Here’s a case of an 8 year old male neutered Bengal cat with acute onset of anorexia and lethargy. Do you want to improve your interpretation skills? Post your interpretations in the comments section!
8 year old Bengal cat
Teaching and learning about veterinary diagnostic imaging.
The urinary bladder is distended and displacing the intestines cranialy. There is some feces seen in the colon.
There is air seen on the abdominal side of the diaphragm, therefore I suspect possible pneumo-peritoneum. There is also a focal area of loss of serosal details cranial to the bladder. This might indicate local inflammation or small amount of abdominal fluid.
DD’s for pneumo-peritoneum:
GI rupture
Penetrating wound
Gas forming bacteria- usually focal (abscess).
Post surgical
I see what you are looking at caudal to the more cranial diaphragmatic crus. It is more radiolucent, but I think it’s because of superimposition of the lung lobe. You can see the matching triangular lung lobe tip of the other caudal lobe just dorsal to that one. There isn’t a true thin, sharp line such as you would see with a pneumoperitoneum outlining the abdominal side of the diaphragm. I always check on the orthogonal view as well, and don’t see any free air.
Do you see any other abnormalities? The enlarged bladder is causing some crowding of organs and makes interpretation a bit more difficult.
Radiographic signs:
Enlarged R kidney (>3x L2 on VD view), L kidney appears absent. Descending colon displaced ventrally likely due to kidney enlargement. Bone opacity present within R kidney.
Distended urinary bladder.
Small intestinal mass displaced cranially due to distended bladder.
Cat is very fat.
Interpretation:
Enlargement of the R kidney is the most significant finding.
Differentials include chronic interstitial nephritis with compensatory hypertrophy, neoplasia, polycystic kidney disease, hydronephrosis
I see the urinary bladder distended but I also see at the area where the kidneys are an enlargement of one of them… I believe the left one. Could it be?
I agree with jams
Right, you’ve all seen the enlarged kidney. Remember to check the v/d projection to determine which one is enlarged. What do you think of the detail in the retroperitoneal space?
Some minelar opacities across the Rt renal pelvis could indicate calculus.If the curvey mineral opacity is across the recess or the renal sinus , this shows that the pelvis is not significantly dilated. Some soft tissue opacities caudally to the Rt kidney on the retroperitoneal space, could suggest dilated or neoplastic ureter. Most possibly a dilated UB indicates obstruction? The outline of the rt kidney is quite even. LK is “missing” . Upon all these I guess hydronephrosis is not first in the list. Compensatory hypertrophic RK , neoplasia, pyelonephritis, abscess.
Emailed comment:
The Bengal cat with acute onset of anorexia has enlarged bladder which is pushing the intestine cranial it also has enlarged kidney.
Pushproop Brar
Yes there is mottled soft tissue opacity in the retroperitoneal space. An enlarged ureter is a good suggestion, but consider etiologies such as edema, inflammation and urine as well. Fluid in the retroperitoneal space often has this appearance.
Although the calculus will give an approximation of the size of the renal pelvis, it takes time for significant hydronephrosis to occur. Could this kidney still be obstructed? How big would the renal pelvis be in an acute obstruction?
I guess acute obstruction does not severely dilates the pelvis. In this case the kidney could be obstructed but simultaneously hypertrophied, inflamed or neoplastic as well.