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