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RADIOLOGIA TORÁCICA
PULMÃO
DIAGNÓSTICO POR IMAGEM
M.V., Esp. MSc., Andressa Cristina de Souza
LuminaVet Diagnóstico por Imagem Veterinária
CENTRO INTEGRADO DE ESPECIALIDADES VETERINÁRIAS
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INTRODUÇÃO
» Técnica radiográfica
» Anatomia radiográfica
» Indicações
» Padrões e doenças pulmonares
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Técnica Radiográfica
»Tripla exposição radiográfica
» Lateral direita
» Lateral esquerda
» Ventrodorsal ou Dorsoventral
LATERAL ___________________________________
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VENTRODORSAL ___________________________________
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 DORSOVENTRAL
 Utilizar em animais dispnéicos
 Avaliação de massas pulmonares
 Cuidado na avaliação cardíaca
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 LATERAL COM RAIO HORIZONTAL___________________________________
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Confirmar e quantificar a presença de líquido
e gás livre na cavidade.
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Inspiração X Expiração
ANATOMIA RADIOGRÁFICA
VASCULARIZAÇÃO
PULMONAR
 a b v

VASCULARIZAÇÃO
PULMONAR
 ___________________________________
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INDICAÇÕES
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» Tosse ___________________________________
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» Dispnéia ___________________________________
» Taquipnéia ___________________________________
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» Doença cardiovascular ___________________________________
» Trauma torácico ___________________________________
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» Pesquisa por neoplasia primária ou metástase ___________________________________
»
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Alterações na auscultação ___________________________________
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 ___________________________________
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RADIOLOGIA PULMONAR ___________________________________

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» DESAFIO: uma doença várias formas de apresentação ___________________________________
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Uma apresentação várias doenças ___________________________________
» Somente estruturas com opacidades de tecidos moles ___________________________________
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são visíveis: ___________________________________
» Parede das vias aéreas (Brônquios e bronquíolos) ___________________________________
» Artérias e veias pulmonares ___________________________________
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» Interstício pulmonar ___________________________________
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 ___________________________________
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PADRÕES PULMONARES ___________________________________

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Padrão ___________________________________
Compartimento ___________________________________
Radiográfico ___________________________________
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Interstício Intersticial ___________________________________
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Vias aéreas Bronquial ___________________________________
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Alvéolos Alveolar ___________________________________
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Vasos sanguíneos Vascular ___________________________________
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INTERSTÍCIO ___________________________________
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O que é espaço intersticial? ___________________________________
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Composto por: ___________________________________
 Tecido conectivo ___________________________________
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 Vasos linfáticos ___________________________________
 Nervos ___________________________________
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 Normalmente são radiograficamente invisíveis ___________________________________
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Preenchimento espaço intersticial ___________________________________
• Fluido, exsudato, fibrose, massa, metástase ___________________________________
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• Alterações crônicas ou agudas ___________________________________
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PADRÃO INTERSTICIAL ___________________________________

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» Aumento de radiopacidade com pouca a moderada ___________________________________
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perda da definição das vias aéreas e vasos pulmonares ___________________________________
» Padrão não específico - associação com histórico ___________________________________
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Classificação radiográfica: ___________________________________
» Aspecto não estrutural ___________________________________
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o Reticular ___________________________________
o Reticulo-nodular * ___________________________________
» Aspecto nodular ___________________________________
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o • < 3cm – nódulo ___________________________________
o • > 3cm – massa ___________________________________
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 normal
Normal

Padrão
intersticial
reticular
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PADRÃO INTERSTICIAL ___________________________________

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Diagnósticos diferenciais: ___________________________________
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» Pneumonia intersticial (doenças virais – cinomose) ___________________________________
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» Edema ___________________________________
» Hemorragia ___________________________________
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» Metástases pulmonares difusas ___________________________________

» Pneumonite – viral, uremia, inalantes tóxicos

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» Doenças em transição ___________________________________

» Fibrose pulmonar
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PADRÃO INTERSTICIAL ___________________________________

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CUIDADO ___________________________________
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Artefatos: ___________________________________
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» Radiografia subexposta ___________________________________
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» Filme na expiração ___________________________________
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» Animal obeso ___________________________________
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» Hipoventilação ___________________________________
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Padrão intersticial reticular
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PADRÃO INTERSTICIAL NODULAR

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Primária ___________________________________
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» Animais idosos ___________________________________
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» Maligno – massa única ___________________________________
» Carcinoma bronquíolo-alveolar – mais comum ___________________________________
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Secundária – Metástase ___________________________________
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» Secundário a neoplasia primária ___________________________________
» Múltiplos nódulos ___________________________________
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Padrão intersticial nodular
Neoplasia primária
Padrão intersticial nodular
Metástase

PADRÃO ALVEOLAR
» Aumento de radiopacidade dos alvéolos – sangue,
infiltrado inflamatório, fluido (edema) ou células
neoplásicas
Característica radiográfica:
» Aumento de radiopacidade que promove a perda da
visualização das estruturas adjacentes
» Aspecto “nebuloso”
» Broncograma aéreo
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PADRÃO ALVEOLAR
Diagnósticos diferenciais:
o Pneumonia/ Broncopneumonia
o Edema pulmonar
o Hemorragia/contusão pulmonar
o Consolidação/atelectasia
o Neoplasia
o Tromboembolismo
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BRONCOGRAMA AÉREO
SINAL LOBAR - CONSOLIDAÇÃO
 Edema pulmonar

Região peri-hilar
Lobos caudodorsais
Edema pulmonar - Gato
Pneumonia

Lobos cranioventrais
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PADRÃO BRONQUIAL ___________________________________

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» Calcificação / Espessamento das vias aéreas ___________________________________
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» Causas: ___________________________________
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» Bronquite crônica ___________________________________

» Asma felina
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» Broncopneumonia
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Donuts
Padrão Bronquial
Asma Felina
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BRONQUIECTASIA ___________________________________
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» Dilatação permanente das vias aéreas;

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» Causas: ___________________________________
» Infecção crônica ___________________________________
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» Desordem mucociliar ___________________________________
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» Obstrução ___________________________________
» Envelhecimento ___________________________________
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PADRÃO VASCULAR ___________________________________

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Avaliar calibre/diâmetro dos vasos ___________________________________
» Hipovascularização ___________________________________
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» Hipervascularização ___________________________________
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Arterial ___________________________________

» Dirofilariose
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Venosa ___________________________________

» Congestão (Insuficiência cardíaca esquerda)

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» Doenças congênitas ___________________________________
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CONGESTÃO VENOSA ___________________________________
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 ___________________________________
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Testando conhecimentos ___________________________________

1. Na imagem radiográfica do tórax não são
diagnósticos diferenciais de padrão intersticial
não estruturado (difuso), exceto:
a. Subexposição radiográfica;
b. “Pulmão de cão idoso”;
c. Broncopneumonia;
d. Abcesso pulmonar
e. Pneumonia na cinomose.
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Testando conhecimentos ___________________________________

2. É sinal radiográfico de comprometimento alveolar no
pulmão a presença de:
a) broncogramas aéreos.
b) sinais radiográficos em formato de anéis no parênquima
pulmonar.
c) aumento de radiopacidade difuso em forma de malha no
parênquima pulmonar.
d) nódulos maiores que 0,5 cm de diâmetro em todo o
parênquima pulmonar.
e) dilatação vascular por todo o parênquima pulmonar.
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RADIOLOGIA TORÁCICA
CORAÇÃO
DIAGNÓSTICO POR IMAGEM
M.V., Esp. MSc., Andressa Cristina de Souza
LuminaVet Diagnóstico por Imagem Veterinária
CENTRO INTEGRADO DE ESPECIALIDADES VETERINÁRIAS
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 ___________________________________
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INTRODUÇÃO ___________________________________
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» Técnica radiográfica ___________________________________
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» Anatomia radiográfica ___________________________________
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» Ecocardiografia ___________________________________

» Métodos de avaliação e mensuração cardíaca

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» Indicações ___________________________________
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» Doenças congênitas ___________________________________
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» Doenças adquiridas ___________________________________
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INTRODUÇÃO ___________________________________
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» Técnica de triagem ___________________________________
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» Avaliação apenas da silhueta cardíaca ___________________________________
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o Pericárdio (eventuais acúmulos em saco pericárdico) ___________________________________
o Coração ___________________________________
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o Volume sanguíneo ___________________________________
o Grandes vasos ___________________________________
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o Arco aórtico, Aorta, Artéria pulmonar ___________________________________
o Gordura em saco pericárdico e mediastino ___________________________________
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Adequado posicionamento

X
Adequado posicionamento

X
Tamanho normal do coração

 Projeção Lateral:
2,5 a 3 espaços
intercostais

Cuidar com variações

raciais
Tamanho normal
do coração

 Projeção dorsoventral: 2/3

do tórax (largura)
Anatomia Radiográfica
 Métodos de avaliação e mensuração
Vertebral heart size - VHS

VHS = 8,7 a 10,7

Eixo longo

T4
Eixo curto

Eixo curto

Eixo longo
Métodos de avaliação e mensuração
Relógio

12
1
2

9 3

6
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RADIOLOGIA CARDÍACA ___________________________________

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» Avaliação subjetiva ___________________________________
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» ECOCARDIOGRAFIA ___________________________________
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Pacientes cardíacos: ___________________________________
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» Avaliação pulmonar (edema e congestão venosa) ___________________________________
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» Monitoramento terapêutico ___________________________________
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» Progressão da doença ___________________________________
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ECOCARDIOGRAFIA
» Anatomia interna do coração
» Tamanho de câmaras
» Avaliação das valvas
» Direção e velocidade do fluxo sanguíneo
» Capacidade contrátil do coração
» Pericárdio
» Neoplasias em base cardíaca
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GIANICCO, AT
 ___________________________________
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DIFICULDADES ___________________________________
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» Alterações de posicionamento ___________________________________
» Fase respiratória ___________________________________
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» Fase de ciclo cardíaco ___________________________________
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» Variação inter-racial ___________________________________
o Raças braquiocefálicas e condrodistróficas ___________________________________
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» Animais atletas ___________________________________
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» Tipo de alteração - fisiopatologia ___________________________________
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INDICAÇÕES ___________________________________
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1. Intolerância ao exercício ___________________________________
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2. Tosse ___________________________________
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3. Cianose ___________________________________
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4. Dispnéia ou taquipnéia ___________________________________
5. Arritmia ___________________________________
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6. Sopro à ausculta ___________________________________
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DOENÇAS CONGÊNITAS ___________________________________

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1. Persistência do ducto arterioso - PDA ___________________________________
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2. Estenose pulmonar ___________________________________
3. Estenose aórtica ___________________________________
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4. Defeito/ comunicação do septo ___________________________________
interventricular ___________________________________
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5. Displasia de tricúspide ___________________________________
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Fique atento: Paciente jovem com aumento
generalizado das câmaras cardíacas e edema
pulmonar
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DOENÇAS ADQUIRIDAS ___________________________________

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1. Insuficiência mitral ___________________________________
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2. Insuficiência tricúspide ___________________________________
3. Cardiomiopatia dilatada e hipertrófica ___________________________________
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4. Efusão pericárdica ___________________________________
5. Dirofilariose ___________________________________
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ENDOCARDIOSE
» Degeneração primária dos folhetos
valvares
» Raças pequenas e toy
» Insuficiência mitral (esquerdo) mais
comum que tricúspide (direito)
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ENDOCARDIOSE MITRAL
» Aumento cardíaco mais comum ao exame
radiográfico
» Deficiência no fechamento dos folhetos 
Regurgitação  dilatação  aumento atrial
esquerdo
» Pode haver aumento de ventrículo esquerdo
(dilatação ou hipertrofia)
» Aumento de veias pulmonares (congestão)
» Edema pulmonar  ICCE
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Aumento de átrio esquerdo – projeção lateral
Insuficiência de mitral

» Mudança do aspecto
dorsocaudal
» Perda da cintura caudal
» Abaulamento entre 12 e 2
horas
» Elevação da bifurcação da
traqueia na região da carina
traqueal – compressão
bronquial
Aumento de átrio esquerdo – projeção VD

Insuficiência de mitral

» Aumento de radiopacidade na linha

média, sobreposta a silhueta cardíaca
» Divergência dos brônquios principais –
aumenta o ângulo
» Abaulamento entre 2-3 horas (aurícula
esquerda)
 ___________________________________
Edema pulmonar
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CÂMARAS CARDÍACAS DIREITAS
Aumento de câmaras cardíacas direitas:
1. Insuficiência de tricúspide
2. Core pulmonale (hipertensão pulmonar)
3. Dirofilariose
4. Estenose pulmonar
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Aumento de câmaras direitas
Átrio:
• Abaulamento craniodorsal em projeção lateral e entre 9 e 11 horas em projeção VD
Ventrículo
• Aumento do contato com o esterno na lateral
• Abaulamento entre 6 e 12 horas em VD - Aspecto de “D” invertido
Aumento atrial bilateral
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AUMENTO GENERALIZADO ___________________________________

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1. Cardiomiopatia dilatada ___________________________________
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2. Efusão pericárdica ___________________________________
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» Abaulamento generalizado ___________________________________
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» Aspecto globoso (efusão) ___________________________________
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Cardiomiopatia Dilatada

CARDIOMIOPATIA DILATADA
» Disfunção sistólica ventricular
» Enfraquecimento da contratilidade do
miocárdio
» Aumento das câmaras cardíacas devido a
sobrecarga de volume
» Cardiomegalia
» Efusão pleural e ascite  ICCD
» Raças grandes e gigantes
» Pode não apresentar alterações na silhueta
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 ___________________________________
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CARDIOMIOPATIA HIPERTRÓFICA ___________________________________
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» Gatos ___________________________________
» Primária ou idiopática ___________________________________
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» Caracterizada pela hipertrofia ventricular esquerda  ___________________________________
cavidade diminuida  dilatação atrial esquerda ___________________________________
importante ___________________________________
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» Severo aumento de átrio esquerdo pode mimetizar ___________________________________
um aumento biatrial ___________________________________
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» Ventrículo não aparece aumentado pois aumento é ___________________________________
concêntrico ___________________________________
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» Desenvolve ICC esquerda  edema pulmonar ___________________________________
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Cardiomiopatia hipertrófica
na espécie felina

EFUSÃO PERICÁRDICA
» Associado a ICCD, pericardite, neoplasia,
hipoproteinemia e trauma
» Coração globoso em todas as projeções
» Volumes pequenos podem não alterar a
silhueta
» Diferenciar de cardiomegalia e hérnia
diafragmática peritonio-pericárdica
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Efusão pericárdica
Efusão Pericárdica

DIROFILARIOSE
» Artérias pulmonares dilatadas e tortuosas
» Hipertensão pulmonar pela lesão das camadas
vasculares ou pela presença de dirofilárias
» Visualização mais comum em artérias lobares
caudais
» Aumento das câmaras cardíacas direitas
» Coração em D invertido
» ICCD (Efusão pleural e ascite)
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Dirofilariose
 ___________________________________
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MICROCARDIA ___________________________________
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» Desidratação severa ___________________________________
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» Choque hipovolêmico ___________________________________

» Addison
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» Caquexia
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Considerações finais
» Informações somente sobre a silhueta cardíaca
» Não é uma imagem direta do coração
» As alterações devem ser significantes para serem
visíveis
» Sinais iniciais da doença podem não ser evidentes
» As alterações internas não são evidentes
(aumentos concêntricos)
» Não permite informações sobre a função cardíaca
» Muito importante na avaliação geral da ICC –
edema pulmonar
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 ___________________________________
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Testando conhecimentos ___________________________________

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1. Na imagem radiográfica do coração nas ___________________________________
projeções ventrodorsal ou dorsoventral pode-se ___________________________________
realizar uma analogia com um relógio. A aurícula ___________________________________
___________________________________
esquerda corresponde a: ___________________________________
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a. 1-2 h; ___________________________________
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b. 2-3 h; ___________________________________
c. 3-4 h; ___________________________________
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d. 12-1h; ___________________________________
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e. 4-6 h. ___________________________________
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Testando conhecimentos
2. São sinais radiográficos de cardiomegalia
generalizada:
a. Silhueta cardíaca perde a sua forma ovalada
porém não adquire uma forma globosa;
b. Silhueta cardíaca está aumentada de volume e se
apresenta sob a forma esférica ou globosa;
c. Aumento de densidade radiográfica da cava
posterior;
d. Dilatação da margem cardíaca na posição entre 9
e 11 h;
e. nenhuma das alternativas anteriores.
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