Thoracic radiographs

Basic veterinary thoracic radiographic interpretation

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Thoracic radiographs by Mind Map: Thoracic radiographs

1. Signalment and History

1.1. cough

1.2. respiratory distress

1.3. regurgitation

1.4. trauma

1.5. Breed or species prone to thoracic disease

1.6. Metastasis screening

1.7. geriatric screening

2. Technically acceptable

2.1. Correct views

2.2. Positioned appropriately

2.3. Proper exposure

2.4. Inspiration

3. Physical exam

3.1. Signs of primary intrathoracic disease

3.2. abnormal heart or lung sounds

3.3. palpable abnormality

3.4. systemic disease

3.4.1. fever

3.4.2. sepsis

3.4.3. immune-mediated disease

3.4.4. paraneoplastic syndrome

4. Problem List

5. Evaluate lungs

5.1. Under inflated lungs

5.1.1. Too white

5.1.1.1. Atelectasis

5.2. Well inflated lungs

5.2.1. Too white

5.2.1.1. unstructured

5.2.1.1.1. alveolar (consolidation)

5.2.1.1.2. interstitial (ground glass)

5.2.1.2. structured

5.2.1.2.1. Nodules/masses (dots)

5.2.1.2.2. Bronchovascular (lines and rings)

5.3. Hyperinflated lungs

5.3.1. Too black

5.3.2. Too white

5.3.2.1. Bronchovascular (lines and rings)

6. Evaluate pleural space

6.1. lungs don't reach the periphery of the thoracic cavity

6.1.1. soft tissue opacity in the pleural space

6.1.1.1. pleural effusion or mass/nodules

6.1.1.2. diaphragmatic hernia (see body wall)

6.1.2. Gas opacity in the pleural space

6.1.2.1. pneumothorax

6.1.3. fat opacity in the pleural space

6.1.3.1. incomplete pulmonary expansion

7. Evaluate cardiovascular structures

7.1. Size of cardiac silhouette

7.1.1. small

7.1.1.1. hypovolemia

7.1.2. normal

7.1.3. enlarged

7.1.3.1. left-sided enlargement

7.1.3.2. generalized

7.1.3.3. globoid

7.1.3.4. right-sided enlargement

7.2. Pulmonary blood vessels

7.2.1. small

7.2.2. normal

7.2.3. enlarged veins

7.2.4. enlarged arteries

8. Evaluate mediastinum

8.1. cranial mediastinum

8.1.1. normal

8.1.2. wide

8.1.2.1. fat deposition

8.1.2.2. soft tissue opaque mass

8.1.2.3. enlarged esophagus

8.2. esophagus

8.2.1. segmental enlargement

8.2.1.1. foreign body?

8.2.2. diffuse enlargement

8.2.3. normal (not seen)

8.3. lymph nodes

8.3.1. normal (not seen)

8.3.2. enlarged, soft tissue opaque nodules/masses

8.4. trachea

8.4.1. normal diameter

8.4.2. narrow

8.5. Can you see serosal margins of mediastinal structures, including the great vessels, esophagus, and trachea?

8.5.1. Pneumomediastinum

9. Evaluate body wall

9.1. skeletal structures

9.1.1. fracture

9.1.2. aggressive bone lesion(s)

9.1.3. malformation

9.1.4. degenerative change

9.2. diaphragm

9.2.1. normal appearance

9.2.1.1. diaphragmatic hernia

9.2.1.2. peritoneopericardial diaphragmatic hernia

9.3. soft tissues

9.3.1. thickening with soft tissue opacity

9.3.1.1. mass

9.3.2. thickening with gas

9.3.2.1. abscess

9.3.2.2. wound

10. Evaluate extra-thoracic anatomy

10.1. visible portion of abdomen

10.1.1. poor serosal detail

10.1.2. liver abnormalities

10.1.3. gastric abnormalities

10.2. limbs

10.2.1. aggressive bone lesion(s)

10.2.2. degenerative joint disease

10.2.3. trauma

11. Thoracic point of care ultrasound

11.1. Evaluate pleural space

11.1.1. absent glide sign

11.1.1.1. pneumothorax

11.1.2. pleural effusion

11.2. Evaluate cardiac structures

11.2.1. pericardial effusion

11.3. Evaluate lungs

11.3.1. b-lines

11.3.1.1. "wet lung"

11.3.1.1.1. pulmonary edema

11.3.1.1.2. early pneumonia

11.3.1.1.3. few with atelectasis

11.3.2. consolidation

11.3.2.1. pneumonia

11.3.2.2. neoplasia

12. Other diagnostics

12.1. POC bloodwork

12.2. Referral images

12.3. Urinalysis