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thoracic radiographs should be made at what phase of respiration?
full inspiration (to maximize the amount of gas within the thorax, so abnormal soft tissue opacities can be visualized)
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How do you know you have caudal thoracic radiographs properly exposed in an adult large animal patient?
under-exposed (too white) cranial abdomen
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Which lungs are best evaluated in recumbent thoracic radiographs?
- non-recumbent lung lobes are evaluated best (b/c the recumbent lungs cannot fully inflate d/t compression)
- R recumbent lateral- evaluate left lobes best
- L recumbent lateral- evaluate right lobes best
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Which lungs are best evaluated in standing thoracic radiographs?
- the lobes closest to the film (sharper, less magnification, no concern with compression when standing)
- R standing lateral- right lobes evaluated best
- L standing lateral- left lobes evaluated best
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Describe the vascular pulmonary pattern.
- increased or decreased prominence of pulmonary vascular structures (lungs don't look as black as they should be, can see defined vessels)
- may look like increased number of vessel (d/t smaller peripheral vessels becoming enlarged and more prominent)
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What types of pathology cause a bronchial pattern?
- fluid and/ or cellular material within bronchial walls, bronchial lumens, and/or peribronchial space
- commonly associated with chronic inflammation and hypersensitivity
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What are the subsets of bronchial pattern? (4)
- mineralization- age related change
- bronchiectasis- dilation of bronchi
- bronchial thickening- actual bronchial walls are thicker
- peri-bronchial edema- darker around each bronchus
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What is the radiographic appearance of bronchiectasis?
- increased diameter of bronchus
- donuts
- tram lines
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What is the radiographic appearance of a bronchial pattern?
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What causes an interstitial pattern?
accumulation of fluid and/or cells in the pulmonary interstitial space (connective tissue b/w airway and alveoli)
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What are the types of interstitial pattern, and how does each appear radiographically?
- Unstructured interstitial: soft tissue haze that obscures the pulmonary vasculature; fluid and/or cells within the interstitium
- Structured interstitial: round, soft tissue opacities, solid or cavitated; aggregation of cells within the interstitium
- [must do FNA to Dx]
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What is the general pathology behind an alveolar pattern?
- displacement of air from the distal spaces of the lung
- flooding of pulmonary acini with pus, edema, or blood
- collapse of airways
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Describe how an alveolar pattern spreads.
acini are connected by pores that allow the fluid to spread; HOWEVER, pleural fissures act as a barrier, so fluid can't move b/w lung lobes unless it travels through the bronchi
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How does an alveolar pattern appear radiographically?
"air bronchograms"- air-filled airways surrounded by soft tissue opacity; you CANNOT see the blood vessels around the airways
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How can you diagnose the cause of an alveolar pattern?
trans-tracheal wash or bronchoalveolar lavage
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What is a lobar sign?
- pattern of pathology outlines the lobe; diseased lung next to normal, aerated lung
- most commonly with alveolar pattern (sometimes with unstructured interstitial pattern)
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