Radiology Packet 14

Thorax-Trauma

3 yr old male DSH cat

• HX = presentation of severe respiratory distress, missing for 2 days, open mouth breathing and cyanotic mucous membranes on PE, lack of lung sounds bilaterally in caudal thorax on auscultation

3 yr old male DSH cat

3 yr old male DSH cat

• RF

– In the VD view the heart is shifted cranially and to the left.

– In the VD view there is increased lung opacity in the mid R hemithorax.

– Large rounded and bilobed lucent structure seen in the caudal thorax (gas dilated stomach).

• RD

– Diaphragmatic hernia

• Next

– Surgery

1 yr old MC Golden Retriever“Max”

• HX = presented 6 hrs after being hit by car, initially seemed fine to owners but 2 hours after accident

increased respiratory difficulty was noted

1 yr old MC Golden Retriever“Max”

1 yr old MC Golden Retriever“Max”

• RF– In the lateral view there is separation of the heart from the sternum.– A triangular soft-tissue structure is seen caudally, just ventral to the aorta.– In the VD view the left hemi-thorax appears exceptionally lucent.– Three structures with roughly triangular shape and soft tissue opacity are visible

to the left of the heart (totally collapsed lung lobes).– Retraction of the right caudal lung lobe from the thoracic wall is present.– Cardiac shift (mediastinal shift) to the right.

• RD– Bilateral pneumothorax– Tension pneumothorax (L sided)

• Next– Place chest tube, monitor

5 yr old female Golden Retriever“Bella”

• HX = hit by car

5 yr old female Golden Retriever“Bella”

5 yr old female Golden Retriever“Bella”

• RF– On the lateral view there are bizarre gas streaks over the thorax, shoulder,

sternum and cranial mediastinum.– There is visualization of the outer wall of the trachea, esophagus, and

brachiocephalic artery, separation of the heart from the sternum, and retraction of the caudal lung lobes.

– On the VD view there is subcutaneous gas along the left thoracic wall, increased opacity of the cranial mediastinum, cardiac shift to the left, left 5-7 rib fractures.

– Also, lobar borders are seen between the right middle and caudal lung lobes as well as heavy pulmonary infiltrates throughout all the lungs.

• RD– Pneumomediastinum/thorax– Subcutaneous emphysema– Pulmonary contusions– Rib fractures

• Next– Supportive care

13 yr old male Pekingese“Benjamin”

• Hx = presented for routine vaccines and a dentistry, on auscultation the heart sounds are muffled

13 yr old male Pekingese“Benjamin”

• RF

– Silhouetting of the cardiac and diaphragmatic shadows are noted, esp in the right caudal region.

– Radiolucent tubular structures were seen, especially cranial and left of the heart.

• RD

– Peritoneal-pericardial diaphragmatic hernia

– Traumatic diaphragmatic hernia

• Next

– Surgery is an option if the hernia causes clinical signs, currently the dog is not experiencing any.

5 yr old male Golden Retriever“Dune”

• HX = Presented in respiratory distress and limping on right hind limb, owners report he escaped for 3 hours and believe he may have been hit by a car

5 yr old male Golden Retriever“Dune”

5 yr old male Golden Retriever“Dune”

• RF– Increased opacity of the lung tissue cranioventral to the heart, air bronchograms are visible.

– Minor retraction of the left lung lobes from the thoracic wall by the presence of a small amount of gas.

– A small band of gas is seen surrounding the cardiac silhouette on the right side.

– On the lateral view the heart is separated from the sternum and there is a focal area of lucency between the cardiac apex and sternum.

– Fractures are present of the left 1st through 5th ribs.

– A faint pleural fissure line is present at the 7 th rib on the right indicating a small amount of free pleural fluid.

• RD – Pulmonary contusion, mild pneumothorax, multiple rib fractures, subcutaneous edema of the

axillary region

• Next– Supportive care

9 yr old FS Cocker Spaniel“Sarah”

• HX = hit by car on 10/12 and presented for evaluation of labored breathing on 10/31

9 yr old FS Cocker Spaniel“Sarah”

9 yr old FS Cocker Spaniel“Sarah”

• RF

– Cannot evaluate the cardiac silhouette or diaphragmatic margin due to increased soft tissue opacity within the pleural cavity.

– Cardiac silhouette in shifted to the left.

– Multiple tubular gas-filled structures are visible in the left half of the thoracic cavity.

– A metallic projectile is visible in the cranial abdominal cavity.

• RD

– Right-sided traumatic diaphragmatic hernia

• Next

– Surgery to repair the hernia