Case Study: Lung Lobe Torsion in 5-Year-Old Pug
Dr Barry Kipperman, DVM, DACVIM; VetCare, Dublin, California
Summary
A pug dog presenting with acute onset lethargy was tentatively diagnosed with aspiration pneumonia, based on lab work and radiographs. After standard treatment seemed not to have effect, further examination was performed by CT scan via Fidex from Animage, LLC. The CT scan revealed a lung lobe torsion. The patient was treated surgically. The patient then began improving and recovered completely after five days.
Case
Winston, a 5 year-old, male neutered Pug presented to the Veterinary Emergency and Specialist Center with acute onset lethargy. Physical examination confirmed lethargy and mild fever. Dyspnea was not evident. Lab work revealed an elevated white blood cell count, and radiographs revealed complete consolidation of the left cranial lung lobe with air bronchograms (Figure 1). A tentative diagnosis of aspiration pneumonia was made, and therapy was initiated with IV fluids and broad-spectrum antibiotics. No improvement was noted over the day.
Figure 1: Radiograph of Thorax
Winston was anesthetized with Propofol, and a thoracic CT scan (via Fidex, from Animage, LLC) was performed using a standard breath-hold technique. Pre- and post-contrast images revealed complete consolidation of the left cranial lung lobe with alveolar infiltrates. Air pockets were noted in the central regions of the lobe (Figure 2). The main-stem bronchus to this lobe was constricted at the base and opacified. All other lung lobes appeared normal. CT diagnosis was left cranial lung lobe torsion.
Figure 2: CT Showing Lung Lobe Torsion
The next day a left lateral thoracotomy was performed, with resection of the diseased and infarcted lung lobe. Recovery was uneventful after analgesic support including meloxicam, fentanyl, and local intercostal nerve blocks. Histopathology of the excised lung lobe revealed acute fibrinohemorrhagic necrosis. Winston made a complete recovery by day 5 after surgery.
Lung lobe torsion (LLT) is a rare, life-threatening condition in which a lung lobe rotates along its long axis with twisting of the broncho-vascular pedicle.i The cause is unknown. Diagnosis is challenging as LLT is often not suspected until the patient fails to respond to treatment for more common conditions such as pneumonia, and/or pleural effusion occurs. Serial radiographs, thoracic ultrasound and bronchoscopy have been reported as diagnostic aids in past literature.ii
A recent report documented a series of 7 Pugs with LLT over a thirteen year period.iii Median age was 1.5 years, and 6 out of 7 cases involved the left cranial lung lobe. In veterinary medicine, CT is being recognized as a valuable tool in clarifying the cause of pulmonary parenchymal diseases. Common CT features of LLT in dogs include pleural effusion, abrupt ending of the affected bronchus, consolidation of the affected lung lobe, and lobar emphysema.iv
Winston’s clinical and radiographic findings were suggestive of pneumonia. The decision to pursue CT was based on the absence of any known predisposing factors (vomiting, anesthesia, immuno-suppression) and the known predisposition of young Pugs to develop this disease. In this case, the availability of, and decision to pursue CT imaging early was pivotal in achieving a positive outcome.
i Lord PF, Greiner TP, Greene RW, et al: Lung lobe torsion in the dog. Journal American Animal Hospital Association 1973; 9; 473-482
ii Moon, M, Fossum, TW. Lung lobe torsion. In; Bonagura, JD, ed. Kirk’s Current Veterinary Therapy XII; Small Animal Practice. Philadelphia; WB Saunders Co, 1995; 919-921.
iii Murphy, KA, Brisson, BA; Evaluation of lung lobe torsion in Pugs; 7 cases. Journal American Veterinary Medical Association 2006; No 1; 86-90.
iv Seiler, G, Schwarz, T, Vignoli, M, Rodriguez, D. Computed tomographic features of lung lobe torsion. Journal of Veterinary Radiology and Ultrasound, Vol 49, No 6, 2008; 504-508.
Animage, LLC Will Exhibit at the Pacific Veterinary Conference/Vet Expo in San Francisco
7/9/10, Pleasanton, CA
Animage, LLC will appear at the Pacific Veterinary Conference as an exhibitor in its Vet Expo. Vet Expo will take place on July 16 and 17 in San Francisco, California at the Hilton Union Square at 333 O’Farrell Street, San Francisco. Animage, LLC will be on hand to discuss their new veterinary diagnostic imaging system, Fidex. Fidex is the only veterinary diagnostic imaging system that can do CT, DR, and fluoroscopy with one machine.
We'll be in Booth 404.
We'd love to see you at our booth and discuss your practice and Fidex. If you like, you'll have the opportunity to take control of the Fidex user interface and view and manipulate Fidex CT images.
The combination of CT, radiography, and fluoroscopy in one machine creates unprecedented economies of space, energy, and financial resources. Because of this, Fidex can put the benefits of the diagnostic power of CT at the service of many more veterinarians, their patients, and the people who love their patients.
Even as just a CT scanner, Fidex offers a brand new CT system that is smaller, requires much less power and room modification, is easier to operate and maintain, and costs less to operate and maintain than a refurbished, used human CT scanner. Fidex runs from a standard 120 V wall outlet (optionally 240 V), requires no cooling beyond standard office temperature controls, has similar shielding parameters to standard radiography systems, and can go right through standard doors and hallways and be installed in as little as an hour - ready to run in two hours.
Please feel free to contact us any time at mvhaz@animage-llc.com.
We look forward to discussing Fidex further with you.
Fidex Draws Much Interest at the ACVIM Forum
6/15/10, Pleasanton, California
Animage, LLC exhibited their multi-modality veterinary diagnostic imaging system at the ACVIM Forum in Anaheim, CA on June 10, 11, 12, 2010.
ACVIM attendees from all over the USA and eleven nations visited the Animage booth. Visitors to the Animage booth were uniformly impressed by the economies of space, power, and financial resources Fidex offers, as well as by Fidex’s image quality and ease of use. Many took the opportunity to take mouse in hand and perform no-X-ray CT ‘scans’, search the Fidex database, and manipulate stored Fidex CT images – learning first-hand how easy indeed Fidex is to operate.
Animage to Exhibit Fidex at the ACVIM Forum Exhibition
6/1/10, Pleasanton, California
Animage, LLC will exhibit Fidex - the only veterinary diagnostic imaging system that can do CT, DR, and fluoroscopy with one machine - at the 2010 ACVIM Forum in Anaheim, California on June 10, 11, and 12.
We'll be in Booth 357.
We'd love to see you at our booth and discuss your practice and Fidex. If you like, you'll have the opportunity to take control of the Fidex user interface and view and manipulate Fidex CT images.
The combination of CT, radiography, and fluoroscopy in one machine creates unprecedented economies of space, energy, and financial resources. Because of this, Fidex can put the benefits of the diagnostic power of CT at the service of many more veterinarians, their patients, and the people who love their patients.
Even as just a CT scanner, Fidex offers a brand new CT system that is smaller, requires much less power and room modification, is easier to operate and maintain, and costs less to operate and maintain than a refurbished, used human CT scanner. Fidex runs from a standard 120 V wall outlet (optionally 240 V), requires no cooling beyond standard office temperature controls, has similar shielding parameters to standard radiography systems, and can go right through standard doors and hallways and be installed in as little as an hour - ready to run in two hours.
Please feel free to contact us any time at mvhaz@animage-llc.com.
We look forward to discussing Fidex further with you.
Animage Releases New Software Upgrades for Fidex
4/21/10, Pleasanton, California
Animage, LLC has finished and integrated new software upgrades for Fidex, Animage’s multi-modality veterinary diagnostic imaging system that has CT, DR, and fluoroscopy in one machine. The new upgrades make Fidex’s image quality even better.
These and any other software upgrades can easily be added to Fidex systems in the field. During the two-year warranty period of Fidex software, upgrades are available free of charge.
The upgrades mainly concern CT image reconstruction. This includes new image reconstruction algorithms that improve upon Fidex’s already excellent image quality. There are now new reconstruction algorithms and respective mode selections for imaging bone, chest, soft tissue, and brain tissue. Generally, the upgrades address artifacts that are typical of CT imaging. Such software is the specialty of Animage’s parent company, Exxim Computing Corporation, which is used by CT hardware manufacturers worldwide. The upgrades reduce or eliminate ‘noise’ and ‘artifacts’ generated within images, thus making images more clear and better rendered for accurate analysis and diagnosis. A specific way the upgrade will improve image quality is in the ability to discern very subtle variations within various tissues. This will probably be most noticeable in the soft tissue mode and the new brain tissue mode.
The upgrade also makes table control more accurate and gives a larger field of view in Preview mode.
Fidex Piques Interest at Veterinary Conferences 3/31/10
Animage, LLC has been very busy with a succession of veterinary conference exhibitions and stirring up quite a bit of interest among their attendees.
Animage was at the Western Veterinary Conference (WVC) in Las Vegas February 15 – 17 and at the American Animal Hospital Association (AAHA) Conference March 19 – 20. Veterinarians from all over North America, Europe, Asia, and Australia came by Animage’s booth and were treated to seeing something that is truly new and unique to veterinary medicine - something that could make CT imaging practical for many more veterinary clinics and their clients, thus sparing many more pets painful procedures and delayed diagnoses.
Animage had the privilege of meeting many wonderful and talented people. Among them were a good number of very interested veterinarians, practice managers, and technicians in the USA and abroad who are now seriously considering installing Fidex systems in their practices. In turn, these people are passing the word on to their friends and associates in the profession.
In the coming months Animage will exhibit and demonstrate Fidex at further veterinary conferences. June 10 – 12 will see Animage at the American College of Veterinary Internal Medicine (ACVIM) Forum in Anaheim, California. On July 15 – 18, Animage will be at the Pacific Veterinary Conference in San Francisco, California - just a forty-five minute drive from Animage’s headquarters in Pleasanton, California.
Fidex Begins Clinical Testing
8/28/09, Pleasanton, California
Animage, LLC, a veterinary diagnostic imaging technology company,
has begun clinical trial of its premier product, Fidex, a multiple-modality
diagnostic imaging system designed specifically for use in small animal
veterinary practice and clinical research laboratories.
A Fidex system has been installed in Dr Barry Kipperman’s VetCare Emergency
and Specialty Care Center in Dublin, California. Site delivery and installation took
only about three hours. Dr Kipperman and his staff are undergoing familiarization
and training on Fidex, as well as learning how to use manipulate
and use the images Fidex creates. At the same time, Dr Kipperman
and his staff are providing Animage with valuable information on how to optimize Fidex
for veterinary practice.
Fidex is the first system of its kind in veterinary diagnostic imaging.
Fidex has in one machine radiography (CR or DR), computed tomography (CT),
and fluoroscopy. This creates unprecedented economies of both space
and financial resources for veterinarians who want to add to their
clinics’ diagnostic imaging capabilities, but might have been inhibited
from doing so by the availability of space or financial resources
that adding one or two additional machines would require.
Even as just a CT scanner, Fidex offers a brand new system
that is smaller, requires much less power and room modification,
is less complex, is easier to operate and maintain,
and costs less to operate and maintain than a refurbished,
used human CT scanner. Fidex is comparable in price to refurbished,
used human CT scanners.
Animage is now preparing a Fidex system for installation
at the UC Davis School of Veterinary Medicine sometime i
n September, where it will undergo further clinical trial.
Animage plans to make Fidex available to the marketplace
around the end of October, 2009.
Animage, LLC of Pleasanton, California was founded in 2008
by parent company Exxim Computing Corporation in order
to create unique diagnostic imaging products dedicated
to the veterinary practice industry.
Exxim is a diagnostic imaging technology company
that creates CT imaging software products for customers worldwide,
including Siemens, Imaging Sciences, and many others.
VetCare Emergency and Specialty Care Center, of Dublin, California,
was founded in 1997 by Dr Barry Kipperman, DVM.
VetCare is a 24-hour-a-day veterinary hospital providing internal medicine,
surgery, and emergency services.
Dr Kipperman earned his Doctor of Veterinary Medicine degree
in 1987 from the University of Missouri.
He was board certified in internal medicine in 1994. Dr. Kipperman
is an expert in veterinary ethics and animal advocacy,
and is an author of numerous articles on these topics.
Dr Kipperman is also a guest lecturer on veterinary medical ethics
at the UC Davis School of Veterinary Medicine.
Fidex Featured at NIWeek
August 6, 2009, Austin, Texas
National Instruments, creators and manufacturers of open graphical programming software
and modular hardware invited Animage to their annual NIWeek show on August 6, 2009,
as a featured company that has used their products in exceptional and innovative ways.
Animage uses NI’s LabView and Single-Board RIO to facilitate design, development,
and programming of Fidex, Animage’s new multi-modality veterinary
diagnostic imaging system.
Animage was represented in the presentation by James Carver,
principal of Jamco Engineering and mechanical engineering contractor to Animage;
and Dr Ivan Charamisinau, System Engineer for Animage. Mr Carver addressed
over 3,000 engineers to give them an overview of the capabilities of Fidex
as well as the technical and economic advantages made possible in the development
of Fidex by LabView and Single-Board RIO.
After the presentation, Mr Carver and Dr Charamisinau were joined by
Mark Hazarabedian, Director of Marketing for Animage, to take questions
from members of the worldwide engineering and technology press.
Animage, LLC of Pleasanton, California was founded
in 2008 by parent company Exxim Computing Corporation
in order to create unique diagnostic imaging products
dedicated to the veterinary practice industry.
Exxim is a diagnostic imaging technology company that creates
CT imaging software products for customers worldwide,
including Siemens, Imaging Sciences, and many others.
National Instruments creates and manufactures open graphical programming software
and modular hardware used by engineers and scientists in more than 30,000 companies
around the world to design, prototype, and deploy systems for test, control,
and embedded design applications. Using NI, customers simplify development,
increase productivity, and dramatically reduce time to market.
From testing next-generation gaming systems to creating breakthrough medical devices,
NI customers continuously develop innovative technologies that impact millions of people.
