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Radiographic case study: 8 year old dyspnoeic Springer Spaniel

Radiographic case study:


Clinical History:

An 8 year old Male Entire Springer Spaniel. Two week history of mild inappetence and lethargy. Then acutely became tachypnoeic and tachycardic with pale mucous membranes. Blood results are shown below:


Total protein * 50 g/L Low (54.0 -77.0 )
Albumin 29 g/L (26.0 -40.0 )
Globulin * 21 g/L Low (22.0 -52.0 )
Sodium 144 mmol/L (139 -154 )
Potassium 5.0 mmol/L (3.5 -6.0 )
Na:K ratio 29 (25.0 -35.0 )
Chloride 112 mmol/L (99 -125 )
Total calcium 2.32 mmol/L (2.0 -3.0 )
Phosphate 1.60 mmol/L (0.8 -1.6 )
Urea 6.8 mmol/L (2.0 -9.0 )
Creatinine 83 umol/L (40.0 -106.0)

PCV * 24.1 Low (37-55)
RBC * 4.57 x10^12/L Low (5.0 -8.5 )
Hb * 11.7 g/dl Low (12.0 -18.0 )
HCT 37.9 % (37.0 -55.0 )
MCV * 82.9 fl High (60.0 -80.0 )
MCH 25.6 pg (19.0 -26.0 )
MCHC 30.9 g/dl (30.8 -37.0 )
RDW 14.9 % (12.9 -17.8 )
Platelets 225 x10^9/L (160 -500 )
WBC 9.81 x10^9/L (6.0 -15.0 )
Neutrophils 7.26 x10^9/L (3.0 -11.5 )
Lymphocytes 1.61 x10^9/L (1.0 -4.8 )
Monocytes 0.59 x10^9/L (0.0 -1.3 )



Thoracic radiographs were acquired (see below)

Right lateral thorax

Dorsoventral thorax

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Diagnostic Interpretation:

There is a large amount of bilateral pleural effusion. The effusion is seen as homogeneous soft tissue opacity in the pleural space that results in retraction of the lung lobes away from the thoracic wall. On the lateral view, the effusion completely effaces the cardiac silhouette and the ventral diaphragmatic outline. Only portions of the dorsal part of the lung field are visible and are mildly increased in opacity; the ventral parts are retracted, likely completely collapsed.

The intrathoracic part of the trachea is mildly displaced dorsally.

Thick interlobar fissure lines are seen in both hemithoraces. The amount of effusion may be more severe in the left hemithorax as seen on the DV view by the widening of the pleural space between the lateral margins of the lung lobes and the thoracic wall.

There is a small lesion (2.8cm in length) in the mid portion of the left 7th rib. This lesion seems to have an expansile component. The cortex of this rib is thinner and interrupted at this level. Additionally, irregular periosteal reaction encircles this lesion. There is a long zone of transition between this lesion and the normal bone.

The soft tissues of the thoracic wall are normal.



Rib lesion (yellow arrow heads) and a pleural fissure line (purple arrows)


Conclusions:

1. Bilateral pleural effusion.

2. Aggressive lesion in the left 7th rib: most likely primary malignant neoplasia (i.e. osteosarcoma, chrondrosarcoma, fibrosarcoma).

Additional comments:

It is likely that a mass extending into the thoracic cavity exists but is not seen due to effacement with the surrounding pleural fluid. Ultrasound or CT of the thorax is recommended to assess the real extension of the pathology and to guide sampling.


Update:

An ultrasound of the chest was performed which identified a large mass in the left hemithorax emanating from the 7th rib. Further investigations and potential surgery were discussed with the owner, but due to the poor prognosis regardless of the tumour type, euthanasia was elected.