8/14/2017. Objective: correlate radiographic findings of common lung diseases to actual lung pathologic features

Transcription

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 R Cr R Mid L Cr L Mid VD Variations of Thoracic ~ Breed ~ Age ~ Condition Acc Anatomy ~ Respiration ~ Hair coat Right R Cd L Cd ~ Cats DV Left VD Dorsoventral position VS Ventrodorsal position VD DV 1

2 Normal Thorax Normal Thorax Left or Right Lateral? Ventral Dorsal Right Lateral Left Lateral Normal Thorax Right Lateral Normal Thorax Left Lateral *best for left lung evaluation *best for right lung evaluation Abnormal Radiographic Findings Location & Pattern Recognition Radiographic Findings Pulmonary Pattern Recognition Defines disease according to: Airways (conductive structures) Interstitial (matrix or fabric) Alveolar (respiratory exchange zone) Vascular (pulmonary arteries & veins) Radiographic/Histopathologic Correlation 2

3 Normal Pulmonary Parenchyma Pulmonary vasculature clearly visible! Normal lung: leafless Aspen tree branches on a dark night Fixed normal lung tissue Lung Patterns Normal Radiographic Findings Bronchial ~ larger airways Bronchial Interstitial Alveolar Vascular Mixed located between artery & veins not seen distally tapers smoothly from origin to lung periphery Tracheobronchitis Pulmonary Airway Disease Tracheobronchitis Pulmonary Airway Disease Airway Thickening Donuts & Tram Lines Acute Inflammation Post-treatment Recheck 3

4 Tracheobronchitis donuts should come in dozens Chronic Severe Bronchitis Pulmonary Airway Disease Acute Inflammation Post-treatment Recheck Chronic Bronchitis Interstitial Disease + Broncho-interstitial Pattern Normal Pulmonary Parenchyma Pulmonary vasculature clearly visible! tubular bronchiectasis peri-bronchial cuffing Fixed normal lung tissue Interstitial Pattern Recognition Aspen tree branches growing many leaves ~Radiographic/Histopathologic Correlation Normal Lung Loss of vascular-interstitial borders & margins 4

5 Pulmonary Fabric or Structural Lung Disease Interstitial Pattern = Interstitial Disease Pulmonary Interstitial Fibrosis Pulmonary Matrix Disease Diffuse Interstitial Pattern ~ loss of vascular margins Pulmonary Interstitial Fibrosis Unstructured Interstitial Pattern Metastatic Pulmonary Disease Structured Nodular Pattern = Mammary Carcinoma *can be age-related finding, not always active pathologic finding ~ diffuse metastases/granulomas Metastatic Pulmonary Disease? FNA = interstitial metastatic infiltration Histopathological Diagnosis: Transitional Cell Carcinoma Metastatic Pulmonary Disease Unstructured Interstitial Pattern Radiography Transitional Cell Carcinoma = Diffuse Septal Metastases 5

6 Abnormal Radiographic Findings Alveolar Pattern Recognition Dark Night Background Normal lung: leafless Aspen tree branches on a dark night A BV A BV air air-filled small bronchiole terminating into the air-filled alveoli air sacs respiratory zone Left lateral Normal lung: leafless Aspen tree branches on a dark night Left lateral Right lateral Search cranial ventral lobes = windows Pulmonary vessels: branching & smaller towards lung periphery Air-filled airways surrounded by soft tissue/fluid air bronchograms dark air-filled airways surrounded by soft tissue/fluid Abnormal lung: dark tree branches in a snowstorm megaesophagus 6

7 Complete lobar consolidation Fluid-filled airways surrounded by soft tissue/fluid Very abnormal lung: complete whiteout in a blizzard snowstorm Abnormal lung: complete whiteout, consolidation or lung collapsed ddx: lung consolidation, lung masses, torsion, pleural, extra-pleural & mediastinal masses Pulmonary Infections & Inflammation Air Bronchogram Sign Alveolar Pattern = Alveolar Disease Pulmonary Infections Alveolar Pattern Air Bronchogram Sign Air-bronchograms: not always classic dark tree branches surrounded by leaves L Lobar Pneumonia Dependent Right & Left Cranial &/or Middle Lobes Airbronchogram Sign = Alveolar Pattern Mixed Alveolar & Interstitial Disease R Ill-defined dark air-filled airways surrounded by soft tissue/fluid 7

8 Cardiogenic Pulmonary Edema = Alveolar + Interstitial Disease Vascular Pattern Radiography NORMAL Vascular Patterns Vessels change in: Size Shape Margination Density Number Normal lung: leafless Aspen tree branches on a dark night Vascular Patterns Radiographic/Histopathologic Correlation A BV A BV Pulmonary Artery size vs Pulmonary Vein size Large pulmonary arteries & veins Left lateral view ***should be balanced*** ~ check the cranial ventral lung windows Pulmonary vessel = equal to or less than proximal rib diameter 8

9 Large pulmonary arteries & veins Underperfusion = hypovolemia/dehyration Pulmonary vessels less than rib diameter at T10 Overperfusion ~PDA, over-hydration Pulmonary Venous Congestion ~progresses into pulmonary edema Cardiogenic Pulmonary Edema Congestive Heart Failure ~ peri-hilar location Pulmonary Arterial Enlargement artery vein pulmonary artery >> pulmonary vein DDX: Pulmonary hypertension & heartworm 9

10 Feline Heartworm MPA Enlarged Pulmonary Arteries + Veins over perfusion ~ PDA Non-selective Pulmonary Angiography Defines Cardiac & Pulmonary Vascular Anatomy Arterial Phase Venous Phase Non-selective Pulmonary Angiography Defines Cardiac & Pulmonary Vascular Anatomy Arterial Phase Venous Phase 200 mg I/# BW iodinated non-ionic/iso-osmotic contrast IV 0-10 sec sec Thank you for your attention Questions & Comments? 10