Abdominal radiology cases

Question 1

Case 1

A 6 year old, M, Doberman was fine the previous evening when it was fed its normal food. This morning, the dog was found bloated and unwilling to walk.

On examination, the dog appears uncomfortable and resents abdominal palpation. Mucous membranes are slightly congested. Rectal temp. 38.1C (slightly low); HR 150bpm (raised), RR 40bpm (raised). A large, tense viscus is palpable in the cranial abdomen.

You obtain the following right lateral and VD radiographs.

What are key findings?

Answer 1

Key findings:

• A large rounded radiolucency in cranial dorsal/mid abdomen representing a gas–filled, dilated stomach.
• There is no evidence of displacement of the parts of the stomach.
• Small intestines contain gas but no loops are significantly distended.
• Generally poor serosal detail, but dog is very thin with minimal abdominal fat.

Question 2

Case 1

A 6 year old, M, Doberman was fine the previous evening when it was fed its normal food. This morning, the dog was found bloated and unwilling to walk.

On examination, the dog appears uncomfortable and resents abdominal palpation. Mucous membranes are slightly congested. Rectal temp. 38.1C (slightly low); HR 150bpm (raised), RR 40bpm (raised). A large, tense viscus is palpable in the cranial abdomen.

You obtain the following right lateral and VD radiographs.

Diagnosis?

Answer 2

Diagnosis:

• Gastric dilation (without volvulus)

Outcome:

• The stomach was easily decompressed with a stomach tube
• Supportive treatment resulted in a complete recovery

Question 3

Case 2

A 13 year old, FN, Shetland Sheepdog is presented with a two month history of progressive inappetance and abdominal distention.

On examination, the dog is in respiratory distress with marked abdominal distention.

Rectal temp. 38.5C; RR 60bpm. Mucous membranes are pale. Lungs sounds are reduced ventrally and the abdomen is tense on palpation.

You obtain the following right lateral and VD radiographs.

Key findings?

Answer 3

Key findings

• Overall homogeneous, increase in abdominal opacity resulting in loss of serosal detail. Marked abdominal distention.
• Gas filled small intestinal loops have an abnormal distribution -appearing bunched into the mid abdomen.
• The colon is markedly displaced dorsally.
• There is increased opacity in the thorax, especially ventrally with partial obscuring of the ventral diaphragm.
• A small, rounded soft tissue opacity is visible just cranial to the diaphragm in the lateral view.

Question 4

Case 2

A 13 year old, FN, Shetland Sheepdog is presented with a two month history of progressive inappetance and abdominal distention.

On examination, the dog is in respiratory distress with marked abdominal distention.

Rectal temp. 38.5C; RR 60bpm. Mucous membranes are pale. Lungs sounds are reduced ventrally and the abdomen is tense on palpation.

You obtain the following right lateral and VD radiographs.

Further investigation?

Answer 4

Further investigation:

• Obtain thoracic radiographs
• Abdominal ultrasonography

Question 5

Case 2

A 13 year old, FN, Shetland Sheepdog is presented with a two month history of progressive inappetance and abdominal distention.

On examination, the dog is in respiratory distress with marked abdominal distention.

Rectal temp. 38.5C; RR 60bpm. Mucous membranes are pale. Lungs sounds are reduced ventrally and the abdomen is tense on palpation.

You obtain the following right lateral and VD radiographs.

You know obtain further thoracic radiographs that are attached.

Diagnosis?

Answer 5

Radiological diagnosis:

• Free abdominal fluid
• Mass lesion in mid abdomen with bunching of small intestines indicating small intestinal involvement or adhesions
• Pleural fluid
• Soft tissue lung mass compatible with metastasis, although other causes possible as isolated lesion

Outcome

• Jejunal adenocarcima with entrapment of many small intestinal loops.
• Neoplastic abdominal and pleural effusions with lung metastasis
• Euthanasia

Question 6

• Case 3
• An 18 month old, M, medium crossbreed dog was presented with inappetence and lethargy for 24 hours. The dog had vomited that day. Other than being dull, physical examination was normal. Symptomatic treatment was given.
• The dog is presented two days later, still vomiting and the owner is uncertain about defaecation. On examination, the dog is mildly dehydrated and “gassy” bowel loops can be palpated.
• Rectal temp. 38.5C
• You obtain the following radiograph.

Key Points?

Answer 6

Key findings:

• Multiple gas and fluid filled intestinal loops are seen in the mid to caudal abdomen.
• More gas than usual is present in the small intestines.
• All small intestinal loops are of similar diameter. The largest small intestinal loop is only slightly greater in diameter than height of L5 vertebral body

Further investigation:

• A VD abdominal radiograph should be obtained to give further information. In this case, no additional lesions are detected.

Question 7

Case 3

An 18 month old, M, medium crossbreed dog was presented with inappetence and lethargy for 24 hours. The dog had vomited that day. Other than being dull, physical examination was normal. Symptomatic treatment was given.

The dog is presented two days later, still vomiting and the owner is uncertain about defaecation. On examination, the dog is mildly dehydrated and “gassy” bowel loops can be palpated.

Rectal temp. 38.5C

You obtain the following radiograph.

Case outcome?

Answer 7

Radiological diagnosis:

• Increased gas within small intestines.
• Most likely due to enteritis.
• No sign of acute/complete or chronic/partial obstruction.

Outcome:

Presumptive diagnosis of gastroenteritis. The dog passed diarrhoea later that day. Symptomatic treatment resulted in a complete recovery.

Question 8

Case 4

• A 4 year old, M, small crossbreed dog is presented with reduced appetite, weight loss and intermittent vomiting and diarrhoea of several weeks duration.
• The dog is now collapsed, with severe haematemesis.
• After stabilisation, you obtain the following survey and barium series radiographs.

Key findings for barium studies on other side?

Answer 8

Case 4

Key findings:

• Survey: Multiple, slightly irregular, parallel linear opacities are seen in the ventral stomach
• Barium series: The pylorus has a narrowed lumen with an irregular, “eaten out” appearance to the barium.
• The appearance of the pylorus and distal stomach body is virtually identical in the 3 lateral and 2 VD images taken over 75 minutes. This indicates that the stomach wall in this area is irregularly thickened and rigid.
• Only a very small amount of barium has passed into the duodenum at 75 mins.

Question 9

Additional case 4 barium studies?

Answer 9

Key findings:

• Survey: Multiple, slightly irregular, parallel linear opacities are seen in the ventral stomach
• Barium series: The pylorus has a narrowed lumen with an irregular, “eaten out” appearance to the barium. The appearance of the pylorus and distal stomach body is virtually identical in the 3 lateral and 2 VD images taken over 75 minutes. This indicates that the stomach wall in this area is irregularly thickened and rigid.
• Only a very small amount of barium has passed into the duodenum at 75 mins.

Question 10

Case 4 outcome?

Answer 10

Case 4

• Radiological diagnosis:
• Mineralisation of the stomach body and pylorus
• Pyloric lumen narrowing, with slow emptying of barium into the duodenum
• Fixed, irregular appearance of body and pylorus suggesting infiltrative disease.

Outcome:

• At exploratory laparotomy, the distal body and pylorus of the stomach was markedly swollen and stiff.
• Histopathology: Chronic, necrotic and haemorrhagicgastritis.
• The dog was euthanased.