2011 Radiology Exam - Abdomen Case 1

History

• 1 year old, male Great Dane
• This dog presents for vomiting for the past 6 hours, after getting into a fight earlier in the day.

See Images below. Click to enlarge.

Observation

• Loss of serosal detail in the cranial abdomen (minor finding)
• Generalized splenomegaly/mass effect, with caudal displacement of abdominal viscera.

Synthesis

• Cranial abdominal mass effect, likely originating from the spleen
• Loss of serosal detail consistent with effusion
• Differentials: Splenic enlargement secondary to splenic torsion (correct answer), other causes of generalized splenomegaly

Case Management

• Ultrasound to look for splenic involvement, examine spleen for decreased perfusion

All candidates identified a cranial abdominal mass effect, although some felt that abdominal detail was normal, and others attributed loss of detail to a thin body condition. Many candidates attributed the mass effect to either the stomach (outflow obstruction) or to the pancreas (pancreatitis/abscess).

Highest point totals were given to candidates who listed splenic torsion as first in the differential list, although points were also awarded for a diagnosis of generalized splenomegaly with other differentials.