Transcript Take the challenge - University of Florida

Dr. Norman Ackerman served the University of Florida, College of Veterinary Medicine with
distinction as Professor of Radiology from 1979 to 1994. A concerned teacher of veterinary
students and residents of all disciplines, Dr. Ackerman also reached the veterinary scientific
community through his writing. His numerous clinically pertinent publications are still today
a vital part of the veterinary literature; therefore, it is appropriate this site perpetuates Dr
Ackerman’s dedication to teaching. This site is presented in recognition of Dr. Norman
Ackerman and his contributions to the field of
veterinary diagnostic imaging.
Sponsorship of the display supports the Dr. Norman Ackerman Memorial Fund, dedicated to
the teaching of diagnostic imaging residents at the University of Florida College of Veterinary
Medicine.
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Maggie Mae
3 year old SF Mixed Breed Dog
NORMAN ACKERMAN MEMORIAL
RADIOGRAPHY CASE CHALLENGE
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Signalment
 Maggie Mae presents to your clinic with a 3
month history of progressive exercise
intolerance and cough
 On physical examination, you hear increased
lung sounds
 You order thoracic radiographs
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Based on your assessment of the radiographs,
the thoracic body wall is:
A. Normal
B. Abnormal
Correct!
There are no
abnormalities associated
with the thoracic wall.
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Sorry!
The thoracic body wall, including the
extrathoracic structures, are within normal
limits
Click here to proceed to the next
question
Based on your assessment of the radiographs,
the pleural space is:
A. Normal
B. Abnormal
Correct!
There are no
abnormalities associated
with the pleural space.
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Sorry!
The pleural space is normal
Click here to proceed to the next question
Based on your evaluation,
the cardiac silhouette is:
A. Normal
B. Abnormal
Sorry, Try Again
There is an abnormality
associated with the cardiac
silhouette.
Click here to continue
Correct!
The cardiac silhouette is abnormal. Click on the
selection below that correctly identifies the
abnormal area.
A. The Left Ventricle
B. The Right Ventricle
C. The Left Atrium
D. The Right Atrium
E. The Main Pulmonary Artery
Sorry, Try Again
The left ventricle is normal.
Click here to return to the question
Maybe…
On the VD projection, the
heart does appear wider,
particularly in the region of
the right ventricle.
However, there is really no
evidence of right ventricular
enlargement on the lateral
projections. There is
another abnormality…
Click here to continue
Right Ventricle
On the VD projection, the
heart does appear wider,
particularly in the region of
the right ventricle.
However, there is really no
evidence of right ventricular
enlargement on the lateral
projections. There is
another abnormality…
Click here to continue
Nah…
The left and right atria are
both normal.
RA
LA
RA
LA
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LAu
Correct!
The main pulmonary
artery is enlarged.
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Based on your assessment of the radiographs,
the lungs, including the vessels, are:
A. Normal
B. Abnormal
Sorry!
 There is an abnormality
associated with the
pulmonary vessels.
Continue
Correct!
The pulmonary vessels are definitely abnormal.
Based on your evaluation, which vessels are
affected?
A. Pulmonary Veins
B. Pulmonary Arteries
Sorry!
The pulmonary veins are
normal.
Remember, veins are ventral
(on the lateral projection) and
central (on the VD projection)
However, the pulmonary
arteries are enlarged, tortuous,
and in some areas, appear
blunted.
Continue
Correct!
The pulmonary arteries are
enlarged, tortuous, and in
some areas, appear blunted.
Remember, veins are ventral
(on the lateral projection)
and central (on the VD
projection)
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Conclusion
Your findings now include enlarged, tortuous
pulmonary arteries, and an enlarged main
pulmonary artery. There is questionable
enlargement of the right ventricle. Formulate
your top differential diagnosis, and click next.
Diagnosis: Canine Heartworm
Disease
Tortuous, enlarged, and blunted pulmonary
arteries and MPA reflect damage to the intima
of the vessels and the presence of
thromboemboli.
The suspected enlargement of the right
ventricle is related to pulmonary hypertension
caused by the pulmonary arterial changes, also
termed cor pulmonale.
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Dr. Ackerman on Heartworm
Disease
 In 1987, Dr. Ackerman wrote a review article
entitled “Radiographic Aspects of Heartworm
Disease*” documenting the imaging findings
associated with this disease. With today’s
preventatives, we see far fewer cases of this
disease today, but it is important for every
veterinarian to be familiar with it’s
radiographic appearance.
*Seminars in Veterinary Medicine and Surgery (Sm Anim). 1987 Feb;2(1):15-27
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