2007 Radiology Exam - Thorax Case 1

Information Provided to the Candidate

• A 3 year old Persian cat presented for coughing.
• Both laterals and ventrodorsal radiographs of the thorax are available.
• State your radiographic findings
• What is your assessment of these findings?
• Are further imaging studies needed? If so, what are they and why? If no, why not?

See images below. Click to enlarge.

Candidate received points for:
It was important for the candidate to recognize cardiac enlargement with no pulmonary vessel enlargement. There was loss of normal diaphragmatic contours in all views with confluence with the cardiac silhouette. On the lateral views, the presence of a dorsal peritoneopericardial mesothelial remnant could be visualized. There was a diffuse bronchial pattern. An incidental finding was the mineralization associated with adrenal glands.

Radiographic diagnosis: Peritoneopericardial diaphragmatic hernia (PPDH), feline asthma

Next step: echocardiogram, celiogram

Candidate performance:
Many candidates did not recognize the PPDH and leaped to cardiomyopathy. The cat did not present with a murmur and the coughing was related to the bronchial disease associated with feline asthma not cardiac disease.