2009 Radiology Exam - Thorax Case 1

Candidates were given right lateral and VD views of the thorax of a 5 year old Mixed breed canine Intact Female with a history of having a heart murmur since a puppy (never diagnosed or treated) but now lethargic, weak, and inappetant for 48 hours.

See images below. Click to enlarge.

Observations (Radiographic findings):

• a triangular-shaped, bone density foreign object in the region of the mid-thoracic esophagus
• generalized cardiomegaly; the cardiac silhouette is taller than normal and the left atrium is enlarged
• "bumps" on the VD view indicating enlargements of the main pulmonary artery, aortic arch, and left auricular appendage
• overall increased pulmonary vasculature ("hypervascular" pattern/over-circulation)

Synthesis (Radiographic Diagnosis):

• Esophageal foreign body, explaining the recent lethargy, weakness, inappetance
• Patent ductus arteriosus with left to right shunting

Recommendations:

• Echocardiography
• Endoscopy to evaluate esophagus and remove FB; points were not deducted for esophagram to confirm esophageal FB, but candidate was expected to discuss benefits/disadvantages of iodinated vs. barium contrast agents if esophagram was recommended