Cas clinique RX

rotation imagerie

cas clinique rx

Présentation

Chat européen de 12 ans

• Difficultés respiratoires évoluant depuis quelques semaines
• Abattement, dégradation de l’état général
• Antécédent de toux chronique depuis plusieurs années

graou

CLICHÉS

VUE PROFIL LATÉRAL GAUCHE

QUALITÉ DU CLICHÉ

Absence de rotation Fin d'inspiration Contraste correct 4 opacités

Cadrage

Cranial : épaule Caudal : inclut les 2 dernières côtes Ventral : marge sous le sternum Dorsal : marge au-dessus dos

Espèce

Il s'agit bien d'un chat

VUE PROFIL LATÉRAL GAUCHE

STRUCTURESEXTRA-THORACIQUES

Abdomen

Contraste normal

Cadre osseux

13 paires de côtes, 8 sternèbres

Tissus mous

Bon état d'embonpoint

VUE PROFIL LATÉRAL GAUCHE

ESPACE PLEURAL &MÉDIASTIN

Déviation dorsale de la trachée (masse ? épanchement ?) Opacification liquidienne thoracique craniale et ventrale diffuse Scissures lobaires (?) Effacement silhouette du diaphragme (et du coeur)

Epanchement !Masse ?

NL ?

Transsudat (cardiaque) ? Exsudat (pleurésie, tumeur) ?Sang ? Chyle ? Pus ?

VUE PROFIL LATÉRAL GAUCHE

COEUR & VAISSEAUX

Effacement total de la silhouette du coeur Taille ? Vaisseaux non visualisables Aorte ? VCC ?

VUE PROFIL LATÉRAL GAUCHE

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)

Atélectasie (épanchement) ?Bronchopneumonie par aspiration ?

VUE PROFIL LATÉRAL DROIT

QUALITÉ DU CLICHÉ

Absence de rotation Fin d'inspiration Contraste correct 5 opacités

Cadrage

Cranial : épaule Caudal : inclut presque les 2 dernières côtes Ventral : marge sous le sternum Dorsal : marge au-dessus dos

Espèce

Il s'agit toujours aussi bien d'un chat (exemple à droite)

VUE PROFIL LATÉRAL DROIT

STRUCTURESEXTRA-THORACIQUES

Abdomen

Contraste normal

Cadre osseux

13 paires de côtes, 8 sternèbres

Tissus mous

Bon état d'embonpoint

VUE PROFIL LATÉRAL DROIT

ESPACE PLEURAL &MÉDIASTIN

Déviation dorsale de la trachée (plus modérée) Opacification liquidienne thoracique craniale et ventrale diffuse (plus modérée) Effacement silhouette du diaphragme (et du coeur)

Echographie Ponction, cytologie (infectieux ?)

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 DE FACE VENTRO-DORSALE

QUALITÉ DU CLICHÉ

Absence de rotation Fin d'inspiration Contraste correct 5 opacités

Cadrage

Cranial : 2 cm cranialement au manubrium sternal Caudal : inclut les 2 dernières côtes Latéral : larges marges

Espèce

Décidément c'est bel et bien un chat

VUE DE FACE VENTRO-DORSALE

STRUCTURESEXTRA-THORACIQUES

Abdomen

Contraste normal

Cadre osseux

13 paires de côtes

Tissus mous

Bon état d'embonpoint, ce chat mange bien

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

COEUR & VAISSEAUX

Effacement total de la silhouette du coeur Taille ? Vaisseaux non visualisables

Plus que 2 diapos

VUE DE FACE

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)

Hypothèses et examens complémentaires

Echographie thoracique ! Ponction, examen cytologique Biochimie + NFS + Test FIV FeLV PCR PIF Drain

Difficultés respiratoires Antécédents toux chronique...

Epanchement Tumeur : Lymphome ? Thymome ? PIF ? Abcès ?

Fin

Merci de votre attention

J'ai pas tout ça mais ça fait classe

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team

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