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Cas clinique RX
Etienne Novet
Created on March 24, 2025
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Présentation
cas clinique rx
rotation imagerie
graou
- Difficultés respiratoires évoluant depuis quelques semaines
- Abattement, dégradation de l’état général
- Antécédent de toux chronique depuis plusieurs années
Chat européen de 12 ans
CLICHÉS
Il s'agit bien d'un chat
Espèce
Absence de rotation Fin d'inspiration Contraste correct 4 opacités
QUALITÉ DU CLICHÉ
Cranial : épaule Caudal : inclut les 2 dernières côtes Ventral : marge sous le sternum Dorsal : marge au-dessus dos
Cadrage
VUE PROFIL LATÉRAL GAUCHE
Bon état d'embonpoint
Tissus mous
13 paires de côtes, 8 sternèbres
Cadre osseux
Contraste normal
Abdomen
STRUCTURESEXTRA-THORACIQUES
VUE PROFIL LATÉRAL GAUCHE
ESPACE PLEURAL &MÉDIASTIN
NL ?
Transsudat (cardiaque) ? Exsudat (pleurésie, tumeur) ?Sang ? Chyle ? Pus ?
Epanchement !Masse ?
Déviation dorsale de la trachée (masse ? épanchement ?) Opacification liquidienne thoracique craniale et ventrale diffuse Scissures lobaires (?) Effacement silhouette du diaphragme (et du coeur)
VUE PROFIL LATÉRAL GAUCHE
COEUR & VAISSEAUX
Effacement total de la silhouette du coeur Taille ? Vaisseaux non visualisables Aorte ? VCC ?
VUE PROFIL LATÉRAL GAUCHE
Atélectasie (épanchement) ?Bronchopneumonie par aspiration ?
PARENCHYME PULMONAIRE
Volume pulmonaire diminuéVisualisation lobe caudal +Opacification bronchique LCd diffuse (rails, donuts) Opacification interstitielle miliaire (voile gris) Opacification alvéolaire diffuse (effacement silhouettes, bronchogrammes aériques, signe lobaire)
VUE PROFIL LATÉRAL GAUCHE
Il s'agit toujours aussi bien d'un chat (exemple à droite)
Espèce
Absence de rotation Fin d'inspiration Contraste correct 5 opacités
QUALITÉ DU CLICHÉ
Cranial : épaule Caudal : inclut presque les 2 dernières côtes Ventral : marge sous le sternum Dorsal : marge au-dessus dos
Cadrage
VUE PROFIL LATÉRAL DROIT
Bon état d'embonpoint
Tissus mous
13 paires de côtes, 8 sternèbres
Cadre osseux
Contraste normal
STRUCTURESEXTRA-THORACIQUES
Abdomen
VUE PROFIL LATÉRAL DROIT
ESPACE PLEURAL &MÉDIASTIN
Echographie Ponction, cytologie (infectieux ?)
Déviation dorsale de la trachée (plus modérée) Opacification liquidienne thoracique craniale et ventrale diffuse (plus modérée) Effacement silhouette du diaphragme (et du coeur)
VUE PROFIL LATÉRAL DROIT
COEUR & VAISSEAUX
Effacement total de la silhouette du coeur Taille ? Vaisseaux non visualisables Aorte ? VCC ?
VUE PROFIL LATÉRAL DROIT
PARENCHYME PULMONAIRE
Volume pulmonaire diminuéVisualisation lobe caudal + Scissures ?Opacification bronchique diffuse (rails, donuts)Opacification interstitielle miliaire + Opacification alvéolaire diffuse (effacement silhouettes, bronchogrammes aériques, signe lobaire)
VUE PROFIL LATÉRAL DROIT
Décidément c'est bel et bien un chat
Espèce
Absence de rotation Fin d'inspiration Contraste correct 5 opacités
QUALITÉ DU CLICHÉ
Cranial : 2 cm cranialement au manubrium sternal Caudal : inclut les 2 dernières côtes Latéral : larges marges
Cadrage
VUE DE FACE VENTRO-DORSALE
Bon état d'embonpoint, ce chat mange bien
Tissus mous
13 paires de côtes
Cadre osseux
Contraste normal
Abdomen
STRUCTURESEXTRA-THORACIQUES
VUE DE FACE VENTRO-DORSALE
ESPACE PLEURAL & MÉDIASTIN
Opacification liquidienne thoracique craniale diffuse Lésion centrale PEU symétrique à contours peu nets, étenduE jusque caudalement au coeur Opacité de type tissulaire entre les poumons et les côtes Epanchement, masse craniale ? Thymus ?
VUE DE FACE VENTRO-DORSALE
Plus que 2 diapos
COEUR & VAISSEAUX
Effacement total de la silhouette du coeur Taille ? Vaisseaux non visualisables
VUE DE FACE VENTRO-DORSALE
PARENCHYME PULMONAIRE
Volume pulmonaire diminuéVisualisation lobe caudal +Opacification bronchique LCd diffuse (rails, donuts) Opacification interstitielle LCd miliaire Opacification alvéolaire LCr diffuse (effacement silhouettes, bronchogrammes aériques)
VUE DE FACE
Difficultés respiratoires Antécédents toux chronique...
Hypothèses et examens complémentaires
Echographie thoracique ! Ponction, examen cytologique Biochimie + NFS + Test FIV FeLV PCR PIF Drain
Epanchement Tumeur : Lymphome ? Thymome ? PIF ? Abcès ?
J'ai pas tout ça mais ça fait classe
Merci de votre attention
Fin
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- Make sure your audience remembers the message.
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- Generate experiences with your content.
- It’s got the Wow effect. Very Wow.
- Make sure your audience remembers the message.