SMALL ANIMAL RADIOLOGY CASE DISCUSSIONS Sarah Jones, DVM

Case 1 7 year old FS DSH Acute onset vomiting

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This is an after hours study This is an after hours study. There is free gas throughout the abdomen as evidenced by multiple small to large, variably shaped gas bubbles superimposed with the abdominal viscera throughout all quadrants of the abdomen. The largest of these bubbles are noted in the right cranial quadrant. There is decreased serosal detail in the cranial to mid abdomen with some soft tissue opacity superimposed over the falciform fat region. A poorly defined region of increased soft tissue opacity is seen in the right mid abdomen. A number of small and large intestinal loops are superimposed with this region, which may represent fortuitous summation. There is no radiographic evidence of pathologically dilated bowel or intestinal plication. There are no other radiographic abnormalities of the remaining abdominal viscera identified. RADIOGRAPHIC IMPRESSIONS Free abdominal gas and peritoneal effusion most likely due to a gastrointestinal perforation. Peritonitis from a gas producing organism is thought to be less unlikely. Differential diagnoses for gastrointestinal perforation include: gastrointestinal foreign body, ulceration, or an infiltrative process such as neoplasia. Exploratory laparotomy is recommended.

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Case 2 6 year old MN DSH Vomiting

Radiographic findings: An after hours abdominal study is available for review. There is heterogeneous soft tissue and gas opacity within the lumen of the stomach. On the right lateral projection, there is a segment of what is believed to be small intestine that exhibits a gas pattern consistent with marked corrugation plication. This is superimposed over the renal silhouette and retroperitoneal space. The remainder of the small intestine is gas and fluid filled but not pathologically dilated. The serosal detail is good. The remainder of the abdomen appears normal. IMPRESSIONS Findings are most consistent with severe enteritis, but a linear foreign body with small intestinal plication cannot be ruled out. Abdominal ultrasound is recommended to better assess this finding and interrogate the stomach which should be empty in a vomiting patient. ULTRASOUND: No ultrasonographic evidence of linear foreign material. Multifocal, currently non-obstructive small intestinal foreign material with moderate diffuse enteritis and infiltrative bowel disease. Focal marked enteritis of the distal duodenum. Marked colitis. Colic lymphadenopathy. Abdominal ultrasound should be rechecked in 12-24 hours if clinical signs persist or progress to rule out mechanical obstruction.

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Case 3 11 year old FS Border Collie 3-4 week history of lethargy and anorexia

Radiology Report: Three projections of the thorax including a right lateral projection, a dorsoventral projection and a ventrodorsal projection are available for review. There is a moderate to marked volume of pleural effusion resulting in retraction of the lung lobes. The pleural fluid obscures the cardiac silhouette on all projections. There is the appearance of airbronchograms within the left cranial lung lobe on the right lateral projection which is felt to be secondary to atelectasis or superimposition of pleural fluid. This lung lobe appears aerated on the orthogonal projections. The accessory lung lobe does not appear aerated on any projection. An ill defined round soft tissue opacity is seen within the cranial right thorax on the ventrodorsal projection at the level of the second through fourth ribs. Irregular mineral opacity is seen within the cranial thorax on the right lateral projection, surrounded by heterogeneous soft tissue opacity. This is not definitively identified on the orthogonal projections. On the dorsoventral and ventrodorsal projections, there is abaxial deviation of the mainstem bronchi. The trachea appears dorsally deviated. Within the viewable abdomen, the liver extends mildly beyond the costal arch with a slightly rounded margin. The abdominal serosal detail is mildly decreased in the cranial abdomen. There is wet hair artifact seen over the left lateral thoracic body wall and ventral thorax and abdomen. RADIOGRAPHIC IMPRESSIONS Suspected mineralized mass within the cranial mediastinum. Moderate to severe pleural effusion, and suspected hilar lymphadenopathy are highly suggestive of a neoplastic process. Granulomatous disease cannot be entirely excluded, but is felt to be less likely. The rounded soft tissue opacity seen in the right cranial thorax on the ventrodorsal projection likely represents extension of the cranial mediastinal mass. Thoracic ultrasonography and repeat radiography following therapeutic thoracocentesis are recommended. Mild hepatomegaly. The mildly decreased peritoneal detail may be secondary to silhouetting of pleural fluid with the diaphragm and underlying abdominal structures or may represent a small volume of peritoneal effusion or peritonitis. J. Tanner, DVM ...EGJ

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Case 4 7 year old FS Miniature Pinscher Vomited up a piece of blanket

Four orthogonal projections of the abdomen are provided Four orthogonal projections of the abdomen are provided. There are several severely dilated fluid filled small intestinal loops present in the ventral abdomen. There is a distended loop of bowel filled with gas within the cranial abdomen that likely represents duodenum. There is a fragmented gas pattern present within the loops of small bowel in the mid and ventral abdomen. There is soft tissue opaque material present within the pylorus on both lateral projections. The colon is filled with heterogeneous soft tissue and gas opaque material. There is a wispy and striated heterogeneous appearance in the mid abdomen. The liver appears small. There is a round, well circumscribed granular mineral opacity superimposed over the caudal and ventral margin of the liver. Within the viewable thorax, the cardiopulmonary structures appear within normal limits. RADIOGRAPHIC IMPRESSIONS Pathologic dilation of the small intestinal loops highly suspicious for intestinal foreign body. Heterogenous soft tissue opacity in the mid abdomen may represent peritoneal fluid or material within the colon. Persistent soft tissue opaque material within the pylorus is atypical in a vomiting patient. Round soft tissue opacity superimposed over the caudal margin of the liver may represent gallbladder filled with mineralized material. Abdominal ultrasound is recommended to better characterize these findings. S. Jones, DVM ...AY

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Case 5 3 month old F Husky Patient jumped out of a truck, and was acutely lame Right femoral long oblique closed mid-diaphyseal fracture

Case 5 12 year old FS DMH Chronic cough

Severe bronchial pattern with mineralization of the airways and hyperinflation consistent with inflammatory airway disease. Rule out infectious vs. non infectious etiologies. Bronchiectasis of the cranial lobar bronchi. The lobar margin and soft tissue opacity within the right middle lung lobe may be consistent with inflammatory or neoplastic process or broncho-obstruction. Atelectasis is thought less likely given the lack of mediastinal shift. Mild cardiomegaly with prominent pulmonary vasculature is concerning for early cardiac decompensation. Moderate elbow osteoarthrosis. Pectus excavatum. Moderate hepatomegaly.

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Case 6 4 month old MN German Shepherd Chronic regurgitation, thin body condition

Three projections of the thorax are provided Three projections of the thorax are provided. There is a marked alveolar pattern with air bronchograms within the dependent lung fields bilaterally. There is a severely dilated intrathoracic esophagus that on right lateral projection, is filled with gas and highlights the ventral margin of the trachea and the cranial greater vasculature. Also on the right lateral projection, the remaining enlarged esophagus is diffusely fluid-filled contributing to an increased caudodorsal pulmonary opacity. On left lateral projection, the dilated caudal thoracic esophagus is gas-filled, which allows for better visualization of the pulmonary vasculature. On dorsoventral projection, the cranial mediastinum appears wide and the trachea is deviated toward the right, thought most likely due to fluid-filled esophagus. The lateral margins of the esophagus are visualized on dorsoventral projection. The visible cardiac silhouette and pulmonary vasculature appear within normal limits. The patient has a severely decreased body condition. Within the viewable abdomen, abdominal serosal detail is mildly decreased, thought likely due to decreased body condition of this patient. RADIOGRAPHIC IMPRESSIONS Severe megaesophagus with secondary aspiration pneumonia. Differential fluid and gas filled cranial thoracic esophagus may represent esophageal diverticuli and/or esophageal folding. However, vascular ring anomaly causing compartmentalization cannot be entirely excluded. Recommend endoscopy to further characterize this finding

Thank You!! Questions? My email is srjones@ucdavis.edu FEEL FREE TO EMAIL ME WITH SUGGESTIONS FOR NEXT TIME 