Thoracic X-rays : Abnormal Features

INCORRECT – intercostals spaces are a very unreliable method of measurement because the intercostal space width is very dependant on the respiratory phase (inspiratory and expiratory).

INCORRECT - the Vertebral Heart Score is assessed on a lateral rather than DV radiograph

CORRECT - Here are some breed values: Boxer (10.8 – 12.4), Labrador (10.2 – 11.4), GSD (9.0 – 10.4), Dobermann (9.4 – 10.6), Cavalier King Charles Spaniel (10.1 – 11.1), Yorkshire Terrier (9.2 – 10.2), Whippet (10.5 – 11.5), Puppies (8.5 – 10.5)

INCORRECT - the Vertebral Heart Score is measured from the 4th Thoracic Vertebra (T4)

WRONG - this statement is CORRECT. Lung hyperinflation can make a normal heart appear small. Radiographs should therefore be taken on normal inspiration rather than hyperinflation.

YES - this statement is INCORRECT. In large breed dogs, enlargement of the heart shadow may be related to dilated cardiomyopathy but is also seen, for example, with pericardial effusion.

WRONG - this statement is CORRECT.

WRONG - this statement is CORRECT. Mitral regurgitation can occur secondarily in dilated cardiomyopathy when the mitral annulus is dilated by stretching of the whole valve apparatus.

Yes - this statement is INCORRECT. HCM is common in cats but a very rare condition in dogs. In dogs, heart enlargement is normally caused by eccentric hypertrophy (mitral valve disease in small dogs, dilated cardiomyopathy in large dogs) although concentric hypertrophy may also occur, for example in congenital heart diseases such as aortic stenosis

Wrong - this statement is CORRECT. The right atrium will be enlarged if there is severe tricuspid insufficiency because of degenerative valve disease but also in some other disease such as right arrhythmogenic ventricular cardiomypathy.

Wrong - this statement is CORRECT.

This statement is INCORRECT. Pulmonary veins are best visible cranial to the heart shadow.

This statement is INCORRECT. Every brochus is accompanied by a pulmonary artery dorsally and a pulmonary vein ventrally.

Yes, this statement is CORRECT: If the pulmonary vein is larger than the accompanying artery, this suggests pulmonary venous congestion, which may be caused by left sided congestive heart failure.

This statement is INCORRECT. A normal caudal vena cava is always tilted towards the elbow of the dog. It will only become tilted towards the ear if there is right sided cardiac enlargement.

Wrong - this statement is CORRECT. It is therefore very important, before deciding on the presence of an interstitial pattern, that we are sure the radiograph is inspiratory.

Yes, this answer is INCORRECT. A bronchial pattern indicates, in most cases, brochial disease such as chronic bronchitis, eosinophilic infiltrates of the brochi/ pulmonary parenchyma and many other respiratory diseases. It is not characteristic of heart disease.

Wrong - this answer is CORRECT. The respiratory causes are numerous, including interstitial pulmonary fibrosis, non-cardiogenic pulmonary oedema and fatty/ neoplastic infiltrates. However, if it is secondary to left sided congestive heart failure, the infiltrate is localised mainly in the perihilar area.

Wrong, this answer is CORRECT. Alveolar patterns indicate that the whole alveolar space is filled with fluid. This fluid can be oedema (cardiogenic/non cardiogenic) but also pus or blood (as we can see with intrapulmonary haemorrhage or aspiration pneumonia).

This statement is INCORRECT. Some dogs (mainly the large breed dogs) will cough because of heart failure but most of these dogs (mainly the small dogs) are coughing because the enlarged left atrium is causing left mainstem bronchus compression and this mechanical compression is a trigger for the cough. However, many of these small breed older dogs will also have concurrent respiratory disease and the cough may therefore be unrelated to the heart murmur and left atrial enlargement. It is therefore essential to undertake chest radiographs for a dog that is coughing to check the cough is cardiac, respiratory or, in many cases, a bit of both.

This statement is INCORRECT. Left sided congestive heart failure is usually linked to pulmonary venous congestion and interstitial oedema, the latter of which is commonly visible in the perihilar region on lateral X-rays.

This statement is INCORRECT. Pleural effusion, ascites and hepatomegaly are associated with right-sided congestive heart failure, which may occur alone or alongside left-sided congestive heart failure.

YES - this statement is CORRECT,