Diseases of the Respiratory System in Small Animals is that lung disease.pdfDorsoventral position VS Ventrodorsal position VD VD DV. 8/14/2017 2 Normal Thorax Left or Right Lateral?

8/14/2017

1

“What is that lung disease?”

Pulmonary Patterns &

Correlated Pathology

Dr. Russell Tucker, DACVR

Objective: correlate radiographic findings

of common lung diseases to actual lung

pathologic features

Improved recognition & understanding of 5 basic

“radiographic patterns”

1. Bronchial

2. Interstitial

3. Alveolar

4. Vascular

5. Mixed

~ Breed

~ Age

~ Condition

~ Respiration

~ Hair coat

~ Cats

Variations of

Thoracic

AnatomyRight L CdR Cd

Acc

R Mid

R Cr

L Cr

L Mid

Left

VDDV

Dorsoventral position VS Ventrodorsal position

VD

DVVD

8/14/2017

2

Normal Thorax

Left or Right Lateral? Ventral Dorsal

Normal Thorax

Right Lateral Left Lateral

Normal ThoraxRight Lateral

*best for left lung evaluation

Normal Thorax

Left Lateral

*best for right lung evaluation

Abnormal Radiographic Findings

Location & Pattern RecognitionRadiographic Findings

Defines disease according to:

– Airways (conductive structures)

– Interstitial (matrix or fabric)

– Alveolar (respiratory exchange zone)

– Vascular (pulmonary arteries & veins)

“Pulmonary Pattern” Recognition

Radiographic/Histopathologic Correlation

8/14/2017

3

Normal Pulmonary Parenchyma

Radiology Histopathology

Pulmonary vasculature clearly visible!

Fixed normal lung tissue

Normal lung:

“leafless Aspen

tree branches

on a dark night”

“Lung Patterns”

• Bronchial

• Interstitial

• Alveolar

• Vascular

• Mixed

Normal Radiographic Findings“Bronchial” ~ larger airways

tapers smoothly

from origin to

lung periphery

located between

artery & veins

not seen

distally

Airway Thickening

“Donuts & Tram Lines”

Pulmonary Airway Disease

Tracheobronchitis

Acute Inflammation Post-treatment Recheck

Pulmonary Airway Disease

Tracheobronchitis

8/14/2017

4

Tracheobronchitis

Acute Inflammation Post-treatment Recheck

“donuts should come in dozens” Chronic Severe BronchitisPulmonary Airway Disease

Chronic Bronchitis

Radiology Histopathology

Interstitial Disease + Broncho-interstitial Pattern

“tubular bronchiectasis” “peri-bronchial cuffing”

Normal Pulmonary Parenchyma

Radiology Histopathology

Pulmonary vasculature clearly visible!

Fixed normal lung tissue

Interstitial Pattern Recognition

~Radiographic/Histopathologic Correlation

Normal Lung

Loss of vascular-interstitial

borders & margins

“Aspen tree branches

growing many leaves”

8/14/2017

5

Pulmonary “Fabric or Structural”

Lung DiseaseInterstitial Pattern = Interstitial Disease

~ loss of vascular margins

Pulmonary Interstitial FibrosisPulmonary Matrix Disease

Radiology Histopathology

“Diffuse Interstitial Pattern”

Pulmonary Interstitial Fibrosis

“Unstructured” Interstitial Pattern

Radiology Histopathology

*can be age-related finding, not always active pathologic finding

Metastatic Pulmonary DiseaseStructured “Nodular” Pattern

Radiology Histopathology

~ diffuse metastases/granulomas

= Mammary Carcinoma

Metastatic Pulmonary Disease?

Histopathological Diagnosis: Transitional Cell Carcinoma

FNA = interstitial metastatic infiltration“Unstructured” Interstitial Pattern

Metastatic Pulmonary Disease

Transitional Cell Carcinoma = “Diffuse Septal Metastases”

Radiography Histopathology

8/14/2017

6

Abnormal Radiographic Findings

“Alveolar” Pattern Recognition

Normal lung:

“leafless Aspen

tree branches

on a dark night”

AB

VAB

V

air

air-filled small bronchiole

terminating into the

air-filled alveoli air sacs

“Dark Night Background”

“respiratory zone”

Left lateral

Search cranial ventral lobes = “windows”

Left lateral Right lateral

Normal lung:

“leafless Aspen

tree branches

on a dark night”

Pulmonary vessels:

branching & smaller

towards lung periphery

Air-filled airways surrounded by soft tissue/fluid

Abnormal lung:

“dark tree branches

in a snowstorm”

dark air-filled airways surrounded by soft tissue/fluid

megaesophagus

“air bronchograms”

8/14/2017

7

Fluid-filled airways

surrounded by

soft tissue/fluid

Very abnormal lung:

“complete whiteout

in a blizzard snowstorm”

Complete lobar

consolidation

Abnormal lung:

“complete whiteout,

consolidation or

lung collapsed”

ddx: lung consolidation,

lung masses, torsion,

pleural, extra-pleural

& mediastinal masses

Pulmonary Infections & Inflammation

Alveolar Pattern = Alveolar Disease

“Air Bronchogram” Sign

Pulmonary InfectionsAlveolar Pattern

“Air Bronchogram Sign”

Ill-defined dark air-filled airways surrounded by soft tissue/fluid

Air-bronchograms:

not always classic

dark tree branches

surrounded by leaves

Lobar PneumoniaDependent Right & Left Cranial &/or Middle Lobes

Airbronchogram Sign = Alveolar Pattern

“Mixed” Alveolar & Interstitial Disease

L R

8/14/2017

8

Cardiogenic Pulmonary Edema

= Alveolar + Interstitial Disease

Radiography Histopathology

Vascular “Pattern”

NORMAL

“Vascular Patterns”

Vessels change in:

• Size

• Shape

• Margination

• Density

• Number

Vascular Patterns

Radiographic/Histopathologic Correlation

Normal lung:

“leafless Aspen

tree branches

on a dark night”

AB

VAB

V

Pulmonary Artery size

vs

Pulmonary Vein size

***should be balanced***

~ check the cranial ventral lung windows

Left lateral view

Pulmonary vessel = “equal to or less than proximal rib diameter ”

Large pulmonary arteries & veins

8/14/2017

9

“Overperfusion” ~PDA, over-hydration

Large pulmonary arteries & veins

Pulmonary vessels

less than rib

diameter at T10

“Underperfusion”

= hypovolemia/dehyration

Pulmonary Venous Congestion

~progresses into pulmonary edema“Cardiogenic” Pulmonary Edema

Congestive Heart Failure

~ peri-hilar location

artery

vein

pulmonary artery >> pulmonary vein

Pulmonary Arterial Enlargement

DDX: Pulmonary hypertension & heartworm

8/14/2017

10

Feline Heartworm

MPA

Enlarged Pulmonary Arteries + Veins

“over perfusion” ~ PDA

Non-selective Pulmonary Angiography

Defines Cardiac & Pulmonary Vascular Anatomy

Arterial Phase Venous Phase

200 mg I/# BW iodinated non-ionic/iso-osmotic contrast IV

Non-selective Pulmonary Angiography

Defines Cardiac & Pulmonary Vascular Anatomy

Arterial Phase Venous Phase

0-10 sec 10 -20 sec

Questions & Comments?

Thank you for your attention