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Introduction to Thoracic Radiology Dr. Meghan Woodland September 30, 2010.

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Presentation on theme: "Introduction to Thoracic Radiology Dr. Meghan Woodland September 30, 2010."— Presentation transcript:

1 Introduction to Thoracic Radiology Dr. Meghan Woodland September 30, 2010.

2 Indications Coughing Dyspnea / Tachypnea Heart Murmur, Collapse Primary or Secondary Neoplasia –Check for metastasis Thoracic Trauma Chest Wall Mass Exercise Intolerance, Weight Loss

3 Technical Factors Potential for Movement –Respiration –Decrease mAs High inherent contrast –High kVp Collimation –Should include thoracic inlet to diaphragm Center over the heart Pull thoracic limbs forward Radiographic techniques: the dog By Joe P. Morgan, John Doval, Valerie Samii

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6 Determining the Phase of Respiration Always expose at peak inspiration –Maximizes lung contrast –Better visualization of pulmonary parenchyma –Less compression of lungs by diaphragm Inspiratory lateral view: –Caudodorsal aspect of lung is caudal to T12 –Increased aeration of accessory lung lobe –Separation of cardiac silhouette and diaphragm Inspiratory VD/DV view: –Diaphragmatic cupola caudal to mid-T8 –Tips of lung caudal to T10

7 Inspiratory vs. Expiratory Lateral Notice size of triangle

8 Inspiratory vs. Expiratory VD Easy to see the difference in well visualized lung

9 DV vs. VD DV –Best view to evaluate cardiac silhouette and caudal pulmonary vessels –Less stressful for the patient –Diaphragm rounded –See small amounts of pleural air VD –Best view to evaluate lungs –Heart appears elongated –Flat diaphragm – Mickey Mouse ears –See small amounts of pleural fluid

10 DVVD

11 DV vs. VD

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17 Right vs. Left Lateral Caudal Vena Cava enters the right diaphragmatic crus Right Lateral –Better cardiac detail –R crus forward See CVC go into it Left Lateral –Heart appears round –L crus forward See Cava go past Caudal vena cava

18 Left or Right Lateral?

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20 The Effects of Lateral Recumbency Lung lesions (mass, nodule, infiltrate) may only be seen on a single view Only the non-dependent (up) lung can be critically evaluated –Dependent lung loses aeration (atelectasis) Increased opacity Silhouettes with lesions

21 Sedation Induced Atelectasis

22 Interpretation of Thoracic Radiographs Systematic approach is crucial Heart (Cardiac Silhouette) Lungs Mediastinum Pleural space Chest wall Bones, Abdomen, Neck

23 Normal Cardiac Silhouette Size is subjective Lateral views: –Dog = 2 ½ - 3 ½ intercostal spaces –Cat = 2 – 2 ½ intercostal spaces VD/DV views: –65% the width of the thorax Objective: –Buchanan method Vertebral heart scale

24 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

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26 Lateral View Make a Plus sign Bermuda triangle –Right atrium –Main pulmonary artery –Aortic Arch Left atrium Left Ventricle Right Ventricle

27 Thoracic and Pulmonary Vessels Aorta Caudal Vena Cava Cranial pulmonary vessels –Proximal third rib Caudal pulmonary vessels –Where crosses 9 th rib Veins are ventral and central –Artery, bronchus, vein –ABV’s

28 Trachea, Bronchial Tree Trachea ends at the carina Then splits to the main stem bronchi followed by the lobar bronchi Tracheal rings can mineralize (age) Decreased tracheal diameter –Tracheal narrowing (stenosis, extramural compression) –Tracheal hypoplasia –Tracheal collapse

29 Lungs Normal anatomy –Left Cranial (cranial subsegment) 1 Cranial (caudal subsegment) 2 Caudal 3 –Right Cranial 4 Middle 5 Caudal 6 Accessory

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31 The Mediastinum Cranial, middle, caudal compartments Routinely visible structures: –Cardiac silhouette, trachea, caudal vena cava, aorta, +/- thymus, +/- esophagus –Cranioventral mediastinal reflection –Caudoventral mediastinal reflection Aka phrenopericardiac ligament Left side on VD radiograph

32 Mediastinal Reflection Caudoventral mediastinal reflection

33 Extrathoracic Structures Sternum Vertebrae Ribs Adjacent soft tissues Diaphragm

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35 The Diaphragm 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

36 The Diaphragm

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38 The End


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