Looking for the lung lesions

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Looking for the lung lesions

  • 9 yr old FS DSH presented for anorexia
  • Chest radiographs showed an alveolar pattern in both cranial lung fields and the caudal right lung field
  • Radiology report indicated pneumonia as the most likely differential  and neoplasia less likely
  • The patient was started on Zenequin and later prednisone
  • FNA’s of the lung lesions were requested
  • I could not find any pleural or pulmonary abnormalities, the lung-pleural interface appeared normal
  • I saw a triangular wedge of tissue near the heart base but suspect this is fat
    • 9 yr old FS DSH presented for anorexia
    • Chest radiographs showed an alveolar pattern in both cranial lung fields and the caudal right lung field
    • Radiology report indicated pneumonia as the most likely differential  and neoplasia less likely
    • The patient was started on Zenequin and later prednisone
    • FNA’s of the lung lesions were requested
    • I could not find any pleural or pulmonary abnormalities, the lung-pleural interface appeared normal
    • I saw a triangular wedge of tissue near the heart base but suspect this is fat
    • I am also including a pic (3rd still below) that shows a hypoechoic structure outside the chest cavity on the cranial right lateral thorax….just wondering what this is…lymph node? 
    • Owner reports cat is doing better although most recent radiographs show no improvement
    • I did FNA’s anyways in the regions where I could see lesions on the radiographs.  Cytology is pending.
    • Am I missing something here?

     

Comments

EL

Your video shows the show

Your video shows the show curtain lung pattern which is tough to stick well because you don’t know whats behind that pattern and there is no solid consolidation. As you say just fat the chest. Things that do this are pneumonitis, neoplasia, thromboembolic disease…. I follow the shower curtain up and down the ribs trying to find a consolidation using variable pressure and even sedation to see if I can get a better acoustic window to a consolidation to stick. I even have a tech use manual pressure on areas on the chest to try to find a window after mapping our the consilidation from a radiograph.

Look at Lindquist compression technique in Interventional procedures

http://sonopath.com/resources/interventional-procedures

If I have nothing more than what you show here I hunt the abdomen for a primary neoplastic lesion playing the odds like a LN or panc tumor or something easier to stick and get solid cyto.

Electrocute

Thanks Eric.  The cat was

Thanks Eric.  The cat was sedated for this procedure.  If I get the opportunity to visit the abdomen, I will.

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