Pulmonary Patterns & Correlated Pathology

Transcription

1 Pulmonary Patterns & Correlated Pathology Russell Tucker, DVM, DACVR Washington State University College of Veterinary Medicine

2 Objective: correlate radiographic findings of common lung diseases to actual lung pathologic features Improved recognition & understanding of basic radiographic patterns 1. Bronchial 2. Interstitial 3. Alveolar 4. Vascular 5. Mixed

3 Normal Thoracic Anatomy

4 ~ Breed ~ Age ~ Condition ~ Respiration ~ Hair coat ~ Cats

5

6

7 R Cr R Mid L Cr L Mid VD Acc DV Right R Cd L Cd Left

8 right C left

9 C

10 Fissure approximation C

11 C

12 Fissure approximation C

13 Dorsoventral position VS Ventrodorsal position

14 VD VD DV

15 Inspiration

16 Expiration

17 ~Heart Size ~Lung Volume ~Pulmonary Density ~False Positives ~False Negatives Inspiration Expiration

18 Normal Thorax Right Lateral Ventral Dorsal

19 Normal Thorax Right Lateral Left Lateral

20 Normal Thorax Right Lateral

21 Normal Thorax Left Lateral

22 Left Lateral Left Lateral

23 Pulmonary Angiography Pulmonary Vascular Anatomy Arterial Phase Venous Phase 200 mg iodinated non-ionic/iso-osmotic contrast IV

24 Pulmonary Angiography Pulmonary Vascular Anatomy Arterial Phase Venous Phase 5-10 sec sec

25 Gross Radiographic Findings Anatomic Description Area or Volume Involved Defines disease according to: Focal/diffuse Local/systemic Dorsal/dependent Hilar/peripheral Lobar/segmental

26 Subgross Radiographic Findings Pattern Recognition Radiographic/Histopathologic Correlation Defines disease according to: Airways (conductive structures) Interstitial (matrix or fabric) Alveolar (respiratory exchange zone) Vascular (pulmonary arteries & veins)

27 Abnormal Radiographic Findings Pattern Recognition Radiographic/Histopathologic Correlation

28 Normal Pulmonary Parenchyma Pulmonary vasculature clearly visible! Radiology Histopathology Fixed normal lung tissue

29 Normal lung: leafless Aspen tree branches on a dark night

30 Lung Patterns Bronchial Interstitial Alveolar Vascular Mixed

31 Normal Radiographic Findings Bronchial Pattern

32 Tracheobronchitis Pulmonary Large Airway Disease Airway Thickening Donuts & Tram Lines

33 Tracheobronchitis Pulmonary Large Airway Disease Acute Inflammation Post-treatment Recheck

34 Tracheobronchitis donuts come in dozens Acute Inflammation Post-treatment Recheck

35 Chronic Severe Bronchitis Pulmonary Large Airway Disease

36 Chronic Bronchitis Interstitial Disease Broncho-interstitial Pattern Radiology Histopathology tubular bronchiectasis peri-bronchial cuffing

37 Abnormal Radiographic Findings Interstitial Pattern Recognition Radiographic/Histopathologic Correlation Normal Lung

38 Loss of vascular interstitial borders & margins

39 Pulmonary Fabric or Structural Disease Interstitial Pattern = Interstitial Disease

40 Pulmonary Interstitial Fibrosis End Pulmonary Airway Disease - respiratory zone Interstitial Pattern = Interstitial Disease Radiology Histopathology

41 Pulmonary Interstitial Fibrosis Unstructured Interstitial Pattern Radiology Histopathology ***often age related finding, not always pathologic finding

42 Metastatic Pulmonary Disease Nodular Interstitial Pattern Radiology Mammary Carcinoma Histopathology Well established diffuse metastases/granulomas

43 Metastatic Pulmonary Disease? Histopathological Diagnosis: Transitional Cell Carcinoma FNA = interstitial metastatic infiltration

44 Metastatic Pulmonary Disease Unstructured Interstitial Pattern Diffuse Septal Metastases Radiography Histopathology Transitional Cell Carcinoma

45 Abnormal Radiographic Findings Alveolar Pattern Recognition Normal lung: leafless Aspen tree branches on a dark night A B V A B V

46 Dark Night Background air air-filled bronchiole terminating into air-filled alveoli air sacs respiratory zone

47 Normal lung: leafless Aspen tree branches on a dark night

48 NORMAL

49 Abnormal lung: dark tree branches in a snowstorm Air-filled airways surrounded by soft tissue/fluid

50 Dark air-filled airways surrounded by soft tissue/fluid

51 Dark air-filled airways surrounded by soft tissue/fluid

52 Fluid-filled airways surrounded by soft tissue/fluid Very abnormal lung: complete whiteout in a blizzard snowstorm

53 Abnormal lung: complete whiteout, consolidation or lung collapsed

54 Pulmonary Inflammation Alveolar Pattern = Alveolar Disease Air Bronchogram Sign

55 Pulmonary Edema Alveolar Pattern Air Bronchogram Sign

56 Lobar Pneumonia Dependent Right & Left Middle Lobes Airbronchogram Sign = Alveolar Pattern Mixed Alveolar and Interstitial Disease

57 Pulmonary Disease Developing or Regressing? Radiography Histopathology

58 Abnormal Radiographic Findings Vascular Pattern Recognition NORMAL

59 Vascular Patterns Vessels change in Size Shape Margination Density Number

60 Pulmonary Artery size vs Pulmonary Vein size ***should be balanced

61 Abnormal Radiographic Findings Vascular Patterns Radiographic/Histopathologic Correlation Normal lung: leafless Aspen tree branches on a dark night A B V A B V

62 Large pulmonary arteries & veins Pulmonary vessel = less than proximal rib diameter

63 Large pulmonary arteries & veins Pulmonary vessels less than rib diameter at T10 Overperfusion

64 Underperfusion = hypovolemia/dehyration

65 Pulmonary Venous Congestion

66 Pulmonary Venous Congestion

67 artery vein pulmonary artery >> pulmonary vein

68 MPA

69 Thank you for your attention Questions & Comments?