Today’s case is a 12 year old female neutered Golden Retriever with coughing and lethargy. Here is the link to the case, feel free to post your interpretations in the comments section.
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March 27th, 2008 at 5:43 am
The chest tube is visble on all the radiographs. On the RL view there is almost a complete opacification cranial to the hear with some air bronchograms. Interstitial to alveolar infiltrates in the caudal lung field. Mild pleural effusion.
On the left lateral view in the area cranial to the heart there are airbronchograms, and the opauque area has a shape of a possible mass. There is a slight elevation of the heart away from the sternum. The diaphragm seems to be normal. On the VD view the opacity and airbronchograms are visible on the cranial lung field, and there is a possible cranial mediastinal mass.
The rad is sllightly oblique but there is a possible mediastinal shift of the heart to the left. Also alveolar infiltrates and airbronchograms in the cleft caudal lung field.
On all views it is difficult to asses the heart and vessels.
On the CT images (no experiennce with those) there is SQ emphysema (probably due to the tube) and a small amount of free air in the thorax. On the first view there are many areas of diffuse lung infiltrates and several small soft tissue opacities.
On the last view there are 2 big masses and many small soft tissue opacities.
The masses could be LN versus neoplasia.
I think this is a neoplastic process with metastasis. Primary lung tumor versus lymphoma etc. Also possible -a granulomatous disease. A biopsy of the masses is recommended.
March 27th, 2008 at 10:33 am
I agree with vet74. I would like to know reults of cytology of the the plueral fluid, also culture results.
March 28th, 2008 at 6:48 pm
Agree with above….
Rdx: Moderate to severe patchy interstitial-alveolar pattern caudal lung field, Mild pneumothorax, mild to moderate pleural effusion, Left cranial lung consolidation/collapse of the lobe, possible mass effect (air bronchogram). The v/d is rotated, there is a large mass effect just to the left of midline. Cardiac silouhette appears wnl for size.
CT (I’ll do my best): consolidation of the left cranial lung lobe ventrally, complete atelectasisi of right cranial lung lobe (?), sq emphysema on the side of the chest tube…I’m concerned about the solid mass effect coming off the tip of the accessory lobe (?)
r/o neoplasia primary v ,metastatic lung mass (carcinoma v lymphoma) v severe pneumonia/abscess (fungal). Rec: cytology/culture chest fluid or maybe bal/abd u/s to screen for neoplasia, thoracoscopy/otomy/lobectomy/bx
April 1st, 2008 at 9:18 am
Good descriptions everyone. The consensus seems to be pneumonia with a mass effect in one or more parts of the lung. Look closely at the opacities in that lung lobe. The answers are available, just click on the case link.