Known Case Conference

Last week it was my turn to find cases to challenge the residents with. I collected some of my favorites from the last several months.

Case 1

10 year male neutered feline domestic shorthair with weight loss and muscle wasting  for 1 year. The abdominal radiographs for this cat showed a cranial abdominal mass which was displacing the gastric axis caudally. The most likey origin of a mass cranial to the stomach is a liver mass, and it can displace the gastric axis on both projections. Differential diagnoses for the mass included benign neoplasia (biliary cystadenoma), aggressive neoplasia, cyst and abscess. Diagnosis: biliary cystadenoma.

Case 2

10 year old female neutered canine mix breed who was not eating, painful. There was an area of focal poor detail in the pelvic inlet and caudal abdomen that appeared to be a mass. It was not the correct shape to be an enlarged bladder, and a second opacity ventral to it was likely urinary bladder. In the portion of the thorax included, there was an extrapleural sign with a mass located in the left caudal thorax in the pleural space. Thoracic radiographs were requested, and confirmed this finding along with small fissure lines. Differential diagnoses included pelvic neoplasia with pleural metastasis, or granuloma with pleural disease. Diagnosis: hemangiosarcoma with pleural metastasis.

 

Case 3

Case 3 was a 2 year female neutered canine boxer rolled over by truck 1 week ago. The thoracic radiographs showed moderate pleural effusion with rounding and retraction of the lung lobes. The stomach appeared to be closer to the diaphragm than usual, and the diaphragm itself was not visible. The top differential was diaphragmatic rupture with perhaps liver present in the thoracic cavity. Recommendations for further diagnostics included abdominal ultrasound and a horizontal beam radiograph. The horizontal beam showed the stomach present in the thoracic cavity. This technique moves the pleural effusion into the dorsal thorax, allowing better visualization of organs in the ventral thorax.