1 Lung Lung Patterns Patterns VMB 960 3/7/2011 Abnormal Lung Pattern Abnormal Lung Pattern Classification Classification Alveolar Interstitial Bronchial Bronchial Vascular (covered with heart lecture) Mixed Normal Normal May be the MOST DIFFICULT pattern to diagnose! The ability to see vessels, bronchi and some interstitial markings is NORMAL Although “technically” not a pattern, determination of ‘normal’ is obviously critical
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A severe unstructured interstitial pattern may mimic a mild alveolar patternmay mimic a mild alveolar pattern– Sometimes cannot distinguish between the
two patterns
– If in doubt identify the pattern as alveolar - being most severe
Horizontal beam radiograph - note the fluid lines in the pulmonary masses.
Structured Interstitial – cavitary
Bronchial PatternBronchial Pattern
Radiographic appearanceIncreased visualization of the bronchi
Typically most difficult pattern for students to recognize
Must look for normally visualized pulmonary structures– Bronchi– Vessels
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Bronchial PatternBronchial PatternRadiographic FindingsIncrease in size of bronchiApparent increase in number of bronchi
– Due to increase in size of bronchi
Loss of taperBronchial walls become parallel– Bronchial walls become parallel
Bronchial wall thickening– Can be difficult to distinguish from peribronchial
enhancement
Special CircumstancesBronchial mineralization
– Can be a normal aging change If only finding, probably do NOT have a bronchial
pattern
Bronchial PatternBronchial Pattern
Radiographic FindingsIncrease in size is RELATIVELook in the periphery of the lung fields
– Look for end on bronchi– Should have a lucent center
Look VERY closely!Although identified as large, the bronchi are
still very small!– Especially in CATS!!!
Severe Bronchial Pattern
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Bronchial Bronchial
BronchiectasisBronchiectasisnote airway collapse on expirationnote airway collapse on expiration
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Lung Patterns Case Discussions
3/8/2011
Lung Model using Adobe PhotoshopLung Model using Adobe Photoshop
Case Discussions Case Discussions
Things we will cover Things we will cover
Case 1Case 1
1 year old German Shepherd 707221 year old German Shepherd 70722
Female spayed Female spayed
Febrile and dyspnea Febrile and dyspnea
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Case 1 Findings Case 1 Findings
There is soft tissue opacification with air bronchograms There is soft tissue opacification with air bronchograms in the right middle lung lobe, caudal part of the right in the right middle lung lobe, caudal part of the right cranialcranial lung lobe and to a lesser degree of the caudal lung lobe and to a lesser degree of the caudal portion of the left cranial lung lobe. portion of the left cranial lung lobe.
The heart and pulmonary vessels are small consistent The heart and pulmonary vessels are small consistent with hypovolemia possibly due to dehydration. with hypovolemia possibly due to dehydration.
What are the most likely differentials for this pattern?What are the most likely differentials for this pattern?
Case 2Case 2
12 year old Labrador Retriever 12 year old Labrador Retriever 6793367933
There is a moderate diffuse bronchial There is a moderate diffuse bronchial (bronchointerstitial)(bronchointerstitial) lung pattern with thickening and lung pattern with thickening and mineralization of bronchial walls.mineralization of bronchial walls.
Ple ral fiss re lines are presentPle ral fiss re lines are present probably aprobably a Pleural fissure lines are present Pleural fissure lines are present –– probably a probably a manifestation of pleural fibrosis. manifestation of pleural fibrosis.
Changes are consistent with chronic Changes are consistent with chronic inflammatory airway disease. inflammatory airway disease.
Bronchial Bronchial -- another example another example
Case 3Case 3
2 year old Chinese Crested 2 year old Chinese Crested 5116751167
Male Male
Rescued from a garage fire. Severe dyspneaRescued from a garage fire. Severe dyspnea
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Case 3 Findings Case 3 Findings
Extensive air bronchograms are present Extensive air bronchograms are present throughout the lung parenchyma, indicating a throughout the lung parenchyma, indicating a diffuse, intense alveolar pattern. diffuse, intense alveolar pattern.
In light of the history p lmonary edemaIn light of the history p lmonary edema In light of the history, pulmonary edema In light of the history, pulmonary edema secondary to smoke inhalation is the most likely secondary to smoke inhalation is the most likely diagnosis.diagnosis.
Case 4Case 4
10 year old Golden Retriever 8690610 year old Golden Retriever 86906
Multiple variablyMultiple variably--sized soft tissue pulmonary nodules sized soft tissue pulmonary nodules are present throughout the lungs. are present throughout the lungs.
Cardiovascular structures appear within normal limits. Cardiovascular structures appear within normal limits. Ca d ovascu a st uctu es appea w t o a ts.Ca d ovascu a st uctu es appea w t o a ts.
This pattern is typical of metastatic lung disease.This pattern is typical of metastatic lung disease.
What are other differentials for a nodular interstitial What are other differentials for a nodular interstitial pattern? pattern?
Case 5Case 5
5 year old Cocker Spaniel 5 year old Cocker Spaniel 6655866558
Constipation and tachypneaConstipation and tachypnea
Constipation thought due to pelvic canal mass Constipation thought due to pelvic canal mass
What are the radiographic findings? What are the radiographic findings?
What are the most likely differentials? What are the most likely differentials?
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Case 5 Findings Case 5 Findings
A soft tissue opacity is superimposed over the A soft tissue opacity is superimposed over the carina with apparent ventral deviation of the carina with apparent ventral deviation of the principal bronchi. This finding is consistent with principal bronchi. This finding is consistent with tracheobronchial lymphomegalytracheobronchial lymphomegalytracheobronchial lymphomegaly. tracheobronchial lymphomegaly.
There is a fine reticular interstitial pattern, most There is a fine reticular interstitial pattern, most pronounced in the caudodorsal lung fields. pronounced in the caudodorsal lung fields.
An infiltrative disease as with Lymphoma or a An infiltrative disease as with Lymphoma or a fungal infection should be considered. fungal infection should be considered.
Case 6Case 6
10 year old German Shepherd 10 year old German Shepherd 8462384623
Male castrateMale castrate
Intermittent cough Intermittent cough
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Case 6 Findings Case 6 Findings
An alveolar pattern is present in the caudal part of the An alveolar pattern is present in the caudal part of the left cranial lung lobe.left cranial lung lobe.
A patchy alveolar pattern is also present in the right A patchy alveolar pattern is also present in the right cranial lung lobe.cranial lung lobe.gg
The cardiovascular structures are within normal The cardiovascular structures are within normal limits.limits.
Dorsal deviation of the trachea is likely a manifestation Dorsal deviation of the trachea is likely a manifestation of head position.of head position.
What are the most likely differentials for this pattern?What are the most likely differentials for this pattern?