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

142 Radiology of Thoracic Trauma

2.2.12 Iatrogenic injury

Case 2.69

2

Day 1

Signalment/History: “Princess” was a 2-year-old, female mixed breed with a chronic, productive cough for the previous two months. The cough had been treated symptomatically with no success. No history of trauma was suggested.

Radiographic diagnosis (referral day 1): Radiographs made at the referral clinic were indicative of a peribronchial pulmonary pattern indicating a lower airway disease. The perihilar region was more dense than normal, but did not appear as a mass lesion. The possible value of a tracheal wash was discussed. An unexpected dyspnea had then developed within 12 hours after performing the tracheal wash and the patient was referred.

Iatrogenic injury 143

2

Day 3

Radiographic diagnosis (day 3): A marked pneumothorax was evident with retraction of the lung lobes from the thoracic wall and separation of the cardiac silhouette from the sternum. The pleural air was mostly on the left. The density of the at-

electic lungs was higher than before.

144 Radiology of Thoracic Trauma

2

Day 4

Radiographic diagnosis (day 4): The pneumothorax had diminished and the lung lobes were more normal in appearance with an increase in aeration.

Treatment/Management: It was feared that the tracheal wash had been performed in such a manner that it caused a tearing of the lung tissue resulting in the pneumothorax and unexpected dyspnea. The dog recovered with conservative treatment and was discharged.

Iatrogenic injury 145

Case 2.70

2

Signalment/History: “Charlie Brown” was a 14-year-old, male Miniature Poodle that had had a surgical procedure the day before. He had made an unremarkable recovery, but was found moribund 14 hours after the surgery.

Radiographic procedure: Radiographs were made because of the abnormal lung sounds in the caudal portion of the thorax.

Radiographic diagnosis: Increased fluid density was noted in all the lung lobes except for the right cranial lobe. That lobe was overinflated and had herniated across the midline to the left side. Air bronchograms were present in all the affected lobes in addition to an accentuated airway pattern. Silhouetting caused an inability to visualize the caudal vena cava. No pleural fluid could be identified. The diaphragm was intact. Note the distention of the trachea.

Treatment/Management: The increase in pulmonary fluid could best be explained by a high-permeability type pulmonary edema due to an intrinsic trauma such as aspiration of acid material. The patient died, but a necropsy examination was not permitted.

146 Radiology of Thoracic Trauma

Case 2.71

Signalment/History: “Saki” was a 3-year-old, male mixed breed cat that had had dental surgery eight days earlier. The

day following surgery, he began to “inflate”.

2

Physical examination: A subcutaneous emphysema was prominent.

Radiographic procedure: Radiographs were made of the entire body.

Radiographic diagnosis: The massive subcutaneous emphysema and pneumomediastinum made evaluation of the cervical trachea and lung fields difficult. The dorsal position of the cardiac silhouette was the result of a congenital anomaly of the xiphisternum.

Treatment/Management: Surgery was delayed for 12 days because of a deteriorating clinical condition. At that time, a 3-cm long tear in the tracheal wall at the thoracic inlet was repaired. “Saki” died four days after surgery. The presence of a necrotizing inflammatory process involving the larynx, trachea, esophagus, and lungs was noted at necropsy. The exact cause of the tracheal injury was assumed to have occurred at the time of the anesthesia for dental surgery.

Iatrogenic injury 147

2

148 Radiology of Thoracic Trauma

Case 2.72

2

Day 1

Signalment/History: “Niko” was a 1-year-old, male Akita with a history of dyspnea, tachypnea, and nasal hemorrhage. It was thought that the epistaxis could be the result of pulmonary hemorrhage because of its frothy appearance. The owner did not know of any trauma.

Radiographic procedure (day 1): Multiple pulmonary nodules had coalesced causing sufficient fluid density in the lungs to create air-bronchogram patterns. The nodular pulmonary pattern was thought to be nonspecific and possibly compatible with a metastatic tumor, hematogeneous bacterial pneumonia, fungal pneumonia, or parasitic pneumonia. No pleural fluid was noted and the heart shadow was normal in size, shape, and position.

Treatment/Management: A transtracheal wash was performed that collected cells indicative of a pyogranulomatous inflammation with a moderate eosinophilic component.

Iatrogenic injury 149

2

Following transtracheal wash

Radiographic diagnosis (following the transtracheal wash): A marked bilateral pneumothorax with atelectasis of all lobes could be seen.

Comments: It was thought that the diagnostic procedure had probably resulted in the pneumothorax.

150 Radiology of Thoracic Trauma

Case 2.73

2

Iatrogenic injury 151

Signalment/History: “Fritz”, a 5-year-old, male Doberman Pinscher, had eaten a kitchen sponge. The owner had attempted to induce vomiting by feeding him salt water and vegetable oil. “Fritz” began to cough and gasp for air following this medication.

Physical examination: The dog was febrile and dyspneic at the time of admission to the clinic.

Radiographic procedure: Radiographs were made of the thorax. The study was overexposed but was not repeated.

Radiographic diagnosis: An increase in fluid density was present within the right middle and accessory lobes with a generalized air-bronchogram pattern supporting the clinical diagnosis of an aspiration pneumonia. The presence of thickened pleura adjacent to malunion fractures of the 6th, 7th, and 8th ribs on the right suggested an old trauma.

A gastric foreign body was suggestive of the sponge that the owners reported the dog had eaten.

Note the silhouetting of the radiodense accessory lung lobe with the caudal vena cava making that structure difficult to vi-

sualize.

2

Treatment/Management: Lipid aspiration pneumonia was diagnosed by combining the clinical history plus the radiographic pattern. “Fritz” was radiographed eight days later and the pneumonia was clearing. Lipid pneumonia clears more slowly then typical airway-oriented pneumonia. It is difficult to safely administer any oily medication since it does not stimulate a cough reflex if it enters the upper airways and so it tends to be inhaled.