KCC was another great session with interesting cases. Here are the highlights:
Case 1
2 year old female neutered Rottweiler vomiting for 2 days. The abdomen in this dog had poor detail, and there were some very angular bowel loops and gas that might be free within the abdomen. Key point – request a horizontal beam. In this case it was negative for free air, but clearly showed some plicated bowel loops. Diagnosis and recommendations: Linear foreign body, surgery.
Quotables (anonymous :)) for how to remember which way to take the horizontal beam:
Right side up, not upside down!
It’s best taken in left lateral recumbency so that the gas-filled fundus doesn’t impede your search for a gas cap under the diaphragm. This is an example of a linear foreign body with no suspicion of free gas.
Case 2
11 month old female neutered Springer Spaniel with a soft cough. The cardiac silhouette was markedly enlarged, especially the left atrium and ventricle. Both the pulmonary arteries and pulmonary veins were enlarged. There was also an interstitial pulmonary pattern in the dorsal lung lobes. On the d/v projection, the aortic arch, pulmonary artery and left auricle formed 3 bulges at the 1, 2 and 3 o’clock positions. Diagnosis: PDA.
Quotables:
The aortic arch should always look convex on the d/v, not concave.
The bulge in the cranial part of the arch caused a concave contour as it came back toward the spine. Here’s an example of a more subtle PDA than the one described here.
Case 3
10 year old female neutered Visla with 2 months of difficulty urinating. The radiographs we had were of an excretory urogram followed by a vaginourethrogram. The EU showed bilaterally dilated renal pelves and ureters with no mass visible in the slightly opacified bladder. On the retrograde vaginourethrogram, the vagina and vestiblule filled with contrast, but the proximal urethra did not. Diagnosis: transitional cell carcinoma of the urethra. The key was to recognize that with enough pressure to open the distal urethra, the whole urethra should fill with contrast. Pyelonephritis also came up as a differential, but the renal diverticulae were sharply outlined and looked like fingers which is characteristic of obstructive disease. Pyelonephritis causes altered diverticular shapes, with a more angular contour.
Could you post images for the EU/vaginourethrogram case (#3)? It sounds like a really good case!
Thanks for posting your KCC case info for everyone!
Unfortunately most of these cases are on film so there’s quite a lot involved to get them online. I’ll see what I can do, and will post links to similar cases whenever I can. Thanks for letting me know what you want to see on the site!