Dr.-Ackermans-Display-Clinical-Case-Nov12.ppsx

Dr.-Ackermans-Display-Clinical-Case-Nov12.ppsx

1. Dr. Norman Ackerman served the University of Florida, College of Veterinary
Medicine with distinction as Professor of Radiology from 1979 to 1994. A
concerned teacher of veterinary students and residents of all disciplines, Dr.
Ackerman also reached the veterinary scientific community through his writing. His
numerous clinically pertinent publications are still today a vital part of the veterinary
literature; therefore, it is appropriate this site perpetuates Dr Ackerman’s dedication
to teaching.
   This site is presented in recognition of Dr. Norman Ackerman and his
contributions to the field of veterinary diagnostic imaging.
Sponsorship of the display supports the Dr. Norman Ackerman Memorial Fund,
dedicated to the teaching of diagnostic imaging residents at the University of
Florida College of Veterinary Medicine.
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2. Norman Ackerman Memorial
Radiography Case
Challenge
SAM
9 year old MN Mixed Breed Dog
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3. Signalment
Sam presents to your clinic with a acute
history of cough and exercise
intolerance
On physical examination, you hear
crackling lung sounds cranially, on the
right side
You order thoracic radiographs
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4. Next SlidePrevious Slide

5. Next SlidePrevious Slide

6. Next Slide
Previou
s
Slide

7. Based on your assessment of the
radiographs, the thoracic body wall is:
A.Normal
B.Abnormal
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8. Correct!
There are no
abnormalities
associated with the
thoracic wall.
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9. Sorry!
The thoracic body wall, including the
extrathoracic structures, are within
normal limits
Click here to proceed to the next question

10. Based on your assessment of the
radiographs, the pleural space is:
A.Normal
B.Abnormal

11. Correct!
There are no
abnormalities
associated with the
pleural space.
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12. Sorry!
The pleural space is normal
Click here to proceed to the next question

13. Based on your
evaluation, the cardiac
silhouette is:
A.Normal
B.Abnormal

14. Sorry, Try Again
The cardiac silhouette is
within normal limits.
Click here to continue

15. Correct!
There are no
abnormalities
associated with
the cardiac
silhouette
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16. Based on your assessment of the
radiographs, the lungs, including the
vessels, are:
A.Normal
B.Abnormal

17. Sorry!
There is an
abnormality
associated with the
lungs.
Continue

18. Correct!
There is an area of increased soft tissue
opacity mainly on the ventral aspect of
the right cranial lung lobe. Based on your
assessment, which pulmonary pattern is
predominant within that lobe?
A.Bronchial
B.Alveolar
C.Vascular
D. Unstrutured Interstitial

19. Sorry!
Indefinition of the
pulmonary vessels, air
bronchograms, lobar
sign, and (in this case,
discrete) border
effacement of the
lobar opacification with
the cardiac silhouette
are not characteristics
of this pulmonary
pattern
Previous Slide

20. Correct!
This is an example of an
alveolar pulmonary
pattern.
Some of the features of this
pattern include: Indefinition
of the pulmonary vessels, air
bronchograms, lobar sign,
and (in this case, discrete)
border effacement of the
lobar opacification with the
cardiac silhouette.
Remember: It does not have
to have all these features to
be considered an alveolar
pattern!
Continue

21. 21
IV
AB
BE
AB=air bronchogram
IV=indefinition of vessels
BE=border effacement on the cardiac silhouette
LS=lobar sign
LS
ContinuePrevious Slide

22. Conclusion
Your findings now include: increased soft
tissue pulmonary opacity within the right
cranial lung lobe, with presence of
indefinition of the pulmonary vessels, air
bronchograms, lobar sign, and (in this
case, discrete) border effacement of the
lobar opacification with the cardiac
silhouette. This represents an alveolar
pulmonary pattern, which, in this case, is
mainly ventral. click next.

23. 23
Conclusion
What is top differential diagnosis?
Cardiogenic pulmonary edema
Aspiration pneumonia
Recumbence atelectasia

24. 24
Sorry!
Usually cardiogenic
edema has a
caudodorsal
distribution within the
lung parenquima of
dogs
Although we cannot
totally ruled out cardiac
disease just using
radiographs, the cardiac
silhouette is within
normal limits in this
case.
One more try!

25. 25
Sorry!
In addition to the soft
tissue opacification
within the lungs, in
cases of atelectasis,
usually is observed a
decreased volume of
the affected lung lobe,
and sometimes
ipsilateral mediastinal
shift (MS). In Sam’s
case, the volume of the
right cranial lung lobe
is normal (not
decreased).
MS
One more try!

26. 26
Correct!
Aspiration pneumonias are usually
ventral, due to gravitational forces.
This also goes along with the acute
clinical signs.
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27. 27
Some causes of Aspiration
Pneumonia (Dennis, Kirberger, Barr, Wrigley:
Handbook of Small Animal Radiology and Ultrasound,
2nd ed., 2010):
Regurgitation and vomiting, especially if esophageal
dilation is present;
Iatrogenic aspiration: force feeding, medication,
anesthesia and oral administration of contrast
medium;
Swallowing disorders;
Weakness and debilitation;
Cleft palate;
Tracheo-esophageal or broncho-esophageal fistula.
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