis with secondary right heart hypertophy, or less likely a cranial mediastinal mass. Diagnosis: pulmonary fibrosis with severe pulmonary hypertension. Comment: On echocardiogram, look for pulmonic regurgitation with a velocity of 2.2 m/s to diagnose pulmonary hypertension.
10 year old domestic short hair cat with chronic respiratory issues and cough.
There is increased soft tissue opacity in the cranial thorax occupying the area of the cranial lung lobes bilaterally. The soft tissue opacity is imixed with multifocal nodular mineral opacities which also extend into the aerated portions of the lung. Some of the mineral opacities have a linear pattern which may repesent an airway association. The caudal lung lobes are hyperinflated, with a severe bronchial pattern. The carina is displaced cranially by the hyperinflated caudal lung lobes. The pleural surfaces of the caudal lung lobes are rounded and retracted from the chest wall. The cardiac silhouette is obscured by the lung pathology. Differential diagnoses include inflammatory airway disease with granulomatous change, dystrophic mineralization, +/- pulmonary neoplasia. The airway obstruction is likely causing atelectasis of the cranial lung lobes, and there appears to be a component of pleural fibrosis although there is no pleural effusion visible at this time. Diagnosis: chronic lower airway inflammation.
1 year old Quarter Horse gelding holding his head low.
There are moderate osteophytes at the facettes of C6-7 with an irregular, vertical radiolucent line superimposed over the joint. There is a step defect of the ventral vertebral canal at this level. A collimated projection was requested and showed the osteophytes to extend cranially over the lamina of C6. Differential diagnoses include a fracture and cervical spondylomyelopathy. Since there is no history of neurologic defecits a congenital vertebral malformation is less likely. Next steps could include nuclear scintigraphy to assess bone activity, CT to look at stenosis of the canal and search for fractures, or a myelogram to evaluate for spinal cord compression. A CT examination showed a fracture of the right vertebral facet of C6. The fracture line is irregular and widened, and there is varying bone density of the surrounding bone with periosteal proliferation. Diagnosis: chronic fracture with degenerative changes. The lucent area between the fragments and the osteolysis was likely due to a fibrous malunion. Comment: look for vertical lines since the normal facet joints are angled caudodorsally.
10 year old female neutered Basset Hound with lethargy and painful abdomen.
On radiographs, there is extensive bridging spondylosis of the lumbar spine. There is increased, streaky soft tissue opacity in the retroperitoneal space with a mass effect. There is also streaky soft tissue opacity in the peritoneal space, though the effect is much milder. On the v/d projection, the left kidney is enlarged. There is no normal left kidney visible. The descending colon is displaced ventrally supporting a left retroperitoneal mass. Radiographic diagnosis is retroperitoneal mass, with retroperitoneal and peritoneal effusion. Origins for the mass include the kidney, adrenal gland, or retroperitoneal tissues (hemangiosarcoma). Differentials include neoplasia (primary, metastatic) with effusion or hemorrhage, renal obstruction with uroretroperitoneum, pyelonephritis with associated inflammatory disease. Recommend abdominal ultrasound to positively identify the organ of origin and evaluate and sample tissue and fluid, and thoracic radiographs. Diagnosis: adrenal cortical carcinoma with hemorrhage.