2012 Radiology Exam - Thorax Case 1

History: 3 month old male intact Vizsla, presented for respiratory distress and has harsh lung sounds.

Radiographic Finding: There is a diffuse bronchial pattern in the lungs with thickening of bronchial walls. There is also a diffuse interstitial pattern with indistinct vessel margins. There is a focal alveolar pattern with air bronchograms in the right middle lung lobe with lobar consolidation. There are faint pleural fissure lines present. There is an incidental small, metal foreign body in the stomach.

Radiographic Interpretation/Synthesis: There is diffuse bronchial disease that is complicated by probable hematogenous bronchopneumonia that could be viral or bacterial in nature. Fungal disease is unlikely in a patient of this age. Other less likely rule-outs are ciliary dyskinesia or PIE.

Management: Bronchoscopy with BAL or trans-tracheal wash.

Outcome: The patient was diagnosed with bordetella and mycoplasma pneumonia.

Successful candidates recognized and described all components of pulmonary disease and realized there was a complicating factor to the underlying bronchial disease. Unsuccessful candidates did not recognize the bronchial pattern or came to inappropriate conclusions such as aspiration pneumonia or pleural disease.