The lungs

Peter Scrivani; Tobias Schwarz; Tiziana Liuti

doi:10.22233/9781910443941.12

The lungs

British Small Animal Veterinary Association , 356 (2024); https://doi.org/10.22233/9781910443941.12

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The lungs

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Authors: Peter Scrivani, Tobias Schwarz and Tiziana Liuti
From: BSAVA Manual of Canine and Feline Thoracic Imaging
Item: Chapter 12, pp 356 - 453
DOI: 10.22233/9781910443941.12
Copyright: © 2024 British Small Animal Veterinary Association
Publication Date: January 2024

Abstract

Thoracic imaging plays a pivotal role in the diagnosis and management of respiratory diseases in veterinary medicine. Diagnostic pulmonary image interpretation is a multistep process that requires an in-depth knowledge of pulmonary anatomy, physiology and pathology, epidemiological principles and the capabilities of different imaging modalities. This chapter provides the knowledge required to evaluating diseases of the pleural space in dogs and cats using a variety of imaging techniques.

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Figures

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12.1

Lateral thoracic radiographs from four dogs. (a) Alveolar pattern due to pneumonia. (b) Interstitial pattern due to lymphoma. (c) Bronchial pattern due to bronchitis. (d) Vascular pattern due to patent ductus arteriosus. © 2024 British Small Animal Veterinary Association

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12.1 Lateral thoracic radiographs from four dogs. (a) Alveolar pattern due to pneumonia. (b) Interstitial pattern due to lymphoma. (c) Bronchial pattern due to bronchitis. (d) Vascular pattern due to patent ductus arteriosus.

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12.4

(a–c) Lung morphology depicting progressively smaller organization. Grossly, the lung is divided into lobes, bronchopulmonary segments and lobules. Carnivore lungs have distinct lobes. The other structures are reflected in the branching pattern of the bronchial tree, but are otherwise unnoticeable when normal. (c) Alveoli are below the spatial resolution of X-ray-based medical imaging: each pixel in a radiograph or CT image represents a summation shadow or average density of several alveoli. The grayscale is more of a representation of the amount of gas within the lung parenchyma than an indication of whether there is an influx of blood, interstitial fluid, cells, or fibre into the alveolar wall or space. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. (Redrawn after Lauren D. Sawchyn, DVM, CMI) © 2024 British Small Animal Veterinary Association

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12.4 (a–c) Lung morphology depicting progressively smaller organization. Grossly, the lung is divided into lobes, bronchopulmonary segments and lobules. Carnivore lungs have distinct lobes. The other structures are reflected in the branching pattern of the bronchial tree, but are otherwise unnoticeable when normal. (c) Alveoli are below the spatial resolution of X-ray-based medical imaging: each pixel in a radiograph or CT image represents a summation shadow or average density of several alveoli. The grayscale is more of a representation of the amount of gas within the lung parenchyma than an indication of whether there is an influx of blood, interstitial fluid, cells, or fibre into the alveolar wall or space. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. (Redrawn after Lauren D. Sawchyn, DVM, CMI)

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12.5

Normal (a) bovine and (b) canine lungs. Lung morphology varies among species due to differences in lobation and lobulation. Pulmonary lobules are much more prominent in cattle than dogs because cattle have more peripheral lung connective tissue. (a, Courtesy of Dr. Elena Demeter; b, Courtesy of Dr. Shotaro Nakagun) © 2024 British Small Animal Veterinary Association

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12.5 Normal (a) bovine and (b) canine lungs. Lung morphology varies among species due to differences in lobation and lobulation. Pulmonary lobules are much more prominent in cattle than dogs because cattle have more peripheral lung connective tissue. (a, Courtesy of Dr. Elena Demeter; b, Courtesy of Dr. Shotaro Nakagun)

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12.6

(a) Dorsal aspect photograph and (b) transverse CT image of a silicone cast of a bronchial tree of a large dog. (a) Blue silicone forms a cast of the lumens of the large airways (trachea and bronchi) and small airways (bronchioles). Notice that the airways maintain the lobular structure even though this is not grossly apparent. (b) The silicone is hyperattenuating compared with air. Notice the lobular structure with the central arteriole (appearing as a black dot) and bronchiole (appearing as a white dot). Studying casts with visual inspection and imaging aids understanding of morphology ( Scrivani and Percival, 2023 ). For example, the pulmonary lobules are easier to appreciate as they are further apart than in vivo. © 2024 British Small Animal Veterinary Association

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12.6 (a) Dorsal aspect photograph and (b) transverse CT image of a silicone cast of a bronchial tree of a large dog. (a) Blue silicone forms a cast of the lumens of the large airways (trachea and bronchi) and small airways (bronchioles). Notice that the airways maintain the lobular structure even though this is not grossly apparent. (b) The silicone is hyperattenuating compared with air. Notice the lobular structure with the central arteriole (appearing as a black dot) and bronchiole (appearing as a white dot). Studying casts with visual inspection and imaging aids understanding of morphology ( Scrivani and Percival, 2023 ). For example, the pulmonary lobules are easier to appreciate as they are further apart than in vivo.

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12.7

(a) Dorsal aspect photograph, (b) ventral aspect 3D volume-rendered CT image, (c) DV radiograph, and (d) transverse CT image of a silicone cast of a bronchial tree of a small dog. (a) White silicone forms a cast of the lumens of the large airways (trachea and bronchi) and small airways (bronchioles). (b) The large airways are depicted. The trachea splits into the left and right principal bronchi, which give rise to lobar bronchi and then segmental bronchi. (a–c) The lung is organized into lobes and bronchopulmonary segments. (c, d) Notice the differences between the large and small airways. In addition to size differences, the large airways radiate outwards from the lung hilus, and the small airways predominantly form a speckled background that conforms to the overall shape of the lungs ( Scrivani and Percival, 2023 ). Interestingly, the lucent circles that appear like end-on air-filled bronchiole lumens are negative summation shadows between silicone-filled (hyperattenuating) bronchiolar lumens. L = left;R = right. © 2024 British Small Animal Veterinary Association

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12.7 (a) Dorsal aspect photograph, (b) ventral aspect 3D volume-rendered CT image, (c) DV radiograph, and (d) transverse CT image of a silicone cast of a bronchial tree of a small dog. (a) White silicone forms a cast of the lumens of the large airways (trachea and bronchi) and small airways (bronchioles). (b) The large airways are depicted. The trachea splits into the left and right principal bronchi, which give rise to lobar bronchi and then segmental bronchi. (a–c) The lung is organized into lobes and bronchopulmonary segments. (c, d) Notice the differences between the large and small airways. In addition to size differences, the large airways radiate outwards from the lung hilus, and the small airways predominantly form a speckled background that conforms to the overall shape of the lungs ( Scrivani and Percival, 2023 ). Interestingly, the lucent circles that appear like end-on air-filled bronchiole lumens are negative summation shadows between silicone-filled (hyperattenuating) bronchiolar lumens. L = left;R = right.

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12.8

(a) Lateral thoracic radiograph of a dog and (b-d) sequential transverse CT images of the left caudal lung lobe of another dog; (b) is closest to the lung hilus and (d) is the farthest caudal. The pulmonary artery (A) carries deoxygenated blood (blue) and is closely apposed to the bronchus (B). The pulmonary vein (V) caries oxygenated blood (red) and is further away from the bronchus than the artery. (a, b) Notice the classic artery–bronchus–vein triad, where the pulmonary vein is closest to the heart, is seen only occasionally and typically where the large diameter bronchi and blood vessels are close to the lung hilus. (b–d) Once the lobar bronchi and blood vessels begin branching, the pulmonary vein does not follow the bronchus to the visceral pleura. Blood vessels travel through connective tissue pathways. © 2024 British Small Animal Veterinary Association

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12.8 (a) Lateral thoracic radiograph of a dog and (b-d) sequential transverse CT images of the left caudal lung lobe of another dog; (b) is closest to the lung hilus and (d) is the farthest caudal. The pulmonary artery (A) carries deoxygenated blood (blue) and is closely apposed to the bronchus (B). The pulmonary vein (V) caries oxygenated blood (red) and is further away from the bronchus than the artery. (a, b) Notice the classic artery–bronchus–vein triad, where the pulmonary vein is closest to the heart, is seen only occasionally and typically where the large diameter bronchi and blood vessels are close to the lung hilus. (b–d) Once the lobar bronchi and blood vessels begin branching, the pulmonary vein does not follow the bronchus to the visceral pleura. Blood vessels travel through connective tissue pathways.

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12.9

The different anatomical compartments of the lung that may be differentiated during radiography and CT. The first compartment comprises the pulmonary artery, bronchus and the surrounding adventitial fibrous sheath that extends between the lung hilus to the terminal bronchiole. It conducts air in and out of the body, delivers blood to the parenchyma for oxygenation and may be subdivided by airway size (large and small). The second compartment is the pulmonary parenchyma where gas exchange occurs between the body and environment, it comprises the structures downstream to the terminal bronchioles (the pulmonary acini) and capillaries. The third compartment comprises the pulmonary veins and the surrounding fibrous sheath that extends between the interlobar septa and visceral pleura. In carnivores, these connective tissue pathways for the blood vessels are very thin. The pulmonary veins eventually return to the lung hilus and bring oxygenated blood to the left atrium. Note that the pulmonary interstitium is inextricably related to the connective tissue and is subdivided into the bronchovascular interstitium, parenchymal interstitium and peripheral interstitium. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. (Redrawn after Lauren D. Sawchyn, DVM, CMI) © 2024 British Small Animal Veterinary Association

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12.9 The different anatomical compartments of the lung that may be differentiated during radiography and CT. The first compartment comprises the pulmonary artery, bronchus and the surrounding adventitial fibrous sheath that extends between the lung hilus to the terminal bronchiole. It conducts air in and out of the body, delivers blood to the parenchyma for oxygenation and may be subdivided by airway size (large and small). The second compartment is the pulmonary parenchyma where gas exchange occurs between the body and environment, it comprises the structures downstream to the terminal bronchioles (the pulmonary acini) and capillaries. The third compartment comprises the pulmonary veins and the surrounding fibrous sheath that extends between the interlobar septa and visceral pleura. In carnivores, these connective tissue pathways for the blood vessels are very thin. The pulmonary veins eventually return to the lung hilus and bring oxygenated blood to the left atrium. Note that the pulmonary interstitium is inextricably related to the connective tissue and is subdivided into the bronchovascular interstitium, parenchymal interstitium and peripheral interstitium. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. (Redrawn after Lauren D. Sawchyn, DVM, CMI)

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12.10

(a) Lateral thoracic radiograph of an adult dog and (b) transverse thoracic CT image of another adult dog. During radiography, normal lungs have homogeneous background opacity that is a dark grey: the only soft tissue opacity seen in the lungs is due to the pulmonary blood vessels. In general, the normal airway walls are too thin to be detected. Occasionally, the bronchial walls are mineralized. This opacity is normal when thin and linear, and not a pattern of disease. During CT, normal lungs have a similar appearance, but the bronchial walls are visible and generally thinner than adjacent blood vessels. From the lung hilus, the pulmonary blood vessels branch numerous times and may be traced to the periphery of the lung. These branches normally have a progressively smaller diameter that tapers towards the periphery. In addition, the airways branch and the walls form corresponding line pairs (tram lines) or rings that progressively taper or become smaller towards the periphery. © 2024 British Small Animal Veterinary Association

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12.10 (a) Lateral thoracic radiograph of an adult dog and (b) transverse thoracic CT image of another adult dog. During radiography, normal lungs have homogeneous background opacity that is a dark grey: the only soft tissue opacity seen in the lungs is due to the pulmonary blood vessels. In general, the normal airway walls are too thin to be detected. Occasionally, the bronchial walls are mineralized. This opacity is normal when thin and linear, and not a pattern of disease. During CT, normal lungs have a similar appearance, but the bronchial walls are visible and generally thinner than adjacent blood vessels. From the lung hilus, the pulmonary blood vessels branch numerous times and may be traced to the periphery of the lung. These branches normally have a progressively smaller diameter that tapers towards the periphery. In addition, the airways branch and the walls form corresponding line pairs (tram lines) or rings that progressively taper or become smaller towards the periphery.

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12.11

(a) VD, (b) right lateral and (c) left lateral thoracic radiographs of a normal dog. The left lung is shaded green and divided into left cranial (LCr) and left caudal (LCd) lung lobes. The left cranial lung lobe is subdivided into cranial (cr) and caudal (cd) parts. The right lung is mostly shaded orange, but the accessory lung lobe (A) is yellow. The right lung is divided into right cranial (RCr), right caudal (RCd), and right middle (RM) lung lobes. © 2024 British Small Animal Veterinary Association

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12.11 (a) VD, (b) right lateral and (c) left lateral thoracic radiographs of a normal dog. The left lung is shaded green and divided into left cranial (LCr) and left caudal (LCd) lung lobes. The left cranial lung lobe is subdivided into cranial (cr) and caudal (cd) parts. The right lung is mostly shaded orange, but the accessory lung lobe (A) is yellow. The right lung is divided into right cranial (RCr), right caudal (RCd), and right middle (RM) lung lobes.

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12.12

(a) Left lateral and (b) DV thoracic radiographs of a normal dog. The pulmonary arteries (blue) carry deoxygenated blood from the right heart to the lungs and the pulmonary veins (red) carry oxygenated blood from the lungs to the left heart. The classic triad of artery (A), bronchus (B) and vein (V) can be differentiated in certain locations. (a) On the lateral view, they form distinct opacities in the left cranial (LCr) and right cranial (RCr) lung lobes. In the other lung lobes, they summate with each other (purple). The diameter of the pulmonary veins where they summate with the fourth rib should not be greater than the width of the dorsal third of that rib (white line). (b) On the DV view, the artery, bronchus and vein are differentiated in the left caudal and right caudal lung lobes. The pulmonary artery diameter should not be greater than the width of the ninth rib (yellow) where they summate. Many additional blood vessels are visible in the lungs, but it is impossible to consistently accurately identify them. T4/9 = fourth/ninth thoracic vertebra. © 2024 British Small Animal Veterinary Association

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12.12 (a) Left lateral and (b) DV thoracic radiographs of a normal dog. The pulmonary arteries (blue) carry deoxygenated blood from the right heart to the lungs and the pulmonary veins (red) carry oxygenated blood from the lungs to the left heart. The classic triad of artery (A), bronchus (B) and vein (V) can be differentiated in certain locations. (a) On the lateral view, they form distinct opacities in the left cranial (LCr) and right cranial (RCr) lung lobes. In the other lung lobes, they summate with each other (purple). The diameter of the pulmonary veins where they summate with the fourth rib should not be greater than the width of the dorsal third of that rib (white line). (b) On the DV view, the artery, bronchus and vein are differentiated in the left caudal and right caudal lung lobes. The pulmonary artery diameter should not be greater than the width of the ninth rib (yellow) where they summate. Many additional blood vessels are visible in the lungs, but it is impossible to consistently accurately identify them. T4/9 = fourth/ninth thoracic vertebra.

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12.13

(a) VD, (b) left lateral and (c) right lateral thoracic radiographs of a normal dog. The trachea divides into the right (RPB) and left (LPB) principal bronchi. The principal bronchi divide into lobar bronchi, which supply the right cranial (RCr), right middle (RM), right caudal (RCd), left cranial (LCr) and left caudal (LCd) lung lobes. The RCd lobar bronchus sends a branch to the accessory (A) lung lobe. The LCr lobar bronchus divides into cranial (cr) and caudal (cd) parts. The carina is a soft tissue structure resembling a keel, located between the RPB and LPB. On lateral views (b, c), a round negative summation shadow produced by the tracheal bifurcation denotes the approximate location of the carina. (b) The RCr and RM lobar bronchi are separate tubes. (c) The LCr lobar bronchus splits into cr and cd branches. © 2024 British Small Animal Veterinary Association

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12.13 (a) VD, (b) left lateral and (c) right lateral thoracic radiographs of a normal dog. The trachea divides into the right (RPB) and left (LPB) principal bronchi. The principal bronchi divide into lobar bronchi, which supply the right cranial (RCr), right middle (RM), right caudal (RCd), left cranial (LCr) and left caudal (LCd) lung lobes. The RCd lobar bronchus sends a branch to the accessory (A) lung lobe. The LCr lobar bronchus divides into cranial (cr) and caudal (cd) parts. The carina is a soft tissue structure resembling a keel, located between the RPB and LPB. On lateral views (b, c), a round negative summation shadow produced by the tracheal bifurcation denotes the approximate location of the carina. (b) The RCr and RM lobar bronchi are separate tubes. (c) The LCr lobar bronchus splits into cr and cd branches.

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12.15

‘Walking through the forest in fog’ can be used as an analogy to better understand parenchymal opacification. Two parenchymal opacity patterns, ground-glass opacity and consolidation, relate to how much air remains in the airspace. In this analogy, tree branches represent pulmonary blood vessels and fog-filled air represents the lung parenchyma. Notice that certain areas may have more fog, and the edges of the fog may be discernible, but the fog is unstructured (i.e. does not form linear or nodular shapes). In the near distance, the trees have clearly visible branches that divide and taper as they extend away from the trunk. This description is like looking at pulmonary blood vessels in a normally expanded and aerated lung. In the mid distance, the tree branches remain visible, but the margins are fuzzy due to the fog, and it may be difficult to see some of the fine twigs at the periphery of the tree. This description is like looking at pulmonary blood vessels when there is ground-glass opacity (unstructured interstitial pattern). In the far distance, the fog completely obscures the branches of the tree (border effacement). This description is like looking at pulmonary blood vessels when there is lung consolidation (alveolar pattern). © 2024 British Small Animal Veterinary Association

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12.15 ‘Walking through the forest in fog’ can be used as an analogy to better understand parenchymal opacification. Two parenchymal opacity patterns, ground-glass opacity and consolidation, relate to how much air remains in the airspace. In this analogy, tree branches represent pulmonary blood vessels and fog-filled air represents the lung parenchyma. Notice that certain areas may have more fog, and the edges of the fog may be discernible, but the fog is unstructured (i.e. does not form linear or nodular shapes). In the near distance, the trees have clearly visible branches that divide and taper as they extend away from the trunk. This description is like looking at pulmonary blood vessels in a normally expanded and aerated lung. In the mid distance, the tree branches remain visible, but the margins are fuzzy due to the fog, and it may be difficult to see some of the fine twigs at the periphery of the tree. This description is like looking at pulmonary blood vessels when there is ground-glass opacity (unstructured interstitial pattern). In the far distance, the fog completely obscures the branches of the tree (border effacement). This description is like looking at pulmonary blood vessels when there is lung consolidation (alveolar pattern).

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12.16

(a) Lateral thoracic radiograph and (b) transverse thoracic CT image (lung window) depicting ground-glass opacity (unstructured interstitial pattern) that affects both lungs. There is widespread unstructured (foggy) parenchymal opacification with blurring of the pulmonary blood vessels and bronchial walls. Some air remains in the airspace. © 2024 British Small Animal Veterinary Association

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12.16 (a) Lateral thoracic radiograph and (b) transverse thoracic CT image (lung window) depicting ground-glass opacity (unstructured interstitial pattern) that affects both lungs. There is widespread unstructured (foggy) parenchymal opacification with blurring of the pulmonary blood vessels and bronchial walls. Some air remains in the airspace.

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12.17

(a) Lateral thoracic radiograph and (b) transverse thoracic CT image (lung window) depicting lung consolidation (alveolar pattern). Notice the unstructured parenchymal opacification with border effacement of the pulmonary blood vessels and bronchial walls. No air remains in the affected airspace – the affected lung is solid. Air bronchograms and lobar signs also are present. © 2024 British Small Animal Veterinary Association

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12.17 (a) Lateral thoracic radiograph and (b) transverse thoracic CT image (lung window) depicting lung consolidation (alveolar pattern). Notice the unstructured parenchymal opacification with border effacement of the pulmonary blood vessels and bronchial walls. No air remains in the affected airspace – the affected lung is solid. Air bronchograms and lobar signs also are present.

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12.18

(a) Lateral and (b) VD thoracic radiographs of different adult dogs with parenchymal opacification. A defining feature of lung consolidation (versus ground-glass opacity) is border effacement of the pulmonary blood vessels. (a) There is diffuse parenchymal opacification with mixed appearances. The cranioventral lung field has a pattern of ground-glass opacity (unstructured interstitial pattern) because the margins of the pulmonary blood vessels are blurred but visible. The caudodorsal lung field has a pattern of consolidation (alveolar pattern) because there is border effacement of the pulmonary blood vessels. The presence of air bronchograms also indicates lung consolidation, but it is not a required feature. (b) The entire left lung has a pattern of consolidation without air bronchograms in the left cranial lung lobe and with air bronchograms in the left caudal lung lobe. There also is a lobar sign between the left caudal and accessory lung lobes. © 2024 British Small Animal Veterinary Association

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12.18 (a) Lateral and (b) VD thoracic radiographs of different adult dogs with parenchymal opacification. A defining feature of lung consolidation (versus ground-glass opacity) is border effacement of the pulmonary blood vessels. (a) There is diffuse parenchymal opacification with mixed appearances. The cranioventral lung field has a pattern of ground-glass opacity (unstructured interstitial pattern) because the margins of the pulmonary blood vessels are blurred but visible. The caudodorsal lung field has a pattern of consolidation (alveolar pattern) because there is border effacement of the pulmonary blood vessels. The presence of air bronchograms also indicates lung consolidation, but it is not a required feature. (b) The entire left lung has a pattern of consolidation without air bronchograms in the left cranial lung lobe and with air bronchograms in the left caudal lung lobe. There also is a lobar sign between the left caudal and accessory lung lobes.

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12.19

(a) Lateral thoracic radiograph and (b) transverse thoracic CT image (lung window) of different dogs with a bronchial pattern. Note the bronchial walls that produce thick rings and tram lines that radiate outwards from the lung hilus. © 2024 British Small Animal Veterinary Association

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12.19 (a) Lateral thoracic radiograph and (b) transverse thoracic CT image (lung window) of different dogs with a bronchial pattern. Note the bronchial walls that produce thick rings and tram lines that radiate outwards from the lung hilus.

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12.20

Close-up lateral thoracic radiograph of an adult dog with bronchial wall mineralization; this finding may be normal or degenerative and of minor consequence or a sign of disease (e.g. causes of metastatic calcification). Notice the thin linear opacities that are parallel to and more opaque than the pulmonary blood vessels. © 2024 British Small Animal Veterinary Association

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12.20 Close-up lateral thoracic radiograph of an adult dog with bronchial wall mineralization; this finding may be normal or degenerative and of minor consequence or a sign of disease (e.g. causes of metastatic calcification). Notice the thin linear opacities that are parallel to and more opaque than the pulmonary blood vessels.

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12.21

(a) Transverse thoracic CT image (lung window) and (b) endoscopic image of the bronchi of a dog with a mucus plug in the lumen of a bronchus (arrowed). © 2024 British Small Animal Veterinary Association

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12.21 (a) Transverse thoracic CT image (lung window) and (b) endoscopic image of the bronchi of a dog with a mucus plug in the lumen of a bronchus (arrowed).

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12.22

(a) Close-up lateral thoracic radiograph and (b) transverse thoracic CT image (lung window) of an adult dog with bronchiectasis. Notice that the bronchi have increased overall diameter, thick walls and lack of tapering. Also notice that the thick lines radiate outwards from the lung hilus, and most lumens are gas-filled, but a few are seen on the radiograph as fluid-filled (especially ventrally). © 2024 British Small Animal Veterinary Association

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12.22 (a) Close-up lateral thoracic radiograph and (b) transverse thoracic CT image (lung window) of an adult dog with bronchiectasis. Notice that the bronchi have increased overall diameter, thick walls and lack of tapering. Also notice that the thick lines radiate outwards from the lung hilus, and most lumens are gas-filled, but a few are seen on the radiograph as fluid-filled (especially ventrally).

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12.23

Close-up VD thoracic radiographs from the same dog as in Figure 12.22. (a) initially and (b) after six weeks of treatment. (a) The enlarged bronchial lumen is fluid-filled and viewed end-on, appearing as a nodule. (b) The bronchial lumen is now air-filled. © 2024 British Small Animal Veterinary Association

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12.23 Close-up VD thoracic radiographs from the same dog as in Figure 12.22. (a) initially and (b) after six weeks of treatment. (a) The enlarged bronchial lumen is fluid-filled and viewed end-on, appearing as a nodule. (b) The bronchial lumen is now air-filled.

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12.24

Transverse thoracic CT images (lung window) of an adult dog (a) before and (b) after intravenous administration of contrast material. (a) Normal bronchial and oesophageal morphology. (b) The dog developed severe diffuse bronchial constriction and oesophageal oedema as a severe adverse reaction to the contrast medium. The bronchi have severely reduced overall diameter and lumen diameter and normal wall thickness. The oesophageal wall is diffusely thick with a smaller lumen diameter and unchanged overall diameter. © 2024 British Small Animal Veterinary Association

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12.24 Transverse thoracic CT images (lung window) of an adult dog (a) before and (b) after intravenous administration of contrast material. (a) Normal bronchial and oesophageal morphology. (b) The dog developed severe diffuse bronchial constriction and oesophageal oedema as a severe adverse reaction to the contrast medium. The bronchi have severely reduced overall diameter and lumen diameter and normal wall thickness. The oesophageal wall is diffusely thick with a smaller lumen diameter and unchanged overall diameter.

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12.25

(a) Lateral thoracic radiograph and (b) transverse thoracic CT image (lung window) depicting a bronchiolar pattern. Fluid, cells or fibre are accumulated in and around the bronchiolovascular bundles (small airways). Notice that the overall pattern appears speckled and any small-gauge tram lines do not radiate outwards from the lung hilus. On CT, the abnormal bronchioles are seen in short-axis and can appear nodular, especially when the lumens are hyperattenuating. This is referred to as a centrilobular distribution when the abnormal opacity is centred in the pulmonary lobule. Notice that the hyperattenuating foci do not extend all the way to the periphery because the airways do not extend to the visceral surface. © 2024 British Small Animal Veterinary Association

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12.25 (a) Lateral thoracic radiograph and (b) transverse thoracic CT image (lung window) depicting a bronchiolar pattern. Fluid, cells or fibre are accumulated in and around the bronchiolovascular bundles (small airways). Notice that the overall pattern appears speckled and any small-gauge tram lines do not radiate outwards from the lung hilus. On CT, the abnormal bronchioles are seen in short-axis and can appear nodular, especially when the lumens are hyperattenuating. This is referred to as a centrilobular distribution when the abnormal opacity is centred in the pulmonary lobule. Notice that the hyperattenuating foci do not extend all the way to the periphery because the airways do not extend to the visceral surface.

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12.26

(a) Close-up transverse thoracic CT image (lung window) of a dog with a tree-in-bud pattern indicating small-airway (bronchiolar) disease. (b) Left aspect photograph of a silicone cast of a bronchial tree of a small dog demonstrating how filling of the bronchiolar lumens can produce a tree-in-bud pattern. © 2024 British Small Animal Veterinary Association

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12.26 (a) Close-up transverse thoracic CT image (lung window) of a dog with a tree-in-bud pattern indicating small-airway (bronchiolar) disease. (b) Left aspect photograph of a silicone cast of a bronchial tree of a small dog demonstrating how filling of the bronchiolar lumens can produce a tree-in-bud pattern.

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12.27

Post-mortem transverse thoracic CT image (lung window) of a dog with bronchiolectasis related to extensive pulmonary fibrosis due to chronic interstitial pneumonia. Notice the bronchiolar dilatation with gas-filled lumens. © 2024 British Small Animal Veterinary Association

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12.27 Post-mortem transverse thoracic CT image (lung window) of a dog with bronchiolectasis related to extensive pulmonary fibrosis due to chronic interstitial pneumonia. Notice the bronchiolar dilatation with gas-filled lumens.

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12.28

(a) Plain and (b) annotated DV thoracic radiograph of a dog with enlargement of the right heart, pulmonic trunk and left pulmonary artery due to heartworm infestation. Deoxygenated blood (blue) is present in the right pulmonary artery (RPA), left pulmonary artery (LPA) and caudal vena cava (CdVC). Oxygenated blood (red) is present in the right pulmonary vein (RPV) and left pulmonary vein (LPV). The LPA is enlarged: notice that the LPA diameter is wider than the ninth rib (yellow) where they summate. T9 = ninth thoracic vertebra. © 2024 British Small Animal Veterinary Association

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12.28 (a) Plain and (b) annotated DV thoracic radiograph of a dog with enlargement of the right heart, pulmonic trunk and left pulmonary artery due to heartworm infestation. Deoxygenated blood (blue) is present in the right pulmonary artery (RPA), left pulmonary artery (LPA) and caudal vena cava (CdVC). Oxygenated blood (red) is present in the right pulmonary vein (RPV) and left pulmonary vein (LPV). The LPA is enlarged: notice that the LPA diameter is wider than the ninth rib (yellow) where they summate. T9 = ninth thoracic vertebra.

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12.29

(a) Right lateral and (b) DV thoracic radiographs of a dog with severe left heart enlargement. There is caudodorsal-to-diffuse pulmonary opacification due to pulmonary venous congestion and early cardiogenic pulmonary oedema. Note the increased number and size of the pulmonary veins. © 2024 British Small Animal Veterinary Association

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12.29 (a) Right lateral and (b) DV thoracic radiographs of a dog with severe left heart enlargement. There is caudodorsal-to-diffuse pulmonary opacification due to pulmonary venous congestion and early cardiogenic pulmonary oedema. Note the increased number and size of the pulmonary veins.

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12.30

(a) Lateral thoracic radiograph and (b) transverse thoracic CT image (lung window) depicting pulmonary stromal bands due to increased thickness of the peripheral connective tissue (peripheral interstitium) that is worst near the visceral pleura and extends deep into the lung. © 2024 British Small Animal Veterinary Association

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12.30 (a) Lateral thoracic radiograph and (b) transverse thoracic CT image (lung window) depicting pulmonary stromal bands due to increased thickness of the peripheral connective tissue (peripheral interstitium) that is worst near the visceral pleura and extends deep into the lung.

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12.31

Transverse thoracic CT images (lung window) of two dogs with coarse reticular patterns due to increased thickness of the peripheral connective tissue (peripheral interstitium) surrounding the pulmonary lobules (i.e. interlobular septa). (a) Notice the central (‘lobular’) bronchiole and arteriole. (b) Stromal bands are visible. © 2024 British Small Animal Veterinary Association

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12.31 Transverse thoracic CT images (lung window) of two dogs with coarse reticular patterns due to increased thickness of the peripheral connective tissue (peripheral interstitium) surrounding the pulmonary lobules (i.e. interlobular septa). (a) Notice the central (‘lobular’) bronchiole and arteriole. (b) Stromal bands are visible.

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12.32

Close-up (a) lateral thoracic radiograph and (b) transverse thoracic CT image (lung window) depicting a solitary pulmonary mass. Note the mass is not bronchocentric. © 2024 British Small Animal Veterinary Association

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12.32 Close-up (a) lateral thoracic radiograph and (b) transverse thoracic CT image (lung window) depicting a solitary pulmonary mass. Note the mass is not bronchocentric.

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12.33

(a) Lateral thoracic radiograph of a dog depicting multiple pulmonary nodules (nodular lung pattern) and (b) transverse thoracic CT image (lung window) of another dog depicting a solitary lung nodule (arrowed). © 2024 British Small Animal Veterinary Association

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12.33 (a) Lateral thoracic radiograph of a dog depicting multiple pulmonary nodules (nodular lung pattern) and (b) transverse thoracic CT image (lung window) of another dog depicting a solitary lung nodule (arrowed).

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12.34

(a) Lateral thoracic radiograph and (b) transverse thoracic CT image (lung window) of a dog depicting micronodules. (b) Notice that the tiny nodules extend to the lung periphery suggesting a haematogenous spread (miliary pattern). © 2024 British Small Animal Veterinary Association

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12.34 (a) Lateral thoracic radiograph and (b) transverse thoracic CT image (lung window) of a dog depicting micronodules. (b) Notice that the tiny nodules extend to the lung periphery suggesting a haematogenous spread (miliary pattern).

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12.35

Close-up transverse thoracic CT images (lung window) of two adult dogs showing different nodule attenuations. (a) An undiagnosed solitary discrete circumscribed lung nodule that is solid. (b) A metastatic mammary carcinoma (confirmed by post-mortem examination) that produced multiple indistinct ground-glass nodules as well as widespread ground-glass opacity. © 2024 British Small Animal Veterinary Association

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12.35 Close-up transverse thoracic CT images (lung window) of two adult dogs showing different nodule attenuations. (a) An undiagnosed solitary discrete circumscribed lung nodule that is solid. (b) A metastatic mammary carcinoma (confirmed by post-mortem examination) that produced multiple indistinct ground-glass nodules as well as widespread ground-glass opacity.

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12.36

Transverse thoracic CT image (lung window) of an adult dog with airspace nodules due to histologically confirmed pyogranulomatous and necrotizing bronchointerstitial pneumonia with oedema (cause undetermined). Notice that the granulomas are discrete, irregularly margined and centred on bronchioles. © 2024 British Small Animal Veterinary Association

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12.36 Transverse thoracic CT image (lung window) of an adult dog with airspace nodules due to histologically confirmed pyogranulomatous and necrotizing bronchointerstitial pneumonia with oedema (cause undetermined). Notice that the granulomas are discrete, irregularly margined and centred on bronchioles.

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12.37

(a) Lateral thoracic radiograph of an adult dog and (b) transverse thoracic CT image of another adult dog. During radiography and CT, hyperlucent lungs have a homogeneous background opacity that is very dark. Hyperlucency may be due to (a) reduced blood volume in the lungs, increased air volume in the lungs, or (b) both. (b) Note the paucity of pulmonary blood vessels in the image: the pulmonary blood vessels are thin and spread further apart by the hyperinflated lung. © 2024 British Small Animal Veterinary Association

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12.37 (a) Lateral thoracic radiograph of an adult dog and (b) transverse thoracic CT image of another adult dog. During radiography and CT, hyperlucent lungs have a homogeneous background opacity that is very dark. Hyperlucency may be due to (a) reduced blood volume in the lungs, increased air volume in the lungs, or (b) both. (b) Note the paucity of pulmonary blood vessels in the image: the pulmonary blood vessels are thin and spread further apart by the hyperinflated lung.

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12.38

(a) Lateral thoracic radiograph and (b) transverse thoracic CT image (lung window) of a cat with multiple cavitary nodules due to anaplastic bronchogenic carcinoma. Notice the gas-filled space within the thick-walled nodules. © 2024 British Small Animal Veterinary Association

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12.38 (a) Lateral thoracic radiograph and (b) transverse thoracic CT image (lung window) of a cat with multiple cavitary nodules due to anaplastic bronchogenic carcinoma. Notice the gas-filled space within the thick-walled nodules.

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12.39

Focal lucent lung abnormalities. Abnormalities differ in size, location and wall thickness. These abnormalities are drawn with a gas-filled centre. Sometimes the lumen may be filled with fluid or a combination of gas and fluid. © 2024 British Small Animal Veterinary Association

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12.39 Focal lucent lung abnormalities. Abnormalities differ in size, location and wall thickness. These abnormalities are drawn with a gas-filled centre. Sometimes the lumen may be filled with fluid or a combination of gas and fluid.

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12.40

(ai) Lateral and (aii) VD thoracic radiographs of an adult cat with bilateral lung hyperinflation and (bi) Lateral and (bii) VD thoracic radiographs of a dog with a large lung mass. The normal size of the lungs is assessed by evaluating the thoracic boundaries (body wall including the ribs, diaphragm and sternum), lobar margins and the mediastinum. (a) Both lungs are enlarged and hyperlucent. The lung hyperinflation causes expansion of the rib cage, flattening of the diaphragm, and rounding of the lung margins. (b) The dog has a large lung mass in the left caudal lung lobe. The lobe is hyperexpanded with overall increased size and a caudal mediastinal shift to the right. The opaque lobe also has convex margins (bulging surface) indicating that a mass is likely present. © 2024 British Small Animal Veterinary Association

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12.40 (ai) Lateral and (aii) VD thoracic radiographs of an adult cat with bilateral lung hyperinflation and (bi) Lateral and (bii) VD thoracic radiographs of a dog with a large lung mass. The normal size of the lungs is assessed by evaluating the thoracic boundaries (body wall including the ribs, diaphragm and sternum), lobar margins and the mediastinum. (a) Both lungs are enlarged and hyperlucent. The lung hyperinflation causes expansion of the rib cage, flattening of the diaphragm, and rounding of the lung margins. (b) The dog has a large lung mass in the left caudal lung lobe. The lobe is hyperexpanded with overall increased size and a caudal mediastinal shift to the right. The opaque lobe also has convex margins (bulging surface) indicating that a mass is likely present.

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12.41

(a) VD thoracic radiographs of an adult dog acquired during (ai) exhalation and (aii) inhalation. Notice the lungs are smaller during exhalation, which gives the illusion of diffuse parenchymal opacification and cardiomegaly. (bi) Lateral and (bii) orthogonal thoracic radiographs of an adult dog with mild relaxation atelectasis associated with recumbent positioning. Note the mediastinal shift towards the side of lung collapse, and ipsilateral rib crowding, cranial displacement of the left diaphragmatic crus and mild pulmonary opacification. © 2024 British Small Animal Veterinary Association

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12.41 (a) VD thoracic radiographs of an adult dog acquired during (ai) exhalation and (aii) inhalation. Notice the lungs are smaller during exhalation, which gives the illusion of diffuse parenchymal opacification and cardiomegaly. (bi) Lateral and (bii) orthogonal thoracic radiographs of an adult dog with mild relaxation atelectasis associated with recumbent positioning. Note the mediastinal shift towards the side of lung collapse, and ipsilateral rib crowding, cranial displacement of the left diaphragmatic crus and mild pulmonary opacification.

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12.42

Atelectatic lungs have reduced size with normal or increased opacity. (a) Transverse thoracic CT image of an adult dog in right lateral recumbency: the image is displayed as acquired (i.e. dorsal is to the left of the image and right is to the bottom of the image). Notice pulmonary opacification and reduced lung volume in the gravity-dependent portion of the right lung. (b) Close-up lateral thoracic radiograph of an adult dog with relaxation atelectasis due to normotensive (simple) pneumothorax. Notice the normal opacity of the lung. The loss of gas is compensated by hypoxic pulmonary vasoconstriction, which is a normal physiological process whereby blood is shunted away from poorly ventilated regions of the lung. (c) Close-up transverse thoracic CT image of an adult dog with relaxation atelectasis due to normotensive pneumothorax. The image was acquired in dorsal recumbency and is displayed as acquired (i.e. dorsal is to the bottom of the image and left is to the left of the image). Notice the lung lobe is small and retracted away from the parietal pleura. The gravity-dependent portion of the lung (dorsal) has increased opacity and increased blood flow (note the blood vessels have a larger diameter and the parenchyma has an increased opacity). The ventral portion of the lung is better ventilated but has less perfusion. Perfusion of poorly ventilated lung and ventilation of poorly perfused lung leads to a physiological left-to-right shunt (V:Q mismatch), which can produce hypoxaemia, especially in anaesthetized patients when hypoxic pulmonary vasoconstriction is less effective. © 2024 British Small Animal Veterinary Association

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12.42 Atelectatic lungs have reduced size with normal or increased opacity. (a) Transverse thoracic CT image of an adult dog in right lateral recumbency: the image is displayed as acquired (i.e. dorsal is to the left of the image and right is to the bottom of the image). Notice pulmonary opacification and reduced lung volume in the gravity-dependent portion of the right lung. (b) Close-up lateral thoracic radiograph of an adult dog with relaxation atelectasis due to normotensive (simple) pneumothorax. Notice the normal opacity of the lung. The loss of gas is compensated by hypoxic pulmonary vasoconstriction, which is a normal physiological process whereby blood is shunted away from poorly ventilated regions of the lung. (c) Close-up transverse thoracic CT image of an adult dog with relaxation atelectasis due to normotensive pneumothorax. The image was acquired in dorsal recumbency and is displayed as acquired (i.e. dorsal is to the bottom of the image and left is to the left of the image). Notice the lung lobe is small and retracted away from the parietal pleura. The gravity-dependent portion of the lung (dorsal) has increased opacity and increased blood flow (note the blood vessels have a larger diameter and the parenchyma has an increased opacity). The ventral portion of the lung is better ventilated but has less perfusion. Perfusion of poorly ventilated lung and ventilation of poorly perfused lung leads to a physiological left-to-right shunt (V:Q mismatch), which can produce hypoxaemia, especially in anaesthetized patients when hypoxic pulmonary vasoconstriction is less effective.

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12.43

Reduced lung size due to different pathogenic mechanisms. (a) Lateral thoracic radiograph of a cat with compressive (restrictive) atelectasis due to pectus excavatum. (b) Lateral thoracic radiograph of a dog with passive (relaxation) atelectasis due to fluid in both pleural cavities. (c) Lateral thoracic radiograph of a cat with resorptive (obstructive) atelectasis due to a neoplasm obstructing the lumen of the lobar bronchus to one of the caudal lung lobes causing the heart to deviate dorsolaterally. (d) Lateral thoracic radiograph of a dog with cicatrization atelectasis because the lung is stiff and cannot expand (poor compliance) due to fibrotic lung disease. The opacity of the affected lung will vary from normal (e.g. in hypoxic pulmonary vasoconstriction) to increased. Increased opacity may be due to reduced air volume in the lung; the infiltration of fluid, cells or fibre into the lungs; summation of pleural, mediastinal, cardiac or thoracic boundary disease; or a combination. © 2024 British Small Animal Veterinary Association

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12.43 Reduced lung size due to different pathogenic mechanisms. (a) Lateral thoracic radiograph of a cat with compressive (restrictive) atelectasis due to pectus excavatum. (b) Lateral thoracic radiograph of a dog with passive (relaxation) atelectasis due to fluid in both pleural cavities. (c) Lateral thoracic radiograph of a cat with resorptive (obstructive) atelectasis due to a neoplasm obstructing the lumen of the lobar bronchus to one of the caudal lung lobes causing the heart to deviate dorsolaterally. (d) Lateral thoracic radiograph of a dog with cicatrization atelectasis because the lung is stiff and cannot expand (poor compliance) due to fibrotic lung disease. The opacity of the affected lung will vary from normal (e.g. in hypoxic pulmonary vasoconstriction) to increased. Increased opacity may be due to reduced air volume in the lung; the infiltration of fluid, cells or fibre into the lungs; summation of pleural, mediastinal, cardiac or thoracic boundary disease; or a combination.

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12.44

The radiographic diagnosis of pulmonary embolus with infarction is challenging because most patients have normal radiographs, signs are variable and are absent in the acute phase. Signs include localized areas of hyperlucency due to decreased perfusion (Westermark sign), parenchymal consolidation by haemorrhage and oedema, non-specific areas of atelectasis, cavitation (most specific sign but late occurring) and pleural fluid. (a) Orthogonal thoracic radiographs of an adult dog with emboli in the right middle, right caudal and left caudal lung lobes (confirmed by post-mortem examination). Notice the wedge-shaped region of consolidation in the right caudal lung lobe. (ai) Notice the absence of pulmonary blood vessels summating with the heart. (aii) Notice the reduced number of pulmonary blood vessels in the left caudal lung lobe. (b) Lateral thoracic radiographs of a dog with pulmonary embolism (confirmed by post-mortem examination). The images were obtained (bi) prior to and (bii) after the dog developed clinical signs. (bii) The only new finding is diffuse atelectasis, which is presumed to be a result of a surfactant deficiency. Notice the reduced lung size, especially the retraction of the ventral lung margin away from the sternum, and diffuse ground-glass opacity. Adhesive atelectasis is a type of cicatrization atelectasis. © 2024 British Small Animal Veterinary Association

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12.44 The radiographic diagnosis of pulmonary embolus with infarction is challenging because most patients have normal radiographs, signs are variable and are absent in the acute phase. Signs include localized areas of hyperlucency due to decreased perfusion (Westermark sign), parenchymal consolidation by haemorrhage and oedema, non-specific areas of atelectasis, cavitation (most specific sign but late occurring) and pleural fluid. (a) Orthogonal thoracic radiographs of an adult dog with emboli in the right middle, right caudal and left caudal lung lobes (confirmed by post-mortem examination). Notice the wedge-shaped region of consolidation in the right caudal lung lobe. (ai) Notice the absence of pulmonary blood vessels summating with the heart. (aii) Notice the reduced number of pulmonary blood vessels in the left caudal lung lobe. (b) Lateral thoracic radiographs of a dog with pulmonary embolism (confirmed by post-mortem examination). The images were obtained (bi) prior to and (bii) after the dog developed clinical signs. (bii) The only new finding is diffuse atelectasis, which is presumed to be a result of a surfactant deficiency. Notice the reduced lung size, especially the retraction of the ventral lung margin away from the sternum, and diffuse ground-glass opacity. Adhesive atelectasis is a type of cicatrization atelectasis.

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12.45

Lateral thoracic radiographs of three adult dogs with widespread distribution of disease in both lungs. (a) Uniform diffuse bronchial (large airway) disease. (b) Non-uniform diffuse parenchymal disease. (c) Multiple pulmonary nodules with a generalized random distribution; notice the normal lung between nodules. © 2024 British Small Animal Veterinary Association

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12.45 Lateral thoracic radiographs of three adult dogs with widespread distribution of disease in both lungs. (a) Uniform diffuse bronchial (large airway) disease. (b) Non-uniform diffuse parenchymal disease. (c) Multiple pulmonary nodules with a generalized random distribution; notice the normal lung between nodules.

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12.46

(a) DV and (b) VD thoracic radiographs of two dogs with widespread non-uniform bilateral lung disease. (a) The spread of disease may be symmetrical, whereby the distribution is comparable in both lungs and roughly forms a mirror image in each lung. (b) Alternatively, the distribution may be asymmetrical when comparing left and right lungs. © 2024 British Small Animal Veterinary Association

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12.46 (a) DV and (b) VD thoracic radiographs of two dogs with widespread non-uniform bilateral lung disease. (a) The spread of disease may be symmetrical, whereby the distribution is comparable in both lungs and roughly forms a mirror image in each lung. (b) Alternatively, the distribution may be asymmetrical when comparing left and right lungs.

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12.47

Orthogonal thoracic radiographs showing two methods for defining lung fields. There are five lung fields. (a, b) Lung fields defined as concentric zones: central or perihilar (bright yellow), middle (medium yellow), and peripheral (light yellow) lung fields. (c, d) Lung fields defined as groups of lung lobes: cranioventral (blue) and caudodorsal (red) lung fields. On DV and VD views, the cranioventral and caudodorsal lung fields overlap (purple). © 2024 British Small Animal Veterinary Association

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12.47 Orthogonal thoracic radiographs showing two methods for defining lung fields. There are five lung fields. (a, b) Lung fields defined as concentric zones: central or perihilar (bright yellow), middle (medium yellow), and peripheral (light yellow) lung fields. (c, d) Lung fields defined as groups of lung lobes: cranioventral (blue) and caudodorsal (red) lung fields. On DV and VD views, the cranioventral and caudodorsal lung fields overlap (purple).

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12.48

(a, b) Orthogonal thoracic radiographs of a mature dog depicting a perihilar distribution of parenchymal lung disease, attributed to lung trauma associated with cardiopulmonary resuscitation. © 2024 British Small Animal Veterinary Association

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12.48 (a, b) Orthogonal thoracic radiographs of a mature dog depicting a perihilar distribution of parenchymal lung disease, attributed to lung trauma associated with cardiopulmonary resuscitation.

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12.49

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12.49 (a, b) Orthogonal thoracic radiographs of a mature dog depicting a cranioventral distribution of parenchymal lung disease.

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12.50

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12.50 (a, b) Orthogonal thoracic radiographs of a mature dog depicting a caudodorsal distribution of parenchymal lung disease.

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12.51

Left aspect photograph of preserved inflated canine lungs. There are two types of pleural fissures seen in this photograph: inconstant (accessory pleural fissure) and constant (interlobar fissure). Notice the small accessory pleural fissure in the craniodorsal aspect of the left caudal lung lobe. Constant pleural fissures reliably divide the lungs into exact lobes. Notice the interlobar fissure (arrowed) between the left cranial and left caudal lung lobes, which corresponds to the division of the lungs into cranioventral and caudodorsal lung fields. Using this definition, no caudoventral nor craniodorsal lung field exists. On DV and VD thoracic radiographs, the two lung fields summate with each other at the level of the heart: a lateral view is needed to determine whether a summation shadow is in the cranioventral or caudodorsal lung field. © 2024 British Small Animal Veterinary Association

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12.51 Left aspect photograph of preserved inflated canine lungs. There are two types of pleural fissures seen in this photograph: inconstant (accessory pleural fissure) and constant (interlobar fissure). Notice the small accessory pleural fissure in the craniodorsal aspect of the left caudal lung lobe. Constant pleural fissures reliably divide the lungs into exact lobes. Notice the interlobar fissure (arrowed) between the left cranial and left caudal lung lobes, which corresponds to the division of the lungs into cranioventral and caudodorsal lung fields. Using this definition, no caudoventral nor craniodorsal lung field exists. On DV and VD thoracic radiographs, the two lung fields summate with each other at the level of the heart: a lateral view is needed to determine whether a summation shadow is in the cranioventral or caudodorsal lung field.

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12.52

(a, b) Orthogonal thoracic radiographs of a mature dog depicting a lobar distribution of parenchymal lung disease. The right middle lung lobe is expanded and consolidated (lobar consolidation). Also notice the lobar signs, air bronchograms and border effacement of the adjacent part of the cardiac silhouette. © 2024 British Small Animal Veterinary Association

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12.52 (a, b) Orthogonal thoracic radiographs of a mature dog depicting a lobar distribution of parenchymal lung disease. The right middle lung lobe is expanded and consolidated (lobar consolidation). Also notice the lobar signs, air bronchograms and border effacement of the adjacent part of the cardiac silhouette.

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12.53

Lateral thoracic radiograph of a mature dog depicting a sublobar (locally extensive) distribution of parenchymal lung disease in the ventral periphery of the lobe (sublobar consolidation). © 2024 British Small Animal Veterinary Association

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12.53 Lateral thoracic radiograph of a mature dog depicting a sublobar (locally extensive) distribution of parenchymal lung disease in the ventral periphery of the lobe (sublobar consolidation).

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12.54

(a) Transverse thoracic CT image (lung window) depicting a generalized central lung (bronchocentric) distribution of disease. (b) Transverse thoracic CT image (lung window) of an adult dog with histologically confirmed spread of carcinoma along the bronchovascular bundle. A bronchocentric distribution may be observed with diseases of the bronchovascular bundle or adjacent lung parenchyma. (c) Transverse thoracic CT image (lung window) depicting a predominantly peripheral distribution of lung disease. © 2024 British Small Animal Veterinary Association

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12.54 (a) Transverse thoracic CT image (lung window) depicting a generalized central lung (bronchocentric) distribution of disease. (b) Transverse thoracic CT image (lung window) of an adult dog with histologically confirmed spread of carcinoma along the bronchovascular bundle. A bronchocentric distribution may be observed with diseases of the bronchovascular bundle or adjacent lung parenchyma. (c) Transverse thoracic CT image (lung window) depicting a predominantly peripheral distribution of lung disease.

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12.55

(a) Lateral thoracic radiograph, (b) thoracic ultrasound image (intercostal window) and (c) transverse thoracic CT image (lung window) of a dog with a lung lobe torsion. The left cranial lung lobe is enlarged and consolidated with innumerable small centrally located gas opacities (vesicular pattern). In (b) and (c) the consolidated edge of the lung lobe forms a distinct peripheral band. Additionally, there is bilateral pleural fluid. © 2024 British Small Animal Veterinary Association

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12.55 (a) Lateral thoracic radiograph, (b) thoracic ultrasound image (intercostal window) and (c) transverse thoracic CT image (lung window) of a dog with a lung lobe torsion. The left cranial lung lobe is enlarged and consolidated with innumerable small centrally located gas opacities (vesicular pattern). In (b) and (c) the consolidated edge of the lung lobe forms a distinct peripheral band. Additionally, there is bilateral pleural fluid.

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12.56

Close-up of a lateral thoracic radiograph of an 8-year-old Domestic Shorthaired cat with prominent bronchial wall thickening. ‘Doughnuts’ (arrowed) are visible throughout the lungs. © 2024 British Small Animal Veterinary Association

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12.56 Close-up of a lateral thoracic radiograph of an 8-year-old Domestic Shorthaired cat with prominent bronchial wall thickening. ‘Doughnuts’ (arrowed) are visible throughout the lungs.

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12.57

VD thoracic radiograph of a Siamese cat with chronic lower airway disease. The right middle lung lobe is collapsed and consolidated and is seen as a triangular soft tissue opacity on the right side adjacent to the cardiac silhouette (arrowed). © 2024 British Small Animal Veterinary Association

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12.57 VD thoracic radiograph of a Siamese cat with chronic lower airway disease. The right middle lung lobe is collapsed and consolidated and is seen as a triangular soft tissue opacity on the right side adjacent to the cardiac silhouette (arrowed).

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12.58

(a) Close-up of a lateral thoracic radiograph of a 15-month-old Domestic Shorthaired cat with chronic lower airway disease. The bronchial walls are thick throughout both lungs and in areas where the lumen is filled with mucus they resemble pulmonary nodules when seen end-on (especially visible in the caudoventral thorax). The lungs are hyperinflated as shown by the flattened diaphragm and ribs that are more widely spaced than normal. (b) Close-up of a VD thoracic radiograph of a 15-month-old Domestic Shorthaired cat with chronic lower airway disease. The bronchial walls are thick throughout both lungs and in areas where the lumen is filled with mucus they resemble pulmonary nodules when seen end-on (especially visible in the right caudal lung lobe). The lungs are hyperinflated as shown by the flattened diaphragm and ribs that are more widely spaced than normal. © 2024 British Small Animal Veterinary Association

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12.58 (a) Close-up of a lateral thoracic radiograph of a 15-month-old Domestic Shorthaired cat with chronic lower airway disease. The bronchial walls are thick throughout both lungs and in areas where the lumen is filled with mucus they resemble pulmonary nodules when seen end-on (especially visible in the caudoventral thorax). The lungs are hyperinflated as shown by the flattened diaphragm and ribs that are more widely spaced than normal. (b) Close-up of a VD thoracic radiograph of a 15-month-old Domestic Shorthaired cat with chronic lower airway disease. The bronchial walls are thick throughout both lungs and in areas where the lumen is filled with mucus they resemble pulmonary nodules when seen end-on (especially visible in the right caudal lung lobe). The lungs are hyperinflated as shown by the flattened diaphragm and ribs that are more widely spaced than normal.

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12.59

Transverse CT image (lung window) of the lung of an 8-year-old Domestic Shorthaired cat with markedly thick bronchial walls visible throughout both lungs. © 2024 British Small Animal Veterinary Association

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12.59 Transverse CT image (lung window) of the lung of an 8-year-old Domestic Shorthaired cat with markedly thick bronchial walls visible throughout both lungs.

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12.60

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12.60 Close-up of a DV thoracic radiograph of a 7-year-old Fox Terrier. The dilated bronchi are visible in longitudinal section and end-on (arrowed).

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12.61

Close-up of a lateral thoracic radiograph of an 8-year-old mixed-breed dog with saccular bronchiectasis. The bronchi are dilated and filled (partially or fully) with secretions (arrowed) and should not be confused with pulmonary nodules. © 2024 British Small Animal Veterinary Association

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12.61 Close-up of a lateral thoracic radiograph of an 8-year-old mixed-breed dog with saccular bronchiectasis. The bronchi are dilated and filled (partially or fully) with secretions (arrowed) and should not be confused with pulmonary nodules.

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12.62

Close-up of a right lateral thoracic radiograph of a 5-year-old Rottweiler with bronchiectasis and ventral bronchopneumonia (seen over the diaphragm) consistent with PCD. © 2024 British Small Animal Veterinary Association

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12.62 Close-up of a right lateral thoracic radiograph of a 5-year-old Rottweiler with bronchiectasis and ventral bronchopneumonia (seen over the diaphragm) consistent with PCD.

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12.63

Composite mucociliary radionuclide scans of a 1-year-old Golden Retriever with PCD and a history of recurrent pneumonia. The two static foci of radioactivity to the right of each image represent external markers positioned at the caudal border of the scapula and 20 cm cranial to it. The images are dorsal views obtained at 0, 5, 10, 15, 20, 25, 30 and 35 minutes after deposition of a small droplet of 99mTc-MAA just cranial to the carina. The radioactive droplet is at the level of the caudal external marker in the top left image (time 0) and remains at the same location throughout the duration of the study, indicating lack of mucociliary function. © 2024 British Small Animal Veterinary Association

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12.63 Composite mucociliary radionuclide scans of a 1-year-old Golden Retriever with PCD and a history of recurrent pneumonia. The two static foci of radioactivity to the right of each image represent external markers positioned at the caudal border of the scapula and 20 cm cranial to it. The images are dorsal views obtained at 0, 5, 10, 15, 20, 25, 30 and 35 minutes after deposition of a small droplet of 99mTc-MAA just cranial to the carina. The radioactive droplet is at the level of the caudal external marker in the top left image (time 0) and remains at the same location throughout the duration of the study, indicating lack of mucociliary function.

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12.64

Right lateral thoracic radiograph of a 4-year-old Golden Retriever with a grass awn in the right caudal lobar bronchus. Note the focal interstitial to alveolar infiltrate in the tip of the caudodorsal lung field (arrowed). © 2024 British Small Animal Veterinary Association

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12.64 Right lateral thoracic radiograph of a 4-year-old Golden Retriever with a grass awn in the right caudal lobar bronchus. Note the focal interstitial to alveolar infiltrate in the tip of the caudodorsal lung field (arrowed).

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12.65

A 3-year-old Labrador Retriever with a bronchial foreign body. (a) Close-up of a DV thoracic radiograph showing a focal interstitial opacity in the left caudal lung lobe (between the arrows). (b) Transverse lung CT image showing a dilated left caudal lobar bronchus containing hyperattenuating material compatible with a foreign body (arrowed). No enhancement of the material was seen. Note also the hyperattenuating ventral tip of the left caudal lung lobe (arrowhead) compatible with aspiration pneumonia. (c) A grass awn was removed from the left caudal lobar bronchus. (Courtesy of S. Niessen) © 2024 British Small Animal Veterinary Association

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12.65 A 3-year-old Labrador Retriever with a bronchial foreign body. (a) Close-up of a DV thoracic radiograph showing a focal interstitial opacity in the left caudal lung lobe (between the arrows). (b) Transverse lung CT image showing a dilated left caudal lobar bronchus containing hyperattenuating material compatible with a foreign body (arrowed). No enhancement of the material was seen. Note also the hyperattenuating ventral tip of the left caudal lung lobe (arrowhead) compatible with aspiration pneumonia. (c) A grass awn was removed from the left caudal lobar bronchus. (Courtesy of S. Niessen)

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12.66

Lateral radiograph of an 8-year-old mixed-breed dog with a chronic cough and weight loss. There is a focal alveolar pattern surrounding a bronchus (arrowed). The bronchus has an irregular outline. The final diagnosis was bronchoalveolar carcinoma. © 2024 British Small Animal Veterinary Association

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12.66 Lateral radiograph of an 8-year-old mixed-breed dog with a chronic cough and weight loss. There is a focal alveolar pattern surrounding a bronchus (arrowed). The bronchus has an irregular outline. The final diagnosis was bronchoalveolar carcinoma.

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12.67

Transverse CT images (soft tissue window) of an 8-year-old Beagle with a bronchoalveolar carcinoma, (a) before and(b) after intravenous contrast medium administration. Both images were acquired at the level of the heart (H). A large mass (M) in the left lung compresses and distorts a bronchus (arrowed). (b) Contrast medium administration reveals multiple non-enhancing cystic or necrotic regions. © 2024 British Small Animal Veterinary Association

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12.67 Transverse CT images (soft tissue window) of an 8-year-old Beagle with a bronchoalveolar carcinoma, (a) before and(b) after intravenous contrast medium administration. Both images were acquired at the level of the heart (H). A large mass (M) in the left lung compresses and distorts a bronchus (arrowed). (b) Contrast medium administration reveals multiple non-enhancing cystic or necrotic regions.

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12.68

Close-up of a lateral thoracic radiograph of a cat. Multiple mineralized opacities are visible throughout the lungs consistent with bronchial microlithiasis. © 2024 British Small Animal Veterinary Association

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12.68 Close-up of a lateral thoracic radiograph of a cat. Multiple mineralized opacities are visible throughout the lungs consistent with bronchial microlithiasis.

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12.70

(a) Central close-up of a right lateral thoracic radiograph of a 12-year-old German Shepherd Dog with a pulmonary carcinoma. The mass slightly deviates the air-filled left cranial lobar bronchus but does not give rise to an air bronchogram. This indicates it has an expansile rather than infiltrative nature. (b) The corresponding CT image confirms how the mass abuts but does not encroach the bronchus. (Courtesy of Lobo Jarrett) © 2024 British Small Animal Veterinary Association

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12.70 (a) Central close-up of a right lateral thoracic radiograph of a 12-year-old German Shepherd Dog with a pulmonary carcinoma. The mass slightly deviates the air-filled left cranial lobar bronchus but does not give rise to an air bronchogram. This indicates it has an expansile rather than infiltrative nature. (b) The corresponding CT image confirms how the mass abuts but does not encroach the bronchus. (Courtesy of Lobo Jarrett)

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12.71

Close-up of a DV thoracic radiograph of a dog with a histiocytic sarcoma in the right middle lung lobe. The mass occupies a large portion of the lobe giving rise to a lobar sign cranially and caudally and does contain air bronchograms. This is consistent with an infiltrative lesion encroaching airways. © 2024 British Small Animal Veterinary Association

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12.71 Close-up of a DV thoracic radiograph of a dog with a histiocytic sarcoma in the right middle lung lobe. The mass occupies a large portion of the lobe giving rise to a lobar sign cranially and caudally and does contain air bronchograms. This is consistent with an infiltrative lesion encroaching airways.

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12.72

Caudal close-up of a VD thoracic radiograph of a 12-year-old Domestic Shorthaired cat with nasal and pulmonary lymphoma. Notice the increased opacity with an alveolar pattern (air bronchogram) supportive of an infiltrative process. Radiographically evident pulmonary involvement in feline lymphoma is extremely rare. © 2024 British Small Animal Veterinary Association

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12.72 Caudal close-up of a VD thoracic radiograph of a 12-year-old Domestic Shorthaired cat with nasal and pulmonary lymphoma. Notice the increased opacity with an alveolar pattern (air bronchogram) supportive of an infiltrative process. Radiographically evident pulmonary involvement in feline lymphoma is extremely rare.

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12.73

Left lateral thoracic radiograph of a 12-year-old mixed-breed dog with primary bronchoalveolar carcinoma. A solitary soft tissue nodule is seen in the right middle lung lobe (arrowed). © 2024 British Small Animal Veterinary Association

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12.73 Left lateral thoracic radiograph of a 12-year-old mixed-breed dog with primary bronchoalveolar carcinoma. A solitary soft tissue nodule is seen in the right middle lung lobe (arrowed).

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12.74

VD thoracic radiograph of an 8-year-old Rottweiler with pulmonary adenocarcinoma. There is a soft tissue mass in the left caudal lung lobe. Note the border effacement between the mass and the heart. © 2024 British Small Animal Veterinary Association

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12.74 VD thoracic radiograph of an 8-year-old Rottweiler with pulmonary adenocarcinoma. There is a soft tissue mass in the left caudal lung lobe. Note the border effacement between the mass and the heart.

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12.75

VD thoracic radiograph of a 12-year-old Bichon Frise with primary pulmonary carcinoma. The entire left cranial lung lobe is consolidated and enlarged. © 2024 British Small Animal Veterinary Association

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12.75 VD thoracic radiograph of a 12-year-old Bichon Frise with primary pulmonary carcinoma. The entire left cranial lung lobe is consolidated and enlarged.

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12.76

Craniodorsal close-up of a right lateral thoracic radiograph of a 10-year-old Domestic Shorthaired cat with a primary lung lobe tumour in the left cranial lobe. There are multiple small mineralizations in the dorsal part of the craniovental lung field. A VD view confirmed their location within the left cranial lung lobe. Such soft tissue mineralization is not uncommon in primary lung lobe tumours in cats and is a relatively specific sign for them. © 2024 British Small Animal Veterinary Association

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12.76 Craniodorsal close-up of a right lateral thoracic radiograph of a 10-year-old Domestic Shorthaired cat with a primary lung lobe tumour in the left cranial lobe. There are multiple small mineralizations in the dorsal part of the craniovental lung field. A VD view confirmed their location within the left cranial lung lobe. Such soft tissue mineralization is not uncommon in primary lung lobe tumours in cats and is a relatively specific sign for them.

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12.77

Close-up of a radiograph of the fifth distal phalanx (P3) of the right manus of a 9-year-old Rottweiler with digital pain. Notice the soft tissue swelling and extensive osteolysis of P3 (histological diagnosis: subungual melanoma). Digital neoplasia is associated with pulmonary primary (cats) or metastatic (dogs) neoplasia and thoracic radiographs should be obtained routinely. © 2024 British Small Animal Veterinary Association

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12.77 Close-up of a radiograph of the fifth distal phalanx (P3) of the right manus of a 9-year-old Rottweiler with digital pain. Notice the soft tissue swelling and extensive osteolysis of P3 (histological diagnosis: subungual melanoma). Digital neoplasia is associated with pulmonary primary (cats) or metastatic (dogs) neoplasia and thoracic radiographs should be obtained routinely.

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12.78

Left lateral thoracic radiograph of a 1-year-old Great Dane with suppurative pneumonia. An abscess is seen as a cavitary mass (M) in the right cranial lung lobe. The centrally present gas delineates a thick wall with irregular inner surface. The caudally adjacent right middle lung is increased in opacity with an alveolar pattern (air bronchograms, lobar sign) consistent with pneumonia. © 2024 British Small Animal Veterinary Association

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12.78 Left lateral thoracic radiograph of a 1-year-old Great Dane with suppurative pneumonia. An abscess is seen as a cavitary mass (M) in the right cranial lung lobe. The centrally present gas delineates a thick wall with irregular inner surface. The caudally adjacent right middle lung is increased in opacity with an alveolar pattern (air bronchograms, lobar sign) consistent with pneumonia.

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12.79

Close-up of a lateral thoracic radiograph of a 3-year-old mixed-breed dog with granulomatous fungal pneumonia (same dog as in Figure 12.94). There are multiple small soft tissue nodules throughout the lungs (arrowed). There is also tracheobronchial lymphadenopathy, evident by the increased opacity dorsal to the heart base. © 2024 British Small Animal Veterinary Association

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12.79 Close-up of a lateral thoracic radiograph of a 3-year-old mixed-breed dog with granulomatous fungal pneumonia (same dog as in Figure 12.94). There are multiple small soft tissue nodules throughout the lungs (arrowed). There is also tracheobronchial lymphadenopathy, evident by the increased opacity dorsal to the heart base.

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12.80

Lateral thoracic radiograph of a 6-year-old Rottweiler with pulmonary infiltration and eosinophilia. There is increased lung opacity with a mixed bronchial and alveolar pattern. Note the nodular component (arrowed) caused by the formation of granuloma. © 2024 British Small Animal Veterinary Association

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12.80 Lateral thoracic radiograph of a 6-year-old Rottweiler with pulmonary infiltration and eosinophilia. There is increased lung opacity with a mixed bronchial and alveolar pattern. Note the nodular component (arrowed) caused by the formation of granuloma.

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12.81

Close-up of a lateral oesophagram of a 14-year-old Boxer with a perihilar mass. Barium outlines the oesophageal mucosa cranial and caudal to the mass with a normal pattern (bolus caudal to the mass). The oesophagus appears deviated and compressed but not invaded by the mass, making an oesophageal lesion unlikely. Final diagnosis: bronchial adenocarcinoma. (Courtesy of the University of Pennsylvania) © 2024 British Small Animal Veterinary Association

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12.81 Close-up of a lateral oesophagram of a 14-year-old Boxer with a perihilar mass. Barium outlines the oesophageal mucosa cranial and caudal to the mass with a normal pattern (bolus caudal to the mass). The oesophagus appears deviated and compressed but not invaded by the mass, making an oesophageal lesion unlikely. Final diagnosis: bronchial adenocarcinoma. (Courtesy of the University of Pennsylvania)

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12.82

Close-up bronchogram of the left lung of an 8-year-old English Springer Spaniel with bronchial adenocarcinoma arising from the left principal bronchus. Survey radiographs showed a hilar soft tissue mass. The contrast study demonstrates the central filling defect owing to the mass and residual patency allowing filling of peripheral bronchi with contrast medium. (Courtesy of the University of Pennsylvania) © 2024 British Small Animal Veterinary Association

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12.82 Close-up bronchogram of the left lung of an 8-year-old English Springer Spaniel with bronchial adenocarcinoma arising from the left principal bronchus. Survey radiographs showed a hilar soft tissue mass. The contrast study demonstrates the central filling defect owing to the mass and residual patency allowing filling of peripheral bronchi with contrast medium. (Courtesy of the University of Pennsylvania)

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12.83

Thoracic linear-transducer ultrasound image of a 5-year-old Domestic Shorthaired cat with a primary lung tumour. The affected lung lobe has lost its normal reflectivity and appears with the echogenicity of soft tissue. Residual amounts of trapped air are hyperechoic and cause dirty shadowing distally (arrowhead). There is a small amount of anechoic pleural effusion (arrowed). © 2024 British Small Animal Veterinary Association

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12.83 Thoracic linear-transducer ultrasound image of a 5-year-old Domestic Shorthaired cat with a primary lung tumour. The affected lung lobe has lost its normal reflectivity and appears with the echogenicity of soft tissue. Residual amounts of trapped air are hyperechoic and cause dirty shadowing distally (arrowhead). There is a small amount of anechoic pleural effusion (arrowed).

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12.84

Thoracic curvilinear transducer ultrasound image of a 2-year-old Weimaraner with a lung abscess. Adjacent to the visceral pleural margin, there is a round mass with a thick echoic capsule with irregular internal margins and a hypoechoic core. The hyperechoic area around the mass represents normal aerated lung. © 2024 British Small Animal Veterinary Association

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12.84 Thoracic curvilinear transducer ultrasound image of a 2-year-old Weimaraner with a lung abscess. Adjacent to the visceral pleural margin, there is a round mass with a thick echoic capsule with irregular internal margins and a hypoechoic core. The hyperechoic area around the mass represents normal aerated lung.

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12.85

(a) Post-contrast transverse thoracic CT image at a level immediately caudal to the carina of a 7-year-old Bulldog with a primary pulmonary carcinoma. A large soft tissue mass (M) displaces the heart (H) and major blood vessels towards the left, deviating and compressing the right middle lung lobe (L) and its bronchus. There is heterogeneous mild enhancement of the mass with rim enhancement and strong enhancement of the collapsed lung. (b) Ventral aspect three-dimensional reconstruction with air-filled spaces in white. A large void in the right lung corresponds to the tumour and atelectatic lung tissue. (b Courtesy of Jennifer Kinns) © 2024 British Small Animal Veterinary Association

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12.85 (a) Post-contrast transverse thoracic CT image at a level immediately caudal to the carina of a 7-year-old Bulldog with a primary pulmonary carcinoma. A large soft tissue mass (M) displaces the heart (H) and major blood vessels towards the left, deviating and compressing the right middle lung lobe (L) and its bronchus. There is heterogeneous mild enhancement of the mass with rim enhancement and strong enhancement of the collapsed lung. (b) Ventral aspect three-dimensional reconstruction with air-filled spaces in white. A large void in the right lung corresponds to the tumour and atelectatic lung tissue. (b Courtesy of Jennifer Kinns)

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12.86

Post-contrast transverse caudal-thoracic CT image of a 2-year-old Cocker Spaniel with a lung abscess. The right caudal lung lobe has a hypoattenuating mass (A) with a thick, mildly enhancing capsule. The liver (L) and hypoattenuating gallbladder (G) are seen ventrally. Note the complete flattening of the contrast-enhanced caudal vena cava (arrowed) due to compression by the mass. © 2024 British Small Animal Veterinary Association

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12.86 Post-contrast transverse caudal-thoracic CT image of a 2-year-old Cocker Spaniel with a lung abscess. The right caudal lung lobe has a hypoattenuating mass (A) with a thick, mildly enhancing capsule. The liver (L) and hypoattenuating gallbladder (G) are seen ventrally. Note the complete flattening of the contrast-enhanced caudal vena cava (arrowed) due to compression by the mass.

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12.87

Lateral thoracic radiograph of a 4-year-old Rottweiler with pulmonary metastasis from an unidentified primary neoplasm. Both lungs have numerous, round, relatively well marginated, randomly distributed, soft tissue nodules of variable size. © 2024 British Small Animal Veterinary Association

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12.87 Lateral thoracic radiograph of a 4-year-old Rottweiler with pulmonary metastasis from an unidentified primary neoplasm. Both lungs have numerous, round, relatively well marginated, randomly distributed, soft tissue nodules of variable size.

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12.88

Close-up of a lateral thoracic radiograph of a 12-year-old Domestic Longhaired cat with metastatic pulmonary neoplasia. Compared with the dog in Figure 12.87, the nodules are ill defined and not round. This is a relatively common appearance of metastatic nodules in cats. © 2024 British Small Animal Veterinary Association

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12.88 Close-up of a lateral thoracic radiograph of a 12-year-old Domestic Longhaired cat with metastatic pulmonary neoplasia. Compared with the dog in Figure 12.87, the nodules are ill defined and not round. This is a relatively common appearance of metastatic nodules in cats.

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12.89

Caudodorsal close-up of a lateral thoracic radiograph of a 10-year-old Papillon with pulmonary metastasis from a splenic haemangiosarcoma. There are multiple poorly defined small coalescing nodules spread throughout the lungs. © 2024 British Small Animal Veterinary Association

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12.89 Caudodorsal close-up of a lateral thoracic radiograph of a 10-year-old Papillon with pulmonary metastasis from a splenic haemangiosarcoma. There are multiple poorly defined small coalescing nodules spread throughout the lungs.

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12.90

Thoracic curvilinear transducer ultrasound image of a 9-year-old Boxer with a neuroendocrine heart base tumour and pulmonary metastasis. The metastatic nodule is round and hypoechoic, with a small hyperechoic core and smooth margins surrounded by hyperechoic aerated lung. © 2024 British Small Animal Veterinary Association

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12.90 Thoracic curvilinear transducer ultrasound image of a 9-year-old Boxer with a neuroendocrine heart base tumour and pulmonary metastasis. The metastatic nodule is round and hypoechoic, with a small hyperechoic core and smooth margins surrounded by hyperechoic aerated lung.

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12.91

(a) Central close-up of a right lateral thoracic radiograph of a 9-year-old mixed-breed dog acquired 3 months after removal of the right middle lung lobe with a pulmonary carcinoma. Notice the surgical staples (arrowhead) and a faintly visible nodular opacity (arrowed). The opposite lateral view was normal. (b) High-resolution thoracic CT image at the level of the tracheal bifurcation. There is a soft tissue nodule in each cranial lung lobe (diameter: right, 6 mm; left, 9 mm) and atelectasis related to ventral recumbency. CT can detect more and smaller nodules. © 2024 British Small Animal Veterinary Association

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12.91 (a) Central close-up of a right lateral thoracic radiograph of a 9-year-old mixed-breed dog acquired 3 months after removal of the right middle lung lobe with a pulmonary carcinoma. Notice the surgical staples (arrowhead) and a faintly visible nodular opacity (arrowed). The opposite lateral view was normal. (b) High-resolution thoracic CT image at the level of the tracheal bifurcation. There is a soft tissue nodule in each cranial lung lobe (diameter: right, 6 mm; left, 9 mm) and atelectasis related to ventral recumbency. CT can detect more and smaller nodules.

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12.92

High-resolution transverse thoracic CT image at the level of the accessory lung lobe of a 7-year-old mixed-breed dog with anal sac adenocarcinoma and pulmonary metastasis. Multiple small (1–4 mm) nodules are visible throughout the lungs. Nodules in the lung periphery are easily identified, whereas more central lesions must be distinguished from normal blood vessels with slice-by-slice comparison. Such nodules appear like granulomatous soft tissue nodules (see Figure 12.94) and must be evaluated in context with clinical history and disease progression. © 2024 British Small Animal Veterinary Association

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12.92 High-resolution transverse thoracic CT image at the level of the accessory lung lobe of a 7-year-old mixed-breed dog with anal sac adenocarcinoma and pulmonary metastasis. Multiple small (1–4 mm) nodules are visible throughout the lungs. Nodules in the lung periphery are easily identified, whereas more central lesions must be distinguished from normal blood vessels with slice-by-slice comparison. Such nodules appear like granulomatous soft tissue nodules (see Figure 12.94) and must be evaluated in context with clinical history and disease progression.

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12.93

High-resolution transverse thoracic CT image just caudal to the carina of a 9-year-old Labrador Retriever with a nasal adenocarcinoma. There are numerous, small (1 mm), mineralized ditzels throughout the lungs. These are incidental osteoma and not neoplastic metastases. Nasal neoplasia rarely metastasizes to the lungs and pulmonary metastases only very rarely mineralize. © 2024 British Small Animal Veterinary Association

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12.93 High-resolution transverse thoracic CT image just caudal to the carina of a 9-year-old Labrador Retriever with a nasal adenocarcinoma. There are numerous, small (1 mm), mineralized ditzels throughout the lungs. These are incidental osteoma and not neoplastic metastases. Nasal neoplasia rarely metastasizes to the lungs and pulmonary metastases only very rarely mineralize.

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12.94

High-resolution transverse thoracic CT image at the level of the aortic arch of the same dog as in Figure 12.79 with granulomatous pneumonia. Note the soft tissue nodules in the peripheral lung (arrowheads). These can be differentiated from blood vessels by their larger size in the peripheral lung, and by evaluating contiguous images (blood vessels can be followed cranially and caudally). © 2024 British Small Animal Veterinary Association

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12.94 High-resolution transverse thoracic CT image at the level of the aortic arch of the same dog as in Figure 12.79 with granulomatous pneumonia. Note the soft tissue nodules in the peripheral lung (arrowheads). These can be differentiated from blood vessels by their larger size in the peripheral lung, and by evaluating contiguous images (blood vessels can be followed cranially and caudally).

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12.95

High-resolution dorsal thoracic CT image through the dorsal part of the lungs of a 13-year-old West Highland White Terrier with idiopathic pulmonary fibrosis. In the cranial aspect of the left lung, there is a small (4 mm) soft tissue nodule (arrowed) including a lucent bronchus. Because the nodule encroaches a bronchus, it is an unlikely candidate for metastasis. A follow-up investigation showed no progression of the lesion. © 2024 British Small Animal Veterinary Association

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12.95 High-resolution dorsal thoracic CT image through the dorsal part of the lungs of a 13-year-old West Highland White Terrier with idiopathic pulmonary fibrosis. In the cranial aspect of the left lung, there is a small (4 mm) soft tissue nodule (arrowed) including a lucent bronchus. Because the nodule encroaches a bronchus, it is an unlikely candidate for metastasis. A follow-up investigation showed no progression of the lesion.

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12.96

High-resolution transverse thoracic CT image at the level of the accessory lung lobe of an 11-year-old Bichon Frisé with an anaplastic carcinoma in the left cranial lung lobe causing complete consolidation of that lobe (L) and deviation of the heart (H). No lung nodule was detected, but the bronchial walls were thick in the left caudal lung lobe (compare with right). Subsequent investigation confirmed neoplastic peribronchial infiltrate. © 2024 British Small Animal Veterinary Association

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12.96 High-resolution transverse thoracic CT image at the level of the accessory lung lobe of an 11-year-old Bichon Frisé with an anaplastic carcinoma in the left cranial lung lobe causing complete consolidation of that lobe (L) and deviation of the heart (H). No lung nodule was detected, but the bronchial walls were thick in the left caudal lung lobe (compare with right). Subsequent investigation confirmed neoplastic peribronchial infiltrate.

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12.97

Close-up transverse thoracic CT image at the level of the accessory lung lobe of an 11-year-old Cairn Terrier with adrenal carcinoma and pulmonary carcinosis with widespread infarction of pulmonary capillaries and tributary lung tissue. Notice the multiple small wedge-shaped subpleural lesions with pleural retraction and ill-defined parenchymal lesions consistent with infarction, and ventral areas of ground-glass opacity, which is a non-specific finding. © 2024 British Small Animal Veterinary Association

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12.97 Close-up transverse thoracic CT image at the level of the accessory lung lobe of an 11-year-old Cairn Terrier with adrenal carcinoma and pulmonary carcinosis with widespread infarction of pulmonary capillaries and tributary lung tissue. Notice the multiple small wedge-shaped subpleural lesions with pleural retraction and ill-defined parenchymal lesions consistent with infarction, and ventral areas of ground-glass opacity, which is a non-specific finding.

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12.98

Different types of pulmonary bullae. The internal and external layers of the visceral pleura (marked as black and grey respectively) are not dissected by bullae but can be herniated in different ways. (a) A type 1 bulla is a round gas accumulation within herniated visceral pleura with a small isthmus to the pulmonary parenchyma. They are usually found at lung apices. These bullae macroscopically resemble blebs, except blebs are usually not spherical. (b) A type 2 bulla arises from subpleural parenchyma and contains emphysematous lung tissue connected to the pulmonary parenchyma with a wider neck. (c) A type 3 bulla is a usually a large gas pocket without emphysematous lung tissue deep in the pulmonary parenchyma and may involve more broad-based deviation of the visceral pleura. (Reprinted from Lipscomb VJ et al. (2003) with permission) © 2024 British Small Animal Veterinary Association

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12.98 Different types of pulmonary bullae. The internal and external layers of the visceral pleura (marked as black and grey respectively) are not dissected by bullae but can be herniated in different ways. (a) A type 1 bulla is a round gas accumulation within herniated visceral pleura with a small isthmus to the pulmonary parenchyma. They are usually found at lung apices. These bullae macroscopically resemble blebs, except blebs are usually not spherical. (b) A type 2 bulla arises from subpleural parenchyma and contains emphysematous lung tissue connected to the pulmonary parenchyma with a wider neck. (c) A type 3 bulla is a usually a large gas pocket without emphysematous lung tissue deep in the pulmonary parenchyma and may involve more broad-based deviation of the visceral pleura. (Reprinted from Lipscomb VJ et al. (2003) with permission)

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12.99

Pulmonary bleb. The internal and external layers of the visceral pleura (marked as black and grey respectively) are dissected by a gas pocket that has escaped from the pulmonary parenchyma. (Reprinted from Lipscomb VJ et al. (2003) with permission) © 2024 British Small Animal Veterinary Association

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12.99 Pulmonary bleb. The internal and external layers of the visceral pleura (marked as black and grey respectively) are dissected by a gas pocket that has escaped from the pulmonary parenchyma. (Reprinted from Lipscomb VJ et al. (2003) with permission)

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12.100

Close-up of a lateral thoracic radiograph of a 10-year-old Labrador Retriever. Notice the round gas opacity surrounded by a very thin opaque wall (arrowed) that summates with the cardiac silhouette. This bulla was an incidental finding. © 2024 British Small Animal Veterinary Association

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12.100 Close-up of a lateral thoracic radiograph of a 10-year-old Labrador Retriever. Notice the round gas opacity surrounded by a very thin opaque wall (arrowed) that summates with the cardiac silhouette. This bulla was an incidental finding.

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12.101

Transverse thoracic CT (dorsal recumbency, lung window) of a 7-year-old Poodle with spontaneous pneumothorax. Notice both pleural cavities are expanded and gas-filled (worse on the right side). A bleb or small bulla (arrowed) is seen at the ventral tip of the right caudal lung lobe. The increased opacity of the lung parenchyma adjacent to the body wall is attributed to atelectasis. © 2024 British Small Animal Veterinary Association

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12.101 Transverse thoracic CT (dorsal recumbency, lung window) of a 7-year-old Poodle with spontaneous pneumothorax. Notice both pleural cavities are expanded and gas-filled (worse on the right side). A bleb or small bulla (arrowed) is seen at the ventral tip of the right caudal lung lobe. The increased opacity of the lung parenchyma adjacent to the body wall is attributed to atelectasis.

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12.102

(a) Close-up of a lateral thoracic radiograph (vertical beam) of a dog that was involved in a road traffic accident 24 hours previously. A sternal dislocation, pneumothorax and multiple ovoid pulmonary soft tissue masses (arrowed) are identified, which could be related to trauma or an unrelated illness. (b) Close-up of a VD thoracic radiograph of the non-dependent hemithorax obtained with a horizontal beam. Beside the serial rib fractures (arrowheads) and free pleural gas (P) in the most elevated part of the thorax, two of the previously seen masses (M) are also visible with a straight fluid–gas interface and a thin smoothly outlined wall. These findings are most consistent with blood- and gas-filled bullae, haemopneumatocoeles. © 2024 British Small Animal Veterinary Association

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12.102 (a) Close-up of a lateral thoracic radiograph (vertical beam) of a dog that was involved in a road traffic accident 24 hours previously. A sternal dislocation, pneumothorax and multiple ovoid pulmonary soft tissue masses (arrowed) are identified, which could be related to trauma or an unrelated illness. (b) Close-up of a VD thoracic radiograph of the non-dependent hemithorax obtained with a horizontal beam. Beside the serial rib fractures (arrowheads) and free pleural gas (P) in the most elevated part of the thorax, two of the previously seen masses (M) are also visible with a straight fluid–gas interface and a thin smoothly outlined wall. These findings are most consistent with blood- and gas-filled bullae, haemopneumatocoeles.

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12.103

The typification of gas- and fluid-containing lung lesions according to gas location and fluid–gas interface. In vertical beam radiography, (i) one large central gas lucency is more likely to indicate a cyst, large abscess or bulla; (ii) Several small, irregularly shaped and distributed gas lucencies are more suggestive of neoplasia, foreign body or gas-producing bacteria. In horizontal beam radiography, (iii) low-viscosity fluid tends to create a straight interface with gas, whereas (iv and v) high-viscosity fluid tends to create a convex or concave margin and (vi) gas within solid lesions creates no interface. (Adapted from Silverman et al. (1976) with permission) © 2024 British Small Animal Veterinary Association

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12.103 The typification of gas- and fluid-containing lung lesions according to gas location and fluid–gas interface. In vertical beam radiography, (i) one large central gas lucency is more likely to indicate a cyst, large abscess or bulla; (ii) Several small, irregularly shaped and distributed gas lucencies are more suggestive of neoplasia, foreign body or gas-producing bacteria. In horizontal beam radiography, (iii) low-viscosity fluid tends to create a straight interface with gas, whereas (iv and v) high-viscosity fluid tends to create a convex or concave margin and (vi) gas within solid lesions creates no interface. (Adapted from Silverman et al. (1976) with permission)

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12.104

The typification of gas-containing lung lesions according to their wall characteristics. The wall can be regular or irregular on either or both sides or have various combinations of the two. Smooth-walled lesions are most likely bullae or cysts, whereas irregular margins are a result of tissue necrosis and infection and are commonly seen with abscesses and neoplasms (cavitating lesions). In lesions that contain fluid and gas, these features can only be applied to horizontal beam radiographs. (Adapted from Silverman et al. (1976) with permission) © 2024 British Small Animal Veterinary Association

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12.104 The typification of gas-containing lung lesions according to their wall characteristics. The wall can be regular or irregular on either or both sides or have various combinations of the two. Smooth-walled lesions are most likely bullae or cysts, whereas irregular margins are a result of tissue necrosis and infection and are commonly seen with abscesses and neoplasms (cavitating lesions). In lesions that contain fluid and gas, these features can only be applied to horizontal beam radiographs. (Adapted from Silverman et al. (1976) with permission)

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12.105

Close-up of a lateral (standing/horizontal) thoracic radiograph of a 4-year-old Great Dane with extreme dyspnoea and cough. In the caudodorsal lung field, there is a cavitating lung abscess with a horizontal fluid line (arrowed) separating fluid from gas. The lungs have an alveolar lung pattern with a diffuse increase in soft tissue opacity. © 2024 British Small Animal Veterinary Association

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12.105 Close-up of a lateral (standing/horizontal) thoracic radiograph of a 4-year-old Great Dane with extreme dyspnoea and cough. In the caudodorsal lung field, there is a cavitating lung abscess with a horizontal fluid line (arrowed) separating fluid from gas. The lungs have an alveolar lung pattern with a diffuse increase in soft tissue opacity.

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12.106

Close-up of a DV thoracic radiograph of an 11-year-old mixed-breed dog with a chronic productive cough. The left cranial lung lobe (caudal part) has a severe increase in soft tissue opacity with retraction of the lobe edge from the thoracic wall (arrowed). There is an irregularly shaped gas opacity eccentrically positioned within the lung lobe (arrowheads), which represents a cavitated centre. This was confirmed to be bronchogenic carcinoma with central necrosis. © 2024 British Small Animal Veterinary Association

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12.106 Close-up of a DV thoracic radiograph of an 11-year-old mixed-breed dog with a chronic productive cough. The left cranial lung lobe (caudal part) has a severe increase in soft tissue opacity with retraction of the lobe edge from the thoracic wall (arrowed). There is an irregularly shaped gas opacity eccentrically positioned within the lung lobe (arrowheads), which represents a cavitated centre. This was confirmed to be bronchogenic carcinoma with central necrosis.

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12.107

Lateral thoracic radiograph of a 6-year-old Domestic Shorthaired cat with Paragonimus kellikotti fluke infection. Notice the multiple pulmonary soft tissue nodules containing irregular small central air bubbles. This is a classical radiographic feature of paragonimiasis in dogs and cats. © 2024 British Small Animal Veterinary Association

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12.107 Lateral thoracic radiograph of a 6-year-old Domestic Shorthaired cat with Paragonimus kellikotti fluke infection. Notice the multiple pulmonary soft tissue nodules containing irregular small central air bubbles. This is a classical radiographic feature of paragonimiasis in dogs and cats.

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12.108

High-resolution transverse thoracic CT image at the level of the accessory lung lobe of a 16-year-old Standard Poodle with numerous pulmonary bullae (*) in both lungs. Slice-by-slice image analysis is necessary to rule out bronchiectasis. These relatively small bullae would be difficult to identify radiographically. The interpretation of the relevance of such small lesions can only be made in light of the clinical history of the patient. There is ventral hypostatic lung collapse. © 2024 British Small Animal Veterinary Association

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12.108 High-resolution transverse thoracic CT image at the level of the accessory lung lobe of a 16-year-old Standard Poodle with numerous pulmonary bullae (*) in both lungs. Slice-by-slice image analysis is necessary to rule out bronchiectasis. These relatively small bullae would be difficult to identify radiographically. The interpretation of the relevance of such small lesions can only be made in light of the clinical history of the patient. There is ventral hypostatic lung collapse.

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12.109

High-resolution transverse thoracic CT image at the level of the aortic arch of an 8-year-old Golden Retriever with spontaneous left-sided pneumothorax (P). CT enabled identification of a leaking type 1 bulla (*) in the left cranial lung lobe. A thoracocentesis drain is seen in cross-section adjacent to the collapsed left lung. © 2024 British Small Animal Veterinary Association

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12.109 High-resolution transverse thoracic CT image at the level of the aortic arch of an 8-year-old Golden Retriever with spontaneous left-sided pneumothorax (P). CT enabled identification of a leaking type 1 bulla (*) in the left cranial lung lobe. A thoracocentesis drain is seen in cross-section adjacent to the collapsed left lung.

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12.110

(a) Expiratory lateral thoracic radiograph of a cat with feline asthma. Notice the small size of cardiovascular structures, generalized bronchial pattern, large bulla and multiple non-union rib fractures. (b) Caudodorsal close-up of the same radiograph reveals hyperlucent peripheral lung fields consistent with air-trapping and emphysema. © 2024 British Small Animal Veterinary Association

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12.110 (a) Expiratory lateral thoracic radiograph of a cat with feline asthma. Notice the small size of cardiovascular structures, generalized bronchial pattern, large bulla and multiple non-union rib fractures. (b) Caudodorsal close-up of the same radiograph reveals hyperlucent peripheral lung fields consistent with air-trapping and emphysema.

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12.111

Lateral thoracic radiograph of a 5-month-old Australian Cattle Dog with chronic bronchopneumonia. Both lungs have multiple distended tortuous bronchi and gas pockets, consistent with bronchiectasis and bullous emphysema. © 2024 British Small Animal Veterinary Association

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12.111 Lateral thoracic radiograph of a 5-month-old Australian Cattle Dog with chronic bronchopneumonia. Both lungs have multiple distended tortuous bronchi and gas pockets, consistent with bronchiectasis and bullous emphysema.

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12.112

High-resolution transverse thoracic CT image at the level of the accessory lung lobe of a 16-year-old cat with chronic lower airway disease. Both lungs have multiple soft tissue septae consistent with fibrotic changes and focal areas of pulmonary hyperlucency consistent with emphysema (*). © 2024 British Small Animal Veterinary Association

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12.112 High-resolution transverse thoracic CT image at the level of the accessory lung lobe of a 16-year-old cat with chronic lower airway disease. Both lungs have multiple soft tissue septae consistent with fibrotic changes and focal areas of pulmonary hyperlucency consistent with emphysema (*).

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12.113

An 8-year-old Jack Russell Terrier with right middle lung lobe torsion. (a) VD thoracic radiograph. Pleural fluid is present in the right cranial thorax, centred around the right middle and right cranial lung lobes. The right middle lung lobe is rounded and contains some air with a vesicular pattern. The cardiac silhouette is misshapen due to a previous pericardectomy. (b) Right lateral thoracic radiograph. In the cranioventral thorax, the lung has an increased opacity with air alveolograms. The right middle lobar bronchus is very narrow close to the carina and turns sharply cranially instead of caudoventrally (arrowed), a sign consistent with lung lobe torsion. © 2024 British Small Animal Veterinary Association

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12.113 An 8-year-old Jack Russell Terrier with right middle lung lobe torsion. (a) VD thoracic radiograph. Pleural fluid is present in the right cranial thorax, centred around the right middle and right cranial lung lobes. The right middle lung lobe is rounded and contains some air with a vesicular pattern. The cardiac silhouette is misshapen due to a previous pericardectomy. (b) Right lateral thoracic radiograph. In the cranioventral thorax, the lung has an increased opacity with air alveolograms. The right middle lobar bronchus is very narrow close to the carina and turns sharply cranially instead of caudoventrally (arrowed), a sign consistent with lung lobe torsion.

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12.114

DV thoracic radiograph of an 18-month-old Pug with a left cranial lung lobe torsion. The left cranial lung lobe is consolidated with a central vesicular pattern, extends abnormally far caudally, and causes a right shift of the cardiac silhouette. © 2024 British Small Animal Veterinary Association

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12.114 DV thoracic radiograph of an 18-month-old Pug with a left cranial lung lobe torsion. The left cranial lung lobe is consolidated with a central vesicular pattern, extends abnormally far caudally, and causes a right shift of the cardiac silhouette.

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12.115

Left lateral thoracic radiograph of a 6-year-old Borzoi with left cranial lung lobe torsion. There is moderate pleural effusion. The carina is axially rotated, resulting in dorsal displacement of the right cranial lobar bronchus (arrowed); a bronchus to the left cranial lung lobe is not visible. The increased opacity dorsal to the carina represents the consolidated left cranial lung lobe. © 2024 British Small Animal Veterinary Association

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12.115 Left lateral thoracic radiograph of a 6-year-old Borzoi with left cranial lung lobe torsion. There is moderate pleural effusion. The carina is axially rotated, resulting in dorsal displacement of the right cranial lobar bronchus (arrowed); a bronchus to the left cranial lung lobe is not visible. The increased opacity dorsal to the carina represents the consolidated left cranial lung lobe.

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12.116

DV thoracic radiograph of a 6-year-old Akita Inu with a left caudal lung lobe torsion. The left caudal lung lobe is enlarged, causing a right mediastinal shift, and contains multiple small air bubbles (vesicular pattern). © 2024 British Small Animal Veterinary Association

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12.116 DV thoracic radiograph of a 6-year-old Akita Inu with a left caudal lung lobe torsion. The left caudal lung lobe is enlarged, causing a right mediastinal shift, and contains multiple small air bubbles (vesicular pattern).

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12.117

Thoracic curvilinear transducer ultrasound images of the same dog as in Figure 12.115. Left oblique (intercostal) window, craniodorsal is to the left. (a) There is a large volume of anechoic pleural fluid and consolidation of both parts of the left cranial lung lobe with an abnormally dorsal location. (b) A slightly more caudal image, showing the periphery of the twisted left cranial lung lobe. There are large pockets of trapped gas present within the lung lobe, seen as hyperechoic areas with distal reverberation artefacts. © 2024 British Small Animal Veterinary Association

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12.117 Thoracic curvilinear transducer ultrasound images of the same dog as in Figure 12.115. Left oblique (intercostal) window, craniodorsal is to the left. (a) There is a large volume of anechoic pleural fluid and consolidation of both parts of the left cranial lung lobe with an abnormally dorsal location. (b) A slightly more caudal image, showing the periphery of the twisted left cranial lung lobe. There are large pockets of trapped gas present within the lung lobe, seen as hyperechoic areas with distal reverberation artefacts.

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12.118

Transverse thoracic CT image at the level of the aortic root of the same dog as in Figure 12.113. There is a left mediastinal shift and free gas in the dorsal pleural spaces. The twisted right middle lung lobe is enlarged and partially consolidated with multiple gas pockets (*). The right cranial lung lobe is completely collapsed (arrowed) and dorsally displaced by the enlarged right middle lung lobe. © 2024 British Small Animal Veterinary Association

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12.118 Transverse thoracic CT image at the level of the aortic root of the same dog as in Figure 12.113. There is a left mediastinal shift and free gas in the dorsal pleural spaces. The twisted right middle lung lobe is enlarged and partially consolidated with multiple gas pockets (*). The right cranial lung lobe is completely collapsed (arrowed) and dorsally displaced by the enlarged right middle lung lobe.

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12.119

(a, b) Transverse thoracic CT images at the level of the cranial mediastinum of a Pug with left cranial lung lobe torsion, the same dog as in Figure 12.114. (a) High-resolution lung CT image showing the enlarged consolidated left cranial lung lobe with central vesicular gas pattern (*) and mediastinal shift towards the right hemithorax (arrowed). (b) Post-contrast CT image showing contrast enhancement only of the pleural layer (arrowed). (c) Virtual bronchoscopy CT image of the left cranial lobar bronchus with a view of the tapered lumen near the torsion site with a fish-mouth appearance. © 2024 British Small Animal Veterinary Association

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12.119 (a, b) Transverse thoracic CT images at the level of the cranial mediastinum of a Pug with left cranial lung lobe torsion, the same dog as in Figure 12.114. (a) High-resolution lung CT image showing the enlarged consolidated left cranial lung lobe with central vesicular gas pattern (*) and mediastinal shift towards the right hemithorax (arrowed). (b) Post-contrast CT image showing contrast enhancement only of the pleural layer (arrowed). (c) Virtual bronchoscopy CT image of the left cranial lobar bronchus with a view of the tapered lumen near the torsion site with a fish-mouth appearance.

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12.120

High-resolution transverse thoracic CT image at the level of the accessory lung lobe of an 11-year-old Domestic Shorthaired cat with a primary lung lobe tumour, leading to bronchial obstruction and collapse of the left caudal lung lobe (L). The compensatory hyperinflation of the right lung leads to mediastinal shift with movement of the right caudal (R) and accessory (A) lung lobes towards the left hemithorax. © 2024 British Small Animal Veterinary Association

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12.120 High-resolution transverse thoracic CT image at the level of the accessory lung lobe of an 11-year-old Domestic Shorthaired cat with a primary lung lobe tumour, leading to bronchial obstruction and collapse of the left caudal lung lobe (L). The compensatory hyperinflation of the right lung leads to mediastinal shift with movement of the right caudal (R) and accessory (A) lung lobes towards the left hemithorax.

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12.121

(a) Expiratory lateral thoracic radiograph of a 9-year-old Yorkshire Terrier with intrathoracic tracheal collapse. The intrathoracic trachea is mildly narrowed. Cranial to the thoracic inlet, both cranial lung lobes protrude into the caudal neck (*). Only the left cranial lung lobe normally protrudes cranial to the thoracic inlet, and usually not during expiration. (b) Expiratory VD fluoroscopic image of the thoracic inlet, demonstrating the cervical herniation of both cranial lung lobes (outlined). (c) Inspiratory VD fluoroscopic image showing the cranial lung margins within the thoracic boundaries. This is cervical lung herniation, secondary to expiratory intrathoracic tracheal collapse and associated pressure changes. © 2024 British Small Animal Veterinary Association

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12.121 (a) Expiratory lateral thoracic radiograph of a 9-year-old Yorkshire Terrier with intrathoracic tracheal collapse. The intrathoracic trachea is mildly narrowed. Cranial to the thoracic inlet, both cranial lung lobes protrude into the caudal neck (*). Only the left cranial lung lobe normally protrudes cranial to the thoracic inlet, and usually not during expiration. (b) Expiratory VD fluoroscopic image of the thoracic inlet, demonstrating the cervical herniation of both cranial lung lobes (outlined). (c) Inspiratory VD fluoroscopic image showing the cranial lung margins within the thoracic boundaries. This is cervical lung herniation, secondary to expiratory intrathoracic tracheal collapse and associated pressure changes.

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12.122

(a) DV thoracic radiograph and (b) transverse thoracic CT image at the level of the 7th intercostal space of an 8-year-old Pomeranian dog with chronic mitral valve disease and an old fracture of the left 7th rib (arrowed). There is herniation of a large part of the left caudal lung lobe through the 7th intercostal space into the external layers of the thoracic wall, consistent with intercostal lung herniation (*). © 2024 British Small Animal Veterinary Association

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12.122 (a) DV thoracic radiograph and (b) transverse thoracic CT image at the level of the 7th intercostal space of an 8-year-old Pomeranian dog with chronic mitral valve disease and an old fracture of the left 7th rib (arrowed). There is herniation of a large part of the left caudal lung lobe through the 7th intercostal space into the external layers of the thoracic wall, consistent with intercostal lung herniation (*).

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12.124

(ai) Lateral thoracic radiograph of a Labrador Retriever with pancreatitis. The thorax is normal. (aii) Lateral thoracic radiograph taken 48 hours later. Note the severe diffuse alveolar pattern, which has developed rapidly following aspiration of gastric fluid. The acute progression of the changes is helpful in producing a differential diagnosis list. (bi) Lateral thoracic radiograph of a 6-year-old Maine Coon cat presented with chronic cough and dyspnoea. There are multiple areas of ill-defined soft tissue opacity in several lung lobes. The presumptive diagnosis was pneumonia, possibly granulomatous or atypical in origin. Open lung biopsy showed chronic inflammatory changes. (bii) Lateral thoracic radiograph following treatment with antibiotics for 3 weeks. There is no change in the lung lesions. Histopathological examination post mortem confirmed diffuse pulmonary adenocarcinoma. (ci) Lateral thoracic radiograph of an Irish Wolfhound with widespread pulmonary oedema secondary to dilated cardiomyopathy. (cii) Lateral thoracic radiograph taken 72 hours later following treatment with diuretics. Note the resolution of the oedema, in contrast to the lack of progression seen in (b). ((b) Courtesy of Cambridge Veterinary School) © 2024 British Small Animal Veterinary Association

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12.124 (ai) Lateral thoracic radiograph of a Labrador Retriever with pancreatitis. The thorax is normal. (aii) Lateral thoracic radiograph taken 48 hours later. Note the severe diffuse alveolar pattern, which has developed rapidly following aspiration of gastric fluid. The acute progression of the changes is helpful in producing a differential diagnosis list. (bi) Lateral thoracic radiograph of a 6-year-old Maine Coon cat presented with chronic cough and dyspnoea. There are multiple areas of ill-defined soft tissue opacity in several lung lobes. The presumptive diagnosis was pneumonia, possibly granulomatous or atypical in origin. Open lung biopsy showed chronic inflammatory changes. (bii) Lateral thoracic radiograph following treatment with antibiotics for 3 weeks. There is no change in the lung lesions. Histopathological examination post mortem confirmed diffuse pulmonary adenocarcinoma. (ci) Lateral thoracic radiograph of an Irish Wolfhound with widespread pulmonary oedema secondary to dilated cardiomyopathy. (cii) Lateral thoracic radiograph taken 72 hours later following treatment with diuretics. Note the resolution of the oedema, in contrast to the lack of progression seen in (b). ((b) Courtesy of Cambridge Veterinary School)

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12.126

(a) VD thoracic radiograph (vertical beam orientation) of a 13-year-old Domestic Shorthaired cat obtained after the cat was under general anaesthesia in left lateral recumbency for 20 minutes. The left cranial lung lobe is collapsed with mild cardiac shift towards the left. (b) Immediate repeat VD thoracic radiograph with the cat in right lateral recumbency (horizontal beam orientation). The non-dependent left lung is now well aerated whereas the dependent right middle and caudal lobes are atelectatic under the weight of the heart (hypostatic lung collapse). L = left; R = right. © 2024 British Small Animal Veterinary Association

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12.126 (a) VD thoracic radiograph (vertical beam orientation) of a 13-year-old Domestic Shorthaired cat obtained after the cat was under general anaesthesia in left lateral recumbency for 20 minutes. The left cranial lung lobe is collapsed with mild cardiac shift towards the left. (b) Immediate repeat VD thoracic radiograph with the cat in right lateral recumbency (horizontal beam orientation). The non-dependent left lung is now well aerated whereas the dependent right middle and caudal lobes are atelectatic under the weight of the heart (hypostatic lung collapse). L = left; R = right.

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12.127

DV thoracic radiograph of a greyhound with a simple pneumothorax following trauma. There is passive collapse of all the lung lobes. Note how the collapsed lobes maintain their shape and collapse to a similar degree (arrowed). There is an increase in opacity within the atelectatic lung due to reduced aeration. © 2024 British Small Animal Veterinary Association

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12.127 DV thoracic radiograph of a greyhound with a simple pneumothorax following trauma. There is passive collapse of all the lung lobes. Note how the collapsed lobes maintain their shape and collapse to a similar degree (arrowed). There is an increase in opacity within the atelectatic lung due to reduced aeration.

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12.128

Lateral thoracic radiograph of a skeletally immature dog with a tension pneumothorax caused by a road traffic accident. The lung lobes are significantly reduced in size and are almost as opaque as other soft tissue structures in the image, indicating compression atelectasis. © 2024 British Small Animal Veterinary Association

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12.128 Lateral thoracic radiograph of a skeletally immature dog with a tension pneumothorax caused by a road traffic accident. The lung lobes are significantly reduced in size and are almost as opaque as other soft tissue structures in the image, indicating compression atelectasis.

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12.129

VD thoracic radiograph of a cat with chronic bronchial disease. The right middle lung lobe is collapsed and has an alveolar pattern (arrowed) probably due to obstruction of the bronchus (plug formation) and resorption of air from the affected lobe and a mild shift of the cardiac silhouette towards the right hemithorax. This is an example of obstructive resorption atelectasis, commonly seen in the right middle or cranial lobes in cats with bronchial disease. © 2024 British Small Animal Veterinary Association

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12.129 VD thoracic radiograph of a cat with chronic bronchial disease. The right middle lung lobe is collapsed and has an alveolar pattern (arrowed) probably due to obstruction of the bronchus (plug formation) and resorption of air from the affected lobe and a mild shift of the cardiac silhouette towards the right hemithorax. This is an example of obstructive resorption atelectasis, commonly seen in the right middle or cranial lobes in cats with bronchial disease.

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12.130

(ai) High-resolution transverse thoracic CT image at the level of the accessory lung lobe of an 8-year-old mixed-breed dog in dorsal recumbency under general anaesthesia with oxygen-supplemented ventilation performed for evaluation of potential lung metastasis. The dorsal lung regions are collapsed (reduced size and increased parenchymal attenuation) and cannot be assessed for metastases. The oesophagus is gas- and fluid-distended (*). (aii) CT image at the same location from a repeat series obtained with the dog in ventral recumbency. The dorsal lung region is completely aerated again; however, the ventral tip of the right caudal lung lobe is now atelectatic. Oxygen supplementation promotes non-obstructive resorption atelectasis, particularly in dependent lung regions (hypostatic component). Changes are quickly reversed with recumbency change, enabling diagnosis of atelectasis and assessment of affected lung regions. (bi) High-resolution transverse thoracic CT image at the level of the accessory lung lobe of a 4-year-old mixed-breed dog in ventral recumbency. Ventrally, the right caudal lung lobe has increased opacity without volume loss (*). (bii) CT image at the same location from a repeat series obtained with the dog in dorsal recumbency. The area of lung opacification is unchanged. The final diagnosis was bacterial bronchopneumonia. © 2024 British Small Animal Veterinary Association

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12.130 (ai) High-resolution transverse thoracic CT image at the level of the accessory lung lobe of an 8-year-old mixed-breed dog in dorsal recumbency under general anaesthesia with oxygen-supplemented ventilation performed for evaluation of potential lung metastasis. The dorsal lung regions are collapsed (reduced size and increased parenchymal attenuation) and cannot be assessed for metastases. The oesophagus is gas- and fluid-distended (*). (aii) CT image at the same location from a repeat series obtained with the dog in ventral recumbency. The dorsal lung region is completely aerated again; however, the ventral tip of the right caudal lung lobe is now atelectatic. Oxygen supplementation promotes non-obstructive resorption atelectasis, particularly in dependent lung regions (hypostatic component). Changes are quickly reversed with recumbency change, enabling diagnosis of atelectasis and assessment of affected lung regions. (bi) High-resolution transverse thoracic CT image at the level of the accessory lung lobe of a 4-year-old mixed-breed dog in ventral recumbency. Ventrally, the right caudal lung lobe has increased opacity without volume loss (*). (bii) CT image at the same location from a repeat series obtained with the dog in dorsal recumbency. The area of lung opacification is unchanged. The final diagnosis was bacterial bronchopneumonia.

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12.131

Close-up of a DV thoracic radiograph of an English Springer Spaniel following thoracocentesis (causing subcutaneous emphysema) for a chronic pyothorax. There is an iatrogenic pneumothorax, which contrasts with the pleural surface of the left caudal lung lobe. The lung has lost its normal shape and is rounded with increased opacity and thick pleura (arrowed). There is cicatrization atelectasis due to the thick pleura preventing lung re-expansion. © 2024 British Small Animal Veterinary Association

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12.131 Close-up of a DV thoracic radiograph of an English Springer Spaniel following thoracocentesis (causing subcutaneous emphysema) for a chronic pyothorax. There is an iatrogenic pneumothorax, which contrasts with the pleural surface of the left caudal lung lobe. The lung has lost its normal shape and is rounded with increased opacity and thick pleura (arrowed). There is cicatrization atelectasis due to the thick pleura preventing lung re-expansion.

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12.132

(a) Lateral thoracic radiograph of a 4-month-old German Shepherd Dog puppy with a patent ductus arteriosus (left-to-right shunting) and congestive heart failure. Note the typical perihilar distribution of the pulmonary oedema and enlargement of the pulmonary veins and arteries and cardiac silhouette. (b) Lateral thoracic radiograph of a kitten with a patent ductus arteriosus and pulmonary oedema. Pulmonary oedema in cats is more variable in distribution than in dogs. (a, Courtesy of Cambridge Veterinary School) © 2024 British Small Animal Veterinary Association

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12.132 (a) Lateral thoracic radiograph of a 4-month-old German Shepherd Dog puppy with a patent ductus arteriosus (left-to-right shunting) and congestive heart failure. Note the typical perihilar distribution of the pulmonary oedema and enlargement of the pulmonary veins and arteries and cardiac silhouette. (b) Lateral thoracic radiograph of a kitten with a patent ductus arteriosus and pulmonary oedema. Pulmonary oedema in cats is more variable in distribution than in dogs. (a, Courtesy of Cambridge Veterinary School)

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12.133

High-resolution transverse CT image of the caudal thorax of a 9-year-old Dalmatian with hypertrophic cardiomyopathy and secondary severe cardiogenic pulmonary oedema. Note the perivascular distribution of lung opacification (*) and pulmonary venous distention (arrowheads). © 2024 British Small Animal Veterinary Association

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12.133 High-resolution transverse CT image of the caudal thorax of a 9-year-old Dalmatian with hypertrophic cardiomyopathy and secondary severe cardiogenic pulmonary oedema. Note the perivascular distribution of lung opacification (*) and pulmonary venous distention (arrowheads).

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12.134

(a) Lateral thoracic radiograph of a 4-year-old mixed-breed dog with neurogenic pulmonary oedema following electrocution due to biting an electric cord. Notice the caudodorsal alveolar lung pattern, consistent with a non-cardiogenic form of pulmonary oedema. (b) Lateral thoracic radiograph of a dog with a history of strangulation. There is a caudodorsal interstitial to alveolar lung pattern. © 2024 British Small Animal Veterinary Association

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12.134 (a) Lateral thoracic radiograph of a 4-year-old mixed-breed dog with neurogenic pulmonary oedema following electrocution due to biting an electric cord. Notice the caudodorsal alveolar lung pattern, consistent with a non-cardiogenic form of pulmonary oedema. (b) Lateral thoracic radiograph of a dog with a history of strangulation. There is a caudodorsal interstitial to alveolar lung pattern.

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12.135

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12.135 Suspected pathophysiology of neurogenic pulmonary oedema.

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12.136

High-resolution transverse CT image of the mid-thorax of a 3-month-old Border Terrier with marked laryngeal oedema and secondary severe pulmonary oedema in the dorsal and caudal aspects of the lungs (*). Note the perivascular distribution. © 2024 British Small Animal Veterinary Association

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12.136 High-resolution transverse CT image of the mid-thorax of a 3-month-old Border Terrier with marked laryngeal oedema and secondary severe pulmonary oedema in the dorsal and caudal aspects of the lungs (*). Note the perivascular distribution.

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12.137

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12.137 Pathophysiology of pulmonary oedema secondary to decreased interstitial tissue pressure.

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12.138

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12.138 Pathophysiology of near drowning.

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12.139

Lateral thoracic radiograph of a dog obtained 8 hours after a near-drowning accident in a river. The dog was able to walk home and became severely dyspnoeic several hours later. The lungs have a diffuse patchy alveolar pattern and slight dyspnoea-related movement blur. © 2024 British Small Animal Veterinary Association

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12.139 Lateral thoracic radiograph of a dog obtained 8 hours after a near-drowning accident in a river. The dog was able to walk home and became severely dyspnoeic several hours later. The lungs have a diffuse patchy alveolar pattern and slight dyspnoea-related movement blur.

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12.140

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12.140 Pathophysiology of smoke inhalation.

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12.141

Lateral thoracic radiograph of a 6-month-old German Shepherd Dog that was rescued from a fire. The lungs have a patchy alveolar pattern, worse caudodorsally, consistent with smoke inhalation. © 2024 British Small Animal Veterinary Association

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12.141 Lateral thoracic radiograph of a 6-month-old German Shepherd Dog that was rescued from a fire. The lungs have a patchy alveolar pattern, worse caudodorsally, consistent with smoke inhalation.

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12.142

(a) VD thoracic radiograph of a 6-year-old Bernese Mountain Dog obtained 1 day after a road traffic accident resulting in multiple pelvic fractures and hindlimb injuries. The thorax is normal.(b) A repeat radiograph obtained 4 days later. There is progressive pulmonary opacification, particularly in the left lung, with a partial alveolar pattern. The dog had developed progressive systemic disease characterized by hyperthermia, immune-mediated haemolytic anaemia, erlichiosis, lymphadenopathy and metabolic acidosis, and was euthanized with a clinical diagnosis of ARDS. © 2024 British Small Animal Veterinary Association

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12.142 (a) VD thoracic radiograph of a 6-year-old Bernese Mountain Dog obtained 1 day after a road traffic accident resulting in multiple pelvic fractures and hindlimb injuries. The thorax is normal.(b) A repeat radiograph obtained 4 days later. There is progressive pulmonary opacification, particularly in the left lung, with a partial alveolar pattern. The dog had developed progressive systemic disease characterized by hyperthermia, immune-mediated haemolytic anaemia, erlichiosis, lymphadenopathy and metabolic acidosis, and was euthanized with a clinical diagnosis of ARDS.

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12.143

Lateral thoracic radiograph of a 5-year-old Domestic Shorthaired cat with terminal chronic renal failure. There is increased opacity with a partial alveolar pattern in the caudal lung lobes, aortic (arrowed) and gastric rugal (arrowhead) mineralization and gas distension of the stomach suggesting dyspnoea. Post-mortem examination confirmed chronic renal failure with extensive metastatic mineralization and uraemic pneumonitis. © 2024 British Small Animal Veterinary Association

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12.143 Lateral thoracic radiograph of a 5-year-old Domestic Shorthaired cat with terminal chronic renal failure. There is increased opacity with a partial alveolar pattern in the caudal lung lobes, aortic (arrowed) and gastric rugal (arrowhead) mineralization and gas distension of the stomach suggesting dyspnoea. Post-mortem examination confirmed chronic renal failure with extensive metastatic mineralization and uraemic pneumonitis.

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12.144

CT image of anomalous systemic arterial supply to the lung in a 3-year-old mixed-breed dog. A small vessel (arrowed) arising from a branch of the left gastric artery is supplying a small caudodorsomedial area in the left caudal lung lobe. Such vessels are occasionally seen in dogs and are incidental, except for surgical planning purposes. © 2024 British Small Animal Veterinary Association

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12.144 CT image of anomalous systemic arterial supply to the lung in a 3-year-old mixed-breed dog. A small vessel (arrowed) arising from a branch of the left gastric artery is supplying a small caudodorsomedial area in the left caudal lung lobe. Such vessels are occasionally seen in dogs and are incidental, except for surgical planning purposes.

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12.145

(a) A VD thoracic radiograph of an 8-year-old Irish Setter with sudden onset of dyspnoea. The left caudal lung lobe appears hyperlucent and less vascularized. (b) Close-up of the left caudal lung lobe. The lobar artery (between arrows) is distended cranial to and disappears at the level of the 9th rib (*). These are classical, albeit rare, signs of pulmonary thromboembolism: a thrombus-distended pulmonary artery and tributary oligaemia. © 2024 British Small Animal Veterinary Association

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12.145 (a) A VD thoracic radiograph of an 8-year-old Irish Setter with sudden onset of dyspnoea. The left caudal lung lobe appears hyperlucent and less vascularized. (b) Close-up of the left caudal lung lobe. The lobar artery (between arrows) is distended cranial to and disappears at the level of the 9th rib (*). These are classical, albeit rare, signs of pulmonary thromboembolism: a thrombus-distended pulmonary artery and tributary oligaemia.

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12.146

A 6-year-old Domestic Shorthaired cat with sudden onset of severe dyspnoea. (a) VD thoracic radiograph. There is increased opacity with a partial alveolar pattern in the left caudal lung lobe at the level of the costodiaphragmatic recess. (b) High-resolution transverse thoracic CT image at the level of the accessory lung lobe. The left caudal lung lobe has a wedge-shaped peripheral consolidation consistent with infarction. (c) A close-up of a pulmonary CT angiogram at the same level demonstrates contrast medium within the caudal vena cava (*) and aorta (A) and a large filling defect (dark core) in the left caudal lobar pulmonary artery (arrowed) indicating an occlusive thrombus. © 2024 British Small Animal Veterinary Association

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12.146 A 6-year-old Domestic Shorthaired cat with sudden onset of severe dyspnoea. (a) VD thoracic radiograph. There is increased opacity with a partial alveolar pattern in the left caudal lung lobe at the level of the costodiaphragmatic recess. (b) High-resolution transverse thoracic CT image at the level of the accessory lung lobe. The left caudal lung lobe has a wedge-shaped peripheral consolidation consistent with infarction. (c) A close-up of a pulmonary CT angiogram at the same level demonstrates contrast medium within the caudal vena cava (*) and aorta (A) and a large filling defect (dark core) in the left caudal lobar pulmonary artery (arrowed) indicating an occlusive thrombus.

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12.147

(a) Close-up of the right caudal lung lobe on a VD thoracic radiograph of a 1-year-old Domestic Shorthaired cat that had sustained a sudden respiratory arrest when an intramedullary pin was advanced into the humerus for a fracture repair. The radiograph was obtained during the resuscitation attempts, which ultimately failed. There is increased lung opacity with an alveolar pattern at the level of the right costodiaphragmatic recess. (b) Microscopic examination of the lungs (Oil Red O with Mayer’s haemulum stain) confirmed a massive shower of occlusive fat emboli (stained red) throughout the pulmonary capillary bed and pulmonary fat embolism was established as the cause of death. (Reprinted from Schwarz et al. (2001) with permission) © 2024 British Small Animal Veterinary Association

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12.147 (a) Close-up of the right caudal lung lobe on a VD thoracic radiograph of a 1-year-old Domestic Shorthaired cat that had sustained a sudden respiratory arrest when an intramedullary pin was advanced into the humerus for a fracture repair. The radiograph was obtained during the resuscitation attempts, which ultimately failed. There is increased lung opacity with an alveolar pattern at the level of the right costodiaphragmatic recess. (b) Microscopic examination of the lungs (Oil Red O with Mayer’s haemulum stain) confirmed a massive shower of occlusive fat emboli (stained red) throughout the pulmonary capillary bed and pulmonary fat embolism was established as the cause of death. (Reprinted from Schwarz et al. (2001) with permission)

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12.148

Caudal close-up of a lateral thoracic radiograph of a 4-year-old Labrador Retriever with a patent ductus arteriosus and left-to-right shunt, obtained during a coil embolization procedure. Three metallic coils have been dislodged into the caudal lung lobe arteries. Coils designed for human infants are commonly used in dogs, which typically have a wider ductus arteriosus. Due to the well developed collateral circulation, dislodged coils are usually of no clinical consequence. The ductus arteriosus was eventually successfully occluded. © 2024 British Small Animal Veterinary Association

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12.148 Caudal close-up of a lateral thoracic radiograph of a 4-year-old Labrador Retriever with a patent ductus arteriosus and left-to-right shunt, obtained during a coil embolization procedure. Three metallic coils have been dislodged into the caudal lung lobe arteries. Coils designed for human infants are commonly used in dogs, which typically have a wider ductus arteriosus. Due to the well developed collateral circulation, dislodged coils are usually of no clinical consequence. The ductus arteriosus was eventually successfully occluded.

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12.149

(a) High-resolution transverse thoracic CT image at the level of the accessory lung lobe of an 8-year-old Hungarian Vizsla with pyrexia and carcinomatous infiltrate in a peripheral lymph node. The dorsal aspects of both caudal lung lobes have a frond-like subpleural infiltrate. (b) Microscopic examination of one corresponding lung area (H&E stain) reveals a matching neoplastic capillary and interstitial subpleural infiltrate. Final diagnosis on post-mortem examination was adrenal carcinoma and pulmonary carcinosis. (Reprinted from Johnson et al. (2004) with permission) © 2024 British Small Animal Veterinary Association

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12.149 (a) High-resolution transverse thoracic CT image at the level of the accessory lung lobe of an 8-year-old Hungarian Vizsla with pyrexia and carcinomatous infiltrate in a peripheral lymph node. The dorsal aspects of both caudal lung lobes have a frond-like subpleural infiltrate. (b) Microscopic examination of one corresponding lung area (H&E stain) reveals a matching neoplastic capillary and interstitial subpleural infiltrate. Final diagnosis on post-mortem examination was adrenal carcinoma and pulmonary carcinosis. (Reprinted from Johnson et al. (2004) with permission)

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12.150

Lateral thoracic radiograph of a Labrador Retriever with coagulopathy due to warfarin toxicity. Note the tracheal narrowing, pleural fluid and partial alveolar lung pattern. This combination is highly suggestive of coumarin toxicity. (Courtesy of Cambridge Veterinary School) © 2024 British Small Animal Veterinary Association

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12.150 Lateral thoracic radiograph of a Labrador Retriever with coagulopathy due to warfarin toxicity. Note the tracheal narrowing, pleural fluid and partial alveolar lung pattern. This combination is highly suggestive of coumarin toxicity. (Courtesy of Cambridge Veterinary School)

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12.151

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12.151 Pathophysiology of blunt external thoracic trauma.

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12.152

DV thoracic radiograph of a Chihuahua following thoracic trauma. There are multiple right rib fractures. The right lung is consolidated and causes a cardiac shift towards the left. Lung contusion is usually adjacent to the site of blunt impact. (Courtesy of Cambridge Veterinary School) © 2024 British Small Animal Veterinary Association

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12.152 DV thoracic radiograph of a Chihuahua following thoracic trauma. There are multiple right rib fractures. The right lung is consolidated and causes a cardiac shift towards the left. Lung contusion is usually adjacent to the site of blunt impact. (Courtesy of Cambridge Veterinary School)

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12.153

(a) Close-up lateral thoracic radiograph of a 10-year-old Labrador Retriever with pulmonary alveolar microlithiasis. The dog had harsh lung sounds but otherwise no cardiorespiratory abnormality. Notice the widespread micronodular mineralization, which is most pronounced in the perihilar region. (b) Post-mortem radiograph of the right lung. The lung was solidly mineralized and had to be sectioned with a saw. Cause of euthanasia was severe chronic hip and elbow arthritis and unrelated to cardiorespiratory disease. (Reproduced from O’Neill et al. (2006) with permission) © 2024 British Small Animal Veterinary Association

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12.153 (a) Close-up lateral thoracic radiograph of a 10-year-old Labrador Retriever with pulmonary alveolar microlithiasis. The dog had harsh lung sounds but otherwise no cardiorespiratory abnormality. Notice the widespread micronodular mineralization, which is most pronounced in the perihilar region. (b) Post-mortem radiograph of the right lung. The lung was solidly mineralized and had to be sectioned with a saw. Cause of euthanasia was severe chronic hip and elbow arthritis and unrelated to cardiorespiratory disease. (Reproduced from O’Neill et al. (2006) with permission)

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12.154

(a) Lateral and (b) DV thoracic radiographs of a 5-year-old crossbreed dog with cough and pyrexia. Note the lobar sign, air bronchogram and consolidation of the right middle lung lobe (arrowed). Bacterial pneumonia was diagnosed on bronchoalveolar lavage. © 2024 British Small Animal Veterinary Association

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12.154 (a) Lateral and (b) DV thoracic radiographs of a 5-year-old crossbreed dog with cough and pyrexia. Note the lobar sign, air bronchogram and consolidation of the right middle lung lobe (arrowed). Bacterial pneumonia was diagnosed on bronchoalveolar lavage.

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12.155

Lateral thoracic radiograph of a 6-year-old Labrador Retriever with severe cough and lethargy. Note the severe alveolar pattern obliterating the cardiac silhouette and extending to the cranial and caudal lung lobes; also note the peribronchial component with increased peribronchial infiltrate (arrowed). Bronchopneumonia was diagnosed on bronchoalveolar lavage. © 2024 British Small Animal Veterinary Association

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12.155 Lateral thoracic radiograph of a 6-year-old Labrador Retriever with severe cough and lethargy. Note the severe alveolar pattern obliterating the cardiac silhouette and extending to the cranial and caudal lung lobes; also note the peribronchial component with increased peribronchial infiltrate (arrowed). Bronchopneumonia was diagnosed on bronchoalveolar lavage.

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12.156

(a) Left and (b) right lateral thoracic radiographs of a 6-year-old Bernese Mountain Dog with severe coughing. Note the cranio-ventral alveolar pattern (*) with peribronchial infiltrate and bronchiectasis (arrowed); bronchopneumonia and bronchiectasis were diagnosed. © 2024 British Small Animal Veterinary Association

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12.156 (a) Left and (b) right lateral thoracic radiographs of a 6-year-old Bernese Mountain Dog with severe coughing. Note the cranio-ventral alveolar pattern (*) with peribronchial infiltrate and bronchiectasis (arrowed); bronchopneumonia and bronchiectasis were diagnosed.

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12.157

Dorsal plane thoracic ultrasound image of a 7-year-old Golden Retriever with lobar pneumonia. Note the consolidated right middle lung lobe (*) with gas bubble and associated reverberation artefact (arrowed); also note the tubular structure (arrowhead) representing a bronchus. © 2024 British Small Animal Veterinary Association

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12.157 Dorsal plane thoracic ultrasound image of a 7-year-old Golden Retriever with lobar pneumonia. Note the consolidated right middle lung lobe (*) with gas bubble and associated reverberation artefact (arrowed); also note the tubular structure (arrowhead) representing a bronchus.

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12.158

(a) High-resolution lung window and (b) post-contrast transverse thoracic CT images of a 3-year-old Golden Retriever with a lung abscess. Note the gas-filled cavity in the dorsal aspect of the left caudal lung lobe (arrowed) and the non-enhancing fluid (*). © 2024 British Small Animal Veterinary Association

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12.158 (a) High-resolution lung window and (b) post-contrast transverse thoracic CT images of a 3-year-old Golden Retriever with a lung abscess. Note the gas-filled cavity in the dorsal aspect of the left caudal lung lobe (arrowed) and the non-enhancing fluid (*).

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12.159

Transverse thoracic CT image of a 7-year-old crossbreed dog with lobar pneumonia (high-resolution lung window). Note the right middle bronchus (arrowed) and the consolidated right middle lung lobe (*). © 2024 British Small Animal Veterinary Association

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12.159 Transverse thoracic CT image of a 7-year-old crossbreed dog with lobar pneumonia (high-resolution lung window). Note the right middle bronchus (arrowed) and the consolidated right middle lung lobe (*).

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12.160

(a) Lateral and (b) DV thoracic radiographs of a 4-year-old Domestic Shorthaired cat with mycoplasmosis. Note the patchy alveolar pattern in the right and left caudal lung lobes with lobar sign (circled). © 2024 British Small Animal Veterinary Association

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12.160 (a) Lateral and (b) DV thoracic radiographs of a 4-year-old Domestic Shorthaired cat with mycoplasmosis. Note the patchy alveolar pattern in the right and left caudal lung lobes with lobar sign (circled).

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12.161

(a) DV and (b) lateral thoracic radiographs of an 8-year-old Domestic Shorthaired cat with mycoplasmosis. Note the widespread nodular pattern involving both lungs. © 2024 British Small Animal Veterinary Association

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12.161 (a) DV and (b) lateral thoracic radiographs of an 8-year-old Domestic Shorthaired cat with mycoplasmosis. Note the widespread nodular pattern involving both lungs.

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12.162

(a) Lateral and (b) DV thoracic radiographs of a 5-year-old English Bulldog with aspiration pneumonia. Note the consolidation (*) with air bronchogram of the left cranial lung lobe and the lobar sign (arrowed). © 2024 British Small Animal Veterinary Association

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12.162 (a) Lateral and (b) DV thoracic radiographs of a 5-year-old English Bulldog with aspiration pneumonia. Note the consolidation (*) with air bronchogram of the left cranial lung lobe and the lobar sign (arrowed).

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12.163

(a) Lateral and (b) DV thoracic radiographs of a 3-year-old French Bulldog with aspiration pneumonia. Note the ill-defined alveolar pattern (*) with air bronchogram involving the right middle lung lobe. © 2024 British Small Animal Veterinary Association

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12.163 (a) Lateral and (b) DV thoracic radiographs of a 3-year-old French Bulldog with aspiration pneumonia. Note the ill-defined alveolar pattern (*) with air bronchogram involving the right middle lung lobe.

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12.164

Lateral thoracic radiograph of a 6-year-old German Shepherd Dog with megaoesophagus and aspiration pneumonia. Note the generalized oesophageal enlargement with gas distension (arrowed) and the cranioventral alveolar pattern (*). © 2024 British Small Animal Veterinary Association

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12.164 Lateral thoracic radiograph of a 6-year-old German Shepherd Dog with megaoesophagus and aspiration pneumonia. Note the generalized oesophageal enlargement with gas distension (arrowed) and the cranioventral alveolar pattern (*).

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12.165

Transverse thoracic CT image of a 4-year-old English Springer Spaniel with a bronchial foreign body (grass awn) (high-resolution lung window). Note the distended and fluid filled bronchus (arrowed) and consolidation (*) secondary to the foreign body pneumonia induced. © 2024 British Small Animal Veterinary Association

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12.165 Transverse thoracic CT image of a 4-year-old English Springer Spaniel with a bronchial foreign body (grass awn) (high-resolution lung window). Note the distended and fluid filled bronchus (arrowed) and consolidation (*) secondary to the foreign body pneumonia induced.

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12.166

Caudodorsal close-up of a lateral thoracic radiograph of a dog with leptospiral pneumonia. There is a mild increase in lung opacity with a fine-structured interstitial pattern, typical of mild or early-phase leptospirosis. © 2024 British Small Animal Veterinary Association

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12.166 Caudodorsal close-up of a lateral thoracic radiograph of a dog with leptospiral pneumonia. There is a mild increase in lung opacity with a fine-structured interstitial pattern, typical of mild or early-phase leptospirosis.

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12.167

Lateral thoracic radiograph of a 9-year-old mixed-breed dog with mycoplasmal pneumonia. There is a diffuse bronchointerstitial lung pattern throughout the lungs. © 2024 British Small Animal Veterinary Association

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12.167 Lateral thoracic radiograph of a 9-year-old mixed-breed dog with mycoplasmal pneumonia. There is a diffuse bronchointerstitial lung pattern throughout the lungs.

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12.168

Lateral thoracic radiograph of a 7-month-old Chihuahua with canine distemper virus infection. There is a diffuse increase in lung opacity with an interstitial pattern, more pronounced caudodorsally. This feature is representative of an early viral stage of pneumonia. Bacterial secondary infection will add a patchy alveolar pattern with a random or ventral distribution. (Courtesy of the University of California Davis) © 2024 British Small Animal Veterinary Association

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12.168 Lateral thoracic radiograph of a 7-month-old Chihuahua with canine distemper virus infection. There is a diffuse increase in lung opacity with an interstitial pattern, more pronounced caudodorsally. This feature is representative of an early viral stage of pneumonia. Bacterial secondary infection will add a patchy alveolar pattern with a random or ventral distribution. (Courtesy of the University of California Davis)

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12.169

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12.169 Major endemic areas for blastomycosis, coccidioidomycosis and histoplasmosis in the USA. (Reproduced from Wolf and Troy (1989) with permission)

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12.170

Lateral thoracic radiograph of a dog with chronic inactive histoplasmosis. The lungs have numerous small, randomly distributed, mineralized nodules (calcified granulomas). The left tracheobronchial lymph node is moderately enlarged and mineralized. © 2024 British Small Animal Veterinary Association

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12.170 Lateral thoracic radiograph of a dog with chronic inactive histoplasmosis. The lungs have numerous small, randomly distributed, mineralized nodules (calcified granulomas). The left tracheobronchial lymph node is moderately enlarged and mineralized.

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12.171

(a) Lateral thoracic radiograph of a 3-year-old Golden Retriever with active pulmonary blastomycosis. There is alveolar disease cranioventrally and caudodorsally, numerous 2–4 mm soft tissue nodules throughout the lung, and a mild dorsal deviation of the thoracic trachea and an associated soft tissue opacity (*) suggestive of cranial mediastinal lymphadenopathy. (bi) Lateral thoracic radiograph of a dog with active diffuse pulmonary blastomycosis. There is a miliary pattern throughout the lungs created by many small soft tissue nodules. (bii) Corresponding post-mortem photograph with multiple small pulmonary granulomas. ((a) Courtesy of the University of California Davis; (b) Courtesy of the University of Pennsylvania) © 2024 British Small Animal Veterinary Association

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12.171 (a) Lateral thoracic radiograph of a 3-year-old Golden Retriever with active pulmonary blastomycosis. There is alveolar disease cranioventrally and caudodorsally, numerous 2–4 mm soft tissue nodules throughout the lung, and a mild dorsal deviation of the thoracic trachea and an associated soft tissue opacity (*) suggestive of cranial mediastinal lymphadenopathy. (bi) Lateral thoracic radiograph of a dog with active diffuse pulmonary blastomycosis. There is a miliary pattern throughout the lungs created by many small soft tissue nodules. (bii) Corresponding post-mortem photograph with multiple small pulmonary granulomas. ((a) Courtesy of the University of California Davis; (b) Courtesy of the University of Pennsylvania)

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12.172

(a) Lateral thoracic radiograph of a 2-year-old Rottweiler with pulmonary coccidioidomycosis. There is a diffuse pattern of poorly circumscribed nodules throughout the lungs and tracheobronchial lymphadenopathy, causing deviation of the caudal trachea. (b) Post-mortem photograph of a lung section that demonstrates disseminated fungal granulomas. (Courtesy of the University of California Davis) © 2024 British Small Animal Veterinary Association

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12.172 (a) Lateral thoracic radiograph of a 2-year-old Rottweiler with pulmonary coccidioidomycosis. There is a diffuse pattern of poorly circumscribed nodules throughout the lungs and tracheobronchial lymphadenopathy, causing deviation of the caudal trachea. (b) Post-mortem photograph of a lung section that demonstrates disseminated fungal granulomas. (Courtesy of the University of California Davis)

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12.173

Lateral thoracic radiograph of a 10-year-old Domestic Shorthaired cat with pulmonary cryptococcosis. There is a large caudodorsal soft tissue mass (granuloma) and moderate tracheobronchial lymphadenopathy. (Courtesy of the University of California Davis) © 2024 British Small Animal Veterinary Association

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12.173 Lateral thoracic radiograph of a 10-year-old Domestic Shorthaired cat with pulmonary cryptococcosis. There is a large caudodorsal soft tissue mass (granuloma) and moderate tracheobronchial lymphadenopathy. (Courtesy of the University of California Davis)

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12.174

Lateral thoracic radiograph of a 1-year-old Cavalier King Charles Spaniel with Pneumocystis carinii infection. There is a generalized interstitial pattern with mildly thick bronchi. The generalized nature of the changes in a young dog is unusual but in combination with the breed is highly suggestive of pneumocystosis. © 2024 British Small Animal Veterinary Association

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12.174 Lateral thoracic radiograph of a 1-year-old Cavalier King Charles Spaniel with Pneumocystis carinii infection. There is a generalized interstitial pattern with mildly thick bronchi. The generalized nature of the changes in a young dog is unusual but in combination with the breed is highly suggestive of pneumocystosis.

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12.175

Right lateral thoracic radiograph of a 10-year-old Domestic Shorthaired cat with pulmonary toxoplasmosis. There are patchy areas of alveolar lung pattern forming summation shadows with the heart. The opposite lateral radiograph revealed right middle lung lobe collapse. © 2024 British Small Animal Veterinary Association

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12.175 Right lateral thoracic radiograph of a 10-year-old Domestic Shorthaired cat with pulmonary toxoplasmosis. There are patchy areas of alveolar lung pattern forming summation shadows with the heart. The opposite lateral radiograph revealed right middle lung lobe collapse.

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12.176

Lateral thoracic radiograph of a dog with dirofilariasis. There is a widespread increase in lung opacity, caused by enlarged, tortuous pulmonary arteries, and oedematous and granulomatous reactive lung. © 2024 British Small Animal Veterinary Association

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12.176 Lateral thoracic radiograph of a dog with dirofilariasis. There is a widespread increase in lung opacity, caused by enlarged, tortuous pulmonary arteries, and oedematous and granulomatous reactive lung.

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12.177

Lateral thoracic radiograph of a Staffordshire Bull Terrier with Angiostrongylus vasorum infection. Note the peripheral distribution of the pulmonary lesions (arrowed), which is commonly seen in angiostrongylosis. © 2024 British Small Animal Veterinary Association

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12.177 Lateral thoracic radiograph of a Staffordshire Bull Terrier with Angiostrongylus vasorum infection. Note the peripheral distribution of the pulmonary lesions (arrowed), which is commonly seen in angiostrongylosis.

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12.178

(a) Lateral thoracic radiograph of a 7-month-old Domestic Shorthaired cat with an Aelurostrongylus abstrusus infection in the small airways. There is a bronchointerstitial infiltrate with peribronchial thickening throughout the lungs. (b) Caudodorsal close-up of a lateral thoracic radiograph of a 2-year-old Cavalier King Charles Spaniel with a Filaroides hirthi infection. There is a bronchointerstitial pattern with bronchial thickening. © 2024 British Small Animal Veterinary Association

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12.178 (a) Lateral thoracic radiograph of a 7-month-old Domestic Shorthaired cat with an Aelurostrongylus abstrusus infection in the small airways. There is a bronchointerstitial infiltrate with peribronchial thickening throughout the lungs. (b) Caudodorsal close-up of a lateral thoracic radiograph of a 2-year-old Cavalier King Charles Spaniel with a Filaroides hirthi infection. There is a bronchointerstitial pattern with bronchial thickening.

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12.179

(a) Right lateral and (b) left lateral thoracic radiographs of a 5-year-old crossbreed dog with eosinophilic bronchopneumopathy. In the cranial thorax, note the patchy lung pattern and the thick peribronchial infiltrate. © 2024 British Small Animal Veterinary Association

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12.179 (a) Right lateral and (b) left lateral thoracic radiographs of a 5-year-old crossbreed dog with eosinophilic bronchopneumopathy. In the cranial thorax, note the patchy lung pattern and the thick peribronchial infiltrate.

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12.180

Right lateral thoracic radiograph of a 4-year-old Labrador Retriever with an early stage of eosinophilic bronchopneumopathy. Note the increased peribronchial thickening and peribronchial infiltrate (arrowed). © 2024 British Small Animal Veterinary Association

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12.180 Right lateral thoracic radiograph of a 4-year-old Labrador Retriever with an early stage of eosinophilic bronchopneumopathy. Note the increased peribronchial thickening and peribronchial infiltrate (arrowed).

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12.181

Transverse thoracic CT image of a 7-year-old Golden Retriever with eosinophilic bronchopneumopathy (high-resolution lung window). Note the increased peribronchial thickening (arrowheads) and the mass-like lesion formed at the level of the accessory lung lobe (arrowed). © 2024 British Small Animal Veterinary Association

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12.181 Transverse thoracic CT image of a 7-year-old Golden Retriever with eosinophilic bronchopneumopathy (high-resolution lung window). Note the increased peribronchial thickening (arrowheads) and the mass-like lesion formed at the level of the accessory lung lobe (arrowed).

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12.182

Lateral thoracic radiograph of a 6-month-old Afghan Hound that developed acute dyspnoea after being doused in chlorinated carpet cleaner. Both lungs have a widespread interstitial to alveolar pattern. The preferential caudodorsal distribution is a hallmark of inhalation pneumonitis. © 2024 British Small Animal Veterinary Association

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12.182 Lateral thoracic radiograph of a 6-month-old Afghan Hound that developed acute dyspnoea after being doused in chlorinated carpet cleaner. Both lungs have a widespread interstitial to alveolar pattern. The preferential caudodorsal distribution is a hallmark of inhalation pneumonitis.

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12.183

Lateral thoracic radiograph of a cat with exogeneous lipid pneumonia. The cat had been medicated with liquid paraffin for constipation. Note the right middle lung lobe collapse, caudodorsal alveolar opacity and bronchiectasis, and cavitating lesions throughout the ventral lungs. The generalized interstitial pattern could be related to lipid transport without removal by pulmonary macrophages. © 2024 British Small Animal Veterinary Association

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12.183 Lateral thoracic radiograph of a cat with exogeneous lipid pneumonia. The cat had been medicated with liquid paraffin for constipation. Note the right middle lung lobe collapse, caudodorsal alveolar opacity and bronchiectasis, and cavitating lesions throughout the ventral lungs. The generalized interstitial pattern could be related to lipid transport without removal by pulmonary macrophages.

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12.184

(a) DV thoracic radiograph of a 12-year-old Springer Spaniel with a lung carcinoma in the left cranial lung lobe and endogenous lipid pneumonia. (b) Transverse thoracic CT image of the same dog (high-resolution lung window). Note the ground-glass opacity in the left cranial lung lobe (arrowed). On FNA the neoplasia was confirmed in association with lipid pneumonia. © 2024 British Small Animal Veterinary Association

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12.184 (a) DV thoracic radiograph of a 12-year-old Springer Spaniel with a lung carcinoma in the left cranial lung lobe and endogenous lipid pneumonia. (b) Transverse thoracic CT image of the same dog (high-resolution lung window). Note the ground-glass opacity in the left cranial lung lobe (arrowed). On FNA the neoplasia was confirmed in association with lipid pneumonia.

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12.185

(a) Lateral and (b) DV thoracic radiographs of a Domestic Shorthaired cat with mycobacteriosis. Note the large cavitated lesions (arrowed) surrounded by a patchy increased lung opacity in the caudodorsal lung field. © 2024 British Small Animal Veterinary Association

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12.185 (a) Lateral and (b) DV thoracic radiographs of a Domestic Shorthaired cat with mycobacteriosis. Note the large cavitated lesions (arrowed) surrounded by a patchy increased lung opacity in the caudodorsal lung field.

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12.186

Transverse thoracic CT image of a 6-year-old cat with mycobacteriosis (high-resolution lung window). Note the increased lung opacity and cavitated lesions (arrowed) in the caudodorsal lung field. © 2024 British Small Animal Veterinary Association

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12.186 Transverse thoracic CT image of a 6-year-old cat with mycobacteriosis (high-resolution lung window). Note the increased lung opacity and cavitated lesions (arrowed) in the caudodorsal lung field.

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12.187

(a) Transverse thoracic CT image of a cat with mycobacteriosis (high-resolution lung window). Note the disseminated and patchy interstitial pattern scattered throughout the lungs (arrowed) and the small amount of pneumothorax dorsal to the right caudal lung lobe. (b) Transverse thoracic CT image of the same cat at the level of the elbow. Note the large amount of periarticular new bone formation (arrowed). © 2024 British Small Animal Veterinary Association

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12.187 (a) Transverse thoracic CT image of a cat with mycobacteriosis (high-resolution lung window). Note the disseminated and patchy interstitial pattern scattered throughout the lungs (arrowed) and the small amount of pneumothorax dorsal to the right caudal lung lobe. (b) Transverse thoracic CT image of the same cat at the level of the elbow. Note the large amount of periarticular new bone formation (arrowed).

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12.188

(a) Lateral thoracic radiograph of a 10-year-old West Highland White Terrier with FNA-confirmed lung lymphoma. Note the alveolar pattern involving the caudal lung lobes (arrowed). (b) Transverse thoracic CT image of the same dog (high-resolution lung window): note the caudodorsal distribution of the alveolar pattern. © 2024 British Small Animal Veterinary Association

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12.188 (a) Lateral thoracic radiograph of a 10-year-old West Highland White Terrier with FNA-confirmed lung lymphoma. Note the alveolar pattern involving the caudal lung lobes (arrowed). (b) Transverse thoracic CT image of the same dog (high-resolution lung window): note the caudodorsal distribution of the alveolar pattern.

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12.189

(a) Lateral and (b) DV thoracic radiographs of a 12-year-old Siamese cat with lung carcinoma. (a) Note the enlarged sternal lymph node (arrowed). (b) Note the ill-defined and patchy alveolar pattern in the left caudal lung lobe (arrowed). © 2024 British Small Animal Veterinary Association

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12.189 (a) Lateral and (b) DV thoracic radiographs of a 12-year-old Siamese cat with lung carcinoma. (a) Note the enlarged sternal lymph node (arrowed). (b) Note the ill-defined and patchy alveolar pattern in the left caudal lung lobe (arrowed).

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12.190

(a) Lateral radiograph of a 10-year-old crossbreed dog with pulmonary histiocytic sarcoma. (b) DV thoracic radiograph of a 10-year-old crossbreed dog with pulmonary histiocytic sarcoma. Note the well defined lung mass (arrowed) in the right caudal lung lobe. © 2024 British Small Animal Veterinary Association

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12.190 (a) Lateral radiograph of a 10-year-old crossbreed dog with pulmonary histiocytic sarcoma. (b) DV thoracic radiograph of a 10-year-old crossbreed dog with pulmonary histiocytic sarcoma. Note the well defined lung mass (arrowed) in the right caudal lung lobe.

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12.191

10-year-old Domestic Shorthaired cat with bronchoalveolar carcinoma. (a) The lateral view demonstrates ill-defined and patchy peribronchial pattern (arrowed).(b) The DV view shows areas of alveolar pattern in the left caudal and right cranial lung lobes (arrowed). Note also the small volume of pleural effusion. © 2024 British Small Animal Veterinary Association

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12.191 10-year-old Domestic Shorthaired cat with bronchoalveolar carcinoma. (a) The lateral view demonstrates ill-defined and patchy peribronchial pattern (arrowed).(b) The DV view shows areas of alveolar pattern in the left caudal and right cranial lung lobes (arrowed). Note also the small volume of pleural effusion.

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12.192

A 14-year-old Domestic Shorthaired cat with bronchoalveolar carcinoma. (a) Lateral thoracic radiograph. Note the ill-defined and patchy peribronchial pattern with areas of alveolar pattern and lung consolidation (arrowed). Note also the large amount of pleural effusion and retraction of the lung lobes from the rib cage. A 14-year-old Domestic Shorthaired cat with bronchoalveolar carcinoma. (b) DV thoracic radiograph. Note the ill-defined and patchy peribronchial pattern with areas of alveolar pattern and lung consolidation (arrowed). Note also the large amount of pleural effusion and retraction of the lung lobes from the rib cage. (c) Transverse CT image (high-resolution lung window). Note the lung consolidation and the dystrophic mineralization within the lung mass (arrowed). © 2024 British Small Animal Veterinary Association

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12.192 A 14-year-old Domestic Shorthaired cat with bronchoalveolar carcinoma. (a) Lateral thoracic radiograph. Note the ill-defined and patchy peribronchial pattern with areas of alveolar pattern and lung consolidation (arrowed). Note also the large amount of pleural effusion and retraction of the lung lobes from the rib cage. A 14-year-old Domestic Shorthaired cat with bronchoalveolar carcinoma. (b) DV thoracic radiograph. Note the ill-defined and patchy peribronchial pattern with areas of alveolar pattern and lung consolidation (arrowed). Note also the large amount of pleural effusion and retraction of the lung lobes from the rib cage. (c) Transverse CT image (high-resolution lung window). Note the lung consolidation and the dystrophic mineralization within the lung mass (arrowed).

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12.193

(a) Dorsal plane thoracic ultrasound image of a 12-year-old Domestic Longhaired cat with lung carcinoma. Note the consolidated right caudal lung lobe (*) with reverberation artefact arising from the normal and adjacent lung (arrowed). A 12-year-old Domestic Longhaired cat with lung carcinoma. (b) Longitudinal plane image: note the bronchus within the consolidated right caudal lung lobe (arrowed). © 2024 British Small Animal Veterinary Association

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12.193 (a) Dorsal plane thoracic ultrasound image of a 12-year-old Domestic Longhaired cat with lung carcinoma. Note the consolidated right caudal lung lobe (*) with reverberation artefact arising from the normal and adjacent lung (arrowed). A 12-year-old Domestic Longhaired cat with lung carcinoma. (b) Longitudinal plane image: note the bronchus within the consolidated right caudal lung lobe (arrowed).

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12.194

(a) Lateral thoracic radiograph of a 15-year-old Schnauzer with lung carcinoma: note the consolidation of the left cranial lung lobe (arrowed). (b) Transverse thoracic CT image of the same dog (high-resolution lung window): note the lung consolidation (arrowed) and the enlarged tracheobronchial lymph node (*). © 2024 British Small Animal Veterinary Association

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12.194 (a) Lateral thoracic radiograph of a 15-year-old Schnauzer with lung carcinoma: note the consolidation of the left cranial lung lobe (arrowed). (b) Transverse thoracic CT image of the same dog (high-resolution lung window): note the lung consolidation (arrowed) and the enlarged tracheobronchial lymph node (*).

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12.195

(a) Lateral thoracic radiograph of a cat with hypertrophic cardiomyopathy and cardiogenic interstitial pulmonary oedema. There is cardiomegaly, pulmonary vascular distension, a small amount of pleural effusion and a diffuse interstitial pattern throughout the lungs, most pronounced in the perihilar region. (b) A repeat radiograph 12 hours after initiation of diuretic treatment reveals persistent cardiomegaly, normal sized pulmonary blood vessels, resolution of pleural effusion and lung opacification, and better lung inflation. Prompt resolution of radiographic signs after diuresis is a hallmark of cardiogenic pulmonary oedema. © 2024 British Small Animal Veterinary Association

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12.195 (a) Lateral thoracic radiograph of a cat with hypertrophic cardiomyopathy and cardiogenic interstitial pulmonary oedema. There is cardiomegaly, pulmonary vascular distension, a small amount of pleural effusion and a diffuse interstitial pattern throughout the lungs, most pronounced in the perihilar region. (b) A repeat radiograph 12 hours after initiation of diuretic treatment reveals persistent cardiomegaly, normal sized pulmonary blood vessels, resolution of pleural effusion and lung opacification, and better lung inflation. Prompt resolution of radiographic signs after diuresis is a hallmark of cardiogenic pulmonary oedema.

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12.196

(a) Lateral thoracic radiograph of a kitten with acute interstitial pneumonia secondary to feline leukaemia virus infection. The fine vascular structures are blurred yet still visible, and there is an overall increase in lung opacity. Acute viral pneumonia typically presents with radiographically normal lungs or interstitial lung pattern as in this case. (b) Lateral thoracic radiograph of a 2-year-old Border Terrier with interstitial pneumonia with cultured Bordetella bronchiseptica. There is a diffuse unstructured interstitial lung pattern, worse caudodorsally. © 2024 British Small Animal Veterinary Association

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12.196 (a) Lateral thoracic radiograph of a kitten with acute interstitial pneumonia secondary to feline leukaemia virus infection. The fine vascular structures are blurred yet still visible, and there is an overall increase in lung opacity. Acute viral pneumonia typically presents with radiographically normal lungs or interstitial lung pattern as in this case. (b) Lateral thoracic radiograph of a 2-year-old Border Terrier with interstitial pneumonia with cultured Bordetella bronchiseptica. There is a diffuse unstructured interstitial lung pattern, worse caudodorsally.

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12.197

Caudodorsal close-up of a lateral thoracic radiograph of a 5-year-old German Shepherd Dog with marked dyspnoea. The caudodorsal lung field has a fine-structured interstitial pattern. The histological diagnosis was pulmonary fibrosis of unknown aetiology. © 2024 British Small Animal Veterinary Association

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12.197 Caudodorsal close-up of a lateral thoracic radiograph of a 5-year-old German Shepherd Dog with marked dyspnoea. The caudodorsal lung field has a fine-structured interstitial pattern. The histological diagnosis was pulmonary fibrosis of unknown aetiology.

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12.198

Lateral thoracic radiograph of a 14-year-old West Highland White Terrier with IPF. Notice the general increase in lung opacity with an interstitial pattern, partial tracheal collapse and dyspnoea-related gas distension of the stomach (aerophagia). There is mild right cardiac and marked hepatic (not included in image) enlargement, features commonly seen in terrier breed dogs with IPF. © 2024 British Small Animal Veterinary Association

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12.198 Lateral thoracic radiograph of a 14-year-old West Highland White Terrier with IPF. Notice the general increase in lung opacity with an interstitial pattern, partial tracheal collapse and dyspnoea-related gas distension of the stomach (aerophagia). There is mild right cardiac and marked hepatic (not included in image) enlargement, features commonly seen in terrier breed dogs with IPF.

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12.199

Lateral thoracic radiograph of a 10-year-old Siamese cat with idiopathic pulmonary fibrosis. There are patchy areas of interstitial to alveolar lung opacity and interspersed hyperlucent areas, consistent with emphysema. © 2024 British Small Animal Veterinary Association

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12.199 Lateral thoracic radiograph of a 10-year-old Siamese cat with idiopathic pulmonary fibrosis. There are patchy areas of interstitial to alveolar lung opacity and interspersed hyperlucent areas, consistent with emphysema.

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12.200

(a) A 12-year-old West Highland White Terrier with idiopathic pulmonary fibrosis. (ai) High-resolution transverse lung CT image at the level of the caudal thorax. There is a mild generalized increase in lung opacity (ground-glass opacity) and small subpleural fibrotic infiltrate in the right caudal lung lobe. The oesophagus is mildly distended with gas. (aii) On a slightly more cranial image, there is hyperattenuating infiltrate in the dorsal portions of both caudal lung lobes and subpleural bands. Patches of ground-glass opacity are present in the right lung. These changes are consistent with fibrosis. (b) High-resolution transverse lung CT image of an 8-year-old West Highland White Terrier with idiopathic pulmonary fibrosis at the level of the left cardiac atrium. There is a mosaic lung pattern, with haphazardly arranged lung areas of different density. © 2024 British Small Animal Veterinary Association

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12.200 (a) A 12-year-old West Highland White Terrier with idiopathic pulmonary fibrosis. (ai) High-resolution transverse lung CT image at the level of the caudal thorax. There is a mild generalized increase in lung opacity (ground-glass opacity) and small subpleural fibrotic infiltrate in the right caudal lung lobe. The oesophagus is mildly distended with gas. (aii) On a slightly more cranial image, there is hyperattenuating infiltrate in the dorsal portions of both caudal lung lobes and subpleural bands. Patches of ground-glass opacity are present in the right lung. These changes are consistent with fibrosis. (b) High-resolution transverse lung CT image of an 8-year-old West Highland White Terrier with idiopathic pulmonary fibrosis at the level of the left cardiac atrium. There is a mosaic lung pattern, with haphazardly arranged lung areas of different density.

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12.201

(a) Transverse thoracic CT image at the level of the accessory lung lobe of an 8-year-old Siamese cat with pulmonary fibrosis. There are parenchymal bands, areas of consolidation and bullous emphysema throughout the lungs. (b) High-resolution transverse lung CT image at the level of the caudal thorax of an 11-year-old obese Domestic Shorthaired cat with fibrotic lung changes. Notice the ground-glass opacity of the lung, a small subpleural consolidation (arrowhead) and bands of soft tissue originating from the pleural surface (arrowed). © 2024 British Small Animal Veterinary Association

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12.201 (a) Transverse thoracic CT image at the level of the accessory lung lobe of an 8-year-old Siamese cat with pulmonary fibrosis. There are parenchymal bands, areas of consolidation and bullous emphysema throughout the lungs. (b) High-resolution transverse lung CT image at the level of the caudal thorax of an 11-year-old obese Domestic Shorthaired cat with fibrotic lung changes. Notice the ground-glass opacity of the lung, a small subpleural consolidation (arrowhead) and bands of soft tissue originating from the pleural surface (arrowed).

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12.202

(a) Radiation treatment planning lateral port image, acquired with cobalt photons, of a 9-year-old Domestic Longhaired cat with a non-resectable interscapular fibrosarcoma. The beam field includes the dorsal aspect of the caudodorsal lung field. (b) Lateral thoracic radiograph obtained 1 month after completion of radiation therapy demonstrates a sharply delineated area of alveolar opacity in the exposed lung, consistent with acute radiation pneumonitis. (c) Caudodorsal close-up of a lateral thoracic radiograph obtained 6 months after radiation. The affected area is now slightly reduced in size and of mixed interstitial–alveolar pattern. These findings are consistent with radiation-induced chronic lung fibrosis and are permanent. (Courtesy of Donald Thrall) © 2024 British Small Animal Veterinary Association

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12.202 (a) Radiation treatment planning lateral port image, acquired with cobalt photons, of a 9-year-old Domestic Longhaired cat with a non-resectable interscapular fibrosarcoma. The beam field includes the dorsal aspect of the caudodorsal lung field. (b) Lateral thoracic radiograph obtained 1 month after completion of radiation therapy demonstrates a sharply delineated area of alveolar opacity in the exposed lung, consistent with acute radiation pneumonitis. (c) Caudodorsal close-up of a lateral thoracic radiograph obtained 6 months after radiation. The affected area is now slightly reduced in size and of mixed interstitial–alveolar pattern. These findings are consistent with radiation-induced chronic lung fibrosis and are permanent. (Courtesy of Donald Thrall)

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12.203

(a) A dog with systemic lymphoma. (ai) VD thoracic radiograph showing diffuse fine-structured interstitial infiltrate. (aii) High-resolution transverse thoracic CT image at the level caudal to the carina demonstrating a diffuse ground-glass opacity throughout the lungs. (b) Transverse thoracic CT image of a 5-year-old Cocker Spaniel with multicentric lymphoma. There is diffuse interstitial lung infiltration resulting in a ground-glass opacity and tracheobronchial lymphadenopathy. © 2024 British Small Animal Veterinary Association

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12.203 (a) A dog with systemic lymphoma. (ai) VD thoracic radiograph showing diffuse fine-structured interstitial infiltrate. (aii) High-resolution transverse thoracic CT image at the level caudal to the carina demonstrating a diffuse ground-glass opacity throughout the lungs. (b) Transverse thoracic CT image of a 5-year-old Cocker Spaniel with multicentric lymphoma. There is diffuse interstitial lung infiltration resulting in a ground-glass opacity and tracheobronchial lymphadenopathy.

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12.204

Left caudal close-up of a VD thoracic radiograph of a 5-year-old Irish Setter with heartworm disease and an associated calcified pulmonary haematoma. Notice the distended left lobar artery (A) and the egg-shell mineralization of the haematoma. © 2024 British Small Animal Veterinary Association

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12.204 Left caudal close-up of a VD thoracic radiograph of a 5-year-old Irish Setter with heartworm disease and an associated calcified pulmonary haematoma. Notice the distended left lobar artery (A) and the egg-shell mineralization of the haematoma.

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12.205

Caudodorsal close-up of a lateral thoracic radiograph of a 5-year-old Dachshund with hyperadrenocorticism. Diffuse interstitial and bronchial mineralization result in a bronchointerstitial pattern. The bronchi and pulmonary parenchyma have a subtle mineral opacity. In most cases interstitial mineralization is insufficient to cause a mineral opacity and the interstitial opacity is often mistaken for interstitial oedema. Persistent interstitial lung pattern despite diuretic treatment in hyperadrenocorticoid dogs should prompt consideration of mineralization or fibrosis as possible causes. © 2024 British Small Animal Veterinary Association

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12.205 Caudodorsal close-up of a lateral thoracic radiograph of a 5-year-old Dachshund with hyperadrenocorticism. Diffuse interstitial and bronchial mineralization result in a bronchointerstitial pattern. The bronchi and pulmonary parenchyma have a subtle mineral opacity. In most cases interstitial mineralization is insufficient to cause a mineral opacity and the interstitial opacity is often mistaken for interstitial oedema. Persistent interstitial lung pattern despite diuretic treatment in hyperadrenocorticoid dogs should prompt consideration of mineralization or fibrosis as possible causes.

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12.206

Lateral oesophagram of a 9-year-old Labrador Retriever obtained after oral administration of a barium sulphate suspension. The oesophagus is normal but barium was aspirated into the right middle and left caudal lung lobes. © 2024 British Small Animal Veterinary Association

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12.206 Lateral oesophagram of a 9-year-old Labrador Retriever obtained after oral administration of a barium sulphate suspension. The oesophagus is normal but barium was aspirated into the right middle and left caudal lung lobes.

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12.207

Close-up of a lateral thoracic radiograph of a 9-year-old Standard Poodle with hyperadrenocorticism causing excessive widespread bronchial mineralization. Increased lung opacity results from bronchi that are more opaque, but not thicker, than normal (bronchial pattern). (Reprinted from Schwarz et al. (2000) with permission) © 2024 British Small Animal Veterinary Association

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12.207 Close-up of a lateral thoracic radiograph of a 9-year-old Standard Poodle with hyperadrenocorticism causing excessive widespread bronchial mineralization. Increased lung opacity results from bronchi that are more opaque, but not thicker, than normal (bronchial pattern). (Reprinted from Schwarz et al. (2000) with permission)

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12.208

Dorsal thoracic scintigram of a dog obtained about 2 hours after intravenous injection of a bone-binding diphosphonate compound. Notice the diffuse radiopharmaceutical uptake in the lungs compared with the photopenic abdomen. Differentials for this uptake include hyperadrenocorticism, heterotopic bone formation, diffuse pulmonary metastases and recently performed lung scintigraphy. © 2024 British Small Animal Veterinary Association

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12.208 Dorsal thoracic scintigram of a dog obtained about 2 hours after intravenous injection of a bone-binding diphosphonate compound. Notice the diffuse radiopharmaceutical uptake in the lungs compared with the photopenic abdomen. Differentials for this uptake include hyperadrenocorticism, heterotopic bone formation, diffuse pulmonary metastases and recently performed lung scintigraphy.