Transcript Document

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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 SAM
 9 year old MN Mixed Breed Dog
Norman Ackerman Memorial
Radiography Case Challenge
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Signalment
 Sam presents to your clinic with a acute
history of cough and exercise intolerance
 On physical examination, you hear crackling
lung sounds cranially, on the right side
 You order thoracic radiographs
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Based on your assessment of the radiographs,
the thoracic body wall is:
A.Normal
B.Abnormal
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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
The cardiac silhouette is
within normal limits.
Click here to continue
Correct!
There are no
abnormalities
associated with
the cardiac
silhouette
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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
lungs.
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Correct!
There is an area of increased soft tissue opacity
mainly on the ventral aspect of the right cranial
lung lobe. Based on your assessment, which
pulmonary pattern is predominant within that
lobe?
A.Bronchial
B.Alveolar
C.Vascular
D. Unstrutured Interstitial
Sorry!
Indefinition of the
pulmonary vessels, air
bronchograms, lobar sign,
and (in this case, discrete)
border effacement of the
lobar opacification with
the cardiac silhouette are
not characteristics of this
pulmonary pattern
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Correct!
This is an example of an
alveolar pulmonary pattern.
Some of the features of this
pattern include: Indefinition of
the pulmonary vessels, air
bronchograms, lobar sign, and (in
this case, discrete) border
effacement of the lobar
opacification with the cardiac
silhouette. Remember: It does not
have to have all these features to
be considered an alveolar pattern!
Continue
LS
AB
IV
BE
AB=air bronchogram
IV=indefinition of vessels
BE=border effacement on the cardiac silhouette
LS=lobar sign
Continue
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Conclusion
Your findings now include: increased soft tissue
pulmonary opacity within the right cranial lung
lobe, with presence of indefinition of the
pulmonary vessels, air bronchograms, lobar
sign, and (in this case, discrete) border
effacement of the lobar opacification with the
cardiac silhouette. This represents an alveolar
pulmonary pattern, which, in this case, is mainly
ventral. click next.
Conclusion
 What is top differential diagnosis?
 Cardiogenic pulmonary edema
 Aspiration pneumonia
 Recumbence atelectasia
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Sorry!
 Usually cardiogenic edema
has a caudodorsal
distribution within the lung
parenquima of dogs
 Although we cannot totally
ruled out cardiac disease
just using radiographs, the
cardiac silhouette is within
normal limits in this case.
One more try!
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Sorry!
 In addition to the soft
tissue opacification within
the lungs, in cases of
atelectasis, usually is
observed a decreased
volume of the affected
lung lobe, and sometimes
ipsilateral mediastinal shift
(MS). In Sam’s case, the
volume of the right cranial
lung lobe is normal (not
decreased).
MS
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One more try!
Correct!
 Aspiration pneumonias are usually ventral,
due to gravitational forces.
 This also goes along with the acute clinical
signs.
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Next
Some causes of Aspiration
Pneumonia (Dennis, Kirberger, Barr, Wrigley:
Handbook of Small Animal Radiology and Ultrasound, 2nd
ed., 2010):
 Regurgitation and vomiting, especially if esophageal dilation is

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present;
Iatrogenic aspiration: force feeding, medication, anesthesia
and oral administration of contrast medium;
Swallowing disorders;
Weakness and debilitation;
Cleft palate;
Tracheo-esophageal or broncho-esophageal fistula.
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