2009 Radiology Exam - CT/MRI Case 2

Signalment: 6-year old, female neutered Labrador

History:

  • lethargy, inappetance, signs of abdominal pain and pyrexia for about 3 weeks
  • mild neutrophilia with left shift
  • sublumbar abscess identified by CT
  • thoracic CT requested to look for additional lesions

See images below. Click to enlarge.

Observations:

  • study comprises transverse non-contrast CT images of the thorax; lung window
  • multiple small pulmonary nodules, predominantly in the periphery

Synthesis:

  • multiple pulmonary nodules is a non-specific finding; potential aetiologies include hematogenous dissemination of disease, e.g. metastasis, embolism
  • embolic pneumonia is compatible with the finding of sublumbar abscess
  • lumbar neoplasm with secondary abscess and pulmonary metastasis should also be considered

Management:

  • further testing may enable diagnosis of pulmonary lesions, e.g. bronchoalveolar lavage, biopsy
  • treatment of lumbar abscess may lead to resolution of embolic pneumonia without need for further testing; this could be determined by follow-up CT scan