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

62 Radiology of Thoracic Trauma

Case 2.22

2

Day 3

	Pleural fluid	63
Signalment/History: “Kato” was a 4-year-old, male Brit-	Radiographic diagnosis (day 16): A persistent mild pul-
tany presented two days after an accidental gunshot wound in	monary infiltrative pattern remained in the caudal half of the
the chest inflicted by his owner.	left cranial lung lobe with the probability that pleural fluid had
	remained pocketed around that lobe. The two metallic pellets
Physical examination: He was quiet, alert, with pale mu-	could still be identified; however, one had moved cranially
cous membranes, and afebrile. Increased sounds could be heard	and was thought lie within the cardiac silhouette, most prob-
in the left lung.	ably within the pericardial sac.	2
Radiographic procedure: Radiographs were made of the	Treatment/Management: The location of the pellet re-
thorax.	mained questionable. The cranial metallic pellet was observed
	fluoroscopically to move dependent on the heart beat and was
Radiographic diagnosis (day 3): Extensive pleural fluid	therefore determined to be located within the pericardial sac.
was present. It was movable as indicated by comparison of the	The pulmonary effusion was slow to clear suggesting either
DV and VD views. A pulmonary infiltration was suspected in
the caudal aspect of the left cranial lobe, but this was difficult	secondary pneumonia or severe pulmonary damage. The dog
to prove because of the pleural fluid that had pocketed in that	was discharged without treatment of the metallic foreign
region. The width of the mediastinum was thought to be nor-	body. “Kato” was only four years old and should have recov-
mal. No evidence of pneumothorax was noted.	ered to have healthy lungs without any residual disease.

Two metallic pellets were located within the thorax on the right side ventrally. On comparison of the DV and VD views, they appeared to be fixed in position. It was assumed that the fluid was the result of hemorrhage secondary to the gunshot wound, but the injury to the lung was difficult to assess.

Day 16

64 Radiology of Thoracic Trauma

2.2.4Lung injury

Case 2.23

2

Signalment/History: “Gypsy”, a 5-year-old, female Brittany, had been hit by a car.

Physical examination: On physical examination, she had increased lung sounds and dyspnea.

Radiographic procedure: Routine studies of the thorax were performed.

Radiographic diagnosis: Pulmonary contusions in the left lung lobes caused an increase in fluid density that was most prominent in the left caudal lobe, and was most likely the result of pulmonary hemorrhage. Minimal pleural fluid was noted and no pleural air could be identified. The chest wall, diaphragm, mediastinum, heart, and great vessels were all normal.

Treatment/Management: While the owners were greatly concerned because they had witnessed the trauma to the dog, the radiographic findings suggest that the injury was rather minor. The dog was released after two days in the hospital following conservative therapy.

Lung injury 65

Case 2.24

2

Signalment/History: “Faswa” was a 5-year-old, female Border Collie who had been struck by a car two days previously.

Physical examination: As she had remained dyspneic and was not moving normally, “Faswa” was brought to the clinic for examination.

Radiographic procedure: Thoracic radiographs were made.

Radiographic diagnosis: Minimal subcutaneous emphysema was present on the right side with an incomplete fracture of the 8th rib. An old malunion fracture of the 9th rib was present on the right. The diaphragm was intact. A small amount of pleural fluid was present, but the major finding was the atelectic right middle lung lobe with a minimal contusion of the right caudal lobe.

Treatment/Management: The right middle lung lobe is comparatively small and yet has a large surface area. If injured or diseased, it can be quickly collapsed by the adjacent aerating lobes leading to the term “right middle lobe syndrome”. Notice that this lobe is superimposed over the cardiac silhouette on the lateral view, so the increase in fluid density cannot be appreciated on that view. A small portion of the hemorrhage in the caudal lobe is noted just dorsal to the hilar region on the lateral view.

66 Radiology of Thoracic Trauma

Case 2.25

Signalment/History: “Tammy” was a 6-year-old, female Labrador Retriever who had been struck by an automobile

one hour earlier.

2

Physical examination: She was slightly dyspneic and nonweight bearing on the right forelimb.

Radiographic procedure: Studies were made of the thorax with additional views of the right scapula.

Radiographic diagnosis (thorax): Collapse of the right middle lobe and an increase in density due to hemorrhage within the caudal lung lobes were noted. The caudal lobes silhouetted with the diaphragm on the lateral view. Because of the lung lobe collapse, the cardiac silhouette was shifted toward the right. Pocketing of pleural fluid was seen around the more severely affected lobe. Compensatory overinfiltration of the caudal lobe resulted in a cranial shifting of the right middle lobe. The diaphragmatic shadow could be seen on the DV view. No injury to the thoracic wall was noted.

Lung injury 67

Radiographic diagnosis (scapula): A comminuted fracture of the right scapula was present, but did not extend into the shoulder joint.

Treatment/Management: Air-bronchograms could be clearly identified in “Tammy’s” lungs indicating a more ex-

tensive amount of fluid than seen in the typical contused lung. 2 She was given several days rest and returned to her owner. The

fracture was not treated.

68 Radiology of Thoracic Trauma

Case 2.26

Signalment/History: “Sampson” was a 3-month-old, male German Shepherd that had been struck by a large board falling

across his body.

2

Physical examination: The dog was in shock when presented and showed great pain. An abdominal tap was negative for fluid.

Radiographic procedure: The thorax was radiographed.

Radiographic diagnosis (day 1): Pulmonary contusion was principally in both caudal lobes and the right cranial lobe, with the presence of air bronchograms. Minimal loculated pleural fluid was present on the left side caudally. The diaphragm appeared to be intact, although the right crus could not be seen clearly.

Day 1

Lung injury 69
Radiographic diagnosis (day 3): Radiographs made two
days later showed a clearing of the pleural fluid on the right,
but increased consolidation of the right middle lobe and left
cranial lobe. The right cranial lobe was hyperinflated. Pleural
fluid was considered to be possibly present on the left.
Treatment/Management: Failure of the fluid in the lung to		2

clear within 48 hours indicates a more severe injury than just pulmonary contusion. The patient was treated with antibiotics and recovered suggesting that pneumonia had been present secondary to the trauma.

Day 3

70 Radiology of Thoracic Trauma

Case 2.27

2

Signalment/History: “Sugar Bear”, a 4-year-old, male Akita, had been caught in a fire one week earlier. He had been unconscious immediately after the fire, but then appeared to make a complete clinical recovery.

Physical examination: He was reported to convulse daily, but appeared relatively normal when presented in the clinic.

Radiographic procedure: Thoracic radiographs were made because of the history.

Radiographic diagnosis: An increase in fluid density in the central portion of the lung field was associated with prominent airway markings. The increase in fluid density around the walls of the bronchi was thought to be associated with the inhalation of noxious agents and also possibly with additional thoracic trauma associated with the fire. A region in the left cranial lobe had increased fluid density, but this was thought to be due to the oblique position of the patient at the time of radiography.

Treatment/Management: “Sugar Bear” failed to improve clinically and was euthanized. At necropsy, cortical necrosis was noted secondary to the anoxia from smoke inhalation at the time of the fire. In the lungs, the main bronchi and smaller broncheoli were filled with a tenacious clear fluid with “black specks”. The alveolar walls were congested. All the lung pathology was secondary to the inhalation of smoke.

Lung injury 71

Case 2.28

2

Signalment/History: “Lady” was a 4-year-old, female, mixed-breed dog who had been hit by a car.

Physical examination: On physical examination, she was dyspneic with decreased lung sounds on the left side.

Radiographic procedure: Studies of the thorax were made.

Radiographic diagnosis: The heart shadow was separated from the sternum on the lateral view and the lung lobes were separated from the chest wall on the left indicative of a pneumothorax. An increase in lung density suggested pulmonary contusion/hemorrhage in both the right and left lung lobes. A large lucent cyst with sharp margins was in the left caudal lobe and represented a traumatic pneumatocele (arrows). A second smaller cyst was located just lateral to the larger lesion. A metallic object lay in the ventral mediastinum (air-gun pellet). Minimal peritoneal effusion (hemorrhage) was noted, indicated by a inability to identify the ventral border of the liver.

Treatment/Management: Because of the suspected peritoneal fluid, “Lady” had a retrograde cystogram performed that proved the urinary bladder to be intact. However, she was found to have a pelvic fracture involving the left hip joint.

Continued monitoring of the effects of the injury to the lungs was important in this dog because the finding of the pneumatocele indicated a more severe trauma than is usually seen in trauma patients with the possibility of secondary infection occurring because of the pooling of stagnant blood.