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

112 Radiology of Thoracic Trauma

Case 2.54

2

First study

Signalment/History: “Greizelda” was a 2–year-old, female Great Dane presented with a history of having had dyspnea for one week.

Radiographic procedure: Radiographs were made of the thorax.

Radiographic diagnosis (first study): A pneumothorax caused marked lung lobe atelectasis and separation of the cardiac silhouette away from the sternum. A single air-filled cyst in the lung was identified just caudoventral to the carina.

Treatment/Management: The thorax was tapped and 4,800 ml of air was removed from the pleural space.

Pleural air 113

2

Second study

Radiographic diagnosis (second study): The second radiographic study showed a marked reduction of the volume of the pneumothorax. The right middle lobe remained collapsed (arrow).

Treatment/Management: It was not known on which side the pneumothorax originated. Because of the persistent collapse of the right middle lobe, the surgeon chose to perform a thoracotomy on that side and luckily was able to identify multiple pulmonary cysts in all of lobes.

Histologic examination of the lobes suggested some superficial cysts were lined with ciliated columnar and stratified squamous epithelium, while others more deep in location indicated an etiology of chronic bronchiectasis.

114 Radiology of Thoracic Trauma

Case 2.55

2

	Pleural air 115
Signalment/History: “Sadie” was a 3-month-old, female	gin of the intrathoracic air is presumably secondary to a punc-
Golden Retriever puppy with a history of a successful removal	ture of the trachea, bronchus, or esophagus with formation of
of a bronchial foreign body the day before. Removal of gastric	a tract through the mediastinum.
foreign bodies was attempted at the same time and was only	How long the bronchial foreign bodies had been present could
partially successful. The owner was concerned about the con-
dition of the patient feeling that she was not breathing nor-	not be determined. It was possible that the foreign bodies had		2
mally.	resulted in a secondary, inflammatory lesion in the tracheal or
	bronchial wall or even an esophageal wall lesion. It was also
Radiographic procedure: Whole body radiographs were	possible that a tear in the wall of the bronchus or trachea had
made.	occurred during removal of the foreign body, or that a tear in
	the esophageal wall had occurred during removal of the gas-
Radiographic diagnosis: Pneumothorax was present with a	tric foreign body (a piece of glass).
suspected collapse of the accessory lung lobe. A small amount	Comments: Note the large costochondral “knobs” typical for
of pleural effusion was noted. The thoracic wall was normal
except for malunion fractures of the 9th and 10th ribs on the	this stage of skeletal development.
right. The gastric metallic foreign body was thought to be a	Malunion fractures of the ribs are not uncommon in puppies,
tack.
Differential diagnosis: The atelectasis of the accessory lobe	but the cause is rather difficult to explain.
	Note the absence of peritoneal fat in this puppy. The small
suggested injury to that bronchus. The pneumothorax was bi-
lateral and had occurred after bronchoscopy and endoscopy.	bowel gas pattern is typical for an active animal frequently
No evidence of pneumomediastinum could be seen. The ori-	swallowing air.

116 Radiology of Thoracic Trauma

Case 2.56

2

Day 1

Signalment/History: “Trixie” was a 7-year-old, female

DLH cat who had been bitten by a dog an hour earlier.

Physical examination: The cat was dyspneic. Subcutaneous air could be palpated on the right chest wall.

Radiographic procedure: Radiographs of the thorax were made.

Radiographic diagnosis (day 1): A pneumothorax was indicated by separation of the cardiac silhouette from the sternum. Subcutaneous emphysema was evident on the right. An increase in lung density dorsally on the right was noted; however, the oblique positioning made evaluation difficult. In addition, this obliquity falsely suggested rib fractures. The diaphragm was intact.

Pleural air 117

2

Day 3

Radiographic diagnosis (day 3): The radiographs made 2 days later clearly showed the resolution of the pneumothorax and most of the pulmonary hemorrhage. This study showed more clearly the absence of rib fractures.

Comments: The distribution of lung hemorrhage was somewhat unique in “Trixie” in that the dorsal lobes are generally better protected from trauma. However, the nature of a bite wound in a small patient permits any part of the thorax to be injured by the puncture wounds. Fractures were thought to be present near the costovertebral joints, an area difficult to diagnose. The location of the lung contusion gives support to the possibility of rib fractures in this region.

118 Radiology of Thoracic Trauma

2

Prior to myelography

Case 2.57

Signalment/History: “Murphy” was a 9-year-old, male Border Collie who underwent anesthesia for a myelogram. The radiographic procedure was delayed and he remained anesthetized for a prolonged period of time.

Radiographic procedure: Thoracic studies were made prior to the myelogram, following the use of positive pressure, and during the use of positive pressure.

Radiographic diagnosis (prior to myelography under anesthesia): Marked atelectasis of the right lung was compensated by the hyperinflation of the left lung. The resulting mediastinal shift was prominent.

Natural respiration

Radiographic diagnosis (natural respiration under anesthesia following positive pressure): Some reinflation of the right lung had occurred, but all the lobes remained partially atelectic.

Pleural air 119

2

Positive pressure

Radiographic diagnosis (made during use of positive pressure under anesthesia): The right lung was reinflated. Minimal pleural fluid was evident. The left cranial and accessory lobes fail to re-inflate completely.

Comments: Atelectasis associated with anesthesia and prolonged patient positioning without manual inflation of the lungs is common. Because of the time involved in some radiographic procedures, it is frequent that during the series of radiographs directed at another part of the body, atelectasis is noted. This case is more severe than usual, possibly due to a bronchial mucous plug that functioned as a one-way valve.

120 Radiology of Thoracic Trauma

Case 2.58

2

Day 1

Signalment/History: “Shorty” was a 2-year-old, male Chihuahua mixed breed who was presented at the clinic following being attacked by a larger dog.

Physical examination: The patient was dyspneic and injuries to the thoracic wall were present.

Radiographic procedure: The thorax was radiographed.

Radiographic diagnosis (day 1): Subcutaneous emphysema was evident on the right side with increased separation between the 6th and 7th ribs. There was also a single fracture of the right 6th rib. Marked pneumothorax on the right caused separation of the atelectic right middle and caudal lung lobes from the diaphragm and from the chest wall. The pneumothorax resulted in a minimal elevation of the heart shadow away from the sternum with displacement to the left. The diaphragm was intact.

Pleural air 121

2

Day 3

Radiographic diagnosis (day 3): Radiographs made on day 3 showed a lessening of the volume of the pneumothorax. The right middle and caudal lobes had regained a part of their normal degree of aeration. The amount of subcutaneous air

had decreased.