2010 Radiology Exam - Thorax Case 2

SIGNALMENT
4 year neutered male OESD

HISTORY

  • History of previous diaphragmatic hernia repair
  • Increased respiratory rate for about 1 week
  • No response to antibiotics

See images below. Click to enlarge.

OBSERVATIONS

  • Soft tissue opacity throughout the R hemithorax with focal ovoid opacity adjacent to the heart base on the right
  • Bronchial changes
  • R middle not clearly seen
  • R caudal terminates abruptly
  • Air bronchograms in right cranial and accessory lobes
  • Margins of diaphragm visible in lateral views
  • Small amount of pleural fluid in the right cranial thorax

SYNTHESIS

  • R caudal lobe mass or lobe torsion
  • Possible involvement of R middle lobe
  • Air bronchograms in R cranial and accessory - primary lung disease or partial atelectasis.

CASE MANAGEMENT

  • CT/US guided biopsy
  • Surgery

CHALLENGES

  • Failure to recognize that both crura were visible on the opposite lateral views
  • Inappropriate identification of cranial displacement of the stomach and decreased volume of liver in the abdomen
  • Failure to evaluate the bronchi and see the lack of an air bronchogram in the right middle lung lobe and truncated right caudal bronchus