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What is the consensus regarding detecting lung lobe torsion with ultrasound? I know the gold standard should be CT, but when unavailable, how can we be certain? Yes, pleural effusion that is usually modified transudate, lots of fibrin, with a poorly aerated lung, or hepatized lung. But in the absence of those & with no pulmonary mass, can it still be torsion?
ThanksI
Comments
I put up this image of a lung
I put up this image of a lung lobe torsion. Smaller breeds have a predisposition for a right cranial lung torsion and larger breeds right medial. This was a necrotic lung lobe torsion in a collie. In my experience there is usually a low grade history that corresponds to the underlying disease followed by sudden onset of “Not doing right.” The progressive cough followed by sudden respiratory distress or anorexia in case of pneumonia/pneumonitis followed by torsion , or low grade weight loss and maybe cough followed by sudden decline such as a lung carcinoma with torsion are the classic scenarios in my experience. The pleurocentesis with hemorrhagic effusion and consolidated lung lobe as seen here should bring LLT up into the top differential and consider thoracotomy right away… which is a tough call but essential. In dogs, things that can be resolved with this type of sonographic presentation necessitate thoracotomy regardless. LLT is one of them
Eric Lindquist DMV (Italy) DABVP
Cert./Pres. IVUSS
Director SE NJ Mobile Associates
Founder/CEO: SonoPath.com
I put up this image of a lung
I put up this image of a lung lobe torsion. Smaller breeds have a predisposition for a right cranial lung torsion and larger breeds right medial. This was a necrotic lung lobe torsion in a collie. In my experience there is usually a low grade history that corresponds to the underlying disease followed by sudden onset of “Not doing right.” The progressive cough followed by sudden respiratory distress or anorexia in case of pneumonia/pneumonitis followed by torsion , or low grade weight loss and maybe cough followed by sudden decline such as a lung carcinoma with torsion are the classic scenarios in my experience. The pleurocentesis with hemorrhagic effusion and consolidated lung lobe as seen here should bring LLT up into the top differential and consider thoracotomy right away… which is a tough call but essential. In dogs, things that can be resolved with this type of sonographic presentation necessitate thoracotomy regardless. LLT is one of them
Eric Lindquist DMV (Italy) DABVP
Cert./Pres. IVUSS
Director SE NJ Mobile Associates
Founder/CEO: SonoPath.com