Today’s case is a 12 year old male neutered English Cocker Spaniel with a soft, non-productive cough. Post your interpretations of the thoracic radiographs in the comments section. Answers will be available within the case on Monday.
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October 9th, 2008 at 10:19 am
There is a large soft tissue mass in the frontal mediastinum, deviating the trachea dorsally. Another smaller mass in contact with the frontal cardiac waist (L-lat view) located in the R (DV view). Nodular-hazy interstitial lung pattern.Slight narrowing of the caudal trachea due propably to compression by hilar lymhadenopathy. Enlargement of the pulmonary veins (DV view). Some calcified bronchial walls. There is no evidence of large amount of pleural fluid.Soft tissue roundy mass in the left abdomen, medially to the spleen and frontally to the LK.
dd: multifocal neoplasia (Lymphosarcoma?), thorachic trauma with mediastinal fluid accumulation, coagulopathy, pulmonary mycoses, lymphomatoid granulomatosis.
Ultrasound is indicated.
October 9th, 2008 at 4:17 pm
There is a soft tissue opacity in contact with the sternum, which is compatible with enlargement of the sternal lymph nodes.
Also there is an enlargement of the cranial mediastinum pushing the trachea dorsally (possibly enlarged LNs, mediastinal mass/granuloma/abscess). There 2 ill defined soft tissue opacities in the R middle lung lobe.
There is a diffuse bronchointerstitial pattern. The cardiovascular structures are within normal limits.
The liver seems rounded. There is an oval soft tissue opacity cranial to the L kidney.
There is also a round SQ soft tissue opacity in the left axillary area.
An aspirate of these masses is indicated.
DDs include neoplasia (lymphosarcoma is very likely, MCT, hystiocytosis stc.), mycoses.
October 9th, 2008 at 6:35 pm
There is a soft tissue opacity in cranial mediastinum making elevate trachea dorsally(crnial mediastinaly lymphadenopathy).
Also, I found soft tissue mass on the 2nd and 3rd sternum suggesting sternal lymphadenopathy.
On ventrodorsal image, variable sized-multiple soft tissue opacity, which have distinct margin, are seen
on the right cardiac region and left axillary region(it may be axillary lymph node).
There is increase of hazy interstitial patttern in general lung field possibly due to lack of airation and patient’s obesity.
Also, there is bronchial pattern. I found a interlobar fissure between right cranial lung lobe and middle lung lobe, but there’s no any evidence of pleural effusion, so I think it could be a change of old aged lung.
The liver seems large and it’s margin seems rounded. Multiple soft tissue opacity are seen on the crnial abdomen.
In summary, radiographic ddx of this case could be neoplasia like mediastinal type of lymphosarcoma ( highly suggestiv), mast cell tumor, fungal infection of lung, lymphoid granulomatosis.
I thick further study could be FNA of mass firstly.
October 12th, 2008 at 1:10 pm
right and left lateral Thorax view and DV thorax
There is a poorly marginated approx 5cm diameter cranial mediastinal soft tissue opacity displacing the trachea dorsally.
A smaller soft tissue opacity just dorsal to the sternum at s2 - s3.
An interstitial lung pattern is present more so in the left lung lobes more than the right.
The cranial mediastinum is widened, the pulmonary veins enlarged. at the level of rib 5 and 6 there is a soft tissue opacity in the right middle lung lobe just off midline and a smaller opacity just overlying the 7th rib.
There is a single circular well marginated soft tissue opacity in the left abdomen (dv) between ribs 10 and 12.
ddx: mediastinal lymphadenopathy, neoplasia (multifocal lymphosarcoma)
October 14th, 2008 at 8:00 am
Is the soft tissue rounded mass in the left subcostal area a pathology?
October 14th, 2008 at 8:01 am
Is the soft tissue rounded mass in the left subcostal area on the VD view, a pathology?
October 14th, 2008 at 8:18 am
I think you are looking at the round soft tissue opacity to the left of T11-12. That is actually the fundus of the stomach but it doesn’t contain any gas at all. It is surrounded by fat rather than air, which helps you to tell that it’s in the abdomen rather than in the lung. The caudal lung lobes and the cranial abdomen overlap in this area.