This week at known case conference we had a collection of interesting thoracic cases. When evaluating masses, try to determine where they are originating and what surrounding structures they affect. There are some clues below that help with localization in each case.
4 year old German Shepherd with respiratory difficulty
On thoracic radiographs, the cranial mediastinum is widened with increased soft tissue density. There is elevation of the trachea and increased density at the hilus with depression of the mainstem bronchi. There are several fissue lines indicating mild pleural effusion. Differential diagnoses for lymphadenopathy and pleural effusion include lymphoma, metastatic neoplasia, fungal pneumonia (aspergillosis in German Shepherds). Recommendations: ventrodorsal projection, abdominal ultrasound. Diagnosis: Aspergillosis. Comment: Check abdomen for fungal disease in spleen, kidneys. Fungal diseases that can cause pleural effusion include aspergillosis, coccidiomycosis.
4 year old Lab cross with coughing and dysphagia
On thoracic radiographs, there is an alveolar pattern in the left cranial lung lobes with air bronchograms and a mediastinal shift to the left. There is also increased opacity dorsal to the trachea which is displacing it ventrally and causing tracheal narrowing. Radiographic diagnosis: esophageal or mediastinal mass causing tracheal compession with possible esophageal dysfunction and secondary aspiration pneumonia. Differential diagnoses include esophageal neoplasia, fungal esophagitis (pythiosis, cryptococcus), mediastinal mass (foreign body, hemorrhage), pulmonary mass. Differentials for the pulmonary pattern include atalectasis +/- additional pneumonia, and bronchial compression by the mass. Recommendation: Esophagram. On the esophagram, the esophageal lumen is normal in size with dorsal deviation over the heart base, indicating an extraluminal mass. Diagnosis: mediastinal Nocardia granuloma.
6 year old lab cross with rales and paroxysmal coughing
There is a diffuse interstitial to alveolar pulmonary pattern with some air bromchograms ventrally. The pattern is most severe in the caudodorsal lungs. The right heart is mildy enlarged as are the pulmonary arteries. Differentials include heartworm disease, non-cardiogenic pulmonary edema, hemorrhage, embolic pneumonia, pulmonary embolism. Diagnosis: Heartworm disease. Marked improvement on anti-inflammatory therapy.
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