This week’s collection of cases was a mixture – from GI to large animal radiographs to thorax. As usual, the residents did a great job of describing the findings, coming up with a radiologic diagnosis, and a list of differential diagnoses. These files are digital so make sure to look at the images as well.
Case 1
10 year old Bull mastiff with 3 weeks of intermittent vomiting. There is a severely dilated bowel loop in the dorsal right abdomen that contains striated foreign material. There is a tortuous, gas dilated loop cranial to this loop. The stomach apppears small. The peritoneal detail is poor. Differentials include chronic partial obstruction secondary to a stricture or mass, or a textile foreign body. Poor detail may indicate peritonitis from inflammation or bowel permeability. There is no free gas. Diagnosis: Schirrous adenocarcinoma with secondary chronic partial obstruction. Tip: Older dogs are less likely to ingest foreign bodies, so be on the lookout for causes of obstruction such as strictures or masses in the GI tract.
Case 2
Equine shoulder radiographs. 27 year old Arab gelding found non-weight bearing. The distal lateral radiograph of the shoulder did not include the glenohumeral joint. However, there is a possible bone fragment at the caudal aspect of the proximal humerus which is not visible on the more proximal views. Differentials include an artifact or a fracture fragment. Request additional radiographs more proximally with increased exposure. These, taken at a cranial 30 degrees medial to caudolateral oblique angle, demonstrated a fracture of the humeral tubercle with moderate caudal and distal displacement. Horses have a medial, central and lateral tubercle of the humerus. Diagnosis: Slab fracture of the humeral head parasagittal with medial tubercle fracture.
Case 3
5 year Arabian gelding. Large swelling with draining wound medial to left stifle. The radiographs are centered on the soft tissue swelling rather than the stifle. There is some motion artifact because the horse was painful. There is a metallic marker delineating the location of the wound. Differentials include hematoma or abscess. There is a linear lucent area in the soft tissues. Diagnosis: 6 inch wooden foreign body..
Case 4
1 year Yorkshire Terrier with polycythemia (77%). On thoracic radiographs, there is marked right sided cardiac enlargement. The aortic arch is enlarged on the d/v projection. One of the caudal lobar pulmonary arteries is blunted which may indicate pulmonary thromboembolism. The diagnosis is a congenital cardiac anomaly. Differentials include a right to left shunt including PDA, VSD, tetralogy of Fallot. Next steps could include non-selective angiography or echocardiography with bubble study, or nuclear scintigraphy. Using echocardiography, bubbles will bypass the lungs and appear in the abdominal aorta.
Case 5
2 month old St Bernard found wet and cold in the house (no images available). The patient presented dyspneic and was placed on the ventilator. Thoracic radiographs showed an alveolar pulmonary pattern in the caudodorsal lungs. A catheter is present in the cranial vena cava and there is an endotracheal tube in the trachea. There are also electrical leads on the chest wall. The most likely differential diagnosis is non-cardiogenic pulmonary edema secondary to asphyxiation, near drowning or electrical shock. Embolic pneumonia is less likely. Diagnosis: Non-cardiogenic pulmonary edema from falling in swimming pool.
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