Thorax x-ray of the week

RE: Thorax x-ray of the week

Andreia Dias — Mon, 11 Nov 2019 15:06:14 GMT

(I really like x-ray challenges!)

I don't see the sternal lymphnode... Caudal aspect of scapula is superimposed above the trachea, which is why I think it looks like there may be increased mediastinal radiopacity (I think this is an artifact). I don't think you can say much about the lung parenchyma from this x-ray since, as it has been commented, it doesn't appear to be inspiratory (or slightly inspiratory). The only extra thing I can see is that the liver may extend a bit past the last costal arch, but you don't have all of the ribs present on this view to be able to tell!

I would say you would need a DV for the mediastinum. I would not be convinced from this x-ray that there was a cause for respiratory distress.

But I'm also a newbie :p I just love these things xD

RE: Thorax x-ray of the week

Neil Wheadon — Mon, 11 Nov 2019 10:01:20 GMT

[quote user="Neil Wheadon"]The main fault here is that it's inspiratory, the heart touches the diaphragm and the crura aren't back enough, that makes interpreting lungs harder as they always look denser.[/quote]

Sorry folks I meant Expiratory, the rest makes sense. The other way to tell is the vertebral number this goes to, in this case 10, should be 11 or 12

Also if looking for lung lesions, do both sides. The theory being you collapse the lower lungs so get less definition

Neil

RE: Thorax x-ray of the week

Michael Woodhouse — Sun, 10 Nov 2019 21:37:21 GMT

[quote user="Gillian Mostyn"]

So you're always in the room when taking chest rads? I realise you'll wear lead screening, but I don't like to be in the room unless really necessary.

[/quote]

Room is an L shape so you can stand around the corner and be completely safe with no lead on, but would usually gown. Never had anything show up on dosimeters. I'm quite happy with it.

RE: Thorax x-ray of the week

An On MRCVS — Sun, 10 Nov 2019 21:35:34 GMT

This shows the pitfalls of seeing 'pathology' in under inflated lungs. There's nothing to see except some aerophagia. I'd wager this was a BOAS and there's no lower respiratory disease at all.

RE: Thorax x-ray of the week

Gillian Mostyn — Sun, 10 Nov 2019 21:24:39 GMT

[quote user="Michael Woodhouse"]we were taught for chest rads to do them under GA with a tube and then fully inflated (close APL valve and squeeze bag while taking exposure).[/quote]

So you're always in the room when taking chest rads? I realise you'll wear lead screening, but I don't like to be in the room unless really necessary.

I usually just watch through a screen and take the exposure at max inspiration.

RE: Thorax x-ray of the week

Michael Woodhouse — Sun, 10 Nov 2019 16:19:17 GMT

I'm not great at radiographic interpretation, but we were taught for chest rads to do them under GA with a tube and then fully inflated (close APL valve and squeeze bag while taking exposure). Was there a reason you didn't do that?

RE: Thorax x-ray of the week

Neil Wheadon — Sun, 10 Nov 2019 15:10:41 GMT

OK, I'll bite

1) It's probably a left lateral. The way to tell is by looking at the diaphragmatic crura. For a left the part just ventral to the spine forms a triangle, for a right they run parallel

2) Positioning is fine. It's not perfect. You can tell there is slight rotation as the chostochondral junctions don't quite align

3) Heart. Yes you can evaluate, it's a reasonable radiograph

Personally I find heart size is really variable, it depends on breed/systole/diastole. In this case the caudal border curves nicely to the base of the heart and the caudal vena cava is going in a South West to North East direction. The vessels look OK, but I'd like a DV. I'm also biased as it's a 2 year old dog, so unlikely to be a heart issue and you can tell quite a lot by clinical exam

The main fault here is that it's inspiratory, the heart touches the diaphragm and the crura aren't back enough, that makes interpreting lungs harder as they always look denser.

Hope that helps, any corrections gratefully received

Neil