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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Norman Ackerman Memorial Radiography Case Challenge

SAM 9 year old MN Mixed Breed Dog

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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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Based on your assessment of the radiographs, the thoracic body wall is:A.NormalB.Abnormal

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Correct!

There are no abnormalities associated with the thoracic wall.

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Sorry!

The thoracic body wall, including the extrathoracic structures, are within normal limits

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Based on your assessment of the radiographs, the pleural space is:A.NormalB.Abnormal

Correct!

There are no abnormalities associated with the pleural space.

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Sorry!

The pleural space is normal

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Based on your evaluation, the cardiac silhouette is:A.NormalB.Abnormal

Sorry, Try Again

The cardiac silhouette is within normal limits.

Click here to continue

Correct!

There are no abnormalities associated with the cardiac silhouette

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Based on your assessment of the radiographs, the lungs, including the vessels, are:A.NormalB.Abnormal

Sorry!

There is an abnormality associated with the lungs.

Continue

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.BronchialB.AlveolarC.VascularD. Unstrutured Interstitial

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

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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

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IV

AB

BE

AB=air bronchogramIV=indefinition of vesselsBE=border effacement on the cardiac silhouetteLS=lobar sign

LS

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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.

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Conclusion

What is top differential diagnosis?

Cardiogenic pulmonary edema Aspiration pneumonia Recumbence atelectasia

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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!

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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!

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Correct!

Aspiration pneumonias are usually ventral, due to gravitational forces.

This also goes along with the acute clinical signs.

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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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