INTERACTIVE RADIOGRAPHIC CASE STUDIES

 
 

JasmineCase Background

 
Name Jasmine
Age 12 years
Sex Female, spayed
Breed Shih Tzu
 

Please review Jasmine's clinical history.

Coughing for the past 4-6 weeks; getting worse in the last week. No respiratory difficulty. Still has good energy and will go for walks. Eating and drinking fine.

View Jasmine's right lateral radiograph
View Jasmine's ventrodorsal radiograph
View Jasmine's annotated right lateral radiograph  

TECHNICAL DETAILS

Location of images: Thoracic radiographs obtained.

Views of images: Right lateral and ventrodorsal radiographs were obtained.

RADIOGRAPHIC FINDINGS

Technical issues: May be slightly expiratory on lateral, increasing the subjective impression of the opacity of the pulmonary parenchyma in the perihilar area.

Cardiac size including VHS: VHS 11.8, predominantly LV and LA enlargement (especially on lateral, to a lesser extent on the VD); subjectively right side may also be enlarged (wide on lateral and VD suggests some RVE).

Other Findings: Pulmonary vasculature relatively normal with no interstitial changes; no pleural effusion; patient is overweight; trachea narrows slightly, with significant narrowing of airways at heart base.

 Radiographic Interpretation: Cardiac enlargement, predominantly left sided; pronounced left atrial enlargement associated with airway compression; no CHF.
 Discussion: This patient has clear evidence for left sided enlargement, especially left atrial enlargement. The lack of any interstitial or vascular abnormalities suggests that the coughing is not a manifestation of congestive heart failure. Rather airway compression (with the potential for concurrent airway collapse) is the more likely explanation for the cough. This would fit with the otherwise normal presentation.
Treatment/Management: The lack of congestive heart failure makes therapy with diuretics unnecessary. Cough suppressants would be beneficial in this case given the presenting complaint, especially in the absence of concurrent pneumonia, edema or other pulmonary infiltrate. The use of ACE inhibitors can also be considered given the degree of cardiac enlargement and associated clinical signs.