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