Атлас по рентгенологии травмированных собак и кошек / an-atlas-of-radiology-of-the-traumatized-dog-and-cat

162 Radiology of Thoracic Trauma

Case 2.80

2

Day 1

Signalment/History: “Duke”, a 10-month-old, male Golden Retriever, had a history of difficulty in swallowing. He was referred following an attempt to perform a contrast study of the esophagus in another clinic.

Physical examination: The dog was definitely dyspneic with abnormal lung sounds.

Radiographic procedure: Studies of the thorax were made.

Radiographic diagnosis (day 1): Barium sulfate contrast agent was seen within the main-stem bronchi of the four lobes of the right lung and a portion of the left lung. The bronchi appeared to be ectatic. The barium sulfate had the appearance of being obstructive and did not extend beyond the 3rd or 4th generation of bronchi. No evidence of lung disease could be seen. A diffuse pattern of barium sulfate remained within a dilated segment of the cranial mediastinal esophagus that seemed to place dorsal pressure on the hilar region.

Note the malposition of the right main-stem bronchi. This may be a result of hyperinflation of the left lung or could suggest a congenital right lung disease.

Iatrogenic injury 163

2

Day 3

Radiographic diagnosis (day 3): The barium sulfate within the main-stem bronchi remained unchanged from the earlier study except for the progression of the contrast meal into the left side. The bronchi continued to appear abnormal. There was no change in the size of the affected lung lobes and no increase in lung density suggestive of pneumonia or atelectasis. Clearance of the diffuse pattern of barium sulfate in the esophagus was noted.

Differential diagnosis: Bronchiectasis was suspected as it could explain why “Duke” could not clear the liquid foreign body that had been aspirated during the attempted esophogram. The contrast agent was thick as indicated by its density and failure to spread distally within the lungs.

The atonic wall of the dilated esophagus suggested chronic esophageal disease.

The radiographs of this bronchial foreign body clearly show one of the major problems in the use of contrast agents. Because the contrast agent appears to be tube-shaped, it is assumed that it is a solid plug; however, it may be only a coating of barium sulfate on the bronchial wall. That it was indeed a coating on the wall would explain not only how the passage of air continued to occur into all of the lobes and why the lungs failed to become atelectic with absorption of the air, but also why a pneumonia did not develop.

Treatment/Management: “Duke” was discharged without any explanation of the radiographic changes.

164 Radiology of Thoracic Trauma

Case 2.81

2

Signalment/History: “Wow” was a 9-year-old, female Terrier with a history of chronic, intermittent vomiting for the previous six months. She had been given a barium sulfate upper-intestinal radiographic study at the referring clinic several days earlier.

Radiographic procedure: She had thoracic radiographs prior to anesthesia for a scheduled laparotomy.

Radiographic diagnosis: Alveolarization of barium sulfate was primarily in the caudal lung lobes. No pulmonary masses, pleural fluid, or mediastinal shift were evident. No changes were present in the thoracic wall. The diaphragm was in its normal location. A spondylosis deformans typical for a dog of this age was also apparent.

Treatment/Management: Inhalation of barium sulfate suspension is not a life-threatening event when it is alveolarized and distributed widely as in this dog.

Differential diagnosis: In the absence of the clinical history in a case such as this, other causes of diffuse alveolar densities include several chronic diseases such as inhalation of powdered mineral material. This creates a radiographic pattern because of its density. Other inhaled materials such as asbestos or powered plant material could result in a secondary, alveolar mineralization throughout the lungs that might appear similar to the barium sulfate in this case.

Tracheal/bronchial foreign bodies 165

2.2.13 Tracheal/bronchial foreign bodies

Case 2.82

2

Signalment/History: “Tuffy” was a mature, male DSH cat with a history of acute onset of coughing and dyspnea that was intermittent in severity.

Physical examination: Observation of the cat clearly showed a difficulty in breathing that changed in nature.

Radiographic procedure: Radiographs were made of the thorax.

Radiographic diagnosis: A radiopaque foreign body filled the lumen of the trachea at the tracheal bifurcation. No inflammatory response was noted around the foreign body and the lung lobes did not show any signs of either obstructive atelectasis or obstructive emphysema.

Treatment/Management: A rock was removed through the use of bronchoscopy and “Tuffy” was discharged. Note the difficulty in identifying the foreign body on the DV view, even though it had a high tissue density.

Comments: A comparison of inspiratory and expiratory thoracic radiographs is valuable in determining the obstructive nature of a tracheal foreign body.

166 Radiology of Thoracic Trauma

Case 2.83

2

some of which had been treated surgically. More interesting was the dog’s pattern of breathing that suggested a partial airway obstruction.

Radiographic procedure: Because of the respiratory signs, radiographs were made of the thorax. The stifle joint was also radiographed because of the bite wounds.

Radiographic diagnosis (thorax): A circular, sharply defined, radiodense object lay within the lumen of the right cranial main-stem bronchus and was suspected to be a foreign body (arrows). The remaining pulmonary structures were within normal limits. The cardiovascular structures were within normal limits. Subcutaneous emphysema in the soft tissues on the right lateral cranial thorax was prominent. The appearance of the foreign body varied according to which side of the patient was dependent at the time of radiography.

Radiographic diagnosis (stifle joint lateral view): A severe soft tissue injury with subcutaneous emphysema involved the left pelvic limb. It had been treated with gauze pads identified by radiopaque markers. A rubber Penrose drain was near the stifle joint. No evidence of bone or joint injury could be seen.

Treatment/Management: The bronchial foreign body influenced the clinical signs of this patient, but it is somewhat difficult to relate it to the traumatic incident. It is possible the foreign body had been present for some time without causing an obstruction, although it had stimulated a chronic bronchitis. The peribronchial shadows are more prominent than expected although “Mia” was 8 years of age and the prominence of the airway shadows can be age related.

Comments: Examine the pulmonary vessels and judge if the dog is in shock.

168 Radiology of Thoracic Trauma

Case 2.84

2

Signalment/History: “Ginger” was a 7-year-old, female German Shepherd who had had an acute onset of wheezing and coughing seven days earlier. She had been treated systematically for the past week and then referred for further examination.

Physical examination: A cough could be elicited by palpation of the cervical trachea.

Radiographic procedure: Radiographs were made of the thorax.

Radiographic diagnosis: A radiodense foreign body with a density similar to that of bone was present just proximal to the carina (arrows). No evidence of bronchial obstruction was noted.

Treatment/Management: The foreign body was removed by bronchoscopy. Note the more coarse lung markings in this older dog are probably the result of chronic airway disease (bronchitis). Prominent skin folds lay across the ventral thorax.

Tracheal/bronchial foreign bodies 169

Case 2.85

2

Signalment/History: “Jenny”, a 1-year-old, female DSH cat, had been subjected to elective surgery and was in recovery, when it was noted that the endotracheal tube, which had not been previously removed, had been chewed in half.

Radiographic procedure: A single lateral view of the cervical region and thorax was made.

Radiographic diagnosis: A portion of the endotracheal tube was located in the distal portion of the trachea (arrows).

Comments: Positioning of the forelimbs in this manner makes it possible to evaluate both the cervical and thoracic segments of the trachea.

170 Radiology of Thoracic Trauma

Case 2.86

2

Signalment/History: “Muffet” was a 3-year-old, female

DHL cat with a threeto four-day history of a harsh cough.

Physical examination: The lungs were difficult to auscultate. The abdomen on physical examination was distended with gas-filled bowel loops.

Radiographic procedure: The thorax was radiographed because of the clinical signs.

Radiographic diagnosis: A radiopaque, mid-cervical, freely movable tracheal foreign body was present, most probably a pebble (arrows). The hyperinflated lung fields were an indication of the partially obstructive nature of the foreign body. The gas-filled cranial esophagus and distended stomach were possibly stress related.

Treatment/Management: An upper airway foreign body can function as a valve permitting the passage of air in only one direction. In “Muffet”, it appears as though the pebble permitted air to pass into the lungs, but it at least partially obstructed the trachea on expiration resulting in an obstructive emphysema.

The free movement of the foreign body could be ascertained by a comparison of the location of the object on the two views. This movement could result in changeable clinical signs with the foreign body being obstructive only part of the time.

Tracheal/bronchial foreign bodies 171

Case 2.87

2

Signalment/History: “Raja” was a 2-year-old, male Siamese cat that had been struck by a car two weeks previously. He then had began to show both an inspiratory and an expiratory dyspnea that became more severe. Earlier radiographs were not available for examination.

Physical examination: He was difficult to examine because of the dyspnea.

Radiographic procedure: Radiographs were made of the thorax.

Radiographic diagnosis: A tracheal stenosis was identified by an interruption in the pattern of the air-filled intratracheal shadow at the level of T3–4. A pneumomediastinum reported on earlier radiographs was no longer present.

Treatment/Management: At the time of surgery, a 1–2 cm long fibrous band extended between the torn ends of the trachea. This tube-like structure was removed and a tracheal anastomosis was performed. Post-surgical radiographs showed a trachea with a lumen of normal width.

Comments: The studies were limited to lateral views because of the difficulty in visualization of the trachea on the DV/VD views. It is possible to make VD oblique views to provide additional information about the trachea.