2008 Radiology Exam - Abdomen Case 2

"Biscuit" -- 2 view abdomen

• 3 year old Yorkshire Terrier spayed female
• hit by bicycle

See images below. Click to enlarge.

Radiographic Findings:

• loops of small intestine outside body wall in left ventral/inguinal region
• no visible urinary bladder
• increased soft tissue opacity in retroperitoneal space
• right SI luxation
• left iliac body, right ischial, and bilateral pubic fractures
• wispy subcutaneous soft tissue in lumbar region

Radiographic Diagnoses:

• body wall herniation with small intestine in left inguinal region
• possible urine leakage or hemorrhage in retroperitoneal space
• possible ruptured urinary bladder

Recommendations:

• Excretory urography (once patient hydrated and stable) preferred over cystography, since we need to evalute kidneys and ureters
• +/- ultrasound of abdomen to evaluate for free fluid, etc
• surgery to repair hernia, fractures
• complete thoracic radiographs

Candidate performance:
The retroperitoneal space and lack of urinary bladder visualization was missed by some candidates. The recommendation for excretory urography and why was not consistent.