Here are the challenging cases for this week’s KCC. Due to popular request, I’ve linked some of the actual images to the discussion. Next week is Thanksgiving, and I’ll be at the annual ACVR meeting the following week, so posting will be light.
Case 1
This was a lateral pelvis radiograph and a positive contrast vaginourethrogram of a 1 year old dog with chronic urinary tract infections and vaginitis. The history indicates a congenital type of problem, so the special study was requested to look for abnormalities of the vagina and bladder, as well as ectopic ureter (though there was no reported incontinence). The vaginourethrogram showed good filling of the vestibule and part of the caudal vagina, then it tapered to a point at the level of the ischium. The contrast filled the urethra and bladder normally. Comments were that the vagina should continue to the level of the cervix (at the cranial thigh) and appeared too short. This could represent a congenital stricture or malformation of the vagina, causing urine pooling, vaginitis and cystitis. Diagnosis: Complete vaginal stricture.
Good review points were the parts of the urogenital tract: the vestibule is between the vulva and the urethral papilla, cranial to that it becomes the vagina. Apparently the vagina and vestibule have different embryologic origins so they don’t always fuse normally. This dog had the complete stricture broken down during an endoscopic exam. Take a look at this normal vaginourethrogram.
Case 2
Hind limb radiographs of a 4 year old Mastiff with a two week history of lameness. On the distal tibia, there is an aggressive bone lesion with permeative lysis, cortical destruction, irregular periosteal reaction, a long zone of transition and soft tissue swelling. Some residents noticed an ill-defined lytic and productive lesion in the proximal tibia as well, but it was less clear. Differential diagnoses for two aggressive bone lesions in the tibia included primary bone tumor with metastasis, metastatic disease from elsewhere, and fungal osteomyelitis. Further diagnostic options included thoracic radiographs and a bone scan. Diagnosis: osteosarcoma of the tibia with metastasis.
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