Today’s case is a 12-year-old female neutered Golden Retriever with coughing and lethargy. Feel free to post your interpretations in the comments section.
A severe diffuse alveolar pattern is present in the right cranial, left cranial, and right middle lung lobes. On the left lateral projection, multiple rounded gas opacities are present within the right cranial lung lobe and the caudal margin of the alveolar pattern in this lobe is rounded. A dense interstitial to alveolar pattern is present in the left caudal lung lobe and a moderate interstitial pattern is present in the right caudal lung lobe. A chest tube is present extending through the right thoracic wall to the right cranioventral thorax. A small amount of gas is present in the pleural space ventral to the heart. There is mild pleural effusion. The cardiovascular structures are obscured by the pulmonary pattern. Periarticular osteophytes are present at the caudal aspect of one of the shoulder joints.
CTâ€”7-mm transverse slices were obtained of the entire thorax. Additional 3 mm slices were obtained of the cranial and caudal lungs. There are severe alveolar consolidation of the ventral lungs bilaterally. The ventral aspect of the right cranial lung lobe appears enlarged and has cavitary gas accumulation. There are severe diffuse interstitial infiltrates involving all lung lobes. Bilateral chest tubes are present. There is minimal pleural effusion. There is a small amount of pleural gas bilaterally, left worse than right. There is a large amount of subcutaneous emphysema along the right lateral thorax.
Severe alveolar pattern worse in the cranioventral lung lobes most likely represents bronchopneumonia. A gas pattern and rounding of the caudal margin of the right cranial lung lobe is suggestive of a pulmonary abscess or a neoplasia. The interstitial pattern in the caudal lung lobes may represent infectious or non-infectious inflammatory processes such as ARDS or DIC or partial atelectasis of these lung lobes.
Necropsy – The pathological findings show a severe necrotizing pleuropneumonia. Possible etiologies include hematogenous infections, aspiration pneumonia or foreign body. In this dog, however, no evidence of foreign body, neoplasm or extra-pulmonary active infection was grossly observed. The pneumothorax and pyothorax are likely secondary to the multiple rupture of the lung parenchyma.
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.
I agree with vet74. I would like to know reults of cytology of the the plueral fluid, also culture results.
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
Allison Zwingenberger says
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.
Dr RAHUL DANGI says
gaseous opacity is seen within the right lung, gas is also seen ventral to the heart in plural space.mild plural effusion is visible. slight elevation of heart from sternum.