TEACHING | Clinical Cases | Case Answer/Discussion

Case 2

Answer: There is relatively uniform widening of the cranial and caudal mediastinum on the dorsoventral view. On the lateral view, the heart and ventral diaphragm are poorly visualized due to silhouetting with soft tissue opacity material within the mediastinum. A pleural fissure line is present overlying the cardiac silhouette on the lateral view, and the caudal lung lobes are slightly separated from the thoracic wall by soft tissue opacity material on the DV view. No other abnormalities are detected. Given the history, the most likely differential is mediastinal hemorrhage and mild bilateral pleural hemorrhage secondary to rodenticide toxicity.

Discussion: The normal mediastinum should be no more than twice the width of the spine on the DV view. The relative uniformity of the widening in this case makes the presence of mediastinal fluid more likely than the presence of a mass. Without the history of possible rodenticide toxicity, another differential diagnosis would be the presence of pus within the mediastinum, possibly secondary to a perforating esophageal foreign body.

Thoracic radiographic findings in dogs with anticoagulant rodenticide toxicity have been described. Findings include increased mediastinal soft tissue opacity with or without tracheal narrowing, variable amounts of pleural effusion, and patchy pulmonary infiltrates. (1) The patient in this case had mediastinal fluid without tracheal narrowing and mild pleural effusion, but no pulmonary infiltrates. Remember that the mediastinum extends from the spine to the sternum, so it is superimposed on the lung fields on the lateral view. This can give the false impression of pulmonary changes. Luckily, evaluation of the lung fields is still possible on the DV view.

1) Berry CR, Gallaway A, Thrall DE, Carlisle C. Thoracic radiographic features of anticoagulant rodenticide toxicity in 14 dogs. Vet Radiol Ultrasound 34(6):391-396, 1993.