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com

COM PA N I O N A N I M A L PR ACT I CE Good thoracic radiographic

technique is important to
obtain diagnostically useful
images

Radiological assessment of
lung disease in small animals
1. Bronchial and vascular patterns
RUTH DENNIS

INTERPRETATION of thoracic radiographs is often challenging, even to the extent of differentiating

normal from abnormal images. Overlooking significant lung pathology is clearly a problem but,
conversely, over-reading of radiographs can lead to false positive diagnoses, with potentially serious
consequences for the patient. Problems can arise from suboptimal image quality, variations in
appearance due to technical or patient factors and non-specificity of radiographic changes. This article
demystifies some of the principles surrounding interpretation of lung radiographs to help the reader
gain greater confidence in interpreting thoracic films. An article in the next issue will consider alveolar,
interstitial and mixed lung patterns, nodules, masses and pulmonary mineralisation, and discuss the
Ruth Dennis causes of decreased pulmonary opacity.
graduated from
Cambridge in 1981.
After spending
three years in
PATTERN RECOGNITION these problems, an alternative interpretive approach was
general practice, described by Nykamp and others (2002), who proposed
she returned Four specific lung patterns are recognised in small ani- a new method of classifying lung changes based on four
to Cambridge
to specialise in mal radiology: bronchial, vascular, alveolar and inter- signs: location, severity, ‘lines and rings’ and lung volume.
radiology, and in stitial. These are based on the tissue or anatomical area In fact, the two systems should not be considered mutually
1992 moved to
the Animal Health that is presumed to be abnormal. Mixed patterns are also exclusive, and this article discusses a combined approach.
Trust. She holds the seen and are described in terms of their components (eg,
RCVS diploma in
veterinary radiology,
a ‘bronchointerstitial’ pattern). Although this pattern rec-
and is a diplomate ognition method is widely used, it has limitations as the THORACIC RADIOGRAPHIC TECHNIQUE
of the European
College of Veterinary
perceived pattern does not necessarily reflect the tissue
Diagnostic Imaging involved. In addition, diseases with very different aetiolo- Accurate interpretation of thoracic radiographs requires
and an active gies can look similar, and identification of radiographic high quality images. Factors contributing to this include:
member of the
European Association changes in other organs or further diagnostic tests may be ■ ABSENCE OF MOVEMENT BLUR. This requires the use
of Veterinary required to reach a definitive diagnosis. In order to address of short exposure times, ideally 0·03 seconds or less;
Diagnostic Imaging.
Her particular
interests are
radiology and MRI
in small animals.

(left) Thoracic radiograph of a Border collie under general anaesthesia. The lungs are poorly inflated, resulting in a diffuse
In Practice (2008) increase in lung opacity, especially dorsally. (right) The same dog with manual inflation of the thorax. The lungs are well
30, 182-189 aerated and there is clear delineation of the pulmonary vasculature

182 In Practice ● APRIL 2008

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Ventrodorsal radiograph of the thorax of a terrier under
general anaesthesia and lying in right lateral recumbency,
obtained using a horizontal x-ray beam. The radiograph
shows how the dependent lung field is slightly collapsed
and there is a diffuse increase in opacity, especially under
the heart, which can mask areas of pathology by reducing
aeration of the surrounding lung tissue
■ INFLATION OF THE LUNGS TO MAXIMISE CONTRAST.
Exposures should be made on inspiration and, where
possible, under general anaesthesia with manual infla-
tion of the lungs. This also abolishes respiratory blur.
However, expiratory radiographs may be useful in
selected cases to look for emphysema and small pneumo-
thoraces. Under general anaesthesia, the dependent lung
area often undergoes atelectasis, especially in large
dogs, so radiographs should be acquired as soon as
possible after induction;
■ ACQUISITION OF A SUFFICIENT NUMBER OF PROJEC-
TIONS. It is recommended that both right and left lateral
recumbent lateral radiographs are obtained, as changes
in the dependent area may be masked by atelectasis and
the uppermost lung is more likely to show pathology as
it is better aerated. A dorsoventral (DV) or ventrodorsal
(VD) view should also be obtained in most cases;
■ USE OF APPROPRIATE EXPOSURE FACTORS. Both under-
and overexposure can mimic pathology. For the thorax, a
high kV technique should be employed when using con-
ventional film in order to provide a wide range of con-
trast. This means that the corresponding mAs is small,
which permits short exposure times. For digital images,
an appropriate processing algorithm should be used,
together with short exposure times;
■ USE OF A GRID FOR CHESTS GREATER THAN 15 CM
THICK. This minimises loss of definition due to fog-
ging by scattered radiation, unless it necessitates an
unacceptably long exposure time;
(left) Close-up of the caudoventral lung on a left lateral recumbent thoracic radiograph of a Bernese mountain dog,
showing a discrete soft tissue mass. (right) Right lateral recumbent radiograph of the same dog. The mass is not visible
because the heart compresses the dependent lung field, reducing the contrast between the aerated lung and pathology.
The mass is therefore likely to be in the right lung
In Practice ● APRIL 2008
■ GOOD PROCESSING TECHNIQUE FOR CONVENTIONAL
FILM TO OPTIMISE IMAGE CONTRAST. Under- and over-
development can also mimic diffuse pathology;
■ FOLLOW-UP RADIOGRAPHY WHERE NECESSARY. Iden-
tical technical factors and positioning to those used
for the original radiographs should be employed to
monitor changes over time. Inflammation and oedema
may alter quickly whereas neoplastic disease changes
relatively slowly, and the timescale of changes can aid
diagnosis;
■ CAREFUL VIEWING OF THE RADIOGRAPHS IN APPROPRI-
ATELY DARK CONDITIONS. This allows the eye to adapt and
perceive the fine detail better. This is greatly assisted by
using hot lights and dimmer facilities, and by masking
glare from around the edge of the film using cardboard
or a viewer with movable diaphragms. The use of a mag-
nifying glass is also recommended for examining small
areas of change. Interpretation of digital images on a
work station allows easy manipulation of the image and
is particularly helpful for magnification.
PRINCIPLES OF INTERPRETATION
During interpretation the following questions should be
asked:
■ Is the radiograph normal for the age, breed and body
condition of the patient?
■ If not, which diagnoses are possible?
■ Which diagnoses can be ruled out?
■ What is the next diagnostic or therapeutic step? The
need for endoscopy, bronchoalveolar lavage or thoracic
ultrasonography may be suggested by the radiographs.
The lungs may appear radiographically normal if:
■ No significant disease is present;
■ Respiratory signs are arising from non-thoracic
disease such as pain, anaemia or metabolic acidosis;
■ Pathology is present but is excluded from the image,
is not visible due to technical factors or is overlooked
during interpretation;
■ Visible lung changes have not yet developed (eg,
paraquat poisoning or immediately following trauma). If
respiratory signs continue, repeat radiography is indicated;
■ Lung disease is present but is not producing radio-
graphically detectable changes (eg, acute bronchitis,
pulmonary thromboembolism).
183
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Thoracic radiographs should be evaluated systemati-

cally for the following features of lung disease:
■ Change in lung volume;
A
■ Location of pathology;
■ Bronchi and peribronchial tissue (bronchial pattern); B

■ Number, size and course of blood vessels (vascular V

pattern);
■ Increased opacity of the lungs (poor inflation, techni-
cal factors, alveolar or interstitial patterns);
■ Nodules and masses;
■ Mineralisation;
■ Decreased opacity of the lungs (artefactual or hyper-
lucency);
■ Changes in other intrathoracic structures, including (above) Diagrammatic representation of a normal
bronchovascular lung pattern. On a lateral radiograph,
the trachea, heart, major blood vessels, mediastinum, the artery (A) lies dorsal and the vein (V) ventral to the
pleural cavity, lymph nodes, thoracic wall and dia- corresponding bronchus (B). The bronchial wall is visible
near its origin, although smaller airways are not usually
phragm. In addition to thoracic structures, other areas evident. (below) Close-up of a cranial lobe bronchovascular
such as the thoracic inlet, spine and cranial abdomen pattern in a middle-aged dog
should be examined for possible lesions.
Radiographs should, of course, be interpreted in the
light of the history, clinical findings and results of any
laboratory tests performed.

NORMAL RADIOGRAPHIC APPEARANCE

OF THE LUNGS

For descriptive purposes, lung fields can be divided

into three zones: central (hilar), middle and peripher-
al. Pulmonary structures are seen by contrast with the
surrounding air, although the peripheral area is often
relatively overexposed on conventional films and bright
lighting may be required to identify signs of disease.
With digital radiography, there is more latitude and
both bony structures and the entire lung may be seen
adequately on the same image.
The most visible structures in the lungs of normal,
younger animals are the pulmonary blood vessels, but
bronchial walls can also be identified in the central area.
A faint meshwork-like background opacity is created by
small vessels and airways that cannot be identified indi-
vidually. The arteries and veins run on either side of the
corresponding bronchus, although the space between
them is not completely filled by the airway. On lateral
radiographs, the artery is dorsal to the bronchus and the
vein is ventral, and on DV or VD radiographs the artery
lies laterally and the vein medially. The arteries may be
more sharply defined than the veins.
Normal thoracic radiograph of a four-year-old English
springer spaniel. Most of the lung markings are vascular,
although the walls of larger bronchi are visible in the
central area
Awareness of normal vessel size is important for the
detection of abnormal vascular patterns. Normally, the
artery and its corresponding vein are of similar size.
On lateral radiographs, the right cranial lobe vessels
are most easily assessed as they lie ventral to the left-
sided vessels, which are often superimposed over the
trachea and other cranial mediastinal structures. The
right lobar vessels are more clearly seen on the left lat-
eral recumbent projection due to improved aeration of
the surrounding lung. The maximum vessel diameter
does not usually exceed the width of the proximal part
of the fourth rib (normal size range quoted in the litera-
ture in dogs is 0·25 to 1·25 times the rib width, average
0·75; in cats, the range is 0·5 to 1·0 times, average 0·7).
For the orthogonal view, the DV projection is preferred
to the VD for the assessment of vessel size, and caudal
lobe vessels are compared with the ninth rib where they
cross; similar normal size ranges apply.
Vessel size is dynamic, varying with intraluminal
pressure and volume, depending on the hydration status
of the animal. Signs of disease can be masked due to
dehydration or overhydration, so it is important to know
whether any treatment such as diuretics or fluid therapy
has been administered. Sequential radiographs may be
helpful in this respect. Pulmonary vessel size may also
vary with sedation or general anaesthesia, although this
has not been studied in detail.

184 In Practice ● APRIL 2008

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Lateral (above) and dorsoventral (right) thoracic

radiographs of an elderly Siamese cat with allergic
bronchitis and air-trapping. The lungs are overinflated
(the right lung more so than the left), causing the heart to
be displaced to the left. The diaphragm is displaced caudally
and on the dorsoventral view its costal attachments
(arrows) are visible. There is a marked, generalised
bronchointerstitial pattern

LUNG VOLUME

Changes in the volume of the lungs, either generally or

focally, can give important clues about disease processes.
If the thorax is expanded and the ribs extend perpen-
dicular to the spine on the DV/VD projection, the lungs
remain capable of considerable distension. If the lungs
are well expanded without manual inflation on repeated
radiographs, generalised air-trapping may be present. In
such cases, the diaphragm will be flattened and displaced
caudally and, in cats, the diaphragmatic attachments to
the ribs may be evident on the DV/VD view, giving the
diaphragm a ‘Christmas tree’ shape. Conversely, failure are assessed on DV/VD radiographs better than on the
of the lungs to distend during inspiration or with manual lateral view. The cardinal sign of unilateral volume
inflation is likely to be a sign of diffuse pathology such change is mediastinal shift, with the heart, trachea and
as fibrosis, especially if the intrathoracic trachea is wide. ipsilateral half of the diaphragm displaced either towards
This indicates respiratory effort or significant lumenal a collapsed area or away from an overdistended lung.
pressure during manual inflation. In cases of generalised Where only one or two lobes are affected, the adjacent
over- or underinflation, the lung opacity will be reduced lung lobes may also be passively dilated or compressed.
or increased, respectively, and these are discussed below. However, if concomitant pleural fluid or air is present,
Localised volume changes can be due to mass effect this may fill the space around a collapsed lung lobe
(caused by soft tissue or trapped air) or atelectasis, and and negate any mediastinal shift that might otherwise

R L R L R L

(left) Reduced lung volume. Anaesthesia-induced atelectasis of the left lung field in a labrador retriever that had previously been lying in left lateral
recumbency. There is a mediastinal shift to the left and compensatory overinflation of the right lung. The collapsed left lung shows a diffuse increase in
opacity due to poor aeration. (middle) Increased lung volume. Two large soft tissue masses in the right middle and accessory lung lobes in an eight-year-
old West Highland white terrier. The middle lobe mass distends the affected lobe and displaces the heart slightly to the left. (right) Normal lung volume.
Dorsoventral radiograph of an 11-year-old English bull terrier with right-sided aspiration pneumonia. There is increased opacity of the right middle and
cranial lung lobes, but relatively little volume change, indicating consolidation of the affected area rather than collapse

In Practice ● APRIL 2008 185

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CAUSES OF PULMONARY VOLUME CHANGE
Increased volume Decreased volume
Deep inspiration Expiration
Iatrogenic overinflation Occlusion of airway due to:
Dyspnoea – Mucous plugs
Compensatory hyperinflation – Tumour in, or compressing, the bronchus
Air-trapping due to bronchospasm – Foreign body
Emphysema (congenital/acquired) – Endotracheal tube
Pulmonary mass – Bronchospasm and air absorption
Atelectasis under general anaesthesia
Compression by expanded lung lobe(s)
be present. Increased opacity of a lung lobe without a
change in volume suggests consolidation.
A useful technique for confirming air-trapping is to
obtain a VD radiograph with the animal in lateral recum-
bency and the affected side down, using a horizontal x-ray
beam (pay attention to radiation safety and other techni-
cal factors). Normally, the dependent lung will be slightly
collapsed in lateral recumbency, especially in the mid-
dle lobe area, which is compressed by the heart. In the
presence of air-trapping, the affected portion of the lung
remains fully aerated and the heart does not sink towards
the dependent side.
Decreased lung volume and pulmonary masses
will cause increased radiopacity, while other causes
of increased lung volume result in reduced radiopacity
(hyperlucency).
H
M
(above) Ventrodorsal radiograph of a three-
year-old domestic shorthair cat with severe
bronchopneumonia and emphysema, showing
air-trapping. This image was obtained with the
cat in right lateral recumbency using a horizontal
beam. The dependent lung field is overinflated and
the heart (H) lies closer to the uppermost chest wall.
A soft tissue mass (M) lesion in the caudal midline
represents an area of pneumonic consolidation.
(below) Lateral radiograph of the same cat,
showing widespread pulmonary overinflation and
dorsal lung consolidation
186
TYPICAL DISTRIBUTION OF DISEASES
Cranial and Bronchopneumonia, lobar pneumonia,
ventral aspiration pneumonia, haemorrhage*,
atelectasis*
Caudal and Cardiogenic oedema (especially hilar
dorsal area in dogs), non-cardiogenic oedema,
interstitial pneumonia, infarct due
to pulmonary thromboembolus,
haemorrhage*, atelectasis*
Diffuse Acute cardiogenic and non-cardiogenic
oedema, fibrosis, bronchitis, miliary
metastases, haemorrhage*, atelectasis*,
primary neoplasia in cats
Unifocal Primary neoplasm, solitary metastasis,
abscess, granuloma, bulla, cyst, infarct
due to pulmonary thromboembolus, lobe
torsion, lobe consolidation, atelectasis*
(especially right middle lobe)
Multifocal Metastases, abscesses, granulomata,
bullae, parasitic cysts, cardiogenic oedema
in cats, primary neoplasia in cats
*Varies with the cause (eg, location of trauma impact,
duration and position of recumbency in cases of
coagulopathy and atelectasis)
LOCATION OF PATHOLOGY
Although diseases of different aetiology may produce
identical lung changes in terms of the pattern of opaci-
fication, their distribution may be characteristic. This
allows a shorter list of probable differential diagnoses to
be compiled. The effect of gravity on the distribution of
fluid infiltrates and the location of known impact trauma
should also be considered. The typical distribution of
some diseases is listed in the table above.
BRONCHI AND PERIBRONCHIAL TISSUE
The diagnostic value of a radiographic bronchial pattern
is hindered by the fact that it may be caused not by pri-
mary airway disease but by fluid or cellular infiltrate in
the loose connective tissue surrounding the airways. To
overcome this, Nykamp and others (2002) proposed the
less specific expression ‘lines and rings’. Nevertheless,
the bronchial pattern remains a useful diagnostic sign,
provided the processes that give rise to it are understood.
A bronchial pattern can arise in three ways:
■ BRONCHIAL WALL DISEASE. This is due to mucosal
or submucosal hypertrophy and submucosal glandular
hypertrophy, often in the presence of lumenal discharge.
These diseases cause chronic bronchitis; radiographic evi-
dence of acute bronchitis is rare. Congenital and acquired
bronchiectasis will produce similar changes. Chronic
bronchitis may be caused by infection (bacterial, post-
viral, fungal or protozoal), sterile inflammation, allergy
(eg, feline asthma), parasites (especially Aelurostrongylus
abstrusus in cats and Crenosoma vulpis in dogs) and
irritants;
■ BRONCHIAL CALCIFICATION. This occurs as a natural
ageing process, especially in chondrodystrophic breeds,
and accounts for the increased bronchial pattern that is
visible in many middle-aged and older patients. It may
also be the result of previous, healed bronchial disease,
naturally occurring or iatrogenic hyperadrenocorticism
and chronic renal disease;
■ PERIBRONCHIAL INFILTRATE WITH FLUID OR CELLS. In
cases of pulmonary oedema, fibrosis, eosinophilic infil-
trate (eg, pulmonary infiltrate with eosinophils [PIE]) and
neoplasia (eg, lymphoma or, occasionally, diffuse metas-
tasis), the primary disease is not bronchial in origin.
In Practice ● APRIL 2008
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Diagrammatic representation of an abnormal bronchial

lung pattern. The bronchial markings are thickened
and/or more radiopaque than normal, producing
‘tramlines’, ‘doughnuts’ and ‘signet rings’
Radiographic signs of a bronchial pattern
■ ‘Tramlines’ (non-vascular linear markings) correspond-
ing to bronchial walls are seen longitudinally. Tracing the
lines peripherally helps to differentiate a tramline from
(above) Lateral thoracic radiograph of a four-year-old
griffon showing a marked bronchial lung pattern resulting
in an increase in overall lung opacity due to non-vascular
linear and ring-like markings. The final diagnosis was
pulmonary infiltrate with eosinophils. (below) Close-up
of the radiograph above, showing the linear and ring-
like bronchial markings, which partly obscure the normal
pulmonary vascular pattern, in more detail

parallel blood vessels, which follow a similar course.

Tramlines stay the same size and converge, while blood
vessels taper and diverge;
■ ‘Doughnuts’ (ring markings) corresponding to bron-
chi are seen in cross-section, often with an adjacent
end-on blood vessel, creating a ‘signet ring’ sign;
■ Airways containing significant amounts of debris may
appear as apparent nodules when seen in cross-section;
■ Bronchial markings extend more peripherally than
normal, creating a ‘scruffy’ or ‘busy’ lung field even
though individual bronchioles cannot be identified;
■ Ill-defined bronchial markings suggest peribronchial
infiltrate. Well-defined markings occur with chronic
disease and bronchial calcification produces very fine
but highly radiopaque markings;
■ Blood vessels are less distinct than normal as they are
partly obscured by the bronchial pattern;
■ Lung volume may be increased if bronchospasm causes
air-trapping, or may be reduced if mucous plugs obstruct
the airways (the right middle lobe is usually affected);
■ A background interstitial pattern often coexists when bronchial pattern. In the case of bronchiectasis, bronchial
chronic airway disease is present, and a concomitant markings are present, but show widening of the bron-
alveolar pattern is present with bronchopneumonia. chial lumen in cylindrical or saccular form. Abnormally
Clinical signs are not related to the severity of the large ring markings may mimic cavitary lung masses.
Bronchial obstruction by mucus is common and causes
areas of lung collapse and consolidation distally.

Close-up of the ventral

lung field of a five-year-
old Welsh terrier with
bronchopneumonia that
occurred secondarily to
saccular lobar bronchiectasis.
The terminal bronchioles
are dilated and irregular,
Lateral thoracic radiograph of a 10-year-old Scottish terrier with thickened walls and/or
with hyperadrenocorticism (Cushing’s disease). There is peribronchial cuffing. The
calcification of the bronchial walls and tracheal cartilage ventral part of the lung
rings, which produces a fine, radiopaque shows diffuse opacification
bronchial pattern. Osteopenia, abdominal distension due to consolidation or
and hepatomegaly are also evident collapse

In Practice ● APRIL 2008 187

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BLOOD VESSELS
An abnormal vascular pattern may be either hyper-
vascular (due to overcirculation) or hypovascular (due
to undercirculation). As a result of the wide normal
range of vessel sizes encountered, changes must be quite
marked before being diagnosed with certainty. In the
case of a hypervascular pattern, a discrepancy in size
between the arteries and veins may be helpful in demon-
strating the presence of an abnormality; in the case of a
hypovascular pattern, both sets of vessels are reduced in
size. Changes in visible vessel number, size, shape and
opacity may be evident.
Hypervascular pattern
A hypervascular pattern may be caused by:
■ PULMONARY CONGESTION DUE TO HEART DISEASE. For
example, mitral insufficiency, cardiomyopathy and other
causes of left-sided heart failure;
■ LARGE LEFT-TO-RIGHT SHUNT. Extracardiac shunts,
such as a patent ductus arteriosus (PDA), cause more
pronounced hypervascularity than intracardiac shunts,
such as a ventricular septal defect (VSD);
■ IATROGENIC FLUID OVERLOAD;
■ VERMINOUS ARTERITIS. In the case of dirofilari-
osis and angiostrongylosis, the physical presence of the
worms in the arteries causes distension. In the case of
feline aelurostrongylosis, hypervascularity is due to
arteritis and arterial hyperplasia. Changes are most
dramatic with Dirofilaria species infection;
■ PULMONARY HYPERTENSION. This is due to severe,
chronic lung disease;
■ PERIPHERAL ARTERIOVENOUS FISTULA;
■ SEVERE, CHRONIC ANAEMIA;
Diagrammatic representation of a hypervascular lung
pattern, showing dilation and tortuosity of a pulmonary
artery
Diagrammatic representation of a hypovascular lung
pattern, showing a reduction in the size of the pulmonary
arteries and veins, making them harder to differentiate
from the bronchial markings
188
LA
CVC
Close-up of the caudodorsal lung of a 12-year-old collie
cross with congestive heart failure. The pulmonary blood
vessels are engorged, giving rise to a hypervascular
pattern. An enlarged caudal lobe vein (arrow) extends
towards the left atrium (LA), which is dilated. The caudal
vena cava (CVC) is also distended
■ PULMONARY THROMBUS OR EMBOLUS. For example,
secondary to cardiac disease, heartworm, disseminated
intravascular coagulation (DIC), trauma, renal disease,
septicaemia, pancreatitis, hyperadrenocorticism and
following surgery.
Depending on the cause, both the arteries and veins
may be distended or one set of vessels may be larger.
However, veins distend more readily than arteries due to
their thinner walls.
General signs of a hypervascular pattern are:
■ Increased vessel size (arteries and/or veins);
■ End-on vessels mimicking nodules;
■ Enlarged vessels becoming slightly tortuous;
■ Vessels extending further to the periphery of the lung
field than normal;
■ Overall increase in lung opacity;
■ Loss of clarity of vessel outline in the presence of
early pulmonary oedema;
■ Associated changes in the heart, caudal vena cava,
abdomen, and so on, depending on the cause.
Hypovascular pattern
A generalised hypovascular pattern may be caused by:
■ COMPRESSION OF VESSELS. Due to hyperinflation of
the lungs (air-trapping, overzealous manual inflation);
■ HYPOVOLAEMIA. Due to dehydration or blood loss;
Hypovascular lung pattern and microcardia
in a six-year-old domestic shorthair cat with
hypovolaemia and circulatory shock, secondary
to severe pancreatitis. As well as a reduction
in the size of the pulmonary blood vessels,
the aorta and caudal vena cava are small
In Practice ● APRIL 2008
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R L
Dorsoventral thoracic radiograph of a 10-year-old labrador
retriever with a heart murmur due to pulmonic stenosis,
which had previously been undetected. The lungs are
more radiolucent than normal due to undercirculation
(hypovascular pattern). There is right-sided cardiomegaly
and poststenotic dilation of the main pulmonary artery,
producing a bulge at the 1 to 2 o’clock position on the heart
outline (arrow)
In Practice ● APRIL 2008
■ SHOCK;
■ HYPOADRENOCORTICISM (Addison’s disease);
■ SEVERE PULMONIC STENOSIS;
■ RIGHT-TO-LEFT SHUNTS. For example, tetralogy of
Fallot and reverse-shunting PDA;
■ FORWARD RIGHT-SIDED HEART FAILURE. Due to
pericardial effusion and cardiac tamponade, restrictive
pericarditis or severe tricuspid regurgitation.
Additionally, a localised hypovascular pattern may be
present distal to an occlusion of a pulmonary artery due
to a thrombus.
Radiographic signs of a hypovascular pattern are:
■ Hyperlucency of the lungs due to a reduction in
the volume of circulating blood, which is of soft tissue
opacity;
■ Thin and thread-like vessels, which do not extend to
the periphery;
■ Changes in heart size depending on the cause.
Reduction in the size with circulatory problems and
hyperinflation, and changes in size and shape with
cardiac disease;
■ Reduction in the size of the caudal vena cava and
sometimes also the aorta with circulatory problems and
hyperinflation.
Reference
NYKAMP, S. G., SCRIVANI, P. V. &
DYKES, N. L. (2002) Radiographic
signs of pulmonary disease: an
alternative approach. Compendium
on Continuing Education for the
Practicing Veterinarian 24, 25-35
189
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Radiological assessment of lung disease in

small animals : 1. Bronchial and vascular
patterns
Ruth Dennis

In Practice 2008 30: 182-189

doi: 10.1136/inpract.30.4.182

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