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RADIOLOGY - Coggle Diagram
RADIOLOGY
Lungs
Lateral views: atelectasis
--> in lateral recumbency the dependent lung collapses
Lobe vessels
Cardiac silhouette
Body habitus (weak, normal, obese)
If lung image altered: evaluate the changes (opacity, degree of change, position of mediastinum, pattern)
Alveolar patterns
= air in alveoli replaced by fluid or cells > increased lung opacity
Bacterial pneumonia
Parasitic pneumonia
Toxoplasma (diffuse, nodular or multifocal alveolar pattern infiltrate) or Capillaria/Aelurostrongylus (usually bronchial + fine linear interstitial patterns)
Aspiration pneumonia
passive (sedation) or forced/solide material (> material to R caudal lobe)
Lung lobe torsion
= axial rotation of a lobe around its bronchus
small dogs: torsion of L cranial lobe / large dogs: of R middle lobe
Non-cardiogenic pulmonary edema
= fluid flooding in end-air spaces
Pulmonary hemorrhage or contusion
Bronchial pattern
= fluid or cellular infiltration in bronchial wall or in immediate peribronchial space
Lobar collapse
Bronchiectasis
= abnormal permanent dilation of bronchi
Spontaneous non-traumatic rib fractures
Pulmonary hyperinflation
Bronchial mineralization
Interstitial pattern
= structured (nodule, mass) + unstructured (fluid/cell infiltration)
Structured interstitial pattern
= nodule (<2cm) or mass (>2cm)
mineralized nodules, cavitary nodules/masses (containing an air cavity), lung bullae (cavitary lesion w thin wall)
Unstructured interstitial pattern
= fluid or cellular infiltration into interstitial space of lungs
Cardiogenic lung edema
Vascular pattern
Esophagus
Esophageal dilatation
Megaesophagus
= dilated hypomotile esophagus
segmental (cervical or thoracic) or generalized (mostly thoracic)
Segmental esophageal dilatation
Esophageal diverticula
= pouches of variable size
Vascular ring anomalies
.> congenital focal esophageal dilatation
physio: R 4th aortic arch regresses + L forms aorta / patho: R forms aorta
Hiatal diseases
Hiatal hernia
= diaphragm defect allowing protrusion of distal esophagus, a portion of stomach and other abd. structures into caudal thoracic cavity
Type I = Sliding hiatal hernia / Type II = Paraesophageal hiatal hernia / Type III (mixed) = Types I + II / Type IV (mixed) = large defect in phrenoesophageal mb
esophageal hiatus = opening in diaphragm where esophagus + vagus nerve pass
Gastroesophageal intussusception
= invagination of stomach (+ possibly other abd. organs) into caudal esophageal lumen
Esophageal stricture
= abnormal narrowing of esophageal lumen
FB
non-obstructive (tend to lodge in pharyngeal region) or obstructive
Neoplasia
Perforation
Cardiovascular system
Enlargement
Left atrium enlargement
cause: dilation
Left ventricle enlargement
cause: dilation or hypertrophy
Right atrium enlargement
cause: dilation
Right ventricle enlargement
cause: dilation or hypertrophy
Generalized cardiomegaly
cause: myocardial dysfct
Caudal vena cava enlargement
cause: increased central venous P°
Aorta enlargement
cause: dilation
Main pulmonary artery enlargement
Congestive heart failure
Left or right
Acquired CV lesions
Mitral insufficiency
Heartworm infection
Cardiomyopathy
Dog - Dilated cardiomyopathy
Cat - Feline hypertrophic cardiomyopathy
Pericardial effusion
Congenital CV lesions
Patent ductus arteriosus
= Ductus fails to close normally after birth > abnormal communication btw descending aorta + main pulmonary artery
Pulmonary stenosis
Aortic stenosis
Ventricular septal defect
abnormal dvp > communication btw ventricles
Tricuspid dysplasia
= congenital malformation of tricuspid valve
Reduction in heart size
cause: reduction of circulating vascular V
Heart base masses
tumors (aortic body tumors = chemodectomas or parathyroid tumors) or ectopic thyroid
Pulmonary vessels
Abnormal shape
heartworm (> increased tortuosity), heartworm or lung thromboembolism (> abrupt ending)
Abnormal location
persistent R 4th aortic arch
Abnormal size
Abdomen
Abdomen limits
Abdomen aspect on X-Ray
depends on age, breed, body condition and diet
Abdomen anatomy
Abdominal wall
RX: organs displaced in abd. wall, gas in soft tissues surrounding abdomen, mineralization
neoplasia, abd. wall hernia, gas, lipoma
Peritoneal space
Peritoneal effusion
= increased amount of fluid in peritoneal cavity
Peritoneal metastasis + Steatitis
Metastatic tumors: hemangiosarcoma of spleen, carcinoma of various abd. organs
Steatitis = infl of fat (often yellow fat) > fat necrosis
Peritoneal masses
neoplasia, cyst, hematoma, abscess, granuloma
Intra-abdominal calcification
Focal calcified bodies
= dystrophic calcification of necrotic mesenteric fat (not clinically significant)
Metastatic calcification
= mineralization of normal tissue secondary to hypercalcemia
Mineralized fetus
Peritoneal gas = Pneumoperitoneum
= free gas or air in peritoneal cavity
peritoneum = thin serous mb in 3 layers all continuous (parietal, visceral, connecting)
peritoneal space = space btw parietal + visceral peritoneal layers
intraperitoneal organs = organs covered by visceral peritoneum (≠ organs in peritoneal space, ≠ abd. cavity)
Retroperitoneal space
Retroperitoneal fluid
Retroperitoneal gas = Pneumoretroperitoneum
= space btw abdominal wall + dorsal margin of parietal peritoneum
retroperitoneal organs = near abd. wall, only their ventral part covered by peritoneum (kidneys, adrenal glands, ureters, major blood vessels, sublumbar LN, bladder neck, ventral prostate)
Stomach
Gastric displacement
W intact diaphragm
Hepatomegaly
asymmetric caudo-dorsal-L displacement of stomach
Abdominal mass
L or R displacement of stomach
Smaller liver
cranial displacement of stomach
W rupture or hernia of diaphragm
Acquired traumatic hernia
cranial displacement of stomach + other abd. organs
Hiatal hernia
Peritoneopericardial diaphragmatic hernia
ventral communication btw abd. + pericardial sac
Gastroesophageal intussusception
= invagination of stomach (w/without other abd. organs) into esophagus
.> cranial displacement of stomach
Gastric dilation
Acute gastric dilation
= gaseous dilation without stomach malposition
RX: enlarged filled w gas
Gastric dilation volvulus
= gaseous dilation w stomach malposition
RX: distension, displacement of pylorus dorsally-L, compartmentalization (soft-tissue bands projecting into + across gas-filled lumen)
Chronic pyloric obstruction
restrictive (encircle pylorus ) or obstructive (block orifice of pylorus)
RX: stomach distended w fluid, displacement of transverse colon caudally
FB
Radiopaque
Non-opaque
Ulcers
Neoplasia
benign (adenoma, adenomatous hyperplasia, polyps) or malignant (dog: adenocarcinoma / cat: lymphosarcoma)
Large intestine
Diameter > colonic impaction (accumulation of feces): constipation (infrequent reversible fecal retention), obstipation (permanent reversible loss of colonic fct) or megacolon (permanent irreversible colonic distention)
Size + shape: chronic infl disease
Location
FB, hernia, infl, stricture, neoplasia
Infl
Obstruction (intussusception, torsion, volvulus, strangulation)
Fct: impaired motility, gastroenteritis + diarrhea, soft tissue mass, intussusception
Thorax
Soft tissue
Tumors
benign lipomas, fibrosarcoma, sarcoma or carcinoma
Infection
Thoracic wall
Congenital abnormalities
sternum: decreased nb/fusion, dorsal displacement of sternum “pectus excavatum”, ventral displacement of sternum “pectus carinatum”, peritoneopericardial diaphragmatic hernia
thoracic vertebrae
ribs: rudimentary C7, agenesis/hypoplasia T13
Trauma
SC emphysema, pneumothorax, complete fracture displaced but stable, incomplete fracture (cracks)
Mass
Pleura + pleural space
Pleural fluid
exudate (pyothorax, mediastinitis), transudate (hypoproteinemia), modified transudate (congestive heart failure, lung/pleural tumor, trauma causing hemothorax, mediastinitis, idiopathic chylothorax, diaphragmatic hernia)
Pneumothorax
= air/gas in pleural space
open or closed
Mediastinum
= space btw pleural sacs, containing many organs + structures
Mediastinal shift
ipsilateral shift (unilateral decreased lung V) or contralateral shift (unilateral increased lung V or pleural P°, intrathoracic mass)
Mediastinal mass
Cranio-Ventral mediastinal mass
sternal lymphocenter (dorsal to 2nd-3rd sternebrae), thymus, mediastinal cyst, mediastinal abscess (by esophageal perforation)
Dorsal mediastinal mass
Hilar region mediastinal mass
enlarged tracheobronchial LN
mass arising from heart base
Caudal mediastinal mass
Mediastinal fluid
Mediastinal gas = Pneumomediastinum
4 anatomical regions: extrapulmonary region (thoracic cage: vertebral column, sternum, ribs) + diaphragm), pleural space, mediastinum (esophagus, trachea, heart + large blood vessels, LN), lungs
Diaphragm
Loss of diaphragmatic thoracic surface outline
general (bilateral pleural fluid, consolidation of caudal lung lobes, diaphragmatic hernia) or localized/partial (diaphragmatic hernia, focal lung disease in caudal lung lobes, thoracic mass adjacent to diaphragm)
Shape changes
Position changes
cranial (obesity, peritoneal fluid, abd. pain, abd. mass or organ enlargement) or caudal (severe respi distress, bilateral tension pneumothorax, contact w heart (> caudal displacement of cupula)
Hernias
Diaphragmatic hernias
= protrusion of abd. viscera through diaphragm into thorax
RX: abd. viscera within thorax, cranial displacement of abd. structures, displacement of thoracic structures, partial/complete loss of thoracic diaphragmatic surface outline
Peritoneopericardial diaphragmatic hernia
= protrusion of abd. viscera into pericardial sac through a congenital defect formed btw tendinous portion of diaphragm + pericardial sac
RX: cardiac silhouette, abd. organs in pericardial sac, confluent indistinguishable border btw diaphragm + heart
Hiatal hernias
= diaphragm defect allowing protrusion of distal esophagus, a portion of stomach and other abd. structures into caudal thoracic cavity
Peritoneopleural hernias = “True diaphragmatic hernia”
= protrusion of abd. viscera in thorax through diaphragm defect
Liver
Hepatic enlargement
Generalized enlargement: Hepatomegaly
RX: round or blunt caudoventral liver margins, extension beyond costal arch, caudal displacement of gastric axis/R kidney/transverse colon/cranial duodenal flexure, caudo-dorsal + L displacement of pylorus
Focal enlargement
Hepatic decrease
Hepatic opacity
Mineral opacity
choleliths (focal mineral opacities in gallbladder), choledocholiths or calculi in bile ducts (linear trails of mineral opacities extending peripherally within hepatic parenchyma)
Radiolucent areas: gas
gastric dilatation + volvulus, GI ulcer/distention/trauma/surgery, obstruction of cystic duct, hepatic abscess w gas-forming organisms
Position changes
cause: diaphragmatic defects (diaphragmatic rupture, hiatal hernia type 2 or 4, peritoneopericardial hernia, hepatic hernia through caudal vena cava foramen)
Spleen
Splenomegaly
XR -> cats: tail visible on L view / dogs: thick, round and blunt margins + dorso-caudal displacement of jejunum
Splenic torsion
RX: reserve C-shape or mass in ventral abd.
Splenic mass
RX: local displacement of adjacent viscera, splenic mass obscured
Opacity
Mineralization
dystrophic calcification of abscess, hematoma, fungal granuloma or neoplasia
Gas
splenic torsion, gas-forming organisms in splenic abscess
Small intestine
Bowel dilation
Mechanical obstruction
FB
Linear FB
Intussusception
= invagination of 1 portion of GIT into lumen of an adjacent segment
Functional ileus
Mesenteric volvulus
Infiltrative bowel disease
= generalized/segmental infiltration of bowel wall by infl, infection or neoplasia
Inflammatory bowel disease
= a GIT disease of unknown etiology --> intestinal wall infiltrated by inflammatory cells
Infectious enteritis
RX: mucosa irregular as “indentations” in intestinal wall
Neoplasia
RX: no sign, a soft tissue mass + mass effect if big, or partial/complete obstruction
Bowel-associated masses
Bacterial abscess
Abscess from extrinsic source
retained surgical sponges or pancreatic abscess
Pyogranuloma
Topographic changes
protrusion of intestinal loops (esophageal hiatus, inguinal ring, rupture of abd. wall)
Urinary system
Kidneys
Abnormal size
Renomegaly
Smaller kidneys
Opacity
Mineral opacity
Renal calculi
Nephrocalcinosis (hypercalcemia)
Dystrophic mineralization
Gas opacity
Margination
Shape
Change of size
Renal mass lesions
Renal cysts
Perirenal fluid or Subcapsular fluid
Hydronephrosis
= distention of renal pelvis + pelvic diverticula, by urinary tract obstruction
RX -> renal parenchyma: only a thin rim of cortex remains / renal vessels reaching cortex: elongated thin interlobular vessels form radial streaks
Ureters
Obstruction
Ureterolithiasis
Ectopic ureters
Ureteral tumors
Ureteroceles
Trauma to ureters + kidneys
RX -> physio: not visible / patho: visible by dilatation
Urinary bladder
Radiographic signs of urinary bladder disease
Position
causes: hernia, retroflexion, congenital
Shape
cause: adjacent mass
Density
Gas opacity
iatrogenic (catheterization or cystocentesis)
emphysematous cystitis (glucose-fermenting organism, often w diabetes mellitus)
Mineral opacity
Calculi
Mineralization
Contrast cystography
Mucosal changes
normal: smooth / patho: mucosal proliferation (metaplasia, neoplasia or non-neoplasia)
Intramural changes (wall thickening)
Filling defects
free (air bubbles, calculi, blood clots) or attached (neoplasia, polyps, blood clots, adherent calculi, ureterocele)
Contrast leakage patterns
urine leakage into: urinary tract, adjacent viscera or peritoneal cavity
Urethra
Calculi
Neoplasia + infl
Neoplasia
Granulomatous urethritis
Fibroepithelial polyps
Rupture
Urethral stricture
Urethral fistula
Prostate
Size: Prostatomegaly
Margination
smooth easily seen (benign) or rough/ indistinct despite adequate fat (acute or aggressive)
Opacity
Calcification
areas of calcification within gland or wispy/indistinct
Gas
iatrogenic or gas-forming bacterial prostatitis (Coliform + Clostridial)
Positive-contrast retrograde urethrogram
asymmetric positioning of urethra within prostate or disruption of smooth urethral margin
Larynx + Trachea
Pharyngolarynx
Masses
Extramural
structures surrounding pharyngolarynx (LN, salivary glands, esophagus, thyroid gland, soft tissue, blood vessel)
Mural
neoplasia, granuloma/abscess, polyps, laryngitis/viral papillomatosis/laryngeal cyst, elongated/edematous soft palate in brachycephalic syndrome
Intraluminal
FB
Trauma + FB
Elongation and/or swelling of soft palate
physio: caudal edge of soft palate reaches top of epiglottis
patho: congenital, infl or tumor
Hyoid complex
neoplasia (bone lysis), trauma (dislocations/disarticulation, fractures)
Pharyngeal collapse
= complete/partial dorsal displacement of soft palate + ventral displacement of pharyngeal wall
Nasopharyngeal stenosis
congenital or acquired
Trachea
FB
Rupture
Avulsion
Modification of tracheal diameter
Tracheal stenosis
= focal annular tracheal narrowing
Tracheal hypoplasia
= congenital malformation w generalized reduction in tracheal diameter
Tracheal collapse
= progressive degenerative deficiency of tracheal ring (chondromalacia) > reduces their rigidity
Static
= persistent dorsoventral narrowing of tracheal lumen
Dynamic
Inspiration
tracheal instability in cervical trachea
Expiration
tracheal instability in thoracic trachea especially at carina
Displacement of trachea
Cervical region
lateral-right (FB in distal intra-esophageal) or ventral FB in proximal intra-esophageal or extramural mass) deviation
Cranial mediastinum
dorsal (cranial mediastinal lymphadenomegaly, mediastinal cyst, thymoma) or ventral deviation (neurogenic tumors, esophageal mass)
Middle mediastinum
Mural
Intramural
Brachycephalic syndrome
= complex of upper resp disorders in brachycephalics --> narrowing of ≠ segments of upper airways
obstructive changes: narrowing of nose, narrowing of nasopharynx, laryngomalacia, tracheomalacia + tracheal collapse