Small Animal Urinary Tract Imaging Cases Flashcards
CASE 1
- A five year old, female entire Labrador is presented with recurrent haematuria and stranguria.
- You sedate her and perform ultrasonography of her bladder .
What abnormalities can you see?
- There is marked regional thickening of the cranial aspect of the bladder wall
- The whole of the visible mucosa has an irregular margin (even in the less thickened areas)
- The bladder lumen appears normal (a ‘slice thickness’ artefact is seen caudally in the sagittal view)
In case 1 what conditions would you consider? What is the most likely diagnosis?
- Any conditions that would lead to regional thickening of the bladder wall are possible, e.g. inflammation, neoplastic change or other cellular infiltration
- However, the absence of a mass lesion and the location in the cranial bladder make chronic cystitis the most likely differential.
- Clinical diagnosis = chronic cystitis
CASE 2
A 9 year old neutered male cat is presented with a history of polydipsia and polyuria
You detect an abdominal mass on palpation and perform survey abdominal radiography and ultrasonography.
What abnormalities can you see?
Radiograph:
- A rounded soft tissue mass is present in the craniodorsal abdomen, displacing the descending colon and the small intestines ventrally. It is caudal to the liver and stomach and craniodorsal to the urinary bladder. Normal renal shadows cannot be seen. There is poor serosal detail in the peritoneal cavity.
- There is only a lateral view of the abdomen, so limited information is available from this study, e.g. location of any normal kidneys in the region of the mass.
Ultrasound:
- The visible kidney is markedly enlarged (7.4cm length) with an irregular margin.
- The cortex and medulla can be recognised, but the structure is irregular and poorly defined.
- There is increased cortical echogenicity, which is heterogeneous.
- There is a distinct hypoechoic band around the margin of the kidney.
In case 2 what is your differential diagnosis list?
- As the kidney is enlarged with no signs of fluid filled structures, e.g. hydronephrosis, cysts, haemorrhage, the differential should include diseases that lead to infiltration of the renal parenchyma, e.g. neoplasia, inflammation, amyloidosis.
- The changes seen in this case (particularly the hypoechoic marginal band) are typical for FIP and multicentric neoplasia, e.g. lymphoma, so these would be the top two differentials
- The poor serosal detail in the radiograph could be due to lack of abdominal fat (there is minimal fat in the falciform fat pad and retroperitoneal space) or a scant amount of peritoneal free fluid.
- Clinical diagnosis = lymphoma
CASE 3
- A seven year old, entire female Rottweiler is presented with polydipsia/polyuria with weight loss. Urinalysis: blood ++++; protein +++; SG 1.013.
- You sedate her and perform ultrasonography of her kidneys and survey abdominal radiography.
What abnormalities can you see?
Ultrasonography:
•In both kidneys a convex, well defined and markedly hyperechoic line is seen in the region of the renal pelvis, with acoustic shadowing.
Radiography:
•In the dorsal regions of both kidneys, a single, well marginated, wedge-shaped mineral opacity is seen.
Case 3
What is your diagnosis?
- The ultrasound study indicates a solid, well defined structure in the region of the renal pelvis
- Radiography shows a well defined mineral structure in the same areas
- Diagnosis – bilateral renal calculi
Case 3
What is the important limitation of the radiographic study?
There is much faecal material in the colon. This could obscure any ureteric calculi that might be present.
CASE 4
- A six year old, neutered male crossbreed dog is presented with recurrent haematuria and stranguria.
- You sedate him and perform ultrasonography of his bladder.
What abnormalities can you see?
- In the first image an irregular, medium echogenicity mass is seen in the left portion of the bladder lumen . The bladder is small, so assessment of its location and nature is difficult.
- After instilling 200ml saline into the bladder, the mass lesion is seen to be attached to the near (ventral) wall of the bladder. It has an irregular, but well defined margin. It has a homogeneous echogenicity and is slightly hyperechoic. The mass appears to have a relatively narrow base.
- There is also some evidence of irregularity of the mucosa on the left aspect of the bladder (to the right of the image)
Case 4
What is your differential diagnosis list?
- Differentials for this well defined mass would include mucosal neoplasia and a polyp.
- The relatively homogeneous and hyperechoic appearance of the mass and its relatively narrow base would make a polyp more likely.
- Clinical diagnosis = polypoid cystitis
CASE 5
- A nine year old, neutered female cat is presented with an episode of acute vomiting. On abdominal palpation, you detect an unusual caudal mass.
- You anaesthetise her and perform radiography and ultrasonography.
What abnormalities can you see?
Plain radiography:
- Lateral view: one renal shadow is seen in the craniodorsal abdomen. A rounded soft tissue mass is seen in the caudodorsal abdomen displacing the descending colon ventrally. N.B. There is significant falciform and subcutaneous fat.
- VD view: Neither kidney is clearly seen. There is a rounded soft tissue mass partially overlying the left ilium.
Ultrasound image:
•A dorsal image of a kidney is seen cranial to an rounded structure with an anechoic centre representing an oblique view of the urinary bladder
What radiographic contrast study has been performed?
Intravenous urography (IVU)
Case 5 What abnormalities can you see?
Lateral 0 min IVU: A normal kidney is opacified in the craniodorsal abdomen. The previously identified caudal soft tissue mass is also opacified.
VD 10 min IVU: The right kidney and ureter appear normal. The left kidney is located in the caudal left abdomen. It is slightly smaller and is more rounded compared to the right kidney. The proximal ureter is slightly dilated. Contrast media is present in the bladder. N.B. There is significant degenerative change in both hip joints.
Lateral 15 min IVU: A normal right ureter is seen coursing to a normal termination at the bladder neck. The proximal left ureter is again slightly dilated. It then appears to course ventral to the kidney to terminate normally at the bladder neck.
Case 5
What is your diagnosis?
- Ectopic left kidney
- Mild dilation of the proximal left ureter
This was an incidental finding in this case. Biochemistry/haematology and urinalysis did not show any signs of renal dysfunction. The vomiting was attributed to non-specific gastritis and settled promptly.
The left ureter may be dilated proximally due to back pressure as a result of the abnormal ureteric course. This was unlikely to be significant at this stage, but the owner was advised to return should the cat develop any clinical signs of renal disease.
