Imaging SA Repro Flashcards
- A 10 year old entire male, large crossbreed dog was presented two months previously with haematuria (mostly at the end of urination) and occasional dyschezia. The dog appeared slightly stiff on its hindlegs.
- Physical examination revealed a mildly painful caudal abdomen. Rectal temp. 40.1C. Preputial/penile/perineal examination was normal. Otherwise the dog appeared well.
- The dog was treated for a presumptive lower urinary tract infection with a 7 day course of amoxycillin-clavulanate. The owner did not keep the follow-up appointment.
- The dog is represented. The owner reports that the blood in the urine settled with the treatment, although the dog still struggles to do “number twos” at times.
- In the past few days, the bleeding has returned.
- Physical exam. indicates no abdominal pain this time, but a firm rounded caudal abdominal mass is palpated just cranial to the pelvic inlet. Immediately cranial to this, a larger, tense, rounded mass is felt, and pressure on this results in a small amount of urination.
What do we do next?
Plain radiographs
Then maybe US
What is the normal radiology of the prostate?
•Located in the caudal retroperitoneum
–Caudal to bladder neck
–Ventral to descending colon / rectum
•Seen in the entire dog as a homogenous soft tissue opacity
–Occupies up to 70% of pelvic inlet
–Especially prominent in Scotties
- Smaller and often not seen in neutered males
- Not usually seen in the cat
What can be seen here?
2 ST sections in cd abdo
Which structures do you think are affected?
Prostate
Bladder – big and tense
Urethra
Don’t forget spinal disease in a large bladder
What can be seen here?
Mineral and irregular prostate
New bone around pelvis
Spondylosis of L vert
Which prostatic conditions may be associated with intra prostatic mineralisation? (2)
–Chronic prostatitis
– Neoplasia
What can be seen here?
New bone on the ventral aspect of caudal vertebrae
Spondylosis
Between end plates – more irregular aggressive new bone
If you get this on caudal vert – pathognomic of neoplasia mets
Marked ST opacity ventralll – LN (infection, or neoplasia)
What can be seen here?
Local peritoneal dx – increase opacity
Colon – has gas in
Might be LN enlargement near colon
Inflamm vs neoplasia
What is this?
What is the most liekly prostatic disease causing this appearance?
Pneumocysto and then contrast
Contrast has produced this appearance
What is the most likely prostatic dx causing this appearace?
Neoplasia - characteristic
NB: Cystic disease (e.g. metaplasia) – but youd never get this degree of cavity communicatin with urethra!!!
Dog and dysuric
Large mass mid-cd abdomen
What is the most likely diganosis?
Bladder neoplasia
Extra parenchymal prostatic cyst
What has created this image?
What can be seen?
Pneumocystogram
Bladder normal – just displaced
Parenchymal cyst
You can see a mineral line and this is due to cyst cause mineralised lining (immediately puts this top of D/D)
Hamatouria, dysuria
What can be seen?
2 ST opacity – maybe bladder and prostate
What has created this image?
What is seen?
What is the likely diagnosis?
Positive cystogram
Normal cranial bladder
Caudally – bisected structure
Size over 70% of pelvic inlet – prostate
This is classic for BPH – benign prostatic hyperplasia (smooth)
What is this?
Smooth symmetrical enlargement consistent with BPH
What is this?
Less marked enlargement with irregular contrast leakage suggestive of neoplasia
What is the normal appearance of prostate ultrasound?
- Normal prostate is bilobed with a moderately and even granular echotexture and smooth margins
- The prostate increases in size and echogenicity with age
- Small prostatic cysts are a common incidental finding in older entire dogs
What is this appearance?
Immature Hypoechoic
Discuss the appearance here
Mature – hard to make out margin
Smooth and rounded
Under 2cm
How does the overall echogenicity compare to the normal prostate?
What is the liekly differential?
Heterogenous
More echogenic
Bigger too
Diagnosis:
BPH
Cant rule out infection = not many cysts
What’s going on here?
Several cystic cavities but this can be normal
How does the overall echogenicity compare to the normal prostate?
What is the liekly diagnosis?
Hypoechoic
More heterogenous (marbled appearance)
Slightly enlarged
Likely Diagnosis:
Acute prostatitis ** was this
Neoplasia possible
Note: there are not enough fluid cavities for cystic disease
What is going on here?
Abscess
Hypoenchoic
Infalmmatory disease
From the acute prostatis
Which best describes US signs?
What is the likely diagnosis?
Heterogenous
Irregular shapes
Poorly marginated
Diagnosis:
Neoplasia – so much worse than others
What is this?
This is chronic prostatitis
Care when interpreting the heterogenous appearance
What can be seen here?
Neoplasia
Prostate ventral and invading bladder neck
What is this?
Aorta and see metastatic LN
What is this?
Extra parenchial cyst
What is this?
Extra parenchial cyst
What is this?
How can you tell these are not intestinal loops?
Pyometra
How can you tell these are not intestinal loops?
There is no 5 part intestine layer
What is this?
Cavities in the uterus
CEH early on
What is this? How can we differentiate from stump pyo?
Stump granuloma – dorsal to bladder
(stump pyo would have to have ovarian remnant; seen sometimes after spay unlike granuloma which is seen quicker)
What can be seen?
Heterogeous uterus
What is going on here?
Cavities within
= uterine tumour
What is this?
Bladder and dorsally we have fluid and embryo 23-4days
What is this?
Embryonic membrane and fetal development
Bitch been vomiting so you radiograph
Likely diagnosis? What should we do next?
Pyometra – multiple tubular in the cd abdo
Could be early pregnancy… less than 45 days
Would need to US next
Off colour and abdo distension
Firm mass on palpation
Likely diagnosis?
Splenic mass – most common cause of this appearance
BUT THIS IS OVARIAN MASS – look like above
Need to US or maybe lap
Ovary slip down when they get bigger to ventral wall
How does a kidney mass differ from splenic on radiograph?
kidney – on ventral abdo wall. Retroperitoneal – stuck and would displace SI and colon
What can be seen on this ovary?
Follicle
What is this?
Cystic ovarian tumour
What is this?
Solid and mineralised ovarian tumour
