Case Study

RADS – Traumatic Lung Injury with Pulmonary Contusion/Hemorrhage and Pleural Effusion in a 13 year old MNPug dog

History: hit by truck last weekend, right front brachial plexus avulsion, rib fracture T4, dorsal spinous process fractures T1-T3, starting to have increased respiratory effort and throat clearing.

Physical Exam: non-ambulatory, temp-102.7, RR-16 (sleeping), recieving 2 hyperbaric oxygen therapy treatments daily

History: hit by truck last weekend, right front brachial plexus avulsion, rib fracture T4, dorsal spinous process fractures T1-T3, starting to have increased respiratory effort and throat clearing.

Physical Exam: non-ambulatory, temp-102.7, RR-16 (sleeping), recieving 2 hyperbaric oxygen therapy treatments daily

DX

The radiographic findings were compatible with traumatic lung injury with pulmonary contusion and or hemorrhage within the left cranial lung lobe. There is mid leftsided pleural effusion likely compatible with hemorrhage.

Image Interpretation

right lateral, left lateral and VD thorax- patient was mildly obese.
Radiographic findings:
Osseous structures: There first to third dorsal spinous process and the left third to fifth
rib presented acute traumatic fractures with mild to moderate displacement.
Extrathoracic/-abdominal soft tissues: There was a soft tissue opaque swelling within
the left armpit.
Abdominal Structures:
The serosal detail was preserved. There was moderate aerophagia.
Intrathoracic structures: The course of the trachea was normal.
There was no mediastinal widening and no evidence of mediastinal lymph node
enlargement. There was no mediastinal shift.
The cardiac silhouette was within normal limits regardings size. There appeared to be
mild left atrial tenting which may be a function of the chest rotation. The major and
pulmonary vessels were within normal limits.
The lungs presented a heterogenously increased mixed interstitial and alveolar opacity
localized to the left cranial lung lobe. The left lung was mildly retracted from the chest
wall with mild lobar rounding and soft tissue opaque material between the lungs and
the chest wall.

Comments

Currently there is no pneumothorax. Consider ARDS in case of peracute worsening of dyspnea as this can occur without overt radiographic changes initially. The aerophagia is likely an expression of increased respiratory effort and/or pain here. The osseous changes and soft tissue swelling in the left armpit fit the known fractures and brachial plexus avulsion with hematoma. There are no overt cardiac changes. But in case these radiographs had been obtained ,after administration of diuretics a cardiac echo is warranted.