Help interpreting chest xrays

RE: Help interpreting chest xrays

Tassadar — Mon, 27 Nov 2017 11:05:43 GMT

I can see this discussion heating up. Thank you so much for your input. I really appreciate that.

This dog is located in Lithuania (it is my friends dog who works as a veterinary surgeon there). Sorry for xrays not being perfect. In Lithuania vets are limited in what they can do. This dog lives on a farm with horses. Lung worm has never been found in lithuania (although very little testing has been done into this parasite). We decided to try and give fenbendazol for 7 days to see if it works (no lung worm snap test available). After that to repeat xrays with bronchoscopy + BAL and cytology. If nothing is found then there is an option of CT next.

This animal had cough since january and just a month ago got very bad. Here are xrays from january 2017. Sorry again for them being non diagnostic. It is the way vets take xrays there :-D

RE: Help interpreting chest xrays

Robin Grimmer — Sun, 26 Nov 2017 13:47:43 GMT

I think you are over interpreting it, and you've just done it again by labelling it

These x-rays really aren't of diagnostic quality. As well as the movement blur and being under inflated - they are also poorly collimated and the front legs aren't pulled forward and the head is sticking up rather than forward. Also pretty certain these weren't taken under GA as no et tube.

RE: Help interpreting chest xrays

Neil Wheadon — Sun, 26 Nov 2017 13:19:34 GMT

[quote user="Robin Grimmer"]I wouldn't over interpret, we need better quality radiographs.[/quote]

Agreed with this and I didn't over interpret, more an explanation of how I look at these. However there are signs of other lung lobes affected as below. How significant this is in a older dog, unsure, but it pulls me away from a single lung lobe affected which in effect a lung torsion is.

The big lesson I take from X-Rays is work the picture systematically and don't assume you can see everything as it's like photography, you need contrast between air, fat, soft tissue and bone, that's how you see the edges of lesions

RE: Help interpreting chest xrays

Robin Grimmer — Sun, 26 Nov 2017 13:05:08 GMT

Neil - I think the dorsal lung changes you mention are because the view is expiratory. The pathology is confined to one area - caudoventral.

I wouldn't over interpret, we need better quality radiographs.

RE: Help interpreting chest xrays

Neil Wheadon — Sun, 26 Nov 2017 11:04:03 GMT

[quote user="Robin Grimmer"]You have a density in the caudoventral lung field. I would describe as an alveolar pattern. Differentials include pneumonia, oedema, neoplasia, lung lobe torsion, foreign body granuloma , lungworn. Difficult to interpret further as some blurring and expiratory. I would GA to get some inflated views, then bronchoscopy and BAL.[/quote]

Looking at the entire lung field, the dorsal lung fields are affected as well. There looks to be air bronchograms. You get these because of alveoli filling with something be this pus, exudate, fluid etc, so they provide a contrast against which the bronchioles can now be seen. The lung field has diffuse densities in there as well confirming that you have lung disease.

I agree with Robin in that the caudal lung lobe is radio dense and I can't see the caudal border of the heart.

The carina isn't elevated, though there may? be increased sternal contact, however a clinical examination should be able to differentiate a heart from a lung condition. From the X-Ray I feel this is primarily lung.

With more than one lobe affected, I'd remove torsion and lung lobe granuloma from the differentials and go along the lines of anything that is filling those alveoli

Lungworm - blood, but a 12 year old dog

Pus/exudae - pneumonia

Tumour - Possibly but the caudal looks more consolidated and the dorsal is more diffuse, Lung carcinoma tends to have a more regular pattern.

Oedema - how's the heart sounding, but the densities are in the wrong place.

I'd try to get another with a higher KV and lower MASA and inspirational (definitely for the DV) but appreciate that you may already have anaesthetised once, but the Americans use propofol for X-Rays and I've found it fairly safe.

If money tight treat for pneumonia especially as you have a neutrophilia, though you've tried 3 already, hence the post

Might be worth doing a smear of blood to see what those WBC are. I trust a good pathologist far more than a light throwing IDEXX in house analyser and it's non invasive.

Interesting , thankyou and PLEASE FOLLOW UP (and welcome to the forum)

Neil

RE: Help interpreting chest xrays

Tassadar — Sat, 25 Nov 2017 18:41:56 GMT

No history of travel. Area is not a blackspot for lungworm. Thanks for reply.

RE: Help interpreting chest xrays

grumpyoldman — Sat, 25 Nov 2017 17:28:27 GMT

As above ,with FNA +/- CT if your near one.

RE: Help interpreting chest xrays

Robin Grimmer — Sat, 25 Nov 2017 14:19:24 GMT

You have a density in the caudoventral lung field. I would describe as an alveolar pattern. Differentials include pneumonia, oedema, neoplasia, lung lobe torsion, foreign body granuloma , lungworn. Difficult to interpret further as some blurring and expiratory. I would GA to get some inflated views, then bronchoscopy and BAL.

Also test for lungworm. Are you in a lungworm area? Has the dog travelled?