What does it all mean?
Mike Ackerley
Overview
 What are they?
 What do they look like?
 What are the differentials for each?
 What can I do to diagnose it further?
What are they?
 Interstitial
 Alveolar
 Bronchial
 Mixed
What do they look like?
 Interstitial a.k.a “busy” lungs: smudging or blurring of the
outline of structures.
Stuff scattered in the outside garbage bag.
 Structured
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Nodules - < 3 cm (if you can see them they’re at least 4 – 5 mm)
Masses - > 3 cm
Differentiate nodules from end on vessels.
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Less numerous
End on vessels more opaque, and smaller in diameter
Adjacent to bronchus & have connected “tail” b/c part of vessel projects
laterally
 Unstructured
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Fluid (non-cardiogenic edema)
Cells (pneumonia – bacterial, fungal, viral)
Scar tissue (contusions)
Age
Artifact?
What are the differentials?
 Structured (Nodules/Masses)
 Mineralization: osteomas (large breed dog, not significant)
 Solitary (can be cavitary or solid): Perihilar region or caudal lung lobes
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Tumor
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Adenocarcinoma
Bronchogenic carcinoma
SCC
Malignant histiocytosis (Rotties, Goldens, and Bernese)
Abscesses (Can’t tell difference from tumor)
Granuloma
Hematoma
Fulid filled cyst or bullae
What are the differentials?
 Structured (Nodules/Masses)
 Multiple:
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Metastatic tumors
Fungal granulomas
Parasitic granulomas (Aleurosyrongylus – Feline lung worm)
Abscessation
Lymphoma
Malignant hystiocytosis
Lymphoid granulomatosis
 Miliary (remember what the seeds look like):
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Lymphoma
Fungal pneumonia
Hematogenous bacterial pneumonia
Metastatic thyroid, haemangiosarcoma or mammary carcinoma
What are the differentials?
 Unstructured
 Artifact (MOST COMMON)
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Underexposure/development: film too “light”
Expiratory radiograph
Obese animals
Forelimbs not pulled forward (musculature in way)
 Age: lungs less elastic (scarring)
 Pneumonia (cells)
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Bacterial (MOST COMMON) right middle lung lobe
Fungal: common blasto, crypto, histio, coccidiomycoses
Viral: distemper – caudodorsal distribution
What are the differentials?
 Unstructured
 Cardiogenic edema (fluid): precedes alveolar pattern
 Non-cardiogenic edema: usually caudodorsal
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Near drowning
Epilespy, seizure
Electric cord bite
Head trauma
 Hemorrhage/contusions: DIC, anticoagulant poisoning
 Neoplasia: Lymphoma, metastatic
(hemangio/adenocarcinoma)
 Allergic
 Parasitic: Heartworm or lungworms
What do they look like?
 Alveolar pattern: Alveoli are filled with blood, pus,
edema, etc.
Stuff in the inner garbage bag!!!!!
 Air bronchograms – just b/c they’re not there doesn’t
mean it’s not alveolar (hard to see in cats)
 Lobar sign – alveolar pattern extends to the border of
normal lung lobe
 Difficult to see heart margins, diaphragm, bronchial
walls, or pulmonary vasculature.
What are differentials?
 Consolidation (alveoli infiltrated)
 Pneumonia
 Aspiration usually right middle
 Bronchopneumonia usually cranioventral
 Edema (Caudal lung lobes in dog, variable in cat)
 Cardiogenic – LHF
 Non-Cardiogenic – upper airway obstruction (including
brachycephalics and lar. Par), electrocution, seizures, allergic, near
drowning and blood transfusions.
 Hemorrhage – usually asymmetrical
 Neoplasia
 Atelectasis (alveoli collapsed): look for mediastinal
shift towards affected lung, only see bronchograms
with moderate to severe collapse
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Anesthesia
Pleural effusion
Pneumothorax
Asthma
Lung lobe torsion – usually right middle lung lobe
Remember Dr. Ps ABCs
A = Atelectasis, Anesthesia
B = Bronchopneumonia, Bacterial pneumonia
C = Contusion, Cancer
D = Dirofilaria
E = Edema (Cardiogenic and Non)
F = Bronchial Foreign Body (caudal lobes)
G = Granulomatous (Fungal)
H = Hemorrhage
What can I do to diagnose it
further?
 History & PE big help
 Signalment, Trauma, anesthesia, previously dx heart dz
or murmur ausculted?
 Diuretic – If it is edema you will see significant change
if you re-radiograph in ~ 12 hours. If it is hemorrhage
or bronchopneumonia will see no change
 TTW or BAL – determine what type of fluid and
culture for possible bronchopneumonia
What do they look like?
 Bronchial Pattern: Increased visibility of the bronchial
wall due to thickening or mineralization. May see
change in size and shape of the lumen.
Stuff along the wall of the white balloon.
 Donuts (end on)
 Railroad tracks (longitudinal)
What are differentials?
 Bronchial Mineralization
 AGE: Insignificant in older and chondrodystrophic dogs
 Calcification of peribronchial mucus glands in cats
 Hyperadrenocorticism or long term corticosteroid use
 Bronchial Thickening
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Chronic bronchitis: older animals
Feline asthma
PIE – Pulmonary Infiltrate with eosinophilia
Parasites (aelurostrongylosis)
Neoplasia: Lymphoma, bronchogenic adenocarcinoma
What can I do to diagnose it
further?
 TTW or BAL
 Cytology to determine what type of cells are present
(eosinophils, neoplastic?)
What do they look like?
 Mixed:
 Variable – depends on what process is dominating
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Bronchointerstitial pattern most common
Alveolar and interstitial patterns are sometimes hard to
evaluate and often co-exist