Radiographic Findings - Snowy (Canine, 12 years)

CHEST LATERAL VIEW

• The cardiac silhouette is markedly enlarged and rounded, occupying well more than 3.5 intercostal spaces.
• Loss of caudal cardiac waist is evident.
• This is the dominant and most significant thoracic finding.

• The trachea is displaced dorsally, running nearly parallel to the thoracic spine - a classic secondary sign of severe left-sided or generalized cardiac enlargement.

• Marked diffuse increase in pulmonary opacity, most pronounced in the caudodorsal lung fields.
• In the context of severe cardiomegaly, this pattern is highly consistent with cardiogenic pulmonary edema.
• Caudal lung lobes are severely compressed and poorly aerated.

• Soft tissue/fluid opacity in the ventral and caudal thoracic cavity with border effacement of the ventral cardiac margin and diaphragm, consistent with pleural fluid accumulation.

• The diaphragmatic line is completely obscured due to the adjacent pleural fluid and cardiomegaly.

• Mild increased soft tissue opacity cranially, likely due to pleural fluid tracking into the mediastinal space.

ABDOMEN LATERAL VIEW

• Generalized, severe loss of abdominal serosal detail producing a uniform "ground-glass" soft tissue opacity throughout the entire abdomen.
• The abdomen is moderately to severely distended and pendulous.
• Intestinal loops appear to be "floating" and are displaced dorsally and centrally - pathognomonic for peritoneal fluid.

• Liver, spleen, kidneys, and urinary bladder margins are completely obscured by surrounding fluid. Hepatomegaly or splenomegaly cannot be excluded.

• Minimal intestinal gas with no evidence of mechanical obstruction.

• No free peritoneal gas, radiopaque calculi, or foreign material identified.

Summary & Clinical Interpretation

• Dilated cardiomyopathy (DCM) - common in older large-breed dogs
• Chronic valvular disease (mitral + tricuspid) with biventricular failure
• Pericardial effusion with cardiac tamponade (less likely given the radiographic appearance)

1. Echocardiography - to assess cardiac chamber sizes, wall motion, valve function, and pericardial space
2. Abdominal ultrasound - to characterize the ascitic fluid and evaluate parenchymal organs
3. Abdominocentesis - fluid analysis (transudate vs. modified transudate vs. exudate) to confirm CHF-related effusion vs. other causes
4. Serum biochemistry + albumin - rule out hypoalbuminemia as a contributing cause
5. NT-proBNP - cardiac biomarker to confirm heart failure

Note: This is a medically serious presentation requiring urgent veterinary attention. The combination of pulmonary edema, pleural effusion, and ascites in a 12-year-old dog indicates decompensated congestive heart failure until proven otherwise.

Cardiothoracic Ratio (CTR) vs. Vertebral Heart Score (VHS) in Dogs

Why CTR is Not the Standard in Veterinary Medicine

The Preferred Standard: Vertebral Heart Score (VHS)

1. Measure the long axis (L) of the heart - from the carina to the apex
2. Measure the short axis (S) - perpendicular at the widest point
3. Transfer each measurement to the vertebral column starting at the cranial edge of T4, and count vertebral body lengths
4. VHS = L + S (expressed in vertebral body units)

Breed-Specific Variations

If CTR Must Be Used

• Normal: Cardiac width should not exceed ~60-70% of the thoracic width on a well-inflated lateral
• On a DV/VD view: Heart should occupy no more than 2/3 of the thoracic width

Intercostal Space Method (Alternative Rule of Thumb)

Radiographic Findings - Spondylosis Deformans (Dog)

Standard Report Language

"Ventral and/or ventrolateral bony proliferations (osteophytes/spondylophytes) are noted arising from the vertebral body end plates at [specify level(s), e.g., T10-T11, L2-L3, L7-S1]. The bony projections extend toward the adjacent vertebral body. [Select severity grade below]. The intervertebral disc spaces appear [maintained / mildly narrowed]. No evidence of discospondylitis (no end plate lysis or irregular sclerosis) is noted. These findings are consistent with spondylosis deformans."

Grade the Severity - Pick the Appropriate Description

Full Structured Report Template

RADIOGRAPHIC FINDINGS - SPINE [LATERAL + VD VIEWS]:

Alignment: Vertebral column alignment is [normal / mildly deviated].

Vertebral bodies: Smooth, uniform density. No evidence of lytic or 
  proliferative lesions suspicious for neoplasia.

Intervertebral disc spaces: [Well maintained at all levels / Mild to 
  moderate narrowing noted at ___].

Spondylotic changes: Ventral osteophytic proliferations are present at 
  the following levels:
    - [T___-T___]: [small spur / moderate osteophyte / partial bridge / 
      complete bridge]
    - [L___-L___]: [describe]
    - [L7-S1]: [describe]
  
  The osteophytes are smooth and well-defined, consistent with 
  degenerative (non-inflammatory) origin. No end plate irregularity, 
  erosion, or perivertebral soft tissue opacity to suggest 
  discospondylitis.

Spinal canal: Appears [adequate / not assessable on plain radiographs].

Paravertebral soft tissues: Unremarkable.

IMPRESSION:
Radiographic findings are consistent with spondylosis deformans, 
[mild / moderate / severe / with complete bridging], affecting 
[single level / multiple levels] of the [thoracic / lumbar / 
lumbosacral] spine. 

[Optional add-on if incidental]: These changes are considered a 
degenerative age-related finding and are frequently asymptomatic. 
Clinical correlation is recommended. Advanced imaging (CT/MRI) is 
advised if neurological deficits are present.

Key Points to Always Mention

Common Sites in Dogs (Most to Least Frequent)

1. Thoracolumbar junction (T10-T11, T11-T12, T12-T13) - most common
2. Lumbosacral junction (L7-S1) - clinically important; can cause cauda equina syndrome
3. Caudal lumbar (L4-L5, L5-L6)
4. Mid-thoracic spine

Key Differentials to Exclude in Your Report

• Discospondylitis - end plate lysis, vertebral body destruction, soft tissue swelling
• Neoplasia - lytic, expansile, or irregular vertebral body lesion
• DISH (Diffuse Idiopathic Skeletal Hyperostosis) - flowing ossification along the ventrolateral aspect of at least 4 contiguous vertebrae, disc spaces preserved, no facet joint ankylosis

Is "Proliferative Changes" Correct for Spondylosis Deformans?

How to Use It in a Report

Option 1 - As the primary descriptor:

"Proliferative bony changes are noted at the ventral aspect of the vertebral end plates at [T10-T11, L2-L3], with osteophyte formation extending toward the adjacent vertebral body. Findings are consistent with spondylosis deformans."

Option 2 - Combined with osteophyte terminology:

"Ventral proliferative changes in the form of osteophytes/spondylophytes are observed at [levels], consistent with degenerative spondylosis deformans."

Option 3 - Bridging case:

"Marked proliferative bony changes with complete ventral bridging spondylophyte formation are noted at [L7-S1], consistent with severe spondylosis deformans."

Acceptable Equivalent Terms in Veterinary Radiology

One Important Caution

✅ "Smooth ventral proliferative bony changes consistent with spondylosis deformans"

❌ "Proliferative changes noted" (alone, without context - too vague, may worry the clinician)

Summary