2010 Radiology Exam - Abdomen Case 1

History: Seven year old female cat with a clinical history of lethargy and weight loss. Soft stool noted by the veterinarian.

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Radiographic Findings: There is thickening of the colonic wall at the most cranial aspect of the descending colon, more specifically at the level of the splenic flexure. Though the thickening is better visualized on the lateral view, it can also be discerned on the ventrodorsal projection. Findings of lesser importance included an irregular left kidney and mineral foci in the small intestinal lumen. Differential diagnoses included round cell neoplasia such as lymphoma or mast cell, adenocarcinoma, and less likely a localized severe colitis.

Candidate Performance: Many of the candidates did not recognize thickening of the wall or were hesitant to consider the finding important due to the fact that it was seen on survey radiographs. Comments such as “we are not supposed to call intestinal thickening on radiographs” were surprisingly common. Candidates often requested a barium enema to assess the finding in more detail despite the fact that the lesion was well highlighted by the air-filled colon. Candidates who failed the case did not see the wall thickening and tended to discuss possible renal disease.

Final Histological Diagnosis: Intestinal lymphoma.