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Lesley A. Zwicker, BScPharm, DVM Resident, Diagnostic Imaging.

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Presentation on theme: "Lesley A. Zwicker, BScPharm, DVM Resident, Diagnostic Imaging."— Presentation transcript:

1 Lesley A. Zwicker, BScPharm, DVM Resident, Diagnostic Imaging

2  Heart  Lungs  Mediastinum  Pleural space  Chest wall  …Everything else!  Bones, soft-tissues

3  Coughing  Dyspnea/tachypnea  Neoplasia  Primary/metastases  Trauma ( i.e. hit-by-car)  Chest wall mass  Exercise intolerance  Weight loss

4  High potential for movement  Respiration  High inherent contrast region  Bone  Soft tissue  Fat  Air

5  High kVp  Due to high inherent contrast → can use a high kVp  Decreased mAs  Minimize motion due to decreased time  Collimation  Thoracic inlet → diaphragm ▪ Decrease scatter ▪ Minimize distracting content

6  Pull legs forward  Decrease superimposition of musculature

7  Exposure at peak inspiration  Better aeration of lungs → better contrast → better visualization of lesions/disease  Lateral views  Caudodorsal aspect of lung → caudal to T12  Increased aeration of accessory lung lobe ▪ Separation of cardiac silhouette and diaphragm

8  VD/DV views  Diaphragmatic cupola caudal to mid T8  Lung tips caudal to T10

9 DORSOVENTRAL  Less stressful i.e. dyspneic  Potentially better evaluation of the heart  Better evaluation of the caudal pulmonary vessels  Better visualization of small volume pneumothorax (tips of thorax caudally)  Diaphragm is rounded VENTRODORSAL  Better evaluation of lungs (routine view)  Flat diaphragm – Mickey Mouse ears  Better to see small volume of pleural fluid  Heart appears elongated

10 DORSOVENTRALVENTRODORSAL

11 RIGHT  Right crus is cranial  See vena cava entering right crus cranially  Routine projection  Heart is more elongated  Crura are more parallel* LEFT  Left crus is cranial  See vena cava crossing left crus and entering right crus caudally  Performed for metastasis check or if suspect pathology in right lung lobe  Heart appears more round  Crura diverge* * Does not always hold true but often the case!

12 Right

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14 Left

15  Which side of the hemithorax is seen best with each lateral projection??  The dependent (“down”) lung → compressed → increased radiopacity ▪ Harder to see lesions due to decreased contrast ▪ Compressed lung silhouettes with lesions  The non-dependent (“up”) lung → aerated lung → decreased radiopacity ▪ Easier to see lesions due to increased contrast

16  Only non-dependent lung can be critically evaluated  Clinical applications in practice  Neoplasia ▪ Solitary lesion or metastasis check  Pneumonia  Contusions

17  Lateral projection  Dog: 2 ½ to 3 ½ intercostal spaces  Cat: 2 to 2 ½ intercostal spaces ▪ As cats age → heart lies more parallel to sternum

18  VD/DV projection  Heart should be 65% or less (width) of the thorax  Objective method  Buchanan method

19  Clock face  11-1 Aortic arch  1-2 Main pulmonary trunk  2-3 Left auricle  2-5 Left ventricle  5-9 Right ventricle  9-11 Right atrium  Centrally – Left atrium

20  The “Plus Sign”  Left atrium  Left ventricle  Right ventricle  “Bermuda Triangle” ▪ Right atrium ▪ Aorta ▪ Main Pulmonary Trunk Bermuda triangle Left atrium Left ventricle Right ventricle

21  Aorta  Caudal vena cava  Cranial pulmonary vessels  Best evaluated on lateral view  Should be smaller than proximal portion of 3 rd rib  Caudal pulmonary vessels  Best evaluated on DV  Vessel should make a “ □ ” with the 9 th rib

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24  Normal Anatomy  Left  Cranial (cranial subsegment)  Cranial (caudal subsegment)  Caudal  Right  Cranial  Middle  Caudal  Accessory

25  Compartments → cranial, middle, caudal  What can you routinely see??  Heart, caudal vena cava, aorta  Trachea  +/- thymus  +/- esophagus  Cranioventral mediastinal reflection  Caudoventral mediastinal reflection

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27  Sternum  Vertebrae  Ribs  Adjacent soft tissues  Diaphragm

28  Masses  Neoplasia  Cysts  Granulomas  Abscesses  Lymphadenopathy  Fluid  Hemomediastinum

29  Cupola  Cranioventral convex portion  Right and left crura  Attach to cranioventral border of L3 and body of L4  May cause irregularity on these surfaces  Appearance depends on centering of X-ray beam

30 caudal vena cava vein trachea bronchus aorta artery

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