RADIOGRAPHIC AND ECHOCARDIOGRAPHIC ASSESSMENT OF LEFT ATRIAL SIZE IN 100 CATS WITH ACUTE LEFT‐SIDED CONGESTIVE HEART FAILURE

The aims of this study were to evaluate left atrial size in cats with acute left‐sided congestive heart failure. We hypothesized that left atrial size as determined by thoracic radiography can be normal in cats with acute left‐sided congestive heart failure. One hundred cats with acute left‐sided congestive heart failure in which thoracic radiography and echocardiography were performed within 12 h were identified. Left atrial size was evaluated using right lateral and ventrodorsal radiographs. Measurements were compared to two‐dimensional echocardiographic variables of left atrial size and left ventricular size. On echocardiography, left atrial enlargement was observed in 96% cats (subjective assessment) whereas maximum left atrial dimension was increased (>15.7 mm) in 93% cats. On radiographs left atrial enlargement (subjective assessment) was found in 48% (lateral view), 53% (ventrodorsal view), and 64% (any view) of cats whereas left atrial enlargement was absent in 36% of cats in both views. Agreement between both methods of left atrial size estimation was poor (Cohen's kappa 0.17). Receiver operating characteristic curve analysis identified a maximum echocardiographic left atrial dimension of approximately 20 mm as the best compromise (Youden index) between sensitivity and specificity in the prediction of radiographic left atrial enlargement. Left atrial enlargement as assessed by thoracic radiography may be absent in a clinically relevant number of cats with congestive heart failure. Therefore, normal left atrial size on thoracic radiographs does not rule out presence of left‐sided congestive heart failure in cats with clinical signs of respiratory distress.     

Evaluation of radiographic liver size in twenty-seven normal deep-chested dogs

Radiographic liver size was established in 27 clinically normal deep-chested dogs. In addition, the influence on radiographic liver size of technical factors such as positioning, respiratory phase and position of the central X-ray beam was evaluated. Exact measurement was complicated by two facts. First, the outline of the ventral and caudoventral borders of the liver shadow was not clearly delineated in all dogs. Secondly, in some dogs merging of the silhouettes of liver and spleen was present. As a result in only 14 out of 27 dogs used for this study could exact measurements be made. In this group of deep-chested dogs, the liver shadow was better delineated in left lateral recumbency. In left lateral recumbency less merging of the silhouettes of liver and spleen was noticed. Normal radiographic liver length measured on right lateral views made on expiration and expressed as a ratio to the length of the 11 th thoracic vertebra varied between 4·8 and 7·8 with a mean and standard deviation of 6·1 ± 0·8. The length of the liver tip protruding behind the curve of the 12th rib varied between -0·5 and 1·7 with a mean and standard deviation of 0·6 ± 0.7. This great variability in radiographic liver size between normal dogs of the same thoracic conformnation makes it rather difficult to diagnose hepatomegaly in individual cases. No difference in radiographic liver size of statistical significance could be found between right and left lateral recumbency. The respiratory phase during which the radiograph was made was the only factor causing a difference of statistical significance in radiographic liver size. In all dogs the length of the liver tip protruding behind the costal arch was longer on the view made during inspiration.     

Radiography and computed tomography of the heart and lower respiratory tract in toco toucans (Ramphastos toco)

This study aimed to evaluate normal features of the heart and lower respiratory tract in toco toucans by means of radiography and helical computed tomography (CT) scanner. Fifteen healthy adult toco toucans (Ramphastos toco), 10 females and 5 males, average body mass of 650 g were studied. CT examination as well as right lateral and ventrodorsal radiographic examinations of the coelomic cavity were performed under chemical restraint. Heart, lungs, air sacs, trachea and syrinx were analysed. The mean values of heart length, heart width and thoracic cavity in radiographs were, respectively, 23.76 mm, 25.94 mm and 48.87 mm. In both X-rays and CT scans, the lung parenchyma had honeycomb-like pattern. The topographic areas of the anterior and posterior air sacs were visualized as dark and air-filled spaces in X-rays. On CT evaluation, the air sacs occupied a larger area in the coelomic cavity compared to X-ray. In the lateral radiographic view, the cervical part of the trachea was positioned more ventrally in the transition from cervical to thoracic regions showing a V-shaped appearance. In all CT planes was visible division of the trachea into the right and left main bronchi at the level of 3rd thoracic vertebra. The syrinx was difficult to visualize in X-rays, but on CT it was easily identified in axial slice. In conclusion, the normal features of toco toucan's heart and lower respiratory tract that were determined on X-rays and CT scans are useful to compare with sick toco toucans, as well as other bird species.     

THE EFFECT OF POSITIONING ON THE APPEARANCE OF SELECTED CRANIAL THORACIC STRUCTURES IN THE DOG

In this retrospective study the effect of thoracic positioning on the visibility and size of selected cranial thoracic structures in dogs was investigated. Dorsoventral (DV), ventrodorsal (VD) as well as left lateral recumbent (LLR) and right lateral recumbent (RLR) thoracic radiographs of 17 large, 15 medium, and 10 small skeletally mature dogs were evaluated. The craniodorsal and cranioventral mediastinum, the cupula pleura and sternal lymph nodes were examined. The effect of obesity was also evaluated. The craniodorsal mediastinum was better delineated on DV radiographs and was wider on VD radiographs. The craniodorsal mediastinal width: width of T2 cranial end-plate on VD radiographs was 2.41 for all groups combined and obesity significantly influenced this value. The cranioventral mediastinum was more visible in RLR and VD radiographs. A normal sternal lymph node soft tissue opacity was seen most commonly in RLR in large breed dogs and had a mean length of 30 mm. The pulmonary cupula extended beyond the first rib on all views and extended more cranially and was better visualised on VD than DV views.     

Left principal bronchus rupture in a cat

A two-year-old neutered male domestic shorthaired cat was referred with respiratory compromise. Investigations included thoracic radiography and tracheal endoscopy. Findings were consistent with a traumatic avulsion injury to the left principal bronchus. Treatment involved the resection of the ruptured and stenosed left principal bronchus segment via a fifth right intercostal lateral thoracotomy. Once the damaged portion of bronchus had been removed, bronchial repair was achieved by end-to-end anastomosis. A full recovery was made and, at the time of writing (16 months postoperatively), the cat was clinically normal.     

Assessment of the value of the vertebral heart scale in the radiographic diagnosis of cardiac disease in dogs

In order to assess the influence of the vertebral heart scale (VHS) on the accuracy of the radiographic diagnosis of cardiac disease, thoracic radiographs of 50 dogs with proven cardiac disease, 26 with other thoracic diseases, and 50 with no clinical signs of cardiovascular or respiratory disease were mixed and examined by three independent, blinded observers chosen to represent a range of radiographic abilities. They first examined all the radiographs without making measurements of VHS and made a diagnosis. They then re-examined the radiographs, and measured VHS on both lateral and dorsoventral or ventrodorsal radiographs before again recording a diagnosis without reference to their original diagnoses. For all the observers, the dogs with cardiac disease had a higher mean VHS than the normal dogs. A VHS over 10.7 on the lateral radiograph was a moderately accurate sign of cardiac disease. The observers' accuracy of diagnosis did not change significantly as a result of using VHS as an adjunct to a subjective assessment of the radiographs.     

COMPARISON OF TWO- VS. THREE-VIEW THORACIC RADIOGRAPHIC STUDIES ON CONSPICUITY OF STRUCTURED INTERSTITIAL PATTERNS IN DOGS

Three-view thoracic radiography is often used to evaluate patients for pulmonary metastatic disease. Although use of three views has been reported to be more sensitive than two views for focal lung disease, it also requires increased time, effort, and radiographic exposure of patients and personnel. This study was performed to evaluate the conspicuity of lesions on two-view vs. three-view radiographic procedures to determine the proportion of diagnoses that would change. One hundred three-view radiographic studies of the canine thorax were randomized, and four protocols were reviewed for each study: right lateral and ventrodorsal views, left lateral and ventrodorsal views, both lateral views, and all three views. Radiographs were interpreted as either positive or negative for structured interstitial pulmonary disease, and the certainty of the reading was recorded using a visual analog scale. There was 85-88% agreement between each two-view group and the three-view group, with the kapp statistic ranging from 0.698 to 0.758. There were no differences in certainty of diagnosis among the groups, though within each group there was more certainty for positive diagnoses than negative diagnoses. These findings indicate that three-view studies should be continued when evaluating for possible structured interstitial pulmonary disease, including metastatic disease, as eliminating one view from a three-view study would change the diagnosis in 12-15% of patients.     

CARDIAC AND PULMONARY ARTERY MENSURATION IN FELINE HEARTWORM DISEASE

A retrospective study was undertaken to quantify thoracic radiographic changes in cats with heartworm diseases, ( Dirofilaria immitis ). Using a blinded study format, the cardiac silhouette, thoracic cavity and pulmonary arteries were measured from thoracic radiographs of 21 cats with feline heartworm disease and 30 cats without known cardiac or pulmonary vessel pathology. Measured data were normalized to the thoracic cavity or bony structures within the radiographic field of view. The measurements were compared between the two groups of cats using an unpaired, two-tailed Student's t -test, with a p value of < 0.05 being considered significant. Cats with feline heartworm disease had enlargement of the craniocaudal aspect of the cardiac silhouette and normalized cardiac:thoracic ratio (p < 0.05) on the lateral view. Also, there was significant enlargement of the central and peripheral caudal lobar pulmonary arteries and their normalized ratios (p < 0.05) in the heartworm infected cats as visualized on the ventrodorsal projection. Tortuosity of the pulmonary arteries was seen in three of the 21 infected cats. Eleven of the 21 cats with feline heartworm disease had pulmonary parenchymal changes. Based on the present study, central and peripheral pulmonary artery enlargement as viewed on the ventrodorsal radiograph was the single best radiographic indicator of feline heartworm disease.     

THE CANINE LATERAL THORACIC RADIOGRAPH

Selected structures seen on right and left lateral thoracic radiographs of 12 dogs were evaluated for differences in position, size, and shape. The size and position of the cardiac silhouette were different when thoracic radiographs made in left and right lateral recumbency were compared. These changes were, however, considered insignificant. The position of the right cranial lobe bronchus relative to the left varied in right lateral recumbency and left lateral recumbency. The right cranial lung lobe was better aerated when dogs were positioned in left lateral recumbency.
Lesions seen in the caudal portion of the left cranial lung lobe or the right middle lobe were masked when the affected lobe was dependent, and enhanced when the affected lung lobe was non-dependent. It is believed that this difference occurred due to compression of the dependent lung with greater aeration of the non-dependent lung.     

RADIOGRAPHIC EVALUATION OF CAUDAL VENA CAVA SIZE IN DOGS

Dilation of the caudal vena cava (CVC) on lateral thoracic radiographs is often interpreted as suggestive of right-sided congestive heart failure. To quantitate the clinical utility of evaluating CVC size as an indicator of right-sided heart disease, we compared the ratio of the diameter of the CVC as measured on a left lateral thoracic radiograph to the descending aorta (Ao), length of the thoracic vertebra above the tracheal bifurcation (VL), and width of the right fourth rib (R4) in 35 dogs with right heart disease and 35 control dogs. Each CVC ratio (CVC/Ao, CVC/VL, CVC/R4) was statistically larger in dogs with right heart disease. Response operating characteristic curves and likelihood ratios were used to determine ratios helpful in identifying dogs with right heart disease. A CVC/Ao > 1.50, CVC/VL > 1.30, or CVC/R4 > 3.50 are strongly suggestive of a right-sided heart abnormality in a patent.     

Norwich terriers possess a greater vertebral heart scale than the canine reference value

Previous studies have demonstrated evidence that normal reference ranges for radiographic vertebral heart scale values can vary among dog breeds. The purpose of this retrospective, observational study was to determine whether the normal vertebral heart scale values published by Buchanan and Bücheler for lateral radiographs are applicable to the Norwich terrier. Secondary objectives were to determine if clinical signs of respiratory disease, age, sex, weight, body condition score, recumbency, or thoracic depth‐to‐width ratio had any influence on vertebral heart scale measurements in this breed. The electronic medical record systems of two universities were reviewed and Norwich terriers were included in the study if they had orthogonal thoracic radiographs performed and no historical or radiographic evidence of cardiopulmonary disease. A vertebral heart scale was calculated for each patient. Sixty‐one client‐owned, Norwich terrier dogs with no clinical signs of cardiovascular disease were evaluated. The vertebral heart scale for Norwich terriers without evidence of cardiac disease (10.6 ± 0.6) was found to be significantly greater than the canine reference value of 9.7 ± 0.5 initially established by Buchanan and Bücheler. No significant correlation was found between clinical signs of respiratory disease, sex, age, thoracic depth‐to‐width ratio or lateral recumbency, and vertebral heart scale. Norwich terriers with a body condition score ≥6 had a significantly higher vertebral heart scale than those with a body condition score ≤5. Breed‐specific ranges and body condition scores need to be considered when interpreting vertebral heart scale values for Norwich terriers.     

Effect of expiratory phase for radiographic detection of left heart enlargement in dogs with mitral regurgitation

Radiography is a standard diagnostic test for characterizing left heart enlargement in dogs however limited information is available on the effects of respiratory phases. This prospective and retrospective method comparison study investigated the respiratory effect on the size and shape of the left heart in dogs to determine the usefulness of expiratory radiographs to detect enlargements in the left atrium (LA) and left ventricle (LV). Thoracic radiographs taken at full inspiration and expiration were evaluated in 20 normal beagles and 100 dogs diagnosed with mitral regurgitation (MR). Vertebral heart score (VHS), vertebral left atrial size, elevation of the carina, and dorsal bulging of LA on lateral view and lateral bulging of the left auricular appendage and LV on ventrodorsal view were assessed. In normal dogs, there were no significant differences in the evaluative factors between inspiration and expiration. In dogs with MR, VHS did not change according to respiration. However, bulging of the LA, left auricular appendage, and LV had sharp margin during expiration compared with inspiration. The expiratory radiographic finding of LA bulging had a higher correlation with the LA to aorta ratio compared with LA bulging in the inspiratory radiography. Using a LA to aorta echocardiographic ratio greater than 1.5 as the gold standard, the radiographic sensitivity for LA enlargement was higher during expiration than inspiration. These findings of our study indicated that expiratory radiography can be helpful to support the detection of left heart enlargement, although it can overestimate LA enlargement in dogs with MR.     

Effect of various thoracic radiographic projections on the appearance of selected thoracic viscera

OBJECTIVES: To assess the effect of different radiographic projections on thoracic width, as well as position and visibility of the trachea, principal bronchi, cardiac silhouette, aorta, caudal vena cava (CVC) and oesophagus. METHODS: Right lateral recumbency (RLR), left lateral recumbency (LLR), dorsoventral (DV) and ventrodorsal (VD) thoracic radiographs of 42 dogs were reviewed retrospectively. RESULTS: In 78 per cent of cases the thoracic width was significantly larger on the VD projection than on the DV projection. The angle of divergence formed by the principal bronchi was significantly larger on the VD projection than on the DV projection in 80 per cent of dogs. A cardiac silhouette bulge at 1 to 2 o'clock was apparent on the VD projection in 22 per cent of dogs but was never seen on DV projections. The descending aorta was more visible at the 4 to 5 o'clock cardiac silhouette level on the DV projection and laterally at the T8 level on LLR projections. The CVC was better seen on VD and LLR projections. The oesophagus was visible as a soft tissue opacity in LLR in large dogs with normal thoracic conformation in 35 per cent of cases. CLINICAL SIGNIFICANCE: The DV projection appears to be more reliable for assessing the cardiac silhouette, the descending aorta and the angle of divergence of the principal bronchi. The VD projection should be considered for evaluating the CVC. LLR should be used for assessing the descending aorta and CVC.     

EFFECT OF DEPENDENCY VERSUS NONDEPENDENCY ON LUNG LESION VISUALIZATION

Paraffin blocks and mineral oil were used as a model to determine the effect of dependency versus nondependency on radiographic visualization of lung lesions in lateral thoracic radiographs. It was concluded that the increased opacity of the material surrounding the lesion, not contact between the heart and the lesion, was responsible for the inability to detect lung disease in the dependent lung. The results were tested in dogs with pneumonia in the right middle lung lobe. When the dog was in right lateral recumbency, the dependent right lung was increased in opacity and decreased in volume and the pulmonary lesion was difficult to detect. When the dog was in left lateral recumbency, the nondependent right lung was increased in volume and decreased in opacity and the pulmonary disease was clearly visible. A single recumbent lateral radiograph must not be used to assess a dog with suspected lung disease because lesions in the dependent lung lobes may not be detected.     

Thrombi in the trachea of a dog secondary to placement of a tracheotomy tube

CASE DESCRIPTION: A 7-year-old Spaniel-crossbreed dog was evaluated for stertorous breathing and inspiratory stridor. CLINICAL FINDINGS: A temporary tracheotomy tube was placed prior to referral. Results of physical examination at our facility, including thoracic auscultation, were unremarkable. Examination of the larynx revealed a 2 x 2-cm nodular mass on the lateral aspect of the epiglottis and left arytenoid cartilage. Cytologic examination of the mass indicated septic suppurative inflammation and intracellular rod-shaped bacteria. During the procedures, decreased air movement through the temporary tracheotomy tube was detected, and the tube was replaced. A thrombus was found on the distal end of the temporary tracheotomy tube; the thrombus obstructed 90% of the tube lumen. Approximately 12 hours later, auscultation revealed decreased sounds in all lung fields. Cervical and thoracic radiography revealed an intraluminal soft tissue opacity distal to the tracheotomy tube. A thrombus that contained hair and plant material was removed from the trachea by use of an embolectomy catheter and videogastroscope. Approximately 30 hours after removal of the initial thrombus, the dog had an episode of respiratory distress. Cervical radiography revealed another intraluminal opacity. It was another thrombus, which also was removed by use of the videogastroscope. TREATMENT AND OUTCOME: Tracheoscopy was performed with a videogastroscope in an attempt to remove the thrombi. A Fogarty catheter was used to remove the initial intraluminal thrombus from the trachea. CLINICAL RELEVANCE: Airway obstruction resulting from an intraluminal thrombus in the trachea should be considered as a secondary complication after tracheotomy tube placement.     

Primary pulmonary osteosarcoma treated by thoracoscopy-assisted lung resection in a dog

A 6-year-old female, intact boxer presented with acute respiratory distress due to a mass in the left cranial thorax. The tumor, which originated in the left lung and was shown by histology to be an osteosarcoma, was removed by lateral thoracotomy. The dog died from unrelated disease 7 mo later and no tumor was evident at necropsy.     

Use of computed tomography in the diseased feline thorax

Computed tomography (CT) scanning of the thorax is gaining more attention in veterinary medicine as therapeutic possibilities increase. Plain and contrast-enhanced CT images of the thorax of five referred cats with signs of respiratory disease were evaluated using soft tissue (pleural) and lung windows. The common CT pattern in all cats was involvement of the lung lobes, either as a homogeneous or heterogeneous single lobe hyperdensity. It involved the main bronchus, invaded the cranial or caudal mediastinum, and crossed the border to the opposite lung. Right lung atelectasis and mediastinal shift caused left lung overinflation. Bronchial lymph node enlargement was found unilaterally or bilaterally. CT-guided percutaneous fine needle aspiration biopsy of the lobar lung lesion was performed in four cats; in three cases it revealed carcinoma and in one inflammation, although the cat with suspected inflammation was subsequently found to have a carcinoma on lung lobectomy. Histopathology confirmed lung metastasis in one case and bronchial adenocarcinoma in four cases. A protocol for systematic examination of thoracic CT images is proposed.     

Vertebral heart size in healthy Australian cattle dog

The vertebral heart score or size (VHS) measurement is routinely used to provide a more objective measurement of cardiomegaly in dogs. However, breed or body conformation can influence the VHS. To assess the specific VHS for the Australian Cattle Dog, left‐to‐right lateral, right‐to‐left lateral, dorsoventral and ventrodorsal thoracic radiographs from 20 individuals free from cardiac and pulmonary disease were obtained. The mean VHS was significantly higher in Australian Cattle Dog (10.5 ± 0.4 vertebrae), when compared with the average VHS for 100 normal dogs of different breeds that had been initially published (9.7 ± 0.5 vertebrae). This emphasizes the importance of breed‐specific VHS ranges. In our study group of normal Australian Cattle Dogs, the mean VHS was 10.5 ± 0.5 vertebrae (mean ±SD) on right lateral and 10.3 ± 0.5 vertebrae on left lateral radiographs. The VHS on right lateral views was significantly larger than on left lateral views. The VHS was 10.5 ± 0.6 vertebrae on dorsoventral and 11.1 ± 0.6 vertebrae on ventrodorsal radiographs. The VHS on ventrodorsal views was significantly larger than on dorsoventral views.     

Stage migration in dogs with lymphoma

BACKGROUND: Various diagnostic tests have been used to assign a clinical stage to dogs with lymphoma. As more sensitive staging methods are introduced, dogs are reclassified as having a higher disease stage, thereby affecting comparisons of dogs across differently staged clinical trials, and possibly, prognosis. HYPOTHESIS: The addition of more sensitive staging tests causes stage migration in dogs with lymphoma. ANIMALS: Fifty-nine client-owned dogs with previously untreated cytologically or histologically confirmed lymphoma METHODS: For every dog, the World Health Organization stage classification (I-V) was based on 5 groupings of various diagnostic tests: A (physical examination [PE] and quantitative blood count [QBC]), B (PE, QBC, thoracic and abdominal radiographs), C (PE, complete blood count with blood-smear evaluation [CBC], thoracic and abdominal radiographs), D (PE, CBC, thoracic radiographs, abdominal ultrasound), and E (PE, CBC, thoracic radiographs, abdominal ultrasound, and bone-marrow cytology). Dogs were treated with doxorubicin-based protocols. RESULTS: There was migration between all of the staging methods except D to E. However, the stage was not a predictor of remission rate, remission duration, or survival, regardless of staging method used. CONCLUSIONS AND CLINICAL IMPORTANCE: These data emphasized the need for standardized methods to determine the clinical stage in dogs with lymphoma.     

Bronchial dysgenesis and lobar emphysema in an adult cat

An adult male cat was examined because of chronic respiratory tract disease. Results of thoracic radiography indicated overinflation of the right lung, and atelectasis or agenesis of the left lung. Notable aerosol deposition (ventilation) to the right caudal lung lobe was seen by use of pulmonary ventilation scintigraphy. Postmortem findings suggested the primary pathoanatomic lesion was bronchial dysgenesis involving all but the right caudal lung lobe.