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com

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

technique is important to
obtain diagnostically useful
images

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

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

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

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

182 In Practice ● APRIL 2008

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■ GOOD PROCESSING TECHNIQUE FOR CONVENTIONAL

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

(left) Close-up of the caudoventral lung on a left lateral recumbent thoracic radiograph of a Bernese mountain dog,
showing a discrete soft tissue mass. (right) Right lateral recumbent radiograph of the same dog. The mass is not visible
because the heart compresses the dependent lung field, reducing the contrast between the aerated lung and pathology.
The mass is therefore likely to be in the right lung

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Thoracic radiographs should be evaluated systemati-

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

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

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

NORMAL RADIOGRAPHIC APPEARANCE

OF THE LUNGS

For descriptive purposes, lung fields can be divided

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

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Lateral (above) and dorsoventral (right) thoracic

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

LUNG VOLUME

Changes in the volume of the lungs, either generally or

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

R L R L R L

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

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CAUSES OF PULMONARY VOLUME CHANGE TYPICAL DISTRIBUTION OF DISEASES

Increased volume Decreased volume Cranial and Bronchopneumonia, lobar pneumonia,

ventral aspiration pneumonia, haemorrhage*,
Deep inspiration Expiration atelectasis*
Iatrogenic overinflation Occlusion of airway due to:
Dyspnoea – Mucous plugs Caudal and Cardiogenic oedema (especially hilar
Compensatory hyperinflation – Tumour in, or compressing, the bronchus dorsal area in dogs), non-cardiogenic oedema,
Air-trapping due to bronchospasm – Foreign body interstitial pneumonia, infarct due
Emphysema (congenital/acquired) – Endotracheal tube to pulmonary thromboembolus,
Pulmonary mass – Bronchospasm and air absorption haemorrhage*, atelectasis*
Atelectasis under general anaesthesia
Compression by expanded lung lobe(s) Diffuse Acute cardiogenic and non-cardiogenic
oedema, fibrosis, bronchitis, miliary
metastases, haemorrhage*, atelectasis*,
primary neoplasia in cats
be present. Increased opacity of a lung lobe without a Unifocal Primary neoplasm, solitary metastasis,
change in volume suggests consolidation. abscess, granuloma, bulla, cyst, infarct
due to pulmonary thromboembolus, lobe
A useful technique for confirming air-trapping is to torsion, lobe consolidation, atelectasis*
obtain a VD radiograph with the animal in lateral recum- (especially right middle lobe)
bency and the affected side down, using a horizontal x-ray Multifocal Metastases, abscesses, granulomata,
beam (pay attention to radiation safety and other techni- bullae, parasitic cysts, cardiogenic oedema
in cats, primary neoplasia in cats
cal factors). Normally, the dependent lung will be slightly
*Varies with the cause (eg, location of trauma impact,
collapsed in lateral recumbency, especially in the mid- duration and position of recumbency in cases of
dle lobe area, which is compressed by the heart. In the coagulopathy and atelectasis)
presence of air-trapping, the affected portion of the lung
remains fully aerated and the heart does not sink towards
the dependent side. LOCATION OF PATHOLOGY
Decreased lung volume and pulmonary masses
will cause increased radiopacity, while other causes Although diseases of different aetiology may produce
of increased lung volume result in reduced radiopacity identical lung changes in terms of the pattern of opaci-
(hyperlucency). fication, their distribution may be characteristic. This
allows a shorter list of probable differential diagnoses to
be compiled. The effect of gravity on the distribution of
fluid infiltrates and the location of known impact trauma
should also be considered. The typical distribution of
some diseases is listed in the table above.
H

BRONCHI AND PERIBRONCHIAL TISSUE

The diagnostic value of a radiographic bronchial pattern
M
is hindered by the fact that it may be caused not by pri-
mary airway disease but by fluid or cellular infiltrate in
the loose connective tissue surrounding the airways. To
(above) Ventrodorsal radiograph of a three- overcome this, Nykamp and others (2002) proposed the
year-old domestic shorthair cat with severe
bronchopneumonia and emphysema, showing less specific expression ‘lines and rings’. Nevertheless,
air-trapping. This image was obtained with the the bronchial pattern remains a useful diagnostic sign,
cat in right lateral recumbency using a horizontal
beam. The dependent lung field is overinflated and
provided the processes that give rise to it are understood.
the heart (H) lies closer to the uppermost chest wall. A bronchial pattern can arise in three ways:
A soft tissue mass (M) lesion in the caudal midline
■ BRONCHIAL WALL DISEASE. This is due to mucosal
represents an area of pneumonic consolidation.
(below) Lateral radiograph of the same cat, or submucosal hypertrophy and submucosal glandular
showing widespread pulmonary overinflation and hypertrophy, often in the presence of lumenal discharge.
dorsal lung consolidation
These diseases cause chronic bronchitis; radiographic evi-
dence of acute bronchitis is rare. Congenital and acquired
bronchiectasis will produce similar changes. Chronic
bronchitis may be caused by infection (bacterial, post-
viral, fungal or protozoal), sterile inflammation, allergy
(eg, feline asthma), parasites (especially Aelurostrongylus
abstrusus in cats and Crenosoma vulpis in dogs) and
irritants;
■ BRONCHIAL CALCIFICATION. This occurs as a natural
ageing process, especially in chondrodystrophic breeds,
and accounts for the increased bronchial pattern that is
visible in many middle-aged and older patients. It may
also be the result of previous, healed bronchial disease,
naturally occurring or iatrogenic hyperadrenocorticism
and chronic renal disease;
■ PERIBRONCHIAL INFILTRATE WITH FLUID OR CELLS. In
cases of pulmonary oedema, fibrosis, eosinophilic infil-
trate (eg, pulmonary infiltrate with eosinophils [PIE]) and
neoplasia (eg, lymphoma or, occasionally, diffuse metas-
tasis), the primary disease is not bronchial in origin.

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Diagrammatic representation of an abnormal bronchial

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

parallel blood vessels, which follow a similar course.

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

Close-up of the ventral

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

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BLOOD VESSELS
An abnormal vascular pattern may be either hyper-
vascular (due to overcirculation) or hypovascular (due
to undercirculation). As a result of the wide normal
range of vessel sizes encountered, changes must be quite
marked before being diagnosed with certainty. In the
case of a hypervascular pattern, a discrepancy in size LA
between the arteries and veins may be helpful in demon-
strating the presence of an abnormality; in the case of a
hypovascular pattern, both sets of vessels are reduced in
size. Changes in visible vessel number, size, shape and
opacity may be evident.
CVC

Hypervascular pattern
A hypervascular pattern may be caused by:
■ PULMONARY CONGESTION DUE TO HEART DISEASE. For
example, mitral insufficiency, cardiomyopathy and other Close-up of the caudodorsal lung of a 12-year-old collie
causes of left-sided heart failure; cross with congestive heart failure. The pulmonary blood
vessels are engorged, giving rise to a hypervascular
■ LARGE LEFT-TO-RIGHT SHUNT. Extracardiac shunts, pattern. An enlarged caudal lobe vein (arrow) extends
such as a patent ductus arteriosus (PDA), cause more towards the left atrium (LA), which is dilated. The caudal
vena cava (CVC) is also distended
pronounced hypervascularity than intracardiac shunts,
such as a ventricular septal defect (VSD);
■ IATROGENIC FLUID OVERLOAD; ■ PULMONARY THROMBUS OR EMBOLUS. For example,
■ VERMINOUS ARTERITIS. In the case of dirofilari- secondary to cardiac disease, heartworm, disseminated
osis and angiostrongylosis, the physical presence of the intravascular coagulation (DIC), trauma, renal disease,
worms in the arteries causes distension. In the case of septicaemia, pancreatitis, hyperadrenocorticism and
feline aelurostrongylosis, hypervascularity is due to following surgery.
arteritis and arterial hyperplasia. Changes are most Depending on the cause, both the arteries and veins
dramatic with Dirofilaria species infection; may be distended or one set of vessels may be larger.
■ PULMONARY HYPERTENSION. This is due to severe, However, veins distend more readily than arteries due to
chronic lung disease; their thinner walls.
■ PERIPHERAL ARTERIOVENOUS FISTULA; General signs of a hypervascular pattern are:
■ SEVERE, CHRONIC ANAEMIA; ■ Increased vessel size (arteries and/or veins);
■ End-on vessels mimicking nodules;
■ Enlarged vessels becoming slightly tortuous;
■ Vessels extending further to the periphery of the lung
field than normal;
■ Overall increase in lung opacity;
■ Loss of clarity of vessel outline in the presence of
early pulmonary oedema;
■ Associated changes in the heart, caudal vena cava,
abdomen, and so on, depending on the cause.

Hypovascular pattern
A generalised hypovascular pattern may be caused by:
■ COMPRESSION OF VESSELS. Due to hyperinflation of
the lungs (air-trapping, overzealous manual inflation);
Diagrammatic representation of a hypervascular lung ■ HYPOVOLAEMIA. Due to dehydration or blood loss;
pattern, showing dilation and tortuosity of a pulmonary
artery

Hypovascular lung pattern and microcardia

in a six-year-old domestic shorthair cat with
Diagrammatic representation of a hypovascular lung hypovolaemia and circulatory shock, secondary
pattern, showing a reduction in the size of the pulmonary to severe pancreatitis. As well as a reduction
arteries and veins, making them harder to differentiate in the size of the pulmonary blood vessels,
from the bronchial markings the aorta and caudal vena cava are small

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R L ■ SHOCK;
■ HYPOADRENOCORTICISM (Addison’s disease);
■ SEVERE PULMONIC STENOSIS;
■ RIGHT-TO-LEFT SHUNTS. For example, tetralogy of
Fallot and reverse-shunting PDA;
■ FORWARD RIGHT-SIDED HEART FAILURE. Due to
pericardial effusion and cardiac tamponade, restrictive
pericarditis or severe tricuspid regurgitation.
Additionally, a localised hypovascular pattern may be
present distal to an occlusion of a pulmonary artery due
to a thrombus.
Radiographic signs of a hypovascular pattern are:
■ Hyperlucency of the lungs due to a reduction in
the volume of circulating blood, which is of soft tissue
opacity;
■ Thin and thread-like vessels, which do not extend to
the periphery;
■ Changes in heart size depending on the cause.
Reduction in the size with circulatory problems and
hyperinflation, and changes in size and shape with
cardiac disease;
■ Reduction in the size of the caudal vena cava and
sometimes also the aorta with circulatory problems and
hyperinflation.
Dorsoventral thoracic radiograph of a 10-year-old labrador
retriever with a heart murmur due to pulmonic stenosis, Reference
which had previously been undetected. The lungs are NYKAMP, S. G., SCRIVANI, P. V. &
more radiolucent than normal due to undercirculation DYKES, N. L. (2002) Radiographic
(hypovascular pattern). There is right-sided cardiomegaly signs of pulmonary disease: an
and poststenotic dilation of the main pulmonary artery, alternative approach. Compendium
producing a bulge at the 1 to 2 o’clock position on the heart on Continuing Education for the
outline (arrow) Practicing Veterinarian 24, 25-35

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Radiological assessment of lung disease in

small animals : 1. Bronchial and vascular
patterns
Ruth Dennis

In Practice 2008 30: 182-189

doi: 10.1136/inpract.30.4.182

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