- 12 year old FS Collie mix with history of a cough and wheezing
- Chest radiographs show a possible mass in the right cranial thorax
- I could not find any masses, nodules, or effusions using multiple windows (intercostal/paracostal, thoracic inlet, parasternal) and multiple patient positions (RP, LP, standing).
- I am posting the radiographs and sample ultrasound pic.
- The patient was started on antibiotics and antihistamines and will get follow up radiographs next week.
- 12 year old FS Collie mix with history of a cough and wheezing
- Chest radiographs show a possible mass in the right cranial thorax
- I could not find any masses, nodules, or effusions using multiple windows (intercostal/paracostal, thoracic inlet, parasternal) and multiple patient positions (RP, LP, standing).
- I am posting the radiographs and sample ultrasound pic.
- The patient was started on antibiotics and antihistamines and will get follow up radiographs next week.
- What do you all think? Am I just not finding the right window or is there no mass?
Comments
I see some bronchial changes
I see some bronchial changes and maybe sternal LN starting up but in the VD the right scaula is superimposing on the chest and adding density so not sure that’s a mass there. When the lesion in the lung is not huge and right on the body wall if you sedate and apply pressure and rung the intercostal spaces sternum to spine then find a comet tail and follow it to a consolidation but often need sedation to make that happen. Here is what i do:
Check out compression technique for thoracic fna
http://sonopath.com/resources/interventional-procedures
Eric, in the third u/s still,
Eric, in the third u/s still, could there be a small area of lung consolidation or hypoechoic nodule at the lung/chest wall interface. The bigger arrow is the area I am talking about the the thinner arrow showing the lung interface where you would normally look for the glide sign. I know this would be better evaluated in a clip though.
Just an FYI….I was angling
Just an FYI….I was angling up a little bit into the right axillary region on that shot. This was a large dog with a moderately thick layer of subcutaneous fat over the chest wall. I was trying to get as far cranio-ventral as possible on the chest wall from the left parasternal down position.
OK – maybe just normal tissue
OK – maybe just normal tissue then – helps to know where you are at!
When I look at the VD rads I
When I look at the VD rads I can clearly see the scapula on the right side- but it still seems that R cranial lobe is consolidated. It also appears to be a “fissure” line between the R middle lung lobe and the R Cranial lung lobe. I would consider taking a lateral x-ray from the other side down just for comparison.
Not sure about your US findings- but it does look like some sort of pathology there.
May be worthwhile to treat conservatively and re- x-ray.
Just my 2 cents for what it is worth 🙂
Yeh I see what you are
Yeh I see what you are looking at JP. Thats such a small lesion you would have to play with that lesion to focus on and try to expand into something you can stick. pneumonitis, neoplasia, thromboembolic, all can do this. I will be discussing this at my hour talk on thoracic US at IVUSS as Im speaking for Bob’s hour (He can’t attend this year) and doing a tag team lecture with Nele Ondreka DECVDI. http://www.ivuss.com/meeting/meeting_2015.html
Sorry that Bob can’t attend
Sorry that Bob can’t attend 🙁 It won’t be the same without him.
I will post again next week
I will post again next week if I can get the follow up rads.